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. 2022 Dec;15(12):1455-1458.
doi: 10.1016/j.jiph.2022.10.025. Epub 2022 Nov 2.

De novo natural anti-M alloantibody emergence in severe Coronavirus Disease 2019

Affiliations

De novo natural anti-M alloantibody emergence in severe Coronavirus Disease 2019

Robin Jeannet et al. J Infect Public Health. 2022 Dec.

Abstract

The immune response is a key player in the course of SARS-CoV-2 infection, and is often seriously dysfunctional in severe Coronavirus Disease 2019. The hyperinflammatory status has been described to be accompanied by the appearance of autoantibodies. In a lethal COVID-19 infection, we observed the emergence of a de novo natural alloantibody which targeted the M antigen from the MNS blood group on red blood cells (RBC) without evidence of any cross-reaction with SARS-CoV-2 antigens. This IgM lambda alloantibody was unmutated and unswitched. Here, we describe for the first time the emergence of a bystander de novo natural alloantibody against RBCs in a severe COVID-19 patient, highlighting the extra-follicular humoral response reported in these cases.

Keywords: Alloantibody; COVID-19; M-antigen; Transfusion.

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Conflict of interest statement

Conflict of interest Authors have no competing interest to disclose.

Figures

Fig. 1
Fig. 1
Graphical summary of patient clinical course (see text for details) and sequences of the two major mu heavy chain and lambda light chain clones. A) X-axis: evolution in days. Left Y-axis: Hemoglobin levels (red curve). Right axis: C-reactive protein (CRP) levels (black curve). Time of symptom onset, Intensive Care Unit (ICU) admission/mechanical ventilation (MV), indirect antiglobulin test (IAT), Red blood cell transfusion; and death are indicated by vertical arrows below the x-axis. Duration of corticosteroid (8 days) therapy and extracorporeal membrane oxygenation (ECMO, 5 days) are shown by horizontal bi-directional arrows within the graph. B) IgM heavy chain VH4‐38‐2 (0/11/4) DH3‐3 (4/13/7) JH4*02 amino acid (AA) IMGT/ Collier de perles corresponding to 22.6% of G/A/M repertoire and C) Lambda light chain Vλ3‐1 (2//2) Jλ2 AA IMGT/ Collier de perles representing 5.5% of the Kappa/Lambda repertoire found by high-throughput sequencing (HTS). Amino acids are shown as one-letter abbreviations.

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