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Joyner MJ. Convalescent Plasma and the US Expanded Access Program: A Personal Narrative. Curr Top Microbiol Immunol 2024. [PMID: 38877204 DOI: 10.1007/82_2024_269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2024]
Abstract
Between early April 2020 and late August 2020, nearly 100,000 patients hospitalized with SARS-CoV2 infections were treated with COVID-19 convalescent plasma (CCP) in the US under the auspices of an FDA-authorized Expanded Access Program (EAP) housed at the Mayo Clinic. Clinicians wishing to provide CCP to their patients during that 5-month period early in the COVID pandemic had to register their patients and provide clinical information to the EAP program. This program was utilized by some 2,200 US hospitals located in every state ranging from academic medical centers to small rural hospitals and facilitated the treatment of an ethnically and socio-economically diverse cross section of patients. Within 6 weeks of program initiation, the first signals of safety were found in 5,000 recipients of CCP, supported by a later analysis of 20,000 recipients (Joyner et al. in J Clin Invest 130:4791-4797, 2020a; Joyner et al. in Mayo Clin Proc 95:1888-1897, 2020b). By mid-summer of 2020, strong evidence was produced showing that high-titer CCP given early in the course of hospitalization could lower mortality by as much as a third (Joyner et al. in N Engl J Med 384:1015-1027, 2021; Senefeld et al. in PLoS Med 18, 2021a). These data were used by the FDA in its August decision to grant Emergency Use Authorization for CCP use in hospitals. This chapter provides a personal narrative by the principal investigator of the EAP that describes the events leading up to the program, some of its key outcomes, and some lessons learned that may be applicable to the next pandemic. This vast effort was a complete team response to a crisis and included an exceptional level of collaboration both inside and outside of the Mayo Clinic. Writing just 4 years after the initiation of the EAP, this intense professional effort, comprising many moving parts, remains hard to completely understand or fully explain in this brief narrative. As Nelson Mandela said of the perception of time during his decades in prison, "the days seemed like years, and the years seemed like days."
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Affiliation(s)
- Michael J Joyner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.
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2
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Khawaja T, Kajova M, Levonen I, Pietilä JP, Välimaa H, Paajanen J, Pakkanen SH, Patjas A, Montonen R, Miettinen S, Virtanen J, Smura T, Sironen T, Fagerlund R, Ugurlu H, Iheozor-Ejiofor R, Saksela K, Vahlberg T, Ranki A, Vierikko A, Ihalainen J, Vapalahti O, Kantele A. Double-blinded, randomised, placebo-controlled trial of convalescent plasma for COVID-19: analyses by neutralising antibodies homologous to recipients' variants. Infect Dis (Lond) 2024; 56:423-433. [PMID: 38513074 DOI: 10.1080/23744235.2024.2329957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/08/2024] [Indexed: 03/23/2024] Open
Abstract
INTRODUCTION Convalescent plasma (CP) emerged as potential treatment for COVID-19 early in the pandemic. While efficacy in hospitalised patients has been lacklustre, CP may be beneficial at the first stages of disease. Despite multiple new variants emerging, no trials have involved analyses on variant-specific antibody titres of CP. METHODS We recruited hospitalised COVID-19 patients within 10 days of symptom onset and, employing a double-blinded approach, randomised them to receive 200 ml convalescent plasma with high (HCP) or low (LCP) neutralising antibody (NAb) titre against the ancestral strain (Wuhan-like variant) or placebo in 1:1:1 ratio. Primary endpoints comprised intubation, corticosteroids for symptom aggravation, and safety assessed as serious adverse events. For a preplanned ad hoc analysis, the patients were regrouped by infused CP's NAb titers to variants infecting the recipients i.e. by titres of homologous HCP (hHCP) or LCP (hLCP). RESULTS Of the 57 patients, 18 received HCP, 19 LCP and 20 placebo, all groups smaller than planned. No significant differences were found for primary endpoints. In ad hoc analysis, hHCPrecipients needed significantly less respiratory support, and appeared to be given corticosteroids less frequently (1/14; 7.1%) than those receiving hLCP (9/23; 39.1%) or placebo (8/20; 40%), (p = 0.077). DISCUSSION Our double-blinded, placebo-controlled CP therapy trial remained underpowered and does not allow any firm conclusions for early-stage hospitalised COVID-19 patients. Interestingly, however, regrouping by homologous - recipients' variant-specific - CP titres suggested benefits for hHCP. We encourage similar re-analysis of ongoing/previous larger CP studies. TRIAL REGISTRATION ClinTrials.gov identifier: NCT0473040.
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Affiliation(s)
- T Khawaja
- Meilahti Vaccine Research Center, MeVac, Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- FIMAR, Multidisciplinary Center of Excellence in Antimicrobial Resistance Research, University of Helsinki, Helsinki, Finland
| | - M Kajova
- Meilahti Vaccine Research Center, MeVac, Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- FIMAR, Multidisciplinary Center of Excellence in Antimicrobial Resistance Research, University of Helsinki, Helsinki, Finland
| | - I Levonen
- Meilahti Vaccine Research Center, MeVac, Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - J P Pietilä
- Meilahti Vaccine Research Center, MeVac, Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- FIMAR, Multidisciplinary Center of Excellence in Antimicrobial Resistance Research, University of Helsinki, Helsinki, Finland
| | - H Välimaa
- Meilahti Vaccine Research Center, MeVac, Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Virology, University of Helsinki, Helsinki, Finland
| | - J Paajanen
- Meilahti Vaccine Research Center, MeVac, Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Pulmonary Medicine, Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - S H Pakkanen
- Meilahti Vaccine Research Center, MeVac, Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- FIMAR, Multidisciplinary Center of Excellence in Antimicrobial Resistance Research, University of Helsinki, Helsinki, Finland
| | - A Patjas
- Meilahti Vaccine Research Center, MeVac, Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- FIMAR, Multidisciplinary Center of Excellence in Antimicrobial Resistance Research, University of Helsinki, Helsinki, Finland
| | - R Montonen
- Department of Virology, University of Helsinki, Helsinki, Finland
| | - S Miettinen
- Department of Virology, University of Helsinki, Helsinki, Finland
- Department of Veterinary Biosciences, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - J Virtanen
- Department of Virology, University of Helsinki, Helsinki, Finland
- Department of Veterinary Biosciences, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - T Smura
- Department of Virology, University of Helsinki, Helsinki, Finland
| | - T Sironen
- Department of Virology, University of Helsinki, Helsinki, Finland
- Department of Veterinary Biosciences, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - R Fagerlund
- Department of Virology, University of Helsinki, Helsinki, Finland
| | - H Ugurlu
- Department of Virology, University of Helsinki, Helsinki, Finland
| | - R Iheozor-Ejiofor
- Department of Virology, University of Helsinki, Helsinki, Finland
- Department of Veterinary Biosciences, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - K Saksela
- Department of Virology, University of Helsinki, Helsinki, Finland
- HUS Diagnostic Centre, HUSLAB, Clinical Microbiology, Helsinki University Hospital, Helsinki, Finland
| | - T Vahlberg
- Department of Biostatistics, University of Turku and Turku University Hospital, Turku, Finland
| | - A Ranki
- Department of Dermatology, Allergology and Venereology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - A Vierikko
- Finnish Red Cross Blood Service, Helsinki, Finland
| | - J Ihalainen
- Finnish Red Cross Blood Service, Helsinki, Finland
| | - O Vapalahti
- Department of Virology, University of Helsinki, Helsinki, Finland
- Department of Veterinary Biosciences, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
- HUS Diagnostic Centre, HUSLAB, Clinical Microbiology, Helsinki University Hospital, Helsinki, Finland
| | - A Kantele
- Meilahti Vaccine Research Center, MeVac, Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- FIMAR, Multidisciplinary Center of Excellence in Antimicrobial Resistance Research, University of Helsinki, Helsinki, Finland
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Asadipooya K, Asadipooya A, Adatorwovor R. Combination of spironolactone and DPP-4 inhibitors for treatment of SARS-CoV-2 infection: a literature review. Arch Virol 2024; 169:122. [PMID: 38753071 DOI: 10.1007/s00705-024-06043-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 03/23/2024] [Indexed: 05/21/2024]
Abstract
Coronavirus disease 2019 (COVID-19) is still causing hospitalization and death, and vaccination appears to become less effective with each emerging variant. Spike, non-spike, and other possible unrecognized mutations have reduced the efficacy of recommended therapeutic approaches, including monoclonal antibodies, plasma transfusion, and antivirals. SARS-CoV-2 binds to angiotensin-converting enzyme 2 (ACE2) and probably dipeptidyl peptidase 4 (DPP-4) to initiate the process of endocytosis by employing host proteases such as transmembrane serine protease-2 (TMPRSS-2) and ADAM metallopeptidase domain 17 (ADAM17). Spironolactone reduces the amount of soluble ACE2 and antagonizes TMPRSS-2 and ADAM17. DPP-4 inhibitors play immunomodulatory roles and may block viral entry. The efficacy of treatment with a combination of spironolactone and DPP-4 inhibitors does not appear to be affected by viral mutations. Therefore, the combination of spironolactone and DPP-4 inhibitors might improve the clinical outcome for COVID-19 patients by decreasing the efficiency of SARS-CoV-2 entry into cells and providing better anti-inflammatory, antiproliferative, and antifibrotic effects than those achieved using current therapeutic approaches such as antivirals and monoclonal antibodies.
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Affiliation(s)
- Kamyar Asadipooya
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Barnstable Brown Diabetes and Obesity Center, University of Kentucky, 2195 Harrodsburg Rd, Suite 125, Lexington, KY, 40504, USA.
| | - Artin Asadipooya
- Department of Neuroscience, University of Kentucky, Lexington, KY, USA
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Destremau M, Chaussade H, Hemar V, Beguet M, Bellecave P, Blanchard E, Barret A, Laboure G, Vasco-Moynet C, Lacassin F, Morisse E, Aguilar C, Lafarge X, Lafon ME, Bonnet F, Issa N, Camou F. Convalescent plasma transfusion for immunocompromised viremic patients with COVID-19: A retrospective multicenter study. J Med Virol 2024; 96:e29603. [PMID: 38619025 DOI: 10.1002/jmv.29603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/16/2024]
Abstract
This study aims to assess the safety, virological, and clinical outcomes of convalescent plasma transfusion (CPT) in immunocompromised patients hospitalized for coronavirus disease 2019 (COVID-19). We conducted a retrospective multicenter cohort study that included all immunosuppressed patients with COVID-19 and RNAemia from May 2020 to March 2023 treated with CPT. We included 81 patients with hematological malignancies (HM), transplants, or autoimmune diseases (69% treated with anti-CD20). Sixty patients (74%) were vaccinated, and 14 had pre-CPT serology >264 BAU/mL. The median delay between symptom onset and CPT was 23 days [13-31]. At D7 post-CPT, plasma PCR was negative in 43/64 patients (67.2%), and serology became positive in 25/30 patients (82%). Post-CPT positive serology was associated with RNAemia negativity (p < 0.001). The overall mortality rate at D28 was 26%, being higher in patients with non-B-cell HM (62%) than with B-cell HM (25%) or with no HM (11%) (p = 0.02). Patients receiving anti-CD20 without chemotherapy had the lowest mortality rate (8%). Positive RNAemia at D7 was associated with mortality at D28 in univariate analysis (HR: 3.05 [1.14-8.19]). Eight patients had adverse events, two of which were severe but transient. Our findings suggest that CPT can abolish RNAemia and ameliorate the clinical course in immunocompromised patients with COVID-19.
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Affiliation(s)
- Marjolaine Destremau
- CHU Bordeaux, Service de médecine interne et maladies infectieuses, Bordeaux, France
| | - Hélène Chaussade
- CHU Bordeaux, Service de médecine interne et maladies infectieuses, Bordeaux, France
| | - Victor Hemar
- CHU Bordeaux, Service de médecine interne et maladies infectieuses, Bordeaux, France
| | - Mathilde Beguet
- Etablissement français du sang Nouvelle Aquitaine, Bordeaux, France
| | | | | | - Amaury Barret
- CH Arcachon, Service de médecine interne, La Teste-de-Buch, France
| | | | | | - Flore Lacassin
- CH Mont-de-Marsan, Service de médecine interne, Mont-de-Marsan, France
| | | | - Claire Aguilar
- CH Périgueux, Service de maladies infectieuses, Périgueux, France
| | - Xavier Lafarge
- Etablissement français du sang Nouvelle Aquitaine, Bordeaux, France
- Université de Bordeaux, INSERM U1211 "Maladies Rares: Génétique et Métabolisme", Talence, France
| | | | - Fabrice Bonnet
- CHU Bordeaux, Service de médecine interne et maladies infectieuses, Bordeaux, France
- Université de Bordeaux, Bordeaux Population Health, INSERM U1219, Bordeaux, France
| | - Nahéma Issa
- CHU Bordeaux, Service de réanimation médicale, Bordeaux, France
| | - Fabrice Camou
- CHU Bordeaux, Service de réanimation médicale, Bordeaux, France
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Franchini M, Cruciani M, Casadevall A, Joyner MJ, Senefeld JW, Sullivan DJ, Zani M, Focosi D. Safety of COVID-19 convalescent plasma: A definitive systematic review and meta-analysis of randomized controlled trials. Transfusion 2024; 64:388-399. [PMID: 38156374 DOI: 10.1111/trf.17701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 12/17/2023] [Accepted: 12/18/2023] [Indexed: 12/30/2023]
Affiliation(s)
- Massimo Franchini
- Department of Transfusion Medicine and Hematology, Carlo Poma Hospital, Mantova, Italy
| | - Mario Cruciani
- Department of Transfusion Medicine and Hematology, Carlo Poma Hospital, Mantova, Italy
| | - Arturo Casadevall
- Johns Hopkins Bloomberg School of Public Health, Department of Molecular Microbiology and Immunology, Baltimore, Maryland, USA
| | - Michael J Joyner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jonathon W Senefeld
- Department of Kinesiology and Community Healthy, University of Illinois at Urbana-Champaign, Champaign, Illinois, USA
| | - David J Sullivan
- Johns Hopkins Bloomberg School of Public Health, Department of Molecular Microbiology and Immunology, Baltimore, Maryland, USA
| | - Matteo Zani
- Department of Transfusion Medicine and Hematology, Carlo Poma Hospital, Mantova, Italy
| | - Daniele Focosi
- North-Western Tuscany Blood Bank, Pisa University Hospital, Pisa, Italy
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Falavigna M, de Araujo CLP, Barbosa AN, Belli KC, Colpani V, Dal-Pizzol F, da Silva RM, de Azevedo LCP, Dias MBS, do Amaral JLG, Dorneles GP, Ferreira JC, Freitas APDR, Gräf DD, Guimarães HP, Lobo SMA, Machado FR, Nunes MS, de Oliveira MS, Parahiba SM, Rosa RG, Santos VCC, Sobreira ML, Veiga VC, Xavier RM, Zavascki AP, Stein C, de Carvalho CRR. The II Brazilian Guidelines for the pharmacological treatment of patients hospitalized with COVID-19 Joint Guidelines of the Associação Brasileira de Medicina de Emergência, Associação de Medicina Intensiva Brasileira, Associação Médica Brasileira, Sociedade Brasileira de Angiologia e Cirurgia Vascular, Sociedade Brasileira de Infectologia, Sociedade Brasileira de Pneumologia e Tisiologia and Sociedade Brasileira de Reumatologia. CRITICAL CARE SCIENCE 2023; 35:243-255. [PMID: 38133154 PMCID: PMC10734807 DOI: 10.5935/2965-2774.20230136-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/09/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE To update the recommendations to support decisions regarding the pharmacological treatment of patients hospitalized with COVID-19 in Brazil. METHODS Experts, including representatives of the Ministry of Health and methodologists, created this guideline. The method used for the rapid development of guidelines was based on the adoption and/or adaptation of existing international guidelines (GRADE ADOLOPMENT) and supported by the e-COVID-19 RecMap platform. The quality of the evidence and the preparation of the recommendations followed the GRADE method. RESULTS Twenty-one recommendations were generated, including strong recommendations for the use of corticosteroids in patients using supplemental oxygen and conditional recommendations for the use of tocilizumab and baricitinib for patients on supplemental oxygen or on noninvasive ventilation and anticoagulants to prevent thromboembolism. Due to suspension of use authorization, it was not possible to make recommendations regarding the use of casirivimab + imdevimab. Strong recommendations against the use of azithromycin in patients without suspected bacterial infection, hydroxychloroquine, convalescent plasma, colchicine, and lopinavir + ritonavir and conditional recommendations against the use of ivermectin and remdesivir were made. CONCLUSION New recommendations for the treatment of hospitalized patients with COVID-19 were generated, such as those for tocilizumab and baricitinib. Corticosteroids and prophylaxis for thromboembolism are still recommended, the latter with conditional recommendation. Several drugs were considered ineffective and should not be used to provide the best treatment according to the principles of evidence-based medicine and to promote resource economy.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Juliana Carvalho Ferreira
- Sociedade Brasileira de Pneumologia e Tisiologia - São Paulo
(SP), Brazil
- Associação de Medicina Intensiva Brasileira -
São Paulo (SP), Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Cinara Stein
- Hospital Moinhos de Vento - Porto Alegre (RS), Brazil
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Siripongboonsitti T, Nontawong N, Tawinprai K, Suptawiwat O, Soonklang K, Poovorawan Y, Mahanonda N. Efficacy of combined COVID-19 convalescent plasma with oral RNA-dependent RNA polymerase inhibitor treatment versus neutralizing monoclonal antibody therapy in COVID-19 outpatients: a multi-center, non-inferiority, open-label randomized controlled trial (PlasMab). Microbiol Spectr 2023; 11:e0325723. [PMID: 37975699 PMCID: PMC10714803 DOI: 10.1128/spectrum.03257-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/26/2023] [Indexed: 11/19/2023] Open
Abstract
IMPORTANCE This pivotal study reveals that high neutralizing titer COVID-19 convalescent plasma therapy (CPT) combined with favipiravir (FPV) is non-inferior to sotrovimab in preventing hospitalization and severe outcomes in outpatients with mild-to-moderate COVID-19 and high-risk comorbidities. It underscores the potential of CPT-FPV as a viable alternative to neutralizing monoclonal antibodies like sotrovimab, especially amid emerging variants with spike protein mutations. The study's unique approach, comparing a monoclonal antibody with CPT, demonstrates the efficacy of early intervention using high neutralizing antibody titer CPT, even in populations with a significant proportion of elderly patients. These findings are crucial, considering the alternative treatment challenges, especially in resource-limited countries, posed by the rapidly mutating SARS-CoV-2 virus and the need for adaptable therapeutic strategies.
