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Review
. 2020 Jul:216:108459.
doi: 10.1016/j.clim.2020.108459. Epub 2020 May 11.

Immunoglobulins in the treatment of COVID-19 infection: Proceed with caution!

Alan A Nguyen  1 , Saddiq B Habiballah  1 , Craig D Platt  1 , Raif S Geha  1 , Janet S Chou  1 , Douglas R McDonald  2
Affiliations
Review

Immunoglobulins in the treatment of COVID-19 infection: Proceed with caution!

Alan A Nguyen et al. Clin Immunol. 2020 Jul.

Abstract

The COVID-19 pandemic is one of the greatest infectious challenges in recent history. Presently, few treatment options exist and the availability of effective vaccines is at least one year away. There is an urgent need to find currently available, effective therapies in the treatment of patients with COVID-19 infection. In this review, we compare and contrast the use of intravenous immunoglobulin and hyperimmune globulin in the treatment of COVID-19 infection.

Keywords: COVID-19; Coronavirus; Hyperimmune globulin; Intravenous immunoglobulin; SARS-CoV-2.

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Conflict of interest statement

Declaration of Competing Interest The authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
Proposed mechanisms of neutralizing antibodies and IVIG in COVID-19 infection. (a) Neutralizing antibodies prevent SARS-CoV2 spike protein from attaching to the ACE2 receptor, inhibiting viral entry into the cell. (b) Immune complexes consisting of viral antigens and anti-viral sub-neutralizing antibodies can activate Fcγ receptors on innate immune cells (e.g. macrophages) in the lung, triggering an exaggerated inflammatory response leading to acute lung injury via antibody dependent enhancement (ADE). Additionally, antibody-bound virus can be internalized through Fcγ receptors, enhancing viral replication. (c) Proposed mechanisms whereby IVIG exerts anti-inflammatory action include saturation of Fcγ receptor binding, anti-idiotypic binding to anti-viral antibodies, and binding of proinflammatory cytokines.
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