The Francis Crick Institute
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Commercial immunoglobulin products contain neutralizing antibodies against severe acute respiratory syndrome coronavirus 2 spike protein.

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journal contribution
posted on 2023-10-06, 09:45 authored by Vinit Upasani, Katie Townsend, Mary Y Wu, Edward J Carr, Agnieszka Hobbs, Giulia Dowgier, Martina Ragno, Lou S Herman, Sonal Sharma, Devesh Shah, Simon FK Lee, Neil Chauhan, Julie M Glanville, Lucy Neave, Steven Hanson, Sriram Ravichandran, Aoife Tynan, Mary O'Sullivan, Fernando Moreira, Sarita Workman, Andrew Symes, Siobhan O Burns, Susan Tadros, Jennifer CL Hart, Rupert CL Beale, Sonia Gandhi, Emma C Wall, Laura McCoy, David M Lowe
BACKGROUND: Patients with antibody deficiency respond poorly to COVID-19 vaccination and are at risk of severe or prolonged infection. They are given long-term immunoglobulin replacement therapy (IRT) prepared from healthy donor plasma to confer passive immunity against infection. Following widespread COVID-19 vaccination alongside natural exposure, we hypothesised that immunoglobulin preparations will now contain neutralising SARS-CoV-2 spike antibodies which confer protection against COVID-19 disease and may help to treat chronic infection. METHODS: We evaluated anti-SARS-CoV-2 spike antibody in a cohort of patients before and after immunoglobulin infusion. Neutralising capacity of patient samples and immunoglobulin products was assessed using in vitro pseudo-virus and live-virus neutralisation assays, the latter investigating multiple batches against current circulating omicron variants. We describe the clinical course of nine patients started on IRT during treatment of COVID-19. RESULTS: In 35 individuals with antibody deficiency established on IRT, median anti-spike antibody titre increased from 2123 to 10600 U/ml post-infusion, with corresponding increase in pseudo-virus neutralisation titres to levels comparable to healthy donors. Testing immunoglobulin products directly in the live-virus assay confirmed neutralisation, including of BQ1.1 and XBB variants, but with variation between immunoglobulin products and batches.Initiation of IRT alongside Remdesivir in patients with antibody deficiency and prolonged COVID-19 infection (median 189 days, maximum over 900 days with an ancestral viral strain) resulted in clearance of SARS-CoV-2 virus at a median of 20 days. CONCLUSIONS: Immunoglobulin preparations now contain neutralising anti-SARS-CoV-2 antibodies which are transmitted to patients and help to treat COVID-19 in individuals with failure of humoral immunity.


Crick (Grant ID: CC2087, Grant title: Beale CC2087) Crick (Grant ID: CC2230, Grant title: CSU CC2230) Crick (Grant ID: CC1283, Grant title: Crick legacy study CC1283)