Weiss Svenja, Lin Hung-Mo, Acosta Eric, Komarova Natalia L, Chen Ping, Wodarz Dominik, Baine Ian, Duerr Ralf, Wajnberg Ania, Gervais Adrian, Bastard Paul, Casanova Jean-Laurent, Arinsburg Suzanne A, Swartz Talia H, Aberg Judith A, Bouvier Nicole M, Liu Sean Th, Alvarez Raymond A, Chen Benjamin K
Division of Infectious Diseases and.
Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
J Clin Invest. 2025 Mar 17;135(6):e181136. doi: 10.1172/JCI181136.
Early antibody therapy can prevent severe SARS-CoV-2 infection (COVID-19). However, the effectiveness of COVID-19 convalescent plasma (CCP) therapy in treating severe COVID-19 remains inconclusive. To test a hypothesis that some CCP units are associated with a coagulopathy hazard in severe disease that offsets its benefits, we tracked 304 CCP units administered to 414 hospitalized COVID-19 patients to assess their association with the onset of unfavorable post-transfusion D-dimer trends. CCP recipients with increasing or persistently elevated D-dimer trajectories after transfusion experienced higher mortality than those whose D-dimer levels were persistently low or decreasing after transfusion. Within the CCP donor-recipient network, recipients with increasing or persistently high D-dimer trajectories were skewed toward association with a minority of CCP units. In in vitro assays, CCP from "higher-risk" units had higher cross-reactivity with the spike protein of human seasonal betacoronavirus OC43. "Higher-risk" CCP units also mediated greater Fcγ receptor IIa signaling against cells expressing SARS-CoV-2 spike compared with "lower-risk" units. This study finds that post-transfusion activation of coagulation pathways during severe COVID-19 is associated with specific CCP antibody profiles and supports a potential mechanism of immune complex-activated coagulopathy.
早期抗体疗法可预防严重的SARS-CoV-2感染(新冠肺炎)。然而,新冠肺炎康复期血浆(CCP)疗法治疗重症新冠肺炎的有效性仍无定论。为了验证一个假设,即某些CCP单位与重症疾病中的凝血病风险相关,而这种风险抵消了其益处,我们追踪了给予414名住院新冠肺炎患者的304个CCP单位,以评估它们与输血后D-二聚体不良趋势发作的关联。输血后D-二聚体轨迹升高或持续升高的CCP接受者的死亡率高于输血后D-二聚体水平持续较低或下降的接受者。在CCP供体-受体网络中,D-二聚体轨迹升高或持续处于高位的接受者倾向于与少数CCP单位相关联。在体外试验中,来自“高风险”单位的CCP与人季节性β冠状病毒OC43的刺突蛋白具有更高的交叉反应性。与“低风险”单位相比,“高风险”CCP单位对表达SARS-CoV-2刺突的细胞也介导了更强的Fcγ受体IIa信号传导。本研究发现,重症新冠肺炎期间输血后凝血途径的激活与特定的CCP抗体谱相关,并支持免疫复合物激活的凝血病的潜在机制。