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Affiliation(s)
- Taweegrit Siripongboonsitti
- Division of Infectious Diseases, Department of Medicine, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
- Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, Thailand
| | | | - Kriangkrai Tawinprai
- Division of Infectious Diseases, Department of Medicine, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
- Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Ornpreya Suptawiwat
- Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Kamonwan Soonklang
- Center of Learning and Research in Celebration of HRH Princess Chulabhorn 60th Birthday Anniversary, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Yong Poovorawan
- Department of Pediatrics, Center of Excellence in Clinical Virology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nithi Mahanonda
- Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
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Wu J, Yang H, Yu D, Yang X. Blood-derived product therapies for SARS-CoV-2 infection and long COVID. MedComm (Beijing) 2023; 4:e426. [PMID: 38020714 PMCID: PMC10651828 DOI: 10.1002/mco2.426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/15/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is capable of large-scale transmission and has caused the coronavirus disease 2019 (COVID-19) pandemic. Patients with COVID-19 may experience persistent long-term health issues, known as long COVID. Both acute SARS-CoV-2 infection and long COVID have resulted in persistent negative impacts on global public health. The effective application and development of blood-derived products are important strategies to combat the serious damage caused by COVID-19. Since the emergence of COVID-19, various blood-derived products that target or do not target SARS-CoV-2 have been investigated for therapeutic applications. SARS-CoV-2-targeting blood-derived products, including COVID-19 convalescent plasma, COVID-19 hyperimmune globulin, and recombinant anti-SARS-CoV-2 neutralizing immunoglobulin G, are virus-targeting and can provide immediate control of viral infection in the short term. Non-SARS-CoV-2-targeting blood-derived products, including intravenous immunoglobulin and human serum albumin exhibit anti-inflammatory, immunomodulatory, antioxidant, and anticoagulatory properties. Rational use of these products can be beneficial to patients with SARS-CoV-2 infection or long COVID. With evidence accumulated since the pandemic began, we here summarize the progress of blood-derived product therapies for COVID-19, discuss the effective methods and scenarios regarding these therapies, and provide guidance and suggestions for clinical treatment.
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Affiliation(s)
- Junzheng Wu
- Chengdu Rongsheng Pharmaceuticals Co., Ltd.ChengduChina
| | | | - Ding Yu
- Chengdu Rongsheng Pharmaceuticals Co., Ltd.ChengduChina
- Beijing Tiantan Biological Products Co., Ltd.BeijingChina
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9
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Beetler DJ, Bruno KA, Watkins MM, Xu V, Chekuri I, Giresi P, Di Florio DN, Whelan ER, Edenfield BH, Walker SA, Morales-Lara AC, Hill AR, Jain A, Auda ME, Macomb LP, Shapiro KA, Keegan KC, Wolfram J, Behfar A, Stalboerger PG, Terzic A, Farres H, Cooper LT, Fairweather D. Reconstituted Extracellular Vesicles from Human Platelets Decrease Viral Myocarditis in Mice. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2023; 19:e2303317. [PMID: 37612820 PMCID: PMC10840864 DOI: 10.1002/smll.202303317] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/11/2023] [Indexed: 08/25/2023]
Abstract
Patients with viral myocarditis are at risk of sudden death and may progress to dilated cardiomyopathy (DCM). Currently, no disease-specific therapies exist to treat viral myocarditis. Here it is examined whether reconstituted, lyophilized extracellular vesicles (EVs) from platelets from healthy men and women reduce acute or chronic myocarditis in male mice. Human-platelet-derived EVs (PEV) do not cause toxicity, damage, or inflammation in naïve mice. PEV administered during the innate immune response significantly reduces myocarditis with fewer epidermal growth factor (EGF)-like module-containing mucin-like hormone receptor-like 1 (F4/80) macrophages, T cells (cluster of differentiation molecules 4 and 8, CD4 and CD8), and mast cells, and improved cardiac function. Innate immune mediators known to increase myocarditis are decreased by innate PEV treatment including Toll-like receptor (TLR)4 and complement. PEV also significantly reduces perivascular fibrosis and remodeling including interleukin 1 beta (IL-1β), transforming growth factor-beta 1, matrix metalloproteinase, collagen genes, and mast cell degranulation. PEV given at days 7-9 after infection reduces myocarditis and improves cardiac function. MicroRNA (miR) sequencing reveals that PEV contains miRs that decrease viral replication, TLR4 signaling, and T-cell activation. These data show that EVs from the platelets of healthy individuals can significantly reduce myocarditis and improve cardiac function.
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Affiliation(s)
- Danielle J. Beetler
- Center for Clinical and Translational Science, Mayo Clinic, Rochester, Minnesota 55902, USA; Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida 32224, USA; Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, Minnesota 55902, USA
| | - Katelyn A. Bruno
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida 32224, USA; Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, 32608
| | - Molly M. Watkins
- Center for Clinical and Translational Science, Mayo Clinic, Rochester, Minnesota 55902, USA; Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida 32224, USA; Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, Minnesota 55902, USA
| | - Vivian Xu
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida 32224, USA
| | - Isha Chekuri
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida 32224, USA
| | - Presley Giresi
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida 32224, USA
| | - Damian N. Di Florio
- Center for Clinical and Translational Science, Mayo Clinic, Rochester, Minnesota 55902, USA; Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida 32224, USA; Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, Minnesota 55902, USA
| | - Emily R. Whelan
- Center for Clinical and Translational Science, Mayo Clinic, Rochester, Minnesota 55902, USA; Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida 32224, USA; Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, Minnesota 55902, USA
| | | | - Sierra A. Walker
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, Minnesota 55902, USA; Department of Biochemistry and Molecular Biology, Rochester, Minnesota 55902, USA
| | | | - Anneliese R. Hill
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida 32224, USA
| | - Angita Jain
- Center for Clinical and Translational Science, Mayo Clinic, Rochester, Minnesota 55902, USA; Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida 32224, USA
| | - Matthew E. Auda
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida 32224, USA
| | - Logan P. Macomb
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida 32224, USA
| | - Kathryn A. Shapiro
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida 32224, USA
| | - Kevin C. Keegan
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida 32224, USA
| | - Joy Wolfram
- School of Chemical Engineering, Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Atta Behfar
- Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota 55905, USA; Van Cleve Cardiac Regenerative Medicine Program, Mayo Clinic Center for Regenerative Medicine, Rochester, MN, USA
| | - Paul G. Stalboerger
- Van Cleve Cardiac Regenerative Medicine Program, Mayo Clinic Center for Regenerative Medicine, Rochester, MN, USA
| | - Andre Terzic
- Van Cleve Cardiac Regenerative Medicine Program, Mayo Clinic Center for Regenerative Medicine, Rochester, MN, USA; Department of Clinical Genomics, Mayo Clinic, Rochester, Minnesota 55905, USA
| | - Houssam Farres
- Department of Vascular Surgery, Mayo Clinic, Jacksonville, Florida 32224, USA
| | - Leslie T. Cooper
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida 32224, USA
| | - DeLisa Fairweather
- Center for Clinical and Translational Science, Mayo Clinic, Rochester, Minnesota 55902, USA; Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida 32224, USA; Department of Immunology, Mayo Clinic, Jacksonville, Florida 32224, USA
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10
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Yang X. Passive antibody therapy in emerging infectious diseases. Front Med 2023; 17:1117-1134. [PMID: 38040914 DOI: 10.1007/s11684-023-1021-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 07/20/2023] [Indexed: 12/03/2023]
Abstract
The epidemic of corona virus disease 2019 (COVID-19) caused by severe acute respiratory syndrome Coronavirus 2 and its variants of concern (VOCs) has been ongoing for over 3 years. Antibody therapies encompassing convalescent plasma, hyperimmunoglobulin, and neutralizing monoclonal antibodies (mAbs) applied in passive immunotherapy have yielded positive outcomes and played a crucial role in the early COVID-19 treatment. In this review, the development path, action mechanism, clinical research results, challenges, and safety profile associated with the use of COVID-19 convalescent plasma, hyperimmunoglobulin, and mAbs were summarized. In addition, the prospects of applying antibody therapy against VOCs was assessed, offering insights into the coping strategies for facing new infectious disease outbreaks.
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Affiliation(s)
- Xiaoming Yang
- National Engineering Technology Research Center for Combined Vaccines, Wuhan, 430207, China.
- Wuhan Institute of Biological Products Co., Ltd., Wuhan, 430207, China.
- China National Biotec Group Company Limited, Beijing, 100029, China.
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11
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Scibona P, Burgos Pratx LD, Savoy N, Recart D, Elia Y, Seoane FN, Arrigo D, Portalis MR, Roldan A, Cassoratti BA, Diaz JC, Antonelli CE, Perez L, Posadas-Martinez L, Belloso WH, Simonovich V. Long-term antibody titers variation in unvaccinated patients receiving convalescent plasma or placebo for severe SARS-CoV-2 pulmonary infection. Transfus Apher Sci 2023; 62:103785. [PMID: 37620184 DOI: 10.1016/j.transci.2023.103785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Convalescent plasma (CP) became a prominent treatment in the early stages of the SARS-CoV-2 pandemic. In Argentina, a randomized clinical trial was executed to compare the use of CP in inpatients with severe COVID-19 pneumonia versus placebo. No differences in clinical outcomes or overall mortality between groups were observed. We conducted a cohort study in outpatients enrolled in the trial to describe long-term antibody titer variations between CP and placebo recipients. METHODS Patients' total SARS-CoV-2 IgG antibodies against spike protein were collected 3, 6 and 12 months after hospital discharge from August 2020 to December 2021. In addition, reinfections, deaths and vaccination status were retrieved. Statistical analysis was performed using antibody geometric mean titers (GMT). All estimations were made considering the date of the trial infusion (placebo or CP) as time 0. RESULTS From the 93 patients included in the follow-up, 64 had received CP and 29 placebo. We excluded all 12-month measurements because they were collected after the patients' vaccination date. At 90 days post-infusion, patients had an antibody GMT of 8.1 (IQR 7.4-8.1) in the CP group and 8.8 (IQR 8.1-9.1) in the placebo group. At 180 days, both groups had a GMT of 8.1 (IQR 7.4-8.1). No statistical differences in GMT were found between CP and placebo groups at 90 days (p = 0.12) and 180 days (p = 0.25). No patients registered a new COVID-19 infection; one died in the CP group from an ischemic stroke. CONCLUSIONS No differences were observed in long-term antibody titers in unvaccinated patients that received CP or placebo after severe COVID-19 pneumonia.
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Affiliation(s)
- Paula Scibona
- Clinical Pharmacology Section, Internal Medicine Service, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190 C1199, Buenos Aires, Argentina
| | - Leandro Daniel Burgos Pratx
- Transfusional Medicine Department, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199 Buenos Aires, Argentina
| | - Nadia Savoy
- Clinical Pharmacology Section, Internal Medicine Service, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190 C1199, Buenos Aires, Argentina
| | - Delfina Recart
- Clinical Pharmacology Section, Internal Medicine Service, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190 C1199, Buenos Aires, Argentina.
| | - Yasmin Elia
- Clinical Pharmacology Section, Internal Medicine Service, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190 C1199, Buenos Aires, Argentina
| | - Facundo Nahuel Seoane
- Virology Section, Central Laboratory, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190 C1199, Buenos Aires, Argentina
| | - Diego Arrigo
- Virology Section, Central Laboratory, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190 C1199, Buenos Aires, Argentina
| | - Maximo Rousseau Portalis
- Facultad de Medicina, Universidad de Buenos Aires, Paraguay 2155, C1121A6B Buenos Aires, Argentina
| | - Agustina Roldan
- Facultad de Medicina, Universidad de Buenos Aires, Paraguay 2155, C1121A6B Buenos Aires, Argentina
| | | | - Julio Cesar Diaz
- Facultad de Medicina, Universidad de Buenos Aires, Paraguay 2155, C1121A6B Buenos Aires, Argentina
| | | | - Lucia Perez
- Department of Research, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199 Buenos Aires, Argentina
| | - Lourdes Posadas-Martinez
- Department of Research, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199 Buenos Aires, Argentina
| | - Waldo H Belloso
- Terra Nova Innovation Unit, Hospital Italiano de Buenos Aires, Argentina
| | - Ventura Simonovich
- Clinical Pharmacology Section, Internal Medicine Service, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190 C1199, Buenos Aires, Argentina
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12
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Cross RW, Wiethoff CM, Brown-Augsburger P, Berens S, Blackbourne J, Liu L, Wu X, Tetreault J, Dodd C, Sina R, Witcher DR, Newcomb D, Frost D, Wilcox A, Borisevich V, Agans KN, Woolsey C, Prasad AN, Deer DJ, Geisbert JB, Dobias NS, Fenton KA, Strifler B, Ebert P, Higgs R, Beall A, Chanda S, Riva L, Yin X, Geisbert TW. The Therapeutic Monoclonal Antibody Bamlanivimab Does Not Enhance SARS-CoV-2 Infection by FcR-Mediated Mechanisms. Pathogens 2023; 12:1408. [PMID: 38133292 PMCID: PMC10746090 DOI: 10.3390/pathogens12121408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/10/2023] [Accepted: 11/16/2023] [Indexed: 12/23/2023] Open
Abstract
As part of the non-clinical safety package characterizing bamlanivimab (SARS-CoV-2 neutralizing monoclonal antibody), the risk profile for antibody-dependent enhancement of infection (ADE) was evaluated in vitro and in an African green monkey (AGM) model of COVID-19. In vitro ADE assays in primary human macrophage, Raji, or THP-1 cells were used to evaluate enhancement of viral infection. Bamlanivimab binding to C1q, FcR, and cell-based effector activity was also assessed. In AGMs, the impact of bamlanivimab pretreatment on viral loads and clinical and histological pathology was assessed to evaluate enhanced SARS-CoV-2 replication or pathology. Bamlanivimab did not increase viral replication in vitro, despite a demonstrated effector function. In vivo, no significant differences were found among the AGM groups for weight, temperature, or food intake. Treatment with bamlanivimab reduced viral loads in nasal and oral swabs and BAL fluid relative to control groups. Viral antigen was not detected in lung tissue from animals treated with the highest dose of bamlanivimab. Bamlanivimab did not induce ADE of SARS-CoV-2 infection in vitro or in an AGM model of infection at any dose evaluated. The findings suggest that high-affinity monoclonal antibodies pose a low risk of mediating ADE in patients and support their safety profile as a treatment of COVID-19 disease.
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Affiliation(s)
- Robert W. Cross
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX 77555, USA (A.N.P.)
- Galveston National Laboratory, University of Texas Medical Branch, Galveston, TX 77555, USA
| | | | | | - Shawn Berens
- Eli Lilly and Company, Indianapolis, IN 46285, USA; (P.B.-A.); (S.B.)
| | - Jamie Blackbourne
- Eli Lilly and Company, Indianapolis, IN 46285, USA; (P.B.-A.); (S.B.)
| | - Ling Liu
- Eli Lilly and Company, Indianapolis, IN 46285, USA; (P.B.-A.); (S.B.)
| | - Xiaohua Wu
- Eli Lilly and Company, Indianapolis, IN 46285, USA; (P.B.-A.); (S.B.)
| | | | - Carter Dodd
- Eli Lilly and Company, Indianapolis, IN 46285, USA; (P.B.-A.); (S.B.)
| | - Ramtin Sina
- Eli Lilly and Company, Indianapolis, IN 46285, USA; (P.B.-A.); (S.B.)
| | | | - Deanna Newcomb
- Charles River Laboratories, Inc., Reno, NV 89511, USA; (D.N.); (A.W.)
| | - Denzil Frost
- Charles River Laboratories, Inc., Reno, NV 89511, USA; (D.N.); (A.W.)
| | - Angela Wilcox
- Charles River Laboratories, Inc., Reno, NV 89511, USA; (D.N.); (A.W.)
| | - Viktoriya Borisevich
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX 77555, USA (A.N.P.)
