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Challenges of convalescent plasma infusion therapy in Middle East respiratory coronavirus infection: a single centre
Jae-Hoon Ko1,2, Hyeri Seok1, Sun Young Cho1
1Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Background:
The effects of convalescent plasma (CP) infusion, one of the treatment options for severe Middle East respiratory syndrome coronavirus (MERS-CoV) infections, have not yet been evaluated.
Methods:
Serological responses of CP-infused MERS patients during the 2015 Korean MERS outbreak at a tertiary care centre were evaluated. Serological activity was evaluated with anti-MERS-CoV enzyme-linked immunosorbent assay (ELISA) immunoglobulin (Ig)G, ELISA IgA, immunofluorescence assay IgM and plaque reduction neutralization test (PRNT). Donor plasma and one or two recipient's serum samples per week of illness including one taken the day after each CP infusion were evaluated. For sensitivity and specificity analysis of ELISA IgG in predicting neutralization activity, a data set of 138 previously evaluated MERS-CoV-infected patients was used.
Results:
Three of thirteen MERS patients with respiratory failure received four CP infusions from convalesced MERS-CoV-infected patients, and only two of them showed neutralizing activity. Donor plasma with a PRNT titre 1:80 demonstrated meaningful serological response after CP infusion, while that with a PRNT titre 1:40 did not. ELISA IgG predicted neutralization activity of a PRNT titre ≥1:80 with more than 95% specificity at a cutoff optical density (OD) ratio of 1.6, and with 100% specificity at an OD ratio of 1.9.
Conclusions:
For effective CP infusion in MERS, donor plasma with a neutralization activity of a PRNT titre ≥1:80 should be used. ELISA IgG could substitute for the neutralization test in resource-limited situations.
Insights
Convalescent plasma (CP) infusion is a potential treatment for severe Middle East respiratory syndrome coronavirus (MERS-CoV). Donor plasma with a plaque reduction neutralization test (PRNT) titre of at least 1:80 is recommended for effective CP therapy.
Area of Science:
- Virology
- Immunology
- Infectious Diseases
Background:
- Convalescent plasma (CP) infusion is explored as a treatment for severe Middle East respiratory syndrome coronavirus (MERS-CoV).
- The efficacy of CP infusion for MERS-CoV has not been previously evaluated.
- This study assesses serological responses in MERS patients receiving CP during the 2015 Korean MERS outbreak.
Observation:
- Thirteen MERS patients with respiratory failure received CP infusions.
- Only two of the three patients who received four CP infusions showed neutralizing activity.
- Donor plasma with a PRNT titre of 1:80 showed a meaningful serological response post-infusion, unlike titres of 1:40.
Findings:
- Enzyme-linked immunosorbent assay (ELISA) IgG predicted neutralization activity with high specificity.
- An ELISA IgG cutoff optical density (OD) ratio of 1.6 showed >95% specificity for PRNT titres ≥1:80.
- An ELISA IgG OD ratio of 1.9 demonstrated 100% specificity for PRNT titres ≥1:80.
Implications:
- For effective MERS-CoV CP therapy, donor plasma should possess a PRNT titre of at least 1:80.
- ELISA IgG testing can serve as a substitute for neutralization tests in resource-limited settings.
- These findings guide the selection of effective CP for MERS treatment.
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