Virus and Prion Validation, Octapharma Biopharmaceuticals GmbH, Frankfurt, Germany.
R&D Plasma, Octapharma Pharmazeutika Produktionsgesellschaft m.b.H., Vienna, Austria.
BioDrugs. 2022 Jan;36(1):41-53. doi: 10.1007/s40259-021-00511-9. Epub 2021 Nov 29.
INTRODUCTION: Patients with primary or secondary immunodeficiency (PID or SID) face increased insecurity and discomfort in the light of the COVID-19 pandemic, not knowing if and to what extent their comorbidities may impact the course of a potential SARS-CoV-2 infection. Furthermore, recently available vaccination options might not be amenable or effective for all patients in this heterogeneous population. Therefore, these patients often rely on passive immunization with plasma-derived, intravenous or subcutaneous immunoglobulin (IVIG/SCIG). Whether the ongoing COVID-19 pandemic and/or the progress in vaccination programs lead to increased and potentially protective titers in plasma-derived immunoglobulins (Ig) indicated (e.g., for humoral immunodeficiency) remains a pressing question for this patient population. PURPOSE: We investigated SARS-CoV-2 reactivity of US plasma-derived IVIG/SCIG products from the end of 2020 until June 2021 as well as in convalescent plasma (CP) from May 2020 to August 2020 to determine whether potentially neutralizing antibody titers may be present. METHODS: Final containers of IVIG/SCIG and CP donations were analyzed by commercial ELISA for anti-SARS-CoV-2 S1-receptor binding domain (RBD) IgG as well as microneutralization assay using a patient-derived SARS-CoV-2 (D614G) isolate. Neutralization capacities of 313 single plasma donations and 119 plasma-derived IVIG/SCIG lots were determined. Results obtained from both analytical methods were normalized against the WHO International Standard. Finally, based on dense pharmacokinetic profiles of an IVIG preparation from previously published investigations, possible steady-state plasma levels of SARS-CoV-2 neutralization capacities were approximated based on currently measured anti-SARS-CoV-2 potencies in IVIG/SCIG preparations. RESULTS: CP donations presented with high variability with regards to anti-SARS-CoV-2 reactivity in ELISA as well as in neutralization testing. While approximately 50% of convalescent donations were not/low neutralizing, approximately 10% were at or above 600 IU/mL. IVIG/SCIG lots derived from pre-pandemic plasma donations did not show neutralizing capacities for SARS-CoV-2. Lots produced between December 2020 and June 2021 entailing plasma donations after the emergence of SARS-CoV-2 showed a rapid and constant increase in anti-SARS-CoV-2 reactivity and neutralization capacity over time. While lot-to-lot variability was substantial, neutralization capacity increased from a mean of 21 IU/mL in December 2020 to 506 IU/mL in June 2021 with a maximum of 864 IU/mL for the most recent lots. Pharmacokinetic extrapolations, based on non-compartmental superposition principles using steady-state reference profiles from previously published pharmacokinetic investigations on IVIG in PID, yielded potential steady-state trough plasma levels of 16 IU/mL of neutralizing SARS-CoV-2 IgG based on the average final container concentration from May 2021 of 216 IU/mL. Maximum extrapolated trough levels could reach 64 IU/mL based on the latest maximal final container potency tested in June 2021. CONCLUSIONS: SARS-CoV-2 reactivity and neutralization capacity in IVIG/SCIG produced from US plasma rapidly and in part exponentially increased in the first half of 2021. The observed increase of final container potencies is likely trailing the serological status of the US donor population in terms of COVID-19 convalescence and vaccination by at least 5 months due to production lead times and should in principle continue at least until Fall 2021. In summary, the data support rapidly increasing levels of anti-SARS-CoV-2 antibodies in IVIG/SCIG products, implicating that a certain level of protection could be possible against COVID-19 for regularly substituted PID/SID patients. Nevertheless, more research is still needed to confirm which plasma levels are needed to provide protection against SARS-CoV-2 infection in immune-compromised patients.