- Galveston National Laboratory, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Krystle N. Agans
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX 77555, USA (A.N.P.)
- Galveston National Laboratory, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Courtney Woolsey
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX 77555, USA (A.N.P.)
- Galveston National Laboratory, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Abhishek N. Prasad
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX 77555, USA (A.N.P.)
- Galveston National Laboratory, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Daniel J. Deer
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX 77555, USA (A.N.P.)
- Galveston National Laboratory, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Joan B. Geisbert
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX 77555, USA (A.N.P.)
- Galveston National Laboratory, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Natalie S. Dobias
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX 77555, USA (A.N.P.)
- Galveston National Laboratory, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Karla A. Fenton
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX 77555, USA (A.N.P.)
- Galveston National Laboratory, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Beth Strifler
- Eli Lilly and Company, Indianapolis, IN 46285, USA; (P.B.-A.); (S.B.)
| | - Philip Ebert
- Eli Lilly and Company, Indianapolis, IN 46285, USA; (P.B.-A.); (S.B.)
| | - Richard Higgs
- Eli Lilly and Company, Indianapolis, IN 46285, USA; (P.B.-A.); (S.B.)
| | - Anne Beall
- Immunity and Pathogenesis Program, Infectious and Inflammatory Disease Center, Sanford Burnham Prebys Medical Discovery Institute, 10901 North Torrey Pines Road, La Jolla, CA 92037, USA
| | - Sumit Chanda
- Department of Immunology and Microbiology, Scripps Research, La Jolla, CA 92037, USA
| | - Laura Riva
- Immunity and Pathogenesis Program, Infectious and Inflammatory Disease Center, Sanford Burnham Prebys Medical Discovery Institute, 10901 North Torrey Pines Road, La Jolla, CA 92037, USA
| | - Xin Yin
- Immunity and Pathogenesis Program, Infectious and Inflammatory Disease Center, Sanford Burnham Prebys Medical Discovery Institute, 10901 North Torrey Pines Road, La Jolla, CA 92037, USA
| | - Thomas W. Geisbert
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX 77555, USA (A.N.P.)
- Galveston National Laboratory, University of Texas Medical Branch, Galveston, TX 77555, USA
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13
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Zimmermann P, Sourij H, Aberer F, Rilstone S, Schierbauer J, Moser O. SGLT2 Inhibitors in Long COVID Syndrome: Is There a Potential Role? J Cardiovasc Dev Dis 2023; 10:478. [PMID: 38132646 PMCID: PMC10744331 DOI: 10.3390/jcdd10120478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/25/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023] Open
Abstract
The coronavirus disease (COVID)-19 has turned into a pandemic causing a global public health crisis. While acute COVID-19 mainly affects the respiratory system and can cause acute respiratory distress syndrome, an association with persistent inflammatory stress affecting different organ systems has been elucidated in long COVID syndrome (LCS). Increased severity and mortality rates have been reported due to cardiophysiological and metabolic systemic disorders as well as multiorgan failure in COVID-19, additionally accompanied by chronic dyspnea and fatigue in LCS. Hence, novel therapies have been tested to improve the outcomes of LCS of which one potential candidate might be sodium-glucose cotransporter 2 (SGLT2) inhibitors. The aim of this narrative review was to discuss rationales for investigating SGLT2 inhibitor therapy in people suffering from LCS. In this regard, we discuss their potential positive effects-next to the well described "cardio-renal-metabolic" conditions-with a focus on potential anti-inflammatory and beneficial systemic effects in LCS. However, potential beneficial as well as potential disadvantageous effects of SGLT2 inhibitors on the prevalence and long-term outcomes of COVID-19 will need to be established in ongoing research.
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Affiliation(s)
- Paul Zimmermann
- Division of Exercise Physiology and Metabolism, BaySpo—Bayreuth Center of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany; (P.Z.); (S.R.); (J.S.)
- Interdisciplinary Center of Sportsmedicine Bamberg, Klinikum Bamberg, 96049 Bamberg, Germany
- Department of Cardiology, Klinikum Bamberg, 96049 Bamberg, Germany
| | - Harald Sourij
- Interdisciplinary Metabolic Medicine Research Group, Division of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria; (H.S.); (F.A.)
| | - Felix Aberer
- Interdisciplinary Metabolic Medicine Research Group, Division of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria; (H.S.); (F.A.)
| | - Sian Rilstone
- Division of Exercise Physiology and Metabolism, BaySpo—Bayreuth Center of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany; (P.Z.); (S.R.); (J.S.)
- Faculty of Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, London SW7 2AZ, UK
| | - Janis Schierbauer
- Division of Exercise Physiology and Metabolism, BaySpo—Bayreuth Center of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany; (P.Z.); (S.R.); (J.S.)
| | - Othmar Moser
- Division of Exercise Physiology and Metabolism, BaySpo—Bayreuth Center of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany; (P.Z.); (S.R.); (J.S.)
- Interdisciplinary Metabolic Medicine Research Group, Division of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria; (H.S.); (F.A.)
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14
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Terada M, Saito S, Kutsuna S, Kinoshita-Iwamoto N, Togano T, Hangaishi A, Shiratori K, Takamatsu Y, Maeda K, Ishizaka Y, Ohtsu H, Satake M, Mitsuya H, Ohmagari N. Efficacy and Safety of Treatment with Plasma from COVID-19-Recovered Individuals. Life (Basel) 2023; 13:2184. [PMID: 38004324 PMCID: PMC10671928 DOI: 10.3390/life13112184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/14/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023] Open
Abstract
Convalescent plasma therapy, which involves administering plasma from recovered coronavirus disease 2019 (COVID-19) patients to infected individuals, is being explored as a potential treatment for severe cases of COVID-19. This study aims to evaluate the efficacy and safety of convalescent plasma therapy in COVID-19 patients with moderate to severe illness. An open-label, single-arm intervention study was conducted without a control group. Plasma collected from recovered COVID-19 patients was administered to eligible participants. The primary endpoint was the proportion of patients who were placed on artificial ventilation or died within 14 days of transfusion. Secondary endpoints included clinical improvement, viral load measurements, and adverse event monitoring. A total of 59 cases were included in the study. The primary endpoint was evaluated by comparing the rate obtained in the study to an existing rate of 25%. The study also assessed clinical improvement, viral load changes, and safety endpoints through adverse event monitoring. Convalescent plasma therapy shows potential as a treatment option for COVID-19. This study aimed to provide evidence for the efficacy and safety of this therapy and may contribute to its future use in treating severe cases of COVID-19.
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Affiliation(s)
- Mari Terada
- Center for Clinical Sciences, National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo 162-8655, Japan (S.K.)
| | - Sho Saito
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo 162-8655, Japan (S.K.)
| | - Satoshi Kutsuna
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo 162-8655, Japan (S.K.)
| | - Noriko Kinoshita-Iwamoto
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo 162-8655, Japan (S.K.)
| | - Tomiteru Togano
- Department of Hematology, National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Akira Hangaishi
- Department of Hematology, National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Katsuyuki Shiratori
- Laboratory Testing Department, National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Yuki Takamatsu
- Department of Refractory Viral Infections, National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Kenji Maeda
- Division of Antiviral Therapy Joint Research Center for Human Retrovirus Infection, Kagoshima University, Sakuragaoka, Kagoshima 890-8544, Japan
| | - Yukihito Ishizaka
- Department of Intractable Diseases, National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Hiroshi Ohtsu
- Faculty of Health Data Science, Juntendo, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Masahiro Satake
- Central Blood Institute, Japanese Red Cross, Tatsumi, Koto-ku, Tokyo 135-8521, Japan
| | - Hiroaki Mitsuya
- Department of Intractable Diseases, National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo 162-8655, Japan (S.K.)
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15
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Misset B, Piagnerelli M, Hoste E, Dardenne N, Grimaldi D, Michaux I, De Waele E, Dumoulin A, Jorens PG, van der Hauwaert E, Vallot F, Lamote S, Swinnen W, De Schryver N, Fraipont V, de Mey N, Dauby N, Layios N, Mesland JB, Meyfroidt G, Moutschen M, Compernolle V, Gothot A, Desmecht D, Taveira da Silva Pereira MI, Garigliany M, Najdovski T, Bertrand A, Donneau AF, Laterre PF. Convalescent Plasma for Covid-19-Induced ARDS in Mechanically Ventilated Patients. N Engl J Med 2023; 389:1590-1600. [PMID: 37889107 PMCID: PMC10755833 DOI: 10.1056/nejmoa2209502] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
BACKGROUND Passive immunization with plasma collected from convalescent patients has been regularly used to treat coronavirus disease 2019 (Covid-19). Minimal data are available regarding the use of convalescent plasma in patients with Covid-19-induced acute respiratory distress syndrome (ARDS). METHODS In this open-label trial, we randomly assigned adult patients with Covid-19-induced ARDS who had been receiving invasive mechanical ventilation for less than 5 days in a 1:1 ratio to receive either convalescent plasma with a neutralizing antibody titer of at least 1:320 or standard care alone. Randomization was stratified according to the time from tracheal intubation to inclusion. The primary outcome was death by day 28. RESULTS A total of 475 patients underwent randomization from September 2020 through March 2022. Overall, 237 patients were assigned to receive convalescent plasma and 238 to receive standard care. Owing to a shortage of convalescent plasma, a neutralizing antibody titer of 1:160 was administered to 17.7% of the patients in the convalescent-plasma group. Glucocorticoids were administered to 466 patients (98.1%). At day 28, mortality was 35.4% in the convalescent-plasma group and 45.0% in the standard-care group (P = 0.03). In a prespecified analysis, this effect was observed mainly in patients who underwent randomization 48 hours or less after the initiation of invasive mechanical ventilation. Serious adverse events did not differ substantially between the two groups. CONCLUSIONS The administration of plasma collected from convalescent donors with a neutralizing antibody titer of at least 1:160 to patients with Covid-19-induced ARDS within 5 days after the initiation of invasive mechanical ventilation significantly reduced mortality at day 28. This effect was mainly observed in patients who underwent randomization 48 hours or less after ventilation initiation. (Funded by the Belgian Health Care Knowledge Center; ClinicalTrials.gov number, NCT04558476.).
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Affiliation(s)
- Benoît Misset
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - Michael Piagnerelli
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - Eric Hoste
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - Nadia Dardenne
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - David Grimaldi
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - Isabelle Michaux
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - Elisabeth De Waele
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - Alexander Dumoulin
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - Philippe G Jorens
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - Emmanuel van der Hauwaert
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - Frédéric Vallot
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - Stoffel Lamote
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - Walter Swinnen
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - Nicolas De Schryver
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - Vincent Fraipont
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - Nathalie de Mey
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - Nicolas Dauby
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - Nathalie Layios
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - Jean-Baptiste Mesland
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - Geert Meyfroidt
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - Michel Moutschen
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - Veerle Compernolle
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - André Gothot
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - Daniel Desmecht
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - Maria I Taveira da Silva Pereira
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - Mutien Garigliany
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - Tome Najdovski
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - Axelle Bertrand
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - Anne-Françoise Donneau
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
| | - Pierre-François Laterre
- From the Departments of Intensive Care Medicine (B.M., N.L., A.B.), Infectious Diseases (M.M.), Immunohematology (A.G.), and Microbiology (M.I.T.S.P.), University Hospital of Liège, the Biostatistics Unit, Public Health Department (N. Dardenne, A.-F.D.), and the Department of Animal Pathology (D.D., M.G.), Liège University, and the Department of Intensive Care Medicine, Citadelle General Hospital (V.F.), Liège, the Department of Intensive Care Medicine, Centre Hospitalier Universitaire (CHU) de Charleroi-Marie Curie Hospital, Université Libre de Bruxelles, Charleroi (M.P.), the Department of Intensive Care Medicine, Ghent University Hospital (E. Hoste), and the Faculty of Medicine and Health Sciences (V.C.), Ghent University, Ghent, the Department of Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles (D.G.), the Division of Infectious Diseases, Saint-Pierre University Hospital (N. Dauby), and the Department of Intensive Care Medicine, Saint-Luc University Hospital (J.-B.M., P.-F.L.), Brussels, the Department of Intensive Care, Université Catholique de Louvain (UCL), CHU UCL Namur, Yvoir (I.M.), the Department of Intensive Care Medicine, Brussels University Hospital, Vrije Universiteit Brussel, Jette (E.D.W.), the Department of Intensive Care Medicine, Delta General Hospital, Roeselare (A.D.), the Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem (P.G.J.), the Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden (E. Hauwaert), the Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai (F.V.), the Department of Intensive Care Medicine, Groeninge General Hospital, Kortrijk (S.L.), the Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde (W.S.), the Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies (N.D.S.), the Department of Intensive Care Medicine, Onze-Lieve-Vrouw General Hospital, Aalst (N.M.), the Department of Intensive Care Medicine, University Hospitals Leuven, Leuven (G.M.), Blood Services from the Red Cross, Mechelen (V.C.), Blood Services from the Red Cross, Suarlée (T.N.), and the Department of Intensive Care Medicine, Centre Hospitalier Régional Mons-Hainaut, Mons (P.-F.L.) - all in Belgium
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16
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Zahran TE, Al Hassan S, Al Karaki V, Hammoud L, Helou CE, Khalifeh M, Al Hariri M, Tamim H, Majzoub IE. Outcomes of critically ill COVID-19 patients boarding in the emergency department of a tertiary care center in a developing country: a retrospective cohort study. Int J Emerg Med 2023; 16:73. [PMID: 37833683 PMCID: PMC10576402 DOI: 10.1186/s12245-023-00551-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Boarding of critically ill patients in the emergency department (ED) has long been known to compromise patient care and affect outcomes. During the COVID-19 pandemic, multiple hospitals worldwide experienced overcrowded emergency rooms. Large influx of patients outnumbered hospital beds and required prolonged length of stay (LOS) in the ED. Our aim was to assess the ED LOS effect on mortality and morbidity, in addition to the predictors of in-hospital mortality, intubation, and complications of critically ill COVID-19 ED boarder patients. METHODS This was a retrospective cohort study, investigating 145 COVID-19-positive adult patients who were critically ill, required intensive care unit (ICU), and boarded in the ED of a tertiary care center in Lebanon. Data on patients who boarded in the emergency from January 1, 2020, till January 31, 2021, was gathered and studied. RESULTS Overall, 66% of patients died, 60% required intubation, and 88% developed complications. Multiple risk factors were associated with mortality naming age above 65 years, vasopressor use, severe COVID pneumonia findings on CT chest, chemotherapy treatment in the previous year, cardiovascular diseases, chronic kidney diseases, prolonged ED LOS, and low SaO2 < 95% on triage. In addition, our study showed that staying long hours in the ED increased the risk of developing complications. CONCLUSION To conclude, all efforts need to be drawn to re-establish mitigation strategies and models of critical care delivery in the ED to alleviate the burden of critical boarders during pandemics, thus decreasing morbidity and mortality rates. Lessons from this pandemic should raise concern for complications seen in ED ICU boarders and allow the promotion of health measures optimizing resource allocation in future pandemic crises.
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Affiliation(s)
- Tharwat El Zahran
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Sally Al Hassan
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Victoria Al Karaki
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Lina Hammoud
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Christelle El Helou
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Malak Khalifeh
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Moustafa Al Hariri
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- QU Health, Qatar University, Doha, Qatar
| | - Hani Tamim
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Imad El Majzoub
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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17
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Roham PH, Kamath JJ, Sharma S. Dissecting the Interrelationship between COVID-19 and Diabetes Mellitus. Adv Biol (Weinh) 2023; 7:e2300107. [PMID: 37246237 DOI: 10.1002/adbi.202300107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/20/2023] [Indexed: 05/30/2023]
Abstract
COVID-19 disease, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to enormous morbidity and mortality worldwide. After gaining entry into the human host, the virus initially infects the upper and lower respiratory tract, subsequently invading multiple organs, including the pancreas. While on one hand, diabetes mellitus (DM) is a significant risk factor for severe COVID-19 infection and associated death, recent reports have shown the onset of DM in COVID-19-recovered patients. SARS-CoV-2 infiltrates the pancreatic islets and activates stress response and inflammatory signaling pathways, impairs glucose metabolism, and consequently leads to their death. Indeed, the pancreatic autopsy samples of COVID-19 patients reveal the presence of SARS-CoV-2 particles in β-cells. The current review describes how the virus enters the host cells and activates an immunological response. Further, it takes a closer look into the interrelationship between COVID-19 and DM with the aim to provide mechanistic insights into the process by which SARS-CoV-2 infects the pancreas and mediates dysfunction and death of endocrine islets. The effects of known anti-diabetic interventions for COVID-19 management are also discussed. The application of mesenchymal stem cells (MSCs) as a future therapy for pancreatic β-cells damage to reverse COVID-19-induced DM is also emphasized.
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Affiliation(s)
- Pratiksha H Roham
- Department of Biotechnology, Savitribai Phule Pune University, Ganeshkhind Road, Pune, Maharashtra, 411007, India
| | - Jayesh J Kamath
- Department of Biotechnology, Savitribai Phule Pune University, Ganeshkhind Road, Pune, Maharashtra, 411007, India
| | - Shilpy Sharma
- Department of Biotechnology, Savitribai Phule Pune University, Ganeshkhind Road, Pune, Maharashtra, 411007, India
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18
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Ziganshina MM, Shilova NV, Khalturina EO, Dolgushina NV, V Borisevich S, Yarotskaya EL, Bovin NV, Sukhikh GT. Antibody-Dependent Enhancement with a Focus on SARS-CoV-2 and Anti-Glycan Antibodies. Viruses 2023; 15:1584. [PMID: 37515270 PMCID: PMC10384250 DOI: 10.3390/v15071584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
Antibody-dependent enhancement (ADE) is a phenomenon where virus-specific antibodies paradoxically cause enhanced viral replication and/or excessive immune responses, leading to infection exacerbation, tissue damage, and multiple organ failure. ADE has been observed in many viral infections and is supposed to complicate the course of COVID-19. However, the evidence is insufficient. Since no specific laboratory markers have been described, the prediction and confirmation of ADE are very challenging. The only possible predictor is the presence of already existing (after previous infection) antibodies that can bind to viral epitopes and promote the disease enhancement. At the same time, the virus-specific antibodies are also a part of immune response against a pathogen. These opposite effects of antibodies make ADE research controversial. The assignment of immunoglobulins to ADE-associated or virus neutralizing is based on their affinity, avidity, and content in blood. However, these criteria are not clearly defined. Another debatable issue (rather terminological, but no less important) is that in most publications about ADE, all immunoglobulins produced by the immune system against pathogens are qualified as pre-existing antibodies, thus ignoring the conventional use of this term for natural antibodies produced without any stimulation by pathogens. Anti-glycan antibodies (AGA) make up a significant part of the natural immunoglobulins pool, and there is some evidence of their antiviral effect, particularly in COVID-19. AGA have been shown to be involved in ADE in bacterial infections, but their role in the development of ADE in viral infections has not been studied. This review focuses on pros and cons for AGA as an ADE trigger. We also present the results of our pilot studies, suggesting that AGAs, which bind to complex epitopes (glycan plus something else in tight proximity), may be involved in the development of the ADE phenomenon.
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Affiliation(s)
- Marina M Ziganshina
- National Medical Research Center for Obstetrics, Gynecology and Perinatology of the Ministry of Health of the Russian Federation, Oparina Street 4, 117997 Moscow, Russia
| | - Nadezhda V Shilova
- National Medical Research Center for Obstetrics, Gynecology and Perinatology of the Ministry of Health of the Russian Federation, Oparina Street 4, 117997 Moscow, Russia
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, 117997 Moscow, Russia
| | - Eugenia O Khalturina
- National Medical Research Center for Obstetrics, Gynecology and Perinatology of the Ministry of Health of the Russian Federation, Oparina Street 4, 117997 Moscow, Russia
- Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), 119991 Moscow, Russia
| | - Natalya V Dolgushina
- National Medical Research Center for Obstetrics, Gynecology and Perinatology of the Ministry of Health of the Russian Federation, Oparina Street 4, 117997 Moscow, Russia
- Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), 119991 Moscow, Russia
| | | | - Ekaterina L Yarotskaya
- National Medical Research Center for Obstetrics, Gynecology and Perinatology of the Ministry of Health of the Russian Federation, Oparina Street 4, 117997 Moscow, Russia
| | - Nicolai V Bovin
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, 117997 Moscow, Russia
| | - Gennady T Sukhikh
- National Medical Research Center for Obstetrics, Gynecology and Perinatology of the Ministry of Health of the Russian Federation, Oparina Street 4, 117997 Moscow, Russia
- Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), 119991 Moscow, Russia
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19
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Sixt T, Moretto F, Esteve C, Duong M, Buisson M, Mahy S, Blot M, Piroth L. Healing Treatments in COVID-19 Patients: A Narrative Review. J Clin Med 2023; 12:4672. [PMID: 37510786 PMCID: PMC10380607 DOI: 10.3390/jcm12144672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/04/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
Since December 2019, many drugs have been evaluated or advocated as potential treatments of SARS-CoV-2 induced disease (COVID-19), including many repositioned drugs and some others specifically developed for these diseases. They can be roughly classified into three categories according to their main mechanism of action (passive immunization, direct antivirals, and anti-inflammatory treatments), and their use depends on the stage of the disease. Despite often promising preclinical data, most of the treatments evaluated failed to show a significant clinical benefit. In addition, a few others have seen their effectiveness affected by the occurrence of SARS-CoV-2 variants and sub-variants. Herein, the aim of this article is to take stock of the data available as of the 14th of July 2022, concerning the specific healing options evaluated for patients suffering from COVID-19. We focus particularly on healing treatments of COVID-19 and do not deal with preventive treatments such as vaccine. Associated therapies such as venous thromboembolism prophylaxis are not detailed since they are covered in a specific chapter of this issue. Passive immunization, especially through monoclonal antibodies, showed a positive impact on the clinical evolution, whether in outpatients or inpatients without oxygen supply. However, their effectiveness strongly depends on the type of SARS-CoV-2 variant, and often decreases or even vanishes with the most recent variants. Among direct antiviral treatments, ritonavir-boosted nirmatrelvir appears to currently be the cornerstone in the management of early infections, but its use may be limited by drug interactions. Remdesivir remains as an alternative in this situation, even though it is potentially less convenient. Anti-inflammatory treatments have often been shown to be the most effective in inpatients with oxygen supply. Dexamethasone is now a cornerstone of management of these patients. Added tocilizumab seems beneficial in the case of hyper inflammation. JAK inhibitors and anakinra have also gained an interest in some studies. As a conclusion of this narrative review, the best treatment strategy has yet to be defined and is likely to evolve in the future, not only because many other drugs are still under development and evaluation, but also because of the viral epidemics and epidemiology evolution.
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Affiliation(s)
- Thibault Sixt
- Infectious Diseases Department, Dijon-Bourgogne University Hospital, 21000 Dijon, France
| | - Florian Moretto
- Infectious Diseases Department, Dijon-Bourgogne University Hospital, 21000 Dijon, France
| | - Clementine Esteve
- Infectious Diseases Department, Dijon-Bourgogne University Hospital, 21000 Dijon, France
| | - Michel Duong
- Infectious Diseases Department, Dijon-Bourgogne University Hospital, 21000 Dijon, France
| | - Marielle Buisson
- Infectious Diseases Department, Dijon-Bourgogne University Hospital, 21000 Dijon, France
| | - Sophie Mahy
- Infectious Diseases Department, Dijon-Bourgogne University Hospital, 21000 Dijon, France
| | - Mathieu Blot
- Infectious Diseases Department, Dijon-Bourgogne University Hospital, 21000 Dijon, France
- CHU Dijon-Bourgogne, INSERM, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, 21000 Dijon, France
- Lipness Team, INSERM Research Centre LNC-UMR1231 and LabEx LipSTIC, University of Burgundy, 21078 Dijon, France
| | - Lionel Piroth
- Infectious Diseases Department, Dijon-Bourgogne University Hospital, 21000 Dijon, France
- CHU Dijon-Bourgogne, INSERM, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, 21000 Dijon, France
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20
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Joyner MJ, Wiggins CC, Baker SE, Klassen SA, Senefeld JW. Exercise and Experiments of Nature. Compr Physiol 2023; 13:4879-4907. [PMID: 37358508 PMCID: PMC10853940 DOI: 10.1002/cphy.c220027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
In this article, we highlight the contributions of passive experiments that address important exercise-related questions in integrative physiology and medicine. Passive experiments differ from active experiments in that passive experiments involve limited or no active intervention to generate observations and test hypotheses. Experiments of nature and natural experiments are two types of passive experiments. Experiments of nature include research participants with rare genetic or acquired conditions that facilitate exploration of specific physiological mechanisms. In this way, experiments of nature are parallel to classical "knockout" animal models among human research participants. Natural experiments are gleaned from data sets that allow population-based questions to be addressed. An advantage of both types of passive experiments is that more extreme and/or prolonged exposures to physiological and behavioral stimuli are possible in humans. In this article, we discuss a number of key passive experiments that have generated foundational medical knowledge or mechanistic physiological insights related to exercise. Both natural experiments and experiments of nature will be essential to generate and test hypotheses about the limits of human adaptability to stressors like exercise. © 2023 American Physiological Society. Compr Physiol 13:4879-4907, 2023.
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Affiliation(s)
- Michael J Joyner
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
| | - Chad C Wiggins
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sarah E Baker
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
| | - Stephen A Klassen
- Department of Kinesiology, Brock University, St. Catharines, Ontario, Canada
| | - Jonathon W Senefeld
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
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21
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Favilli A, Mattei Gentili M, De Paola F, Laganà AS, Vitagliano A, Bosco M, Cicinelli E, Chiantera V, Uccella S, Parazzini F, Gerli S, Garzon S. COVID-19 and Pregnancy: An Updated Review about Evidence-Based Therapeutic Strategies. J Pers Med 2023; 13:1035. [PMID: 37511648 PMCID: PMC10381390 DOI: 10.3390/jpm13071035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/16/2023] [Accepted: 06/22/2023] [Indexed: 07/30/2023] Open
Abstract
The COVID-19 pandemic posed a significant challenge for clinicians in managing pregnant women, who were at high risk of virus transmission and severe illness. While the WHO declared in May 2023 that COVID-19 is no longer a public health emergency, it emphasized that it remains a global health threat. Despite the success of vaccines, the possibility of new pandemic waves due to viral mutations should be considered. Ongoing assessment of the safety and effectiveness of pharmacological therapies is crucial in clinical practice. This narrative review summarizes the evidence-based therapeutic strategies for pregnant women with COVID-19, considering over three years of pandemic experience. The review discusses the safety and effectiveness of various drug regimens (antivirals, anticoagulants, corticosteroids, immunoglobulins, monoclonal antibodies, and therapeutic gases) and procedures (prone positioning and extracorporeal membrane oxygenation). Drugs with contraindications, inefficacy during pregnancy, or unknown adverse effects were excluded from our evaluation. The aim is to provide healthcare professionals with a comprehensive guide for managing pregnant women with COVID-19 based on lessons learned from the pandemic outbreak.
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Affiliation(s)
- Alessandro Favilli
- Section of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy
| | - Marta Mattei Gentili
- Section of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy
| | - Francesca De Paola
- Section of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS "Civico-Di Cristina-Benfratelli", Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Amerigo Vitagliano
- Department of Biomedical and Human Oncological Science (DIMO), 1st Unit of Obstetrics and Gynecology, University of Bari, 70121 Bari, Italy
| | - Mariachiara Bosco
- Unit of Obstetrics and Gynecology-Department of Surgery, Dentistry, Pediatrics, and Gynecology, AOUI Verona-University of Verona Piazzale A. Stefani 1, 37126 Verona, Italy
| | - Ettore Cicinelli
- Department of Biomedical and Human Oncological Science (DIMO), 1st Unit of Obstetrics and Gynecology, University of Bari, 70121 Bari, Italy
| | - Vito Chiantera
- Unit of Gynecologic Oncology, ARNAS "Civico-Di Cristina-Benfratelli", Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Stefano Uccella
- Unit of Obstetrics and Gynecology-Department of Surgery, Dentistry, Pediatrics, and Gynecology, AOUI Verona-University of Verona Piazzale A. Stefani 1, 37126 Verona, Italy
| | - Fabio Parazzini
- Department of Clinic and Community Science, Mangiagalli Hospital, University of Milan, 20122 Milan, Italy
| | - Sandro Gerli
- Section of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy
| | - Simone Garzon
- Unit of Obstetrics and Gynecology-Department of Surgery, Dentistry, Pediatrics, and Gynecology, AOUI Verona-University of Verona Piazzale A. Stefani 1, 37126 Verona, Italy
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22
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Bloch EM, Focosi D, Shoham S, Senefeld J, Tobian AAR, Baden LR, Tiberghien P, Sullivan DJ, Cohn C, Dioverti V, Henderson JP, So-Osman C, Juskewitch JE, Razonable RR, Franchini M, Goel R, Grossman BJ, Casadevall A, Joyner MJ, Avery RK, Pirofski LA, Gebo KA. Guidance on the Use of Convalescent Plasma to Treat Immunocompromised Patients With Coronavirus Disease 2019. Clin Infect Dis 2023; 76:2018-2024. [PMID: 36740590 PMCID: PMC10249987 DOI: 10.1093/cid/ciad066] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/23/2023] [Accepted: 02/03/2023] [Indexed: 02/07/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) convalescent plasma (CCP) is a safe and effective treatment for COVID-19 in immunocompromised (IC) patients. IC patients have a higher risk of persistent infection, severe disease, and death from COVID-19. Despite the continued clinical use of CCP to treat IC patients, the optimal dose, frequency/schedule, and duration of CCP treatment has yet to be determined, and related best practices guidelines are lacking. A group of individuals with expertise spanning infectious diseases, virology and transfusion medicine was assembled to render an expert opinion statement pertaining to the use of CCP for IC patients. For optimal effect, CCP should be recently and locally collected to match circulating variant. CCP should be considered for the treatment of IC patients with acute and protracted COVID-19; dosage depends on clinical setting (acute vs protracted COVID-19). CCP containing high-titer severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies, retains activity against circulating SARS-CoV-2 variants, which have otherwise rendered monoclonal antibodies ineffective.
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Affiliation(s)
- Evan M Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Daniele Focosi
- North-Western Tuscany Blood Bank, Pisa University Hospital, Pisa, Italy
| | - Shmuel Shoham
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jonathon Senefeld
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron A R Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lindsey R Baden
- Department of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Pierre Tiberghien
- Etablissement Français du Sang, La Plaine-St-Denis and Université de Franche-Comté, Besançon, France
| | - David J Sullivan
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Claudia Cohn
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Veronica Dioverti
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jeffrey P Henderson
- Departments of Internal Medicine (Division of Infectious Diseases) and Molecular Microbiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Cynthia So-Osman
- Department Transfusion Medicine, Division Blood Bank, Sanquin Blood Supply Foundation, Amsterdam, The Netherlands
- Department Haematology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Justin E Juskewitch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester campus, Minnesota, USA
| | - Raymund R Razonable
- Department of Internal Medicine, Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Massimo Franchini
- Department of Hematology and Transfusion Medicine, Carlo Poma Hospital, Mantua, Italy
| | - Ruchika Goel
- Division of Hematology/Oncology, Simmons Cancer Institute at SIU School of Medicine and Mississippi Valley Regional Blood Center, Springfield, Illinois, USA
| | - Brenda J Grossman
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Arturo Casadevall
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michael J Joyner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Robin K Avery
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Liise-anne Pirofski
- Department of Medicine, Infectious Diseases, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Kelly A Gebo
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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23
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Beetler DJ, Di Florio DN, Law EW, Groen CM, Windebank AJ, Peterson QP, Fairweather D. The evolving regulatory landscape in regenerative medicine. Mol Aspects Med 2023; 91:101138. [PMID: 36050142 PMCID: PMC10162454 DOI: 10.1016/j.mam.2022.101138] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 08/12/2022] [Indexed: 01/17/2023]
Abstract
Regenerative medicine as a field has emerged as a new component of modern medicine and medical research that encompasses a wide range of products including cellular and acellular therapies. As this new field emerged, regulatory agencies like the Food and Drug Administration (FDA) rapidly adapted existing regulatory frameworks to address the transplantation, gene therapy, cell-based therapeutics, and acellular biologics that fall under the broader regenerative medicine umbrella. Where it has not been possible to modify existing regulation and processes, entirely new frameworks have been generated with the intention of providing flexible, forward-facing systems to regulate this rapidly growing field. This review discusses the current state of FDA regulatory affairs in the context of stem cells and extracellular vesicles by highlighting gaps in the current regulatory system and then discussing where regulatory science in regenerative medicine may be headed based on these gaps and the FDA's historical ability to deal with emerging fields. Lastly, we utilize case studies in stem cell and acellular based treatments to demonstrate how regulatory science has evolved in regenerative medicine and highlight the ongoing clinical efforts and challenges of these therapies.
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Affiliation(s)
- Danielle J Beetler
- Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN, 55902, USA; Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Damian N Di Florio
- Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN, 55902, USA; Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Ethan W Law
- Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN, 55902, USA; Center for Regenerative Medicine, Mayo Clinic, Rochester, MN, 55902, USA
| | - Chris M Groen
- Department of Neurology, Mayo Clinic, Rochester, MN, 55902, USA
| | - Anthony J Windebank
- Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN, 55902, USA; Department of Neurology, Mayo Clinic, Rochester, MN, 55902, USA
| | - Quinn P Peterson
- Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN, 55902, USA; Center for Regenerative Medicine, Mayo Clinic, Rochester, MN, 55902, USA
| | - DeLisa Fairweather
- Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN, 55902, USA; Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, 32224, USA; Department of Environmental Health Sciences and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
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24
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Iannizzi C, Chai KL, Piechotta V, Valk SJ, Kimber C, Monsef I, Wood EM, Lamikanra AA, Roberts DJ, McQuilten Z, So-Osman C, Jindal A, Cryns N, Estcourt LJ, Kreuzberger N, Skoetz N. Convalescent plasma for people with COVID-19: a living systematic review. Cochrane Database Syst Rev 2023; 5:CD013600. [PMID: 37162745 PMCID: PMC10171886 DOI: 10.1002/14651858.cd013600.pub6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND Convalescent plasma may reduce mortality in patients with viral respiratory diseases, and is being investigated as a potential therapy for coronavirus disease 2019 (COVID-19). A thorough understanding of the current body of evidence regarding benefits and risks of this intervention is required. OBJECTIVES To assess the effectiveness and safety of convalescent plasma transfusion in the treatment of people with COVID-19; and to maintain the currency of the evidence using a living systematic review approach. SEARCH METHODS To identify completed and ongoing studies, we searched the World Health Organization (WHO) COVID-19 Global literature on coronavirus disease Research Database, MEDLINE, Embase, Cochrane COVID-19 Study Register, and the Epistemonikos COVID-19 L*OVE Platform. We searched monthly until 03 March 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs) evaluating convalescent plasma for COVID-19, irrespective of disease severity, age, gender or ethnicity. We excluded studies that included populations with other coronavirus diseases (severe acute respiratory syndrome (SARS) or Middle East respiratory syndrome (MERS)), as well as studies evaluating standard immunoglobulin. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methodology. To assess bias in included studies we used RoB 2. We used the GRADE approach to rate the certainty of evidence for the following outcomes: all-cause mortality at up to day 28, worsening and improvement of clinical status (for individuals with moderate to severe disease), hospital admission or death, COVID-19 symptoms resolution (for individuals with mild disease), quality of life, grade 3 or 4 adverse events, and serious adverse events. MAIN RESULTS In this fourth review update version, we included 33 RCTs with 24,861 participants, of whom 11,432 received convalescent plasma. Of these, nine studies are single-centre studies and 24 are multi-centre studies. Fourteen studies took place in America, eight in Europe, three in South-East Asia, two in Africa, two in western Pacific and three in eastern Mediterranean regions and one in multiple regions. We identified a further 49 ongoing studies evaluating convalescent plasma, and 33 studies reporting as being completed. Individuals with a confirmed diagnosis of COVID-19 and moderate to severe disease 29 RCTs investigated the use of convalescent plasma for 22,728 participants with moderate to severe disease. 23 RCTs with 22,020 participants compared convalescent plasma to placebo or standard care alone, five compared to standard plasma and one compared to human immunoglobulin. We evaluate subgroups on detection of antibodies detection, symptom onset, country income groups and several co-morbidities in the full text. Convalescent plasma versus placebo or standard care alone Convalescent plasma does not reduce all-cause mortality at up to day 28 (risk ratio (RR) 0.98, 95% confidence interval (CI) 0.92 to 1.03; 220 per 1000; 21 RCTs, 19,021 participants; high-certainty evidence). It has little to no impact on need for invasive mechanical ventilation, or death (RR 1.03, 95% CI 0.97 to 1.11; 296 per 1000; 6 RCTs, 14,477 participants; high-certainty evidence) and has no impact on whether participants are discharged from hospital (RR 1.00, 95% CI 0.97 to 1.02; 665 per 1000; 6 RCTs, 12,721 participants; high-certainty evidence). Convalescent plasma may have little to no impact on quality of life (MD 1.00, 95% CI -2.14 to 4.14; 1 RCT, 483 participants; low-certainty evidence). Convalescent plasma may have little to no impact on the risk of grades 3 and 4 adverse events (RR 1.17, 95% CI 0.96 to 1.42; 212 per 1000; 6 RCTs, 2392 participants; low-certainty evidence). It has probably little to no effect on the risk of serious adverse events (RR 1.14, 95% CI 0.91 to 1.44; 135 per 1000; 6 RCTs, 3901 participants; moderate-certainty evidence). Convalescent plasma versus standard plasma We are uncertain whether convalescent plasma reduces or increases all-cause mortality at up to day 28 (RR 0.73, 95% CI 0.45 to 1.19; 129 per 1000; 4 RCTs, 484 participants; very low-certainty evidence). We are uncertain whether convalescent plasma reduces or increases the need for invasive mechanical ventilation, or death (RR 5.59, 95% CI 0.29 to 108.38; 311 per 1000; 1 study, 34 participants; very low-certainty evidence) and whether it reduces or increases the risk of serious adverse events (RR 0.80, 95% CI 0.55 to 1.15; 236 per 1000; 3 RCTs, 327 participants; very low-certainty evidence). We did not identify any study reporting other key outcomes. Convalescent plasma versus human immunoglobulin Convalescent plasma may have little to no effect on all-cause mortality at up to day 28 (RR 1.07, 95% CI 0.76 to 1.50; 464 per 1000; 1 study, 190 participants; low-certainty evidence). We did not identify any study reporting other key outcomes. Individuals with a confirmed diagnosis of SARS-CoV-2 infection and mild disease We identified two RCTs reporting on 536 participants, comparing convalescent plasma to placebo or standard care alone, and two RCTs reporting on 1597 participants with mild disease, comparing convalescent plasma to standard plasma. Convalescent plasma versus placebo or standard care alone We are uncertain whether convalescent plasma reduces all-cause mortality at up to day 28 (odds ratio (OR) 0.36, 95% CI 0.09 to 1.46; 8 per 1000; 2 RCTs, 536 participants; very low-certainty evidence). It may have little to no effect on admission to hospital or death within 28 days (RR 1.05, 95% CI 0.60 to 1.84; 117 per 1000; 1 RCT, 376 participants; low-certainty evidence), on time to COVID-19 symptom resolution (hazard ratio (HR) 1.05, 95% CI 0.85 to 1.30; 483 per 1000; 1 RCT, 376 participants; low-certainty evidence), on the risk of grades 3 and 4 adverse events (RR 1.29, 95% CI 0.75 to 2.19; 144 per 1000; 1 RCT, 376 participants; low-certainty evidence) and the risk of serious adverse events (RR 1.14, 95% CI 0.66 to 1.94; 133 per 1000; 1 RCT, 376 participants; low-certainty evidence). We did not identify any study reporting other key outcomes. Convalescent plasma versus standard plasma We are uncertain whether convalescent plasma reduces all-cause mortality at up to day 28 (OR 0.30, 95% CI 0.05 to 1.75; 2 per 1000; 2 RCTs, 1597 participants; very low-certainty evidence). It probably reduces admission to hospital or death within 28 days (RR 0.49, 95% CI 0.31 to 0.75; 36 per 1000; 2 RCTs, 1595 participants; moderate-certainty evidence). Convalescent plasma may have little to no effect on initial symptom resolution at up to day 28 (RR 1.12, 95% CI 0.98 to 1.27; 1 RCT, 416 participants; low-certainty evidence). We did not identify any study reporting other key outcomes. This is a living systematic review. We search monthly for new evidence and update the review when we identify relevant new evidence. AUTHORS' CONCLUSIONS For the comparison of convalescent plasma versus placebo or standard care alone, our certainty in the evidence that convalescent plasma for individuals with moderate to severe disease does not reduce mortality and has little to no impact on clinical improvement or worsening is high. It probably has little to no effect on SAEs. For individuals with mild disease, we have very-low to low certainty evidence for most primary outcomes and moderate certainty for hospital admission or death. There are 49 ongoing studies, and 33 studies reported as complete in a trials registry. Publication of ongoing studies might resolve some of the uncertainties around convalescent plasma therapy for people with asymptomatic or mild disease.
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Affiliation(s)
- Claire Iannizzi
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Khai Li Chai
- Transfusion Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Vanessa Piechotta
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Sarah J Valk
- Jon J van Rood Center for Clinical Transfusion Research, Sanquin/Leiden University Medical Center, Leiden, Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | - Catherine Kimber
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK
| | - Ina Monsef
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Erica M Wood
- Transfusion Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - David J Roberts
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK
| | - Zoe McQuilten
- Transfusion Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Cynthia So-Osman
- Sanquin Blood Bank, Amsterdam, Netherlands
- Erasmus Medical Centre, Rotterdam, Netherlands
| | - Aikaj Jindal
- Department of Transfusion Medicine, SPS Hospitals, Ludhiana (Punjab), India
| | - Nora Cryns
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lise J Estcourt
- Haematology/Transfusion Medicine, NHS Blood and Transplant, Oxford, UK
| | - Nina Kreuzberger
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nicole Skoetz
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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25
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Van Denakker TA, Al-Riyami AZ, Feghali R, Gammon R, So-Osman C, Crowe EP, Goel R, Rai H, Tobian AAR, Bloch EM. Managing blood supplies during natural disasters, humanitarian emergencies and pandemics: lessons learned from COVID-19. Expert Rev Hematol 2023:1-14. [PMID: 37129864 DOI: 10.1080/17474086.2023.2209716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has resulted in a historic public health crisis with widespread social and economic ramifications. The pandemic has also affected the blood supply resulting in unprecedented and sustained blood shortages. AREAS COVERED This review describes the challenges of maintaining a safe and sufficient blood supply in the wake of natural disasters, humanitarian emergencies and pandemics. The challenges, which are accentuated in low- and high- income countries, span the impact on human capacity (affecting blood donors and blood collections personnel alike), disruption to supply chains, and economic sustainability. COVID-19 imparted lessons on how to offset these challenges, which may be applied to future pandemics and public health crises. EXPERT OPINION Pandemic emergency preparedness plans should be implemented or revised by blood centers and hospitals to lessen the impact to the blood supply. Comprehensive planning should address the timely assessment of risk to the blood supply, rapid donor recruitment and communication of need, measures to preserve safety for donors and operational staff, careful blood management, and resource sharing.
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Affiliation(s)
- Tayler A Van Denakker
- Johns Hopkins University School of Medicine, Department of Pathology, Transfusion Medicine Division, Baltimore, MD, USA
| | - Arwa Z Al-Riyami
- Department of Hematology, Sultan Qaboos University Hospital Sultan Qaboos University, Muscat, Oman
| | | | - Richard Gammon
- OneBlood, Scientific, Medical, Technical Direction, Orlando, Florida, USA
| | - Cynthia So-Osman
- Sanquin Blood Supply Foundation, Department of Transfusion medicine, Amsterdam, The Netherlands
| | - Elizabeth P Crowe
- Johns Hopkins University School of Medicine, Department of Pathology, Transfusion Medicine Division, Baltimore, MD, USA
| | - Ruchika Goel
- Johns Hopkins University School of Medicine, Department of Pathology, Transfusion Medicine Division, Baltimore, MD, USA
- Simmons Cancer Institute, Department of Internal Medicine, Springfield, IL, USA
| | - Herleen Rai
- Johns Hopkins University School of Medicine, Department of Pathology, Transfusion Medicine Division, Baltimore, MD, USA
| | - Aaron A R Tobian
- Johns Hopkins University School of Medicine, Department of Pathology, Transfusion Medicine Division, Baltimore, MD, USA
| | - Evan M Bloch
- Johns Hopkins University School of Medicine, Department of Pathology, Transfusion Medicine Division, Baltimore, MD, USA
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Casadevall A, Joyner MJ, Pirofski LA, Senefeld JW, Shoham S, Sullivan D, Paneth N, Focosi D. Convalescent plasma therapy in COVID-19: Unravelling the data using the principles of antibody therapy. Expert Rev Respir Med 2023:1-15. [PMID: 37129285 DOI: 10.1080/17476348.2023.2208349] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
INTRODUCTION When the COVID-19 pandemic struck no specific therapies were available and many turned to COVID-19 convalescent plasma (CCP), a form of antibody therapy. The literature provides mixed evidence for CCP efficacy. AREAS COVERED PubMed was searched using the words COVID-19 and convalescent plasma and individual study designs were evaluated for adherence to the three principles of antibody therapy, i.e. that plasma 1) contain specific antibody; 2) have enough specific antibody to mediate a biological effect; and 3) be administered early in the course of disease. Using this approach, a diverse and seemingly contradictory collection of clinical findings was distilled into a consistent picture whereby CCP was effective when used according to the above principles of antibody therapy. In addition, CCP therapy in immunocompromised patients is useful at any time in the course of disease. EXPERT OPINION CCP is safe and effective when used appropriately. Today, most of humanity has some immunity to SARS-CoV-2 from vaccines and infection, which has lessened the need for CCP in the general population. However, COVID-19 in immunocompromised patients is a major therapeutic challenge, and with the deauthorization of all SARS-CoV-2-spike protein-directed monoclonal antibodies, CCP is the only antibody therapy available for this population.
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Affiliation(s)
- Arturo Casadevall
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michael J Joyner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Liise-Anne Pirofski
- Division of Infectious Diseases, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Jonathon W Senefeld
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Shmuel Shoham
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David Sullivan
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nigel Paneth
- Departments of Epidemiology & Biostatistics and Pediatrics & Human Development, Michigan State University, East Lansing, MI, USA
| | - Daniele Focosi
- North-Western Tuscany Blood Bank, Pisa University Hospital, Pisa, Italy
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Kumar NR, Karanam VC, Kumar S, Kumar SD. Convalescent Plasma Therapy in Late-State, Severe COVID-19 Infection. South Med J 2023; 116:427-433. [PMID: 37137479 PMCID: PMC10143395 DOI: 10.14423/smj.0000000000001546] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVES Current evidence favors plasma to be effective against coronavirus disease 2019 (COVID-19) in critically ill patients in the early stages of infection. We investigated the safety and efficacy of convalescent plasma in specifically late-stage (designated as after 2 weeks of hospital admission) severe COVID-19 infection. We also conducted a literature review on the late-stage use of plasma in COVID-19. METHODS This case series examined eight COVID-19 patients admitted to the intensive care unit (ICU) who met criteria for severe or life-threatening complications. Each patient received one dose (200 mL) of plasma. Clinical information was gathered in intervals of 1 day pretransfusion and 1 hour, 3 days, and 7 days posttransfusion. The primary outcome was effectiveness of plasma transfusion, measured by clinical improvement, laboratory parameters, and all-cause mortality. RESULTS Eight ICU patients received plasma late in the course of COVID-19 infection, on average at 16.13 days postadmission. On the day before transfusion, the averaged initial Sequential Organ Failure Assessment (SOFA) score, PaO2:FiO2 ratio, Glasgow Coma Scale (GCS), and lymphocyte count were 6.5, 228.03, 8.63, and 1.19, respectively. Three days after plasma treatment, the group averages for the SOFA score (4.86), PaO2:FiO2 ratio (302.73), GCS (9.29), and lymphocyte count (1.75) improved. Although the mean GCS improved to 10.14 by posttransfusion day 7, the other means marginally worsened with an SOFA score of 5.43, a PaO2:FiO2 ratio of 280.44, and a lymphocyte count of 1.71. Clinical improvement was noted in six patients who were discharged from the ICU. CONCLUSIONS This case series provides evidence that convalescent plasma may be safe and effective in late-stage, severe COVID-19 infection. Results showed clinical improvement posttransfusion as well as decreased all-cause mortality in comparison to pretransfusion predicted mortality. Randomized controlled trials are needed to conclusively determine benefits, dosage, and timing of treatment.
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Affiliation(s)
- Neil R Kumar
- From Internal Medicine, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - Veena C Karanam
- the University of Miami Miller School of Medicine, Miami, Florida
| | - Shari Kumar
- Columbia University College of Dental Medicine, New York, New York
| | - Sunil D Kumar
- the Pulmonary/Critical Care, Broward Health Medical Center, Ft Lauderdale, Florida
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Khullar N, Bhatti JS, Singh S, Thukral B, Reddy PH, Bhatti GK. Insight into the liver dysfunction in COVID-19 patients: Molecular mechanisms and possible therapeutic strategies. World J Gastroenterol 2023; 29:2064-2077. [PMID: 37122601 PMCID: PMC10130970 DOI: 10.3748/wjg.v29.i14.2064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/23/2022] [Accepted: 03/21/2023] [Indexed: 04/13/2023] Open
Abstract
As of June 2022, more than 530 million people worldwide have become ill with coronavirus disease 2019 (COVID-19). Although COVID-19 is most commonly associated with respiratory distress (severe acute respiratory syndrome), meta-analysis have indicated that liver dysfunction also occurs in patients with severe symptoms. Current studies revealed distinctive patterning in the receptors on the hepatic cells that helps in viral invasion through the expression of angiotensin-converting enzyme receptors. It has also been reported that in some patients with COVID-19, therapeutic strategies, including repurposed drugs (mitifovir, lopinavir/ritonavir, tocilizumab, etc.) triggered liver injury and cholestatic toxicity. Several proven indicators support cytokine storm-induced hepatic damage. Because there are 1.5 billion patients with chronic liver disease worldwide, it becomes imperative to critically evaluate the molecular mechanisms concerning hepatotropism of COVID-19 and identify new potential therapeutics. This review also designated a comprehensive outlook of comorbidities and the impact of lifestyle and genetics in managing patients with COVID-19.
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Affiliation(s)
- Naina Khullar
- Department of Zoology, Mata Gujri College, Fatehgarh Sahib 140407, Punjab, India
| | - Jasvinder Singh Bhatti
- Laboratory of Translational Medicine and Nanotherapeutics, Department of Human Genetics and Molecular Medicine, School of Health Sciences, Central University of Punjab, Bathinda 151401, Punjab, India
| | - Satwinder Singh
- Department of Computer Science and Technology, Central University of Punjab, Bathinda 151401, Punjab, India
| | - Bhawana Thukral
- Department of Nutrition and Dietetics, University Institute of Applied Health Sciences, Chandigarh University, Mohali 140413, Punjab, India
| | - P Hemachandra Reddy
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, United States
| | - Gurjit Kaur Bhatti
- Department of Medical Lab Technology, University Institute of Applied Health Sciences, Chandigarh University, Mohali 140413, Punjab, India
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Chavda VP, Bezbaruah R, Dolia S, Shah N, Verma S, Savale S, Ray S. Convalescent plasma (hyperimmune immunoglobulin) for COVID-19 management: An update. Process Biochem 2023; 127:66-81. [PMID: 36741339 PMCID: PMC9886570 DOI: 10.1016/j.procbio.2023.01.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 01/21/2023] [Accepted: 01/25/2023] [Indexed: 02/01/2023]
Abstract
The pandemic COVID-19 has spread widely throughout the globe and has been responsible for millions of deaths worldwide. Recently, it has been identified that there is no specific and 100% effective treatment available to manage the infection especially for the severe cases. A significant amount of research efforts and clinical trials have been undertaken globally and many more are underway to find the potential treatment option. Earlier, convalescent plasma or hyperimmune immunoglobulin was effectively used in the treatment of many endemic or epidemic viral infections as a part of passive immunization. In this article, we have touched upon the immunopathology of COVID-19 infection, a basic understanding of convalescent plasma, it's manufacturing as well as evaluation, and have reviewed the scientific developments focussing on the potential of convalescent plasma vis-à-vis other modalities for the management of COVID-19. The article also covers various research approaches, clinical trials conducted globally, and the clinical trials which are at various stages for exploring the efficacy and safety of the convalescent plasma therapy (CPT) to predict its future perspective to manage COVID-19.
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Affiliation(s)
- Vivek P Chavda
- Department of Pharmaceutics and Pharmaceutical Technology, L M College of Pharmacy, Ahmedabad 380009, Gujarat, India
| | - Rajashri Bezbaruah
- Department of Pharmaceutical Sciences, Faculty of Science and Engineering, Dibrugarh University, Dibrugarh 786004, Assam, India
| | - Sheetal Dolia
- Intas Pharmaceuticals Ltd. (Plasma Fractionation Unit), Ahmedabad 382213, Gujarat, India
| | - Nirav Shah
- Department of Pharmaceutics, SAL Institute of Pharmacy, Sola, Ahmedabad 380060, India
| | - Sachin Verma
- Intas Pharmaceuticals Ltd. (Plasma Fractionation Unit), Ahmedabad 382213, Gujarat, India
| | - Shrinivas Savale
- AIC-LMCP Foundation, L M College of Pharmacy, Ahmedabad 380009, Gujarat, India
| | - Suma Ray
- Intas Pharmaceuticals Ltd. (Plasma Fractionation Unit), Ahmedabad 382213, Gujarat, India
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30
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Yaugel-Novoa M, Noailly B, Jospin F, Berger AE, Waeckel L, Botelho-Nevers E, Longet S, Bourlet T, Paul S. Prior COVID-19 Immunization Does Not Cause IgA- or IgG-Dependent Enhancement of SARS-CoV-2 Infection. Vaccines (Basel) 2023; 11:vaccines11040773. [PMID: 37112685 PMCID: PMC10141984 DOI: 10.3390/vaccines11040773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
Antibody-dependent enhancement (ADE) can increase the rates and severity of infection with various viruses, including coronaviruses, such as MERS. Some in vitro studies on COVID-19 have suggested that prior immunization enhances SARS-CoV-2 infection, but preclinical and clinical studies have demonstrated the contrary. We studied a cohort of COVID-19 patients and a cohort of vaccinated individuals with a heterologous (Moderna/Pfizer) or homologous (Pfizer/Pfizer) vaccination scheme. The dependence on IgG or IgA of ADE of infection was evaluated on the serum samples from these subjects (twenty-six vaccinated individuals and twenty-one PCR-positive SARS-CoV-2-infected patients) using an in vitro model with CD16- or CD89-expressing cells and the Delta (B.1.617.2 lineage) and Omicron (B.1.1.529 lineage) variants of SARS-CoV-2. Sera from COVID-19 patients did not show ADE of infection with any of the tested viral variants. Some serum samples from vaccinated individuals displayed a mild IgA-ADE effect with Omicron after the second dose of the vaccine, but this effect was abolished after the completion of the full vaccination scheme. In this study, FcγRIIIa- and FcαRI-dependent ADE of SARS-CoV-2 infection after prior immunization, which might increase the risk of severe disease in a second natural infection, was not observed.
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Affiliation(s)
- Melyssa Yaugel-Novoa
- CIRI—Centre International de Recherche en Infectiologie, Team GIMAP, Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR530, F42023 Saint-Etienne, France
| | - Blandine Noailly
- CIRI—Centre International de Recherche en Infectiologie, Team GIMAP, Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR530, F42023 Saint-Etienne, France
| | - Fabienne Jospin
- CIRI—Centre International de Recherche en Infectiologie, Team GIMAP, Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR530, F42023 Saint-Etienne, France
| | - Anne-Emmanuelle Berger
- CIRI—Centre International de Recherche en Infectiologie, Team GIMAP, Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR530, F42023 Saint-Etienne, France
- Immunology Department, University Hospital of Saint-Etienne, F42055 Saint-Etienne, France
| | - Louis Waeckel
- CIRI—Centre International de Recherche en Infectiologie, Team GIMAP, Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR530, F42023 Saint-Etienne, France
- Immunology Department, University Hospital of Saint-Etienne, F42055 Saint-Etienne, France
| | - Elisabeth Botelho-Nevers
- CIRI—Centre International de Recherche en Infectiologie, Team GIMAP, Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR530, F42023 Saint-Etienne, France
- Infectious Diseases Department, University Hospital of Saint-Etienne, F42055 Saint-Etienne, France
| | - Stéphanie Longet
- CIRI—Centre International de Recherche en Infectiologie, Team GIMAP, Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR530, F42023 Saint-Etienne, France
| | - Thomas Bourlet
- CIRI—Centre International de Recherche en Infectiologie, Team GIMAP, Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR530, F42023 Saint-Etienne, France
- Infectious Agents and Hygiene Department, University Hospital of Saint-Etienne, F42055 Saint-Etienne, France
| | - Stéphane Paul
- CIRI—Centre International de Recherche en Infectiologie, Team GIMAP, Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR530, F42023 Saint-Etienne, France
- Immunology Department, University Hospital of Saint-Etienne, F42055 Saint-Etienne, France
- CIC 1408 Inserm Vaccinology, University Hospital of Saint-Etienne, F42055 Saint-Etienne, France
- Correspondence:
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Convalescent Plasma Treatment of Patients Previously Treated with B-Cell-Depleting Monoclonal Antibodies Suffering COVID-19 Is Associated with Reduced Re-Admission Rates. Viruses 2023; 15:v15030756. [PMID: 36992465 PMCID: PMC10059055 DOI: 10.3390/v15030756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/12/2023] [Accepted: 03/12/2023] [Indexed: 03/17/2023] Open
Abstract
Patients receiving treatment with B-cell-depleting monoclonal antibodies, such as anti-CD20 monoclonal antibodies, such as rituximab and obinutuzumab, either for hematological disease or another diagnosis, such as a rheumatological disease, are at an increased risk for medical complications and mortality from COVID-19. Since inconsistencies persist regarding the use of convalescent plasma (CP), especially in the vulnerable patient population that has received previous treatment with B-cell-depleting monoclonal antibodies, further studies should be performed in thisdirection. The aim of the present study was to describe the characteristics of patients with previous use of B-cell-depleting monoclonal antibodies and describe the potential beneficial effects of CP use in terms of mortality, ICU admission and disease relapse. In this retrospective cohort study, 39 patients with previous use of B-cell-depleting monoclonal antibodies hospitalized in the COVID-19 department of a tertiary hospital in Greece were recorded and evaluated. The mean age was 66.3 years and 51.3% were male. Regarding treatment for COVID-19, remdesivir was used in 89.7%, corticosteroids in 94.9% and CP in 53.8%. In-hospital mortality was 15.4%. Patients who died were more likely to need ICU admission and also had a trend towards a longer hospital stay, even though the last did not reach statistical significance. Patients treated with CP had a lower re-admission rate for COVID-19 after discharge. Further studies should be performed to identify the role of CP in patients with treatment with B-cell-depleting monoclonal antibodies suffering from COVID-19.
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Hakim SM, Chikhouni GMA, Ammar MA, Amer AM. Effect of convalescent plasma transfusion on outcomes of coronavirus disease 2019: a meta-analysis with trial sequential analysis. J Anesth 2023; 37:451-464. [PMID: 36811668 PMCID: PMC9944423 DOI: 10.1007/s00540-023-03171-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 02/03/2023] [Indexed: 02/24/2023]
Abstract
The aim of this review was to update evidence for benefit of convalescent plasma transfusion (CPT) in patients with coronavirus disease 2019 (COVID-19). Databases were searched for randomized controlled trials (RCT) comparing CPT plus standard treatment versus standard treatment only in adults with COVID-19. Primary outcome measures were mortality and need for invasive mechanical ventilation (IMV). Twenty-Six RCT involving 19,816 patients were included in meta-analysis for mortality. Quantitative synthesis showed no statistically significant benefit of adding CPT to standard treatment (RR = 0.97, 95% CI = 0.92 to 1.02) with unimportant heterogeneity (Q(25) = 26.48, p = .38, I2 = 0.00%). Trim-and-fill-adjusted effect size was unimportantly changed and level of evidence was graded as high. Trial sequential analysis (TSA) indicated information size was adequate and CPT was futile. Seventeen trials involving 16,083 patients were included in meta-analysis for need of IMV. There was no statistically significant effect of CPT (RR = 1.02, 95% CI = 0.95 to 1.10) with unimportant heterogeneity (Q(16) = 9.43, p = .89, I2 = 3.30%). Trim-and-fill-adjusted effect size was trivially changed and level of evidence was graded as high. TSA showed information size was adequate and indicated futility of CPT. It is concluded with high level of certainty that CPT added to standard treatment of COVID-19 is not associated with reduced mortality or need of IMV compared with standard treatment alone. In view of these findings, further trials on efficacy of CPT in COVID-19 patients are probably not needed.
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Affiliation(s)
- Sameh M Hakim
- Department of Anesthesiology, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, 15 Gamal Noah Street, Almaza, Heliopolis, Cairo, 11341, Egypt.
| | - Ghosoun M A Chikhouni
- Department of Anesthesiology, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, 15 Gamal Noah Street, Almaza, Heliopolis, Cairo, 11341, Egypt
| | - Mona A Ammar
- Department of Anesthesiology, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, 15 Gamal Noah Street, Almaza, Heliopolis, Cairo, 11341, Egypt
| | - Akram M Amer
- Department of Anesthesiology, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, 15 Gamal Noah Street, Almaza, Heliopolis, Cairo, 11341, Egypt
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Kandula UR, Tuji TS, Gudeta DB, Bulbula KL, Mohammad AA, Wari KD, Abbas A. Effectiveness of COVID-19 Convalescent Plasma (CCP) During the Pandemic Era: A Literature Review. J Blood Med 2023; 14:159-187. [PMID: 36855559 PMCID: PMC9968437 DOI: 10.2147/jbm.s397722] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/08/2023] [Indexed: 02/25/2023] Open
Abstract
Worldwide pandemic with coronavirus disease-2019 (COVID-19) was caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). As November 2, 2022, World Health Organization (WHO) received 628,035,553 reported incidents on COVID-19, with 6,572,800 mortalities and, with a total 12,850,970,971 vaccine doses have been delivered as of October 31, 2022. The infection can cause mild or self-limiting symptoms of pulmonary and severe infections or death may be caused by SARS-CoV-2 infection. Simultaneously, antivirals, corticosteroids, immunological treatments, antibiotics, and anticoagulants have been proposed as potential medicines to cure COVID-19 affected patients. Among these initial treatments, COVID-19 convalescent plasma (CCP), which was retrieved from COVID-19 recovered patients to be used as passive immune therapy, in which antibodies from cured patients were given to infected patients to prevent illness. Such treatment has yielded the best results in earlier with preventative or early stages of illness. Convalescent plasma (CP) is the first treatment available when infectious disease initially appears, although few randomized controlled trials (RCTs) were conducted to evaluate its effectiveness. The historical record suggests with potential benefit for other respiratory infections, as coronaviruses like Severe Acute Respiratory Syndrome-CoV-I (SARS-CoV-I) and Middle Eastern Respiratory Syndrome (MERS), though the analysis of such research is constrained by some non-randomized experiments (NREs). Rigorous studies on CP are made more demanding by the following with the immediacy of the epidemics, CP use may restrict the ability to utilize it for clinical testing, non-homogenous nature of product, highly decentralized manufacturing process; constraints with capacity to measure biologic function, ultimate availability of substitute therapies, as antivirals, purified immune globulins, or monoclonal antibodies. Though, it is still not clear how effectively CCP works among hospitalized COVID-19 patients. The current review tries to focus on its efficiency and usage in clinical scenarios and identifying existing benefits of implementation during pandemic or how it may assist with future pandemic preventions.
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Affiliation(s)
- Usha Rani Kandula
- Department of Nursing, College of Health Sciences, Arsi University, Asella, Ethiopia
| | - Techane Sisay Tuji
- Department of Nursing, College of Health Sciences, Arsi University, Asella, Ethiopia
| | | | - Kassech Leta Bulbula
- Department of Nursing, College of Health Sciences, Arsi University, Asella, Ethiopia
| | | | - Ketema Diriba Wari
- Department of Nursing, College of Health Sciences, Arsi University, Asella, Ethiopia
| | - Ahmad Abbas
- Department of Nursing, College of Health Sciences, Arsi University, Asella, Ethiopia
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Oliveira I, Ferreira I, Jacob B, Cardenas K, Cerni F, Baia-da-Silva D, Arantes E, Monteiro W, Pucca M. Harnessing the Power of Venomous Animal-Derived Toxins against COVID-19. Toxins (Basel) 2023; 15:159. [PMID: 36828473 PMCID: PMC9967918 DOI: 10.3390/toxins15020159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/11/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023] Open
Abstract
Animal-derived venoms are complex mixtures of toxins triggering important biological effects during envenomings. Although venom-derived toxins are known for their potential of causing harm to victims, toxins can also act as pharmacological agents. During the COVID-19 pandemic, there was observed an increase in in-depth studies on antiviral agents, and since, to date, there has been no completely effective drug against the global disease. This review explores the crosstalk of animal toxins and COVID-19, aiming to map potential therapeutic agents derived from venoms (e.g., bees, snakes, scorpions, etc.) targeting COVID-19.
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Affiliation(s)
- Isadora Oliveira
- Department of BioMolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14040-903, SP, Brazil
| | - Isabela Ferreira
- Department of BioMolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14040-903, SP, Brazil
| | - Beatriz Jacob
- Department of BioMolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14040-903, SP, Brazil
| | - Kiara Cardenas
- Medical School, Federal University of Roraima, Boa Vista 69310-000, RR, Brazil
| | - Felipe Cerni
- Health Sciences Postgraduate Program, Federal University of Roraima, Boa Vista 69310-000, RR, Brazil
| | - Djane Baia-da-Silva
- Institute of Clinical Research Carlos Borborema, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus 69850-000, AM, Brazil
- Postgraduate Program in Tropical Medicine, School of Health Sciences, Amazonas State University, Manaus 69850-000, AM, Brazil
- Department of Collective Health, Faculty of Medicine, Federal University of Amazonas, Manaus 69077-000, AM, Brazil
- Leônidas and Maria Deane Institute, Fiocruz Amazônia, Manaus 69057-070, AM, Brazil
- Faculty of Pharmacy, Nilton Lins University, Manaus 69058-040, AM, Brazil
| | - Eliane Arantes
- Department of BioMolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14040-903, SP, Brazil
| | - Wuelton Monteiro
- Institute of Clinical Research Carlos Borborema, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus 69850-000, AM, Brazil
- Postgraduate Program in Tropical Medicine, School of Health Sciences, Amazonas State University, Manaus 69850-000, AM, Brazil
| | - Manuela Pucca
- Medical School, Federal University of Roraima, Boa Vista 69310-000, RR, Brazil
- Health Sciences Postgraduate Program, Federal University of Roraima, Boa Vista 69310-000, RR, Brazil
- Postgraduate Program in Tropical Medicine, School of Health Sciences, Amazonas State University, Manaus 69850-000, AM, Brazil
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High-Throughput Neutralization and Serology Assays Reveal Correlated but Highly Variable Humoral Immune Responses in a Large Population of Individuals Infected with SARS-CoV-2 in the US between March and August 2020. mBio 2023; 14:e0352322. [PMID: 36786604 PMCID: PMC10128039 DOI: 10.1128/mbio.03523-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
The ability to measure neutralizing antibodies on large scale can be important for understanding features of the natural history and epidemiology of infection, as well as an aid in determining the efficacy of interventions, particularly in outbreaks such as the current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Because of the assay's rapid scalability and high efficiency, serology measurements that quantify the presence rather than function of serum antibodies often serve as proxies of immune protection. Here, we report the development of a high-throughput, automated fluorescence-based neutralization assay using SARS-CoV-2 virus to quantify neutralizing antibody activity in patient specimens. We performed large-scale testing of over 19,000 COVID-19 convalescent plasma (CCP) samples from patients who had been infected with SARS-CoV-2 between March and August 2020 across the United States. The neutralization capacity of the samples was moderately correlated with serological measurements of anti-receptor-binding domain (RBD) IgG levels. The neutralizing antibody levels within these convalescent-phase serum samples were highly variable against the original USA-WA1/2020 strain with almost 10% of individuals who had had PCR-confirmed SARS-CoV-2 infection having no detectable antibodies either by serology or neutralization, and ~1/3 having no or low neutralizing activity. Discordance between neutralization and serology measurements was mainly due to the presence of non-IgG RBD isotypes. Meanwhile, natural infection with the earliest SARS-CoV-2 strain USA-WA1/2020 resulted in weaker neutralization of subsequent B.1.1.7 (alpha) and the B.1.351 (beta) variants, with 88% of samples having no activity against the BA.1 (omicron) variant. IMPORTANCE The ability to directly measure neutralizing antibodies on live SARS-CoV-2 virus in individuals can play an important role in understanding the efficacy of therapeutic interventions or vaccines. In contrast to functional neutralization assays, serological assays only quantify the presence of antibodies as a proxy of immune protection. Here, we have developed a high-throughput, automated neutralization assay for SARS-CoV-2 and measured the neutralizing activity of ~19,000 COVID-19 convalescent plasma (CCP) samples collected across the United States between March and August of 2020. These data were used to support the FDA's interpretation of CCP efficacy in patients with SARS-CoV-2 infection and their issuance of emergency use authorization of CCP in 2020.
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Arrieta A, Galvis AE, Osborne S, Morphew T, Imfeld K, Enriquez C, Hoang J, Swearingen M, Nieves DJ, Ashouri N, Singh J, Nugent D. Use of COVID-19 Convalescent Plasma for Treatment of Symptomatic SARS-CoV-2 Infection at a Children's Hospital: A Contribution to a Still Inadequate Body of Evidence. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020350. [PMID: 36832478 PMCID: PMC9955755 DOI: 10.3390/children10020350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/13/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023]
Abstract
Data on COVID-19 convalescent plasma (CCP) safety and efficacy in children and young adults are limited. This single-center prospective, open-label trial evaluates CCP safety, neutralizing antibody kinetics, and outcomes in children and young adults with moderate/severe COVID-19 (April 2020-March 2021). A total of 46 subjects received CCP; 43 were included in the safety analysis (SAS); 7.0% < 2 years old, 2.3% 2-<6, 27.9% 6-<12, 39.5% 12-<19, and 23.3% > 19 years old; 28 were included in the antibody kinetic analysis (AbKS); 10.7% < 2 years old, 10.7% 6-<12, 53.8% 12-<19, and 25.0% > 19 years old. No adverse events occurred. The median COVID-19 severity score improved (5.0 pre-CCP to 1.0 by day 7; p < 0.001). A rapid increase in the median percentage of inhibition was observed in AbKS (22.5% (13.0%, 41.5%) pre-infusion to 52% (23.7%, 72%) 24 h post-infusion); a similar increase was observed in nine immune-competent subjects (28% (23%, 35%) to 63% (53%, 72%)). The inhibition percentage increased until day 7 and persisted at 21 and 90 days. CCP is well tolerated in children and young adults, providing rapid and robust increased antibodies. CCP should remain a therapeutic option for this population for whom vaccines are not fully available and given that the safety and efficacy of existing monoclonal antibodies and antiviral agents have not been established.
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Affiliation(s)
- Antonio Arrieta
- Pediatrics Infectious Diseases, CHOC Children’s Hospital, Orange, CA 92868, USA
- Department of Pediatrics, University of California Irvine School of Medicine, Irvine, CA 92697, USA
| | - Alvaro E. Galvis
- Pediatrics Infectious Diseases, CHOC Children’s Hospital, Orange, CA 92868, USA
- Department of Pediatrics, University of California Irvine School of Medicine, Irvine, CA 92697, USA
| | - Stephanie Osborne
- Research Administration, CHOC Children’s Hospital, Orange, CA 92868, USA
| | - Tricia Morphew
- Morphew Consulting, LLC, CHOC Research Institute, CHOC Children’s Hospital, Orange, CA 92868, USA
| | - Karen Imfeld
- Hematology Advanced Diagnostics Laboratory, CHOC Children’s Hospital, Orange, CA 92868, USA
| | - Claudia Enriquez
- Research Administration, CHOC Children’s Hospital, Orange, CA 92868, USA
| | - Janet Hoang
- Hematology Advanced Diagnostics Laboratory, CHOC Children’s Hospital, Orange, CA 92868, USA
| | - Marcia Swearingen
- Hematology Advanced Diagnostics Laboratory, CHOC Children’s Hospital, Orange, CA 92868, USA
| | - Delma J. Nieves
- Pediatrics Infectious Diseases, CHOC Children’s Hospital, Orange, CA 92868, USA
- Department of Pediatrics, University of California Irvine School of Medicine, Irvine, CA 92697, USA
- Correspondence: ; Tel.: +714-509-8403; Fax: +714-509-3303
| | - Negar Ashouri
- Pediatrics Infectious Diseases, CHOC Children’s Hospital, Orange, CA 92868, USA
- Department of Pediatrics, University of California Irvine School of Medicine, Irvine, CA 92697, USA
| | - Jasjit Singh
- Pediatrics Infectious Diseases, CHOC Children’s Hospital, Orange, CA 92868, USA
- Department of Pediatrics, University of California Irvine School of Medicine, Irvine, CA 92697, USA
| | - Diane Nugent
- Department of Pediatrics, University of California Irvine School of Medicine, Irvine, CA 92697, USA
- Pediatric Hematology, CHOC Children’s Hospital, Orange, CA 92868, USA
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37
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Shoham S, Bloch EM, Casadevall A, Hanley D, Lau B, Gebo K, Cachay E, Kassaye SG, Paxton JH, Gerber J, Levine AC, Naeim A, Currier J, Patel B, Allen ES, Anjan S, Appel L, Baksh S, Blair PW, Bowen A, Broderick P, Caputo CA, Cluzet V, Elena MC, Cruser D, Ehrhardt S, Forthal D, Fukuta Y, Gawad AL, Gniadek T, Hammel J, Huaman MA, Jabs DA, Jedlicka A, Karlen N, Klein S, Laeyendecker O, Karen L, McBee N, Meisenberg B, Merlo C, Mosnaim G, Park HS, Pekosz A, Petrini J, Rausch W, Shade DM, Shapiro JR, Singleton RJ, Sutcliffe C, Thomas DL, Yarava A, Zand M, Zenilman JM, Tobian AA, Sullivan DJ. Transfusing Convalescent Plasma as Post-Exposure Prophylaxis Against Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection: A Double-Blinded, Phase 2 Randomized, Controlled Trial. Clin Infect Dis 2023; 76:e477-e486. [PMID: 35579509 PMCID: PMC9129191 DOI: 10.1093/cid/ciac372] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/18/2022] [Accepted: 05/10/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The efficacy of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) convalescent plasma (CCP) for preventing infection in exposed, uninfected individuals is unknown. CCP might prevent infection when administered before symptoms or laboratory evidence of infection. METHODS This double-blinded, phase 2 randomized, controlled trial (RCT) compared the efficacy and safety of prophylactic high titer (≥1:320 by Euroimmun ELISA) CCP with standard plasma. Asymptomatic participants aged ≥18 years with close contact exposure to a person with confirmed coronavirus disease 2019 (COVID-19) in the previous 120 hours and negative SARS-CoV-2 test within 24 hours before transfusion were eligible. The primary outcome was new SARS-CoV-2 infection. RESULTS In total, 180 participants were enrolled; 87 were assigned to CCP and 93 to control plasma, and 170 transfused at 19 sites across the United States from June 2020 to March 2021. Two were excluded for screening SARS-CoV-2 reverse transcription polymerase chain reaction (RT-PCR) positivity. Of the remaining 168 participants, 12/81 (14.8%) CCP and 13/87 (14.9%) control recipients developed SARS-CoV-2 infection; 6 (7.4%) CCP and 7 (8%) control recipients developed COVID-19 (infection with symptoms). There were no COVID-19-related hospitalizations in CCP and 2 in control recipients. Efficacy by restricted mean infection free time (RMIFT) by 28 days for all SARS-CoV-2 infections (25.3 vs 25.2 days; P = .49) and COVID-19 (26.3 vs 25.9 days; P = .35) was similar for both groups. CONCLUSIONS Administration of high-titer CCP as post-exposure prophylaxis, although appearing safe, did not prevent SARS-CoV-2 infection. CLINICAL TRIALS REGISTRATION NCT04323800.
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Affiliation(s)
| | | | | | | | - Bryan Lau
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA, Mosaic Consulting Ltd., Israel
| | | | - Edward Cachay
- Department of Medicine, Division of Infectious Diseases
| | - Seble G. Kassaye
- Division of Infectious Diseases/Department of Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - James H. Paxton
- Department of Emergency Medicine Wayne State University, Detroit, Michigan, USA
| | - Jonathan Gerber
- Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worchester, Massachusetts, USA
| | - Adam C Levine
- Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, Rhode Island, USA
| | - Arash Naeim
- Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, California, USA
| | - Judith Currier
- Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, California, USA
| | - Bela Patel
- Department of Medicine, Division Critical Care Medicine, University of Texas Health, Houston, Texas, USA
| | - Elizabeth S. Allen
- Department of Pathology, University of California, San Diego, San Diego, California, USA
| | - Shweta Anjan
- Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | - Sheriza Baksh
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA, Mosaic Consulting Ltd., Israel
| | | | | | | | | | - Valerie Cluzet
- Vassar Brothers Medical Center, Nuvance Health, Poughkeepsie, New York, USA
| | | | | | - Stephan Ehrhardt
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA, Mosaic Consulting Ltd., Israel
| | - Donald Forthal
- Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, California, USA
| | - Yuriko Fukuta
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
| | | | - Thomas Gniadek
- Department of Pathology, Northshore University Health System, Evanston, Illinois, USA
| | | | - Moises A. Huaman
- Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati, Ohio, USA
| | - Douglas A. Jabs
- Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | | | - Sabra Klein
- Department of Molecular Microbiology and Immunology
| | - Oliver Laeyendecker
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore, Maryland, USA
| | | | | | | | | | | | - Han-Sol Park
- Department of Molecular Microbiology and Immunology
| | | | - Joann Petrini
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore, Maryland, USA
| | - William Rausch
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore, Maryland, USA
| | - David M. Shade
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA, Mosaic Consulting Ltd., Israel
| | | | | | - Catherine Sutcliffe
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA, Mosaic Consulting Ltd., Israel
| | | | | | - Martin Zand
- Department of Medicine, University of Rochester, Rochester, New York, USA
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Iannizzi C, Chai KL, Piechotta V, Valk SJ, Kimber C, Monsef I, Wood EM, Lamikanra AA, Roberts DJ, McQuilten Z, So-Osman C, Jindal A, Cryns N, Estcourt LJ, Kreuzberger N, Skoetz N. Convalescent plasma for people with COVID-19: a living systematic review. Cochrane Database Syst Rev 2023; 2:CD013600. [PMID: 36734509 PMCID: PMC9891348 DOI: 10.1002/14651858.cd013600.pub5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Convalescent plasma may reduce mortality in patients with viral respiratory diseases, and is being investigated as a potential therapy for coronavirus disease 2019 (COVID-19). A thorough understanding of the current body of evidence regarding benefits and risks of this intervention is required. OBJECTIVES To assess the effectiveness and safety of convalescent plasma transfusion in the treatment of people with COVID-19; and to maintain the currency of the evidence using a living systematic review approach. SEARCH METHODS To identify completed and ongoing studies, we searched the World Health Organization (WHO) COVID-19 Global literature on coronavirus disease Research Database, MEDLINE, Embase, Cochrane COVID-19 Study Register, and the Epistemonikos COVID-19 L*OVE Platform. We searched monthly until 03 March 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs) evaluating convalescent plasma for COVID-19, irrespective of disease severity, age, gender or ethnicity. We excluded studies that included populations with other coronavirus diseases (severe acute respiratory syndrome (SARS) or Middle East respiratory syndrome (MERS)), as well as studies evaluating standard immunoglobulin. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methodology. To assess bias in included studies we used RoB 2. We used the GRADE approach to rate the certainty of evidence for the following outcomes: all-cause mortality at up to day 28, worsening and improvement of clinical status (for individuals with moderate to severe disease), hospital admission or death, COVID-19 symptoms resolution (for individuals with mild disease), quality of life, grade 3 or 4 adverse events, and serious adverse events. MAIN RESULTS In this fourth review update version, we included 33 RCTs with 24,861 participants, of whom 11,432 received convalescent plasma. Of these, nine studies are single-centre studies and 24 are multi-centre studies. Fourteen studies took place in America, eight in Europe, three in South-East Asia, two in Africa, two in western Pacific and three in eastern Mediterranean regions and one in multiple regions. We identified a further 49 ongoing studies evaluating convalescent plasma, and 33 studies reporting as being completed. Individuals with a confirmed diagnosis of COVID-19 and moderate to severe disease 29 RCTs investigated the use of convalescent plasma for 22,728 participants with moderate to severe disease. 23 RCTs with 22,020 participants compared convalescent plasma to placebo or standard care alone, five compared to standard plasma and one compared to human immunoglobulin. We evaluate subgroups on detection of antibodies detection, symptom onset, country income groups and several co-morbidities in the full text. Convalescent plasma versus placebo or standard care alone Convalescent plasma does not reduce all-cause mortality at up to day 28 (risk ratio (RR) 0.98, 95% confidence interval (CI) 0.92 to 1.03; 220 per 1000; 21 RCTs, 19,021 participants; high-certainty evidence). It has little to no impact on need for invasive mechanical ventilation, or death (RR 1.03, 95% CI 0.97 to 1.11; 296 per 1000; 6 RCTs, 14,477 participants; high-certainty evidence) and has no impact on whether participants are discharged from hospital (RR 1.00, 95% CI 0.97 to 1.02; 665 per 1000; 6 RCTs, 12,721 participants; high-certainty evidence). Convalescent plasma may have little to no impact on quality of life (MD 1.00, 95% CI -2.14 to 4.14; 1 RCT, 483 participants; low-certainty evidence). Convalescent plasma may have little to no impact on the risk of grades 3 and 4 adverse events (RR 1.17, 95% CI 0.96 to 1.42; 212 per 1000; 6 RCTs, 2392 participants; low-certainty evidence). It has probably little to no effect on the risk of serious adverse events (RR 1.14, 95% CI 0.91 to 1.44; 135 per 1000; 6 RCTs, 3901 participants; moderate-certainty evidence). Convalescent plasma versus standard plasma We are uncertain whether convalescent plasma reduces or increases all-cause mortality at up to day 28 (RR 0.73, 95% CI 0.45 to 1.19; 129 per 1000; 4 RCTs, 484 participants; very low-certainty evidence). We are uncertain whether convalescent plasma reduces or increases the need for invasive mechanical ventilation, or death (RR 5.59, 95% CI 0.29 to 108.38; 311 per 1000; 1 study, 34 participants; very low-certainty evidence) and whether it reduces or increases the risk of serious adverse events (RR 0.80, 95% CI 0.55 to 1.15; 236 per 1000; 3 RCTs, 327 participants; very low-certainty evidence). We did not identify any study reporting other key outcomes. Convalescent plasma versus human immunoglobulin Convalescent plasma may have little to no effect on all-cause mortality at up to day 28 (RR 1.07, 95% CI 0.76 to 1.50; 464 per 1000; 1 study, 190 participants; low-certainty evidence). We did not identify any study reporting other key outcomes. Individuals with a confirmed diagnosis of SARS-CoV-2 infection and mild disease We identified two RCTs reporting on 536 participants, comparing convalescent plasma to placebo or standard care alone, and two RCTs reporting on 1597 participants with mild disease, comparing convalescent plasma to standard plasma. Convalescent plasma versus placebo or standard care alone We are uncertain whether convalescent plasma reduces all-cause mortality at up to day 28 (odds ratio (OR) 0.36, 95% CI 0.09 to 1.46; 8 per 1000; 2 RCTs, 536 participants; very low-certainty evidence). It may have little to no effect on admission to hospital or death within 28 days (RR 1.05, 95% CI 0.60 to 1.84; 117 per 1000; 1 RCT, 376 participants; low-certainty evidence), on time to COVID-19 symptom resolution (hazard ratio (HR) 1.05, 95% CI 0.85 to 1.30; 483 per 1000; 1 RCT, 376 participants; low-certainty evidence), on the risk of grades 3 and 4 adverse events (RR 1.29, 95% CI 0.75 to 2.19; 144 per 1000; 1 RCT, 376 participants; low-certainty evidence) and the risk of serious adverse events (RR 1.14, 95% CI 0.66 to 1.94; 133 per 1000; 1 RCT, 376 participants; low-certainty evidence). We did not identify any study reporting other key outcomes. Convalescent plasma versus standard plasma We are uncertain whether convalescent plasma reduces all-cause mortality at up to day 28 (OR 0.30, 95% CI 0.05 to 1.75; 2 per 1000; 2 RCTs, 1597 participants; very low-certainty evidence). It probably reduces admission to hospital or death within 28 days (RR 0.49, 95% CI 0.31 to 0.75; 36 per 1000; 2 RCTs, 1595 participants; moderate-certainty evidence). Convalescent plasma may have little to no effect on initial symptom resolution at up to day 28 (RR 1.12, 95% CI 0.98 to 1.27; 1 RCT, 416 participants; low-certainty evidence). We did not identify any study reporting other key outcomes. This is a living systematic review. We search monthly for new evidence and update the review when we identify relevant new evidence. AUTHORS' CONCLUSIONS For the comparison of convalescent plasma versus placebo or standard care alone, our certainty in the evidence that convalescent plasma for individuals with moderate to severe disease does not reduce mortality and has little to no impact on clinical improvement or worsening is high. It probably has little to no effect on SAEs. For individuals with mild disease, we have low certainty evidence for our primary outcomes. There are 49 ongoing studies, and 33 studies reported as complete in a trials registry. Publication of ongoing studies might resolve some of the uncertainties around convalescent plasma therapy for people with asymptomatic or mild disease.
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Affiliation(s)
- Claire Iannizzi
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Khai Li Chai
- Transfusion Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Vanessa Piechotta
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Sarah J Valk
- Jon J van Rood Center for Clinical Transfusion Research, Sanquin/Leiden University Medical Center, Leiden, Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | - Catherine Kimber
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK
| | - Ina Monsef
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Erica M Wood
- Transfusion Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - David J Roberts
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK
| | - Zoe McQuilten
- Transfusion Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Cynthia So-Osman
- Sanquin Blood Bank, Amsterdam, Netherlands
- Erasmus Medical Centre, Rotterdam, Netherlands
| | - Aikaj Jindal
- Department of Transfusion Medicine, SPS Hospitals, Ludhiana (Punjab), India
| | - Nora Cryns
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lise J Estcourt
- Haematology/Transfusion Medicine, NHS Blood and Transplant, Oxford, UK
| | - Nina Kreuzberger
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nicole Skoetz
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Kandathil AJ, Benner SE, Bloch EM, Shrestha R, Ajayi O, Zhu X, Caturegli PP, Shoham S, Sullivan D, Gebo K, Quinn TC, Casadevall A, Hanley D, Pekosz A, Redd AD, Balagopal A, Tobian AAR. Absence of pathogenic viruses in COVID-19 convalescent plasma. Transfusion 2023; 63:23-29. [PMID: 36268708 PMCID: PMC9840666 DOI: 10.1111/trf.17168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/03/2022] [Accepted: 10/10/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND It is important to maintain the safety of blood products by avoiding the transfusion of units with known and novel viral pathogens. It is unknown whether COVID-19 convalescent plasma (CCP) may contain pathogenic viruses (either newly acquired or reactivated) that are not routinely screened for by blood centers. METHODS The DNA virome was characterized in potential CCP donors (n = 30) using viral genome specific PCR primers to identify DNA plasma virome members of the Herpesviridae [Epstein Barr Virus (EBV), cytomegalovirus (CMV), human herpesvirus 6A/B, human herpesvirus 7] and Anelloviridae [Torque teno viruses (TTV), Torque teno mini viruses (TTMV), and Torque teno midi viruses (TTMDV)] families. In addition, the RNA plasma virome was characterized using unbiased metagenomic sequencing. Sequencing was done on a HiSeq2500 using high output mode with a read length of 2X100 bp. The sequencing reads were taxonomically classified using Kraken2. CMV and EBV seroprevalence were evaluated using a chemiluminescent immunoassay. RESULTS TTV and TTMDV were detected in 12 (40%) and 4 (13%) of the 30 study participants, respectively; TTMDV was always associated with infection with TTV. We did not observe TTMV DNAemia. Despite CMV and EBV seroprevalences of 33.3% and 93.3%, respectively, we did not detect Herpesviridae DNA among the study participants. Metagenomic sequencing did not reveal any human RNA viruses in CCP, including no evidence of circulating SARS-CoV-2. DISCUSSION There was no evidence of pathogenic viruses, whether newly acquired or reactivated, in CCP despite the presence of non-pathogenic Anelloviridae. These results confirm the growing safety data supporting CCP.
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Affiliation(s)
- Abraham J Kandathil
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sarah E Benner
- Department of Pathology, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Evan M Bloch
- Department of Pathology, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ruchee Shrestha
- Department of Pathology, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Olivia Ajayi
- Department of Pathology, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Xianming Zhu
- Department of Pathology, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Patrizio P Caturegli
- Department of Pathology, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Shmuel Shoham
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - David Sullivan
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kelly Gebo
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Thomas C Quinn
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.,Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Arturo Casadevall
- Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Daniel Hanley
- Department of Neurology, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Andrew Pekosz
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Andrew D Redd
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.,Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Ashwin Balagopal
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Aaron A R Tobian
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Pathology, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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Kostandova N, Drabo EF, Yenokyan K, Wesolowski A, Truelove S, Bloch EM, Tobian AAR, Vassallo RR, Bravo MD, Casadevall A, Lessler J, Lau B. Comparison of allocation strategies of convalescent plasma to reduce excess infections and mortality from SARS-CoV-2 in a US-like population. Transfusion 2023; 63:92-103. [PMID: 36345608 PMCID: PMC9878275 DOI: 10.1111/trf.17174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 10/02/2022] [Accepted: 10/10/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND While the use of convalescent plasma (CP) in the ongoing COVID-19 pandemic has been inconsistent, CP has the potential to reduce excess morbidity and mortality in future pandemics. Given constraints on CP supply, decisions surrounding the allocation of CP must be made. STUDY DESIGN AND METHODS Using a discrete-time stochastic compartmental model, we simulated implementation of four potential allocation strategies: administering CP to individuals in early hospitalization with COVID-19; administering CP to individuals in outpatient settings; administering CP to hospitalized individuals and administering any remaining CP to outpatient individuals and administering CP in both settings while prioritizing outpatient individuals. We examined the final size of SARS-CoV-2 infections, peak and cumulative hospitalizations, and cumulative deaths under each of the allocation scenarios over a 180-day period. We compared the cost per weighted health benefit under each strategy. RESULTS Prioritizing administration to patients in early hospitalization, with remaining plasma administered in outpatient settings, resulted in the highest reduction in mortality, averting on average 15% more COVID-19 deaths than administering to hospitalized individuals alone (95% CI [11%-18%]). Prioritizing administration to outpatients, with remaining plasma administered to hospitalized individuals, had the highest percentage of hospitalizations averted (22% [21%-23%] higher than administering to hospitalized individuals alone). DISCUSSION Convalescent plasma allocation strategy should be determined by the relative priority of averting deaths, infections, or hospitalizations. Under conditions considered, mixed allocation strategies (allocating CP to both outpatient and hospitalized individuals) resulted in a larger percentage of infections and deaths averted than administering CP in a single setting.
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Affiliation(s)
- Natalya Kostandova
- Department of Epidemiology, Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Emmanuel Fulgence Drabo
- Department of Health Policy and Management, Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Karine Yenokyan
- Department of Epidemiology, Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Amy Wesolowski
- Department of Epidemiology, Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Shaun Truelove
- Department of Epidemiology, Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMarylandUSA
- Department of International Health, Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Evan M. Bloch
- Division of Transfusion Medicine, Department of Pathology, School of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Aaron A. R. Tobian
- Division of Transfusion Medicine, Department of Pathology, School of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | | | | | - Arturo Casadevall
- Department of Molecular Microbiology and Immunology, Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Justin Lessler
- Department of Epidemiology, Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMarylandUSA
- Department of Epidemiology, Gillings School of Global Public HealthUniversity of North CarolinaChapel HillNorth CarolinaUSA
- Carolina Population CenterUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Bryan Lau
- Department of Epidemiology, Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMarylandUSA
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Oliver JC, Silva EN, Soares LM, Scodeler GC, Santos ADS, Corsetti PP, Prudêncio CR, de Almeida LA. Different drug approaches to COVID-19 treatment worldwide: an update of new drugs and drugs repositioning to fight against the novel coronavirus. Ther Adv Vaccines Immunother 2022; 10:25151355221144845. [PMID: 36578829 PMCID: PMC9791004 DOI: 10.1177/25151355221144845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/18/2022] [Indexed: 12/25/2022] Open
Abstract
According to the World Health Organization (WHO), in the second half of 2022, there are about 606 million confirmed cases of COVID-19 and almost 6,500,000 deaths around the world. A pandemic was declared by the WHO in March 2020 when the new coronavirus spread around the world. The short time between the first cases in Wuhan and the declaration of a pandemic initiated the search for ways to stop the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or to attempt to cure the disease COVID-19. More than ever, research groups are developing vaccines, drugs, and immunobiological compounds, and they are even trying to repurpose drugs in an increasing number of clinical trials. There are great expectations regarding the vaccine's effectiveness for the prevention of COVID-19. However, producing sufficient doses of vaccines for the entire population and SARS-CoV-2 variants are challenges for pharmaceutical industries. On the contrary, efforts have been made to create different vaccines with different approaches so that they can be used by the entire population. Here, we summarize about 8162 clinical trials, showing a greater number of drug clinical trials in Europe and the United States and less clinical trials in low-income countries. Promising results about the use of new drugs and drug repositioning, monoclonal antibodies, convalescent plasma, and mesenchymal stem cells to control viral infection/replication or the hyper-inflammatory response to the new coronavirus bring hope to treat the disease.
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Affiliation(s)
| | | | | | | | - Ana de Souza Santos
- Laboratory of Molecular Biology of Microorganisms, Federal University of Alfenas, Alfenas, Brazil
| | - Patrícia Paiva Corsetti
- Laboratory of Molecular Biology of Microorganisms, Federal University of Alfenas, Alfenas, Brazil
| | - Carlos Roberto Prudêncio
- Laboratory of Immunotechnology , Center of Immunology, Instituto Adolfo Lutz Institute, São Paulo, Brazil
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Cognasse F, Hamzeh-Cognasse H, Rosa M, Corseaux D, Bonneaudeau B, Pierre C, Huet J, Arthaud CA, Eyraud MA, Prier A, Duchez AC, Ebermeyer T, Heestermans M, Audoux-Caire E, Philippot Q, Le Voyer T, Hequet O, Fillet AM, Chavarin P, Legrand D, Richard P, Pirenne F, Gallian P, Casanova JL, Susen S, Morel P, Lacombe K, Bastard P, Tiberghien P. Inflammatory markers and auto-Abs to type I IFNs in COVID-19 convalescent plasma cohort study. EBioMedicine 2022; 87:104414. [PMID: 36535107 PMCID: PMC9758484 DOI: 10.1016/j.ebiom.2022.104414] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 11/10/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND COVID-19 convalescent plasma (CCP) contains neutralising anti-SARS-CoV-2 antibodies that may be useful as COVID-19 passive immunotherapy in patients at risk of developing severe disease. Such plasma from convalescent patients may also have additional immune-modulatory properties when transfused to COVID-19 patients. METHODS CCP (n = 766) was compared to non-convalescent control plasma (n = 166) for soluble inflammatory markers, ex-vivo inflammatory bioactivity on endothelial cells, neutralising auto-Abs to type I IFNs and reported adverse events in the recipients. FINDINGS CCP exhibited a statistically significant increase in IL-6 and TNF-alpha levels (0.531 ± 0.04 vs 0.271 ± 0.04; (95% confidence interval [CI], 0.07371-0.4446; p = 0.0061) and 0.900 ± 0.07 vs 0.283 ± 0.07 pg/mL; (95% [CI], 0.3097-0.9202; p = 0.0000829) and lower IL-10 (0.731 ± 0.07 vs 1.22 ± 0.19 pg/mL; (95% [CI], -0.8180 to -0.1633; p = 0.0034) levels than control plasma. Neutralising auto-Abs against type I IFNs were detected in 14/766 (1.8%) CCPs and were not associated with reported adverse events when transfused. Inflammatory markers and bioactivity in CCP with or without auto-Abs, or in CCP whether or not linked to adverse events in transfused patients, did not differ to a statistically significant extent. INTERPRETATION Overall, CCP exhibited moderately increased inflammatory markers compared to the control plasma with no discernible differences in ex-vivo bioactivity. Auto-Abs to type I IFNs detected in a small fraction of CCP were not associated with reported adverse events or differences in inflammatory markers. Additional studies, including careful clinical evaluation of patients treated with CCP, are required in order to further define the clinical relevance of these findings. FUNDING French National Blood Service-EFS, the Association "Les Amis de Rémi" Savigneux, France, the "Fondation pour la Recherche Médicale (Medical Research Foundation)-REACTing 2020".
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Affiliation(s)
- Fabrice Cognasse
- Établissement Français du Sang Auvergne-Rhône-Alpes, Saint-Étienne, France,Univ Jean Monnet, Mines Saint-Étienne, INSERM, U 1059 Sainbiose, 42023, Saint-Étienne, France,Corresponding author. Etablissement Français du Sang Auvergne-Rhône-Alpes, INSERM U1059, Campus Santé Innovation - 10 rue de la Marandière, 42270, Saint-Priest-en-Jarez, France.
| | - Hind Hamzeh-Cognasse
- Univ Jean Monnet, Mines Saint-Étienne, INSERM, U 1059 Sainbiose, 42023, Saint-Étienne, France
| | - Mickael Rosa
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, CNRS, U1011- EGID, F-59000 Lille, France,Centre National de la Recherche Scientifique (National Scientific Research Centre), Surgical Critical Care, Department of Anaesthesiology and Critical Care, U1019 - Unité Mixte de Recherche 9017 (Mixed Research Unit 9017) – Lille Centre for Infection and Immunity, France
| | - Delphine Corseaux
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, CNRS, U1011- EGID, F-59000 Lille, France,Centre National de la Recherche Scientifique (National Scientific Research Centre), Surgical Critical Care, Department of Anaesthesiology and Critical Care, U1019 - Unité Mixte de Recherche 9017 (Mixed Research Unit 9017) – Lille Centre for Infection and Immunity, France
| | | | - Chloe Pierre
- Etablissement Français du Sang, La Plaine, St Denis, France
| | - Julie Huet
- Etablissement Français du Sang, La Plaine, St Denis, France
| | - Charles Antoine Arthaud
- Établissement Français du Sang Auvergne-Rhône-Alpes, Saint-Étienne, France,Univ Jean Monnet, Mines Saint-Étienne, INSERM, U 1059 Sainbiose, 42023, Saint-Étienne, France
| | - Marie Ange Eyraud
- Établissement Français du Sang Auvergne-Rhône-Alpes, Saint-Étienne, France,Univ Jean Monnet, Mines Saint-Étienne, INSERM, U 1059 Sainbiose, 42023, Saint-Étienne, France
| | - Amélie Prier
- Établissement Français du Sang Auvergne-Rhône-Alpes, Saint-Étienne, France,Univ Jean Monnet, Mines Saint-Étienne, INSERM, U 1059 Sainbiose, 42023, Saint-Étienne, France
| | - Anne Claire Duchez
- Établissement Français du Sang Auvergne-Rhône-Alpes, Saint-Étienne, France,Univ Jean Monnet, Mines Saint-Étienne, INSERM, U 1059 Sainbiose, 42023, Saint-Étienne, France
| | - Theo Ebermeyer
- Univ Jean Monnet, Mines Saint-Étienne, INSERM, U 1059 Sainbiose, 42023, Saint-Étienne, France
| | - Marco Heestermans
- Établissement Français du Sang Auvergne-Rhône-Alpes, Saint-Étienne, France,Univ Jean Monnet, Mines Saint-Étienne, INSERM, U 1059 Sainbiose, 42023, Saint-Étienne, France
| | - Estelle Audoux-Caire
- Établissement Français du Sang Auvergne-Rhône-Alpes, Saint-Étienne, France,Univ Jean Monnet, Mines Saint-Étienne, INSERM, U 1059 Sainbiose, 42023, Saint-Étienne, France
| | - Quentin Philippot
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale U1163 (National Institute for Health and Medical Research), Necker Hospital for Sick Children, Paris, France,University of Paris, Imagine Institute, Paris, France
| | - Tom Le Voyer
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale U1163 (National Institute for Health and Medical Research), Necker Hospital for Sick Children, Paris, France,University of Paris, Imagine Institute, Paris, France
| | - Olivier Hequet
- Établissement Français du Sang Auvergne-Rhône-Alpes, Saint-Étienne, France
| | | | - Patricia Chavarin
- Établissement Français du Sang Auvergne-Rhône-Alpes, Saint-Étienne, France
| | - Dominique Legrand
- Établissement Français du Sang Auvergne-Rhône-Alpes, Saint-Étienne, France
| | | | - France Pirenne
- Univ Paris Est Creteil, INSERM U955, Institut