Nurmi Visa, Mayne Richard, Knight Chanice, Almonacid-Mendoza Hannia L, Secret Shannah, Estcourt Lise, Hepojoki Jussi, Šuštić Tonći, Lamikanra Abigail A, Tsang Hoi Pat, Menon David K, Shankar-Hari Manu, van der Schoot C Ellen, Vidarsson Gestur, Roberts David J, Simmonds Peter, Hedman Klaus, Harvala Heli
Nuffield Department of Medicine, Peter Medawar Building for Pathogen Research, University of Oxford, Oxford, UK; Department of Virology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
Nuffield Department of Medicine, Peter Medawar Building for Pathogen Research, University of Oxford, Oxford, UK.
J Infect. 2025 Feb;90(2):106412. doi: 10.1016/j.jinf.2025.106412. Epub 2025 Jan 9.
Convalescent plasma (CP) treatment of COVID-19 has shown significant therapeutic effect only when administered early. We investigated the importance of patient and CP seroprofiles on treatment outcome in REMAP-CAP CP trial.
We evaluated neutralising antibodies (nAb), anti-spike (S) IgM, IgG, IgG avidity, IgG fucosylation and respiratory viral loads in a sub-set of patients (n=80) and controls (n=51) before and after transfusion, comparing them to those in the CP units (n=157) they received.
Most patients were SARS-CoV-2 seropositive pre-transfusion (72% nAb; 89% S-IgG seropositivity). The majority (80%) had higher pre-transfusion S-IgG levels (median 1.7×10 arbitrary units (AU); 56%) or S-IgG production rates (median 1.1×10 AU/day; 64%) than they received from CP (median 2.2×10 AU). Only 22% of the patients demonstrated significant (median 24-fold) increase in their S-IgG levels acquired from transfusion. Better outcomes, measured by organ support-free days, were associated with increase in S-IgM levels (p=0.007), decreased S-IgG fucosylation (p<0.001), lower patient age (p<0.001) but not with receiving CP (p=0.337).
Based on our data, increased S-antibody levels linked to transfused CP were only observed in pre-seroconversion or immunodeficient patients lacking their own SARS-CoV-2 antibodies, representing the groups where CP treatment has previously shown most benefit.
新冠康复者血浆（CP）治疗新冠病毒病（COVID-19）仅在早期给药时显示出显著治疗效果。我们在REMAP-CAP CP试验中研究了患者和CP血清谱对治疗结果的重要性。
我们评估了一组患者（n=80）和对照组（n=51）输血前后的中和抗体（nAb）、抗刺突蛋白（S）IgM、IgG、IgG亲和力、IgG岩藻糖基化和呼吸道病毒载量，并将其与他们所接受的CP单位（n=157）中的情况进行比较。
大多数患者输血前SARS-CoV-2血清学呈阳性（nAb阳性率72%；S-IgG血清学阳性率89%）。大多数（80%）患者输血前的S-IgG水平（中位数1.7×10任意单位（AU）；56%）或S-IgG产生率（中位数1.1×10 AU/天；64%）高于他们所接受的CP中的水平（中位数2.2×10 AU）。只有22%的患者输血后S-IgG水平有显著（中位数24倍）升高。以无器官支持天数衡量的更好结果与S-IgM水平升高（p=0.007）、S-IgG岩藻糖基化降低（p<0.001）、患者年龄较低（p<0.001）相关，但与接受CP无关（p=0.337）。
根据我们的数据，仅在血清转化前或缺乏自身SARS-CoV-2抗体的免疫缺陷患者中观察到与输注CP相关的S抗体水平升高，这些患者群体是之前显示CP治疗最有益的群体。