简介:原发性或继发性免疫缺陷(PID 或 SID)患者在 COVID-19 大流行期间面临着更大的不安全感和不适,不知道他们的合并症是否会影响潜在 SARS-CoV-2 感染的过程,以及影响程度如何。此外,最近可用的疫苗接种选择可能对这一异质人群中的所有患者都不可行或有效。因此,这些患者通常依赖于血浆衍生的静脉内或皮下免疫球蛋白(IVIG/SCIG)的被动免疫。当前的 COVID-19 大流行和/或疫苗接种计划的进展是否会导致血浆衍生免疫球蛋白(Ig)中潜在的保护性滴度增加(例如,对于体液免疫缺陷),对于这一患者群体来说仍然是一个紧迫的问题。
目的:我们调查了 2020 年底至 2021 年 6 月期间美国血浆衍生的 IVIG/SCIG 产品以及 2020 年 5 月至 2020 年 8 月期间恢复期血浆(CP)的 SARS-CoV-2 反应性,以确定是否存在潜在的中和抗体滴度。
方法:使用商业 ELISA 分析 IVIG/SCIG 和 CP 捐赠的最终容器,以检测抗 SARS-CoV-2 S1-受体结合域(RBD)IgG,以及使用患者来源的 SARS-CoV-2(D614G)分离株进行微量中和测定。确定了 313 份单份血浆捐献和 119 份血浆衍生的 IVIG/SCIG 批次的中和能力。从两种分析方法获得的结果均与世界卫生组织国际标准进行了归一化。最后,根据以前发表的研究中 IVIG 制剂的密集药代动力学概况,根据目前在 IVIG/SCIG 制剂中测量的抗 SARS-CoV-2 效力,近似估算 SARS-CoV-2 中和能力的稳态血浆水平。
结果:CP 捐赠在 ELISA 中和试验中具有很高的 SARS-CoV-2 反应性变异性。虽然大约 50%的恢复期捐赠物没有/低中和,但大约 10%的中和能力在 600 IU/mL 以上。来自于大流行前血浆捐赠的 IVIG/SCIG 批次没有表现出 SARS-CoV-2 的中和能力。2020 年 12 月至 2021 年 6 月期间生产的涉及 SARS-CoV-2 出现后血浆捐赠的批次,其抗 SARS-CoV-2 反应性和中和能力随着时间的推移迅速而持续地增加。虽然批次间的变异性很大,但中和能力从 2020 年 12 月的平均 21 IU/mL 增加到 2021 年 6 月的 506 IU/mL,最新批次的最高值为 864 IU/mL。基于以前发表的 PID 中 IVIG 的药代动力学研究中稳态参考曲线的非房室超叠加原理的药代动力学外推表明,基于 2021 年 5 月的平均最终容器浓度 216 IU/mL,可能达到 16 IU/mL 的 SARS-CoV-2 中和 IgG 的稳态低谷血浆水平。基于 2021 年 6 月测试的最新最大最终容器效价,最大外推低谷水平可达到 64 IU/mL。
结论:2021 年上半年,美国血浆中产生的 SARS-CoV-2 反应性和中和能力迅速增加,部分呈指数增长。由于生产前置时间,最终容器效价的观察到的增加至少滞后于美国捐赠者群体 COVID-19 恢复期和疫苗接种的血清学状态 5 个月,并且原则上至少应持续到 2021 年秋季。总的来说,数据支持 IVIG/SCIG 产品中抗 SARS-CoV-2 抗体水平的迅速增加,这意味着定期替代 PID/SID 患者可能会对 COVID-19 产生一定程度的保护。然而,仍需要更多的研究来确认提供对免疫功能低下患者 SARS-CoV-2 感染保护所需的血浆水平。
MedComm (2020). 2023-11-15
J Allergy Clin Immunol. 2021-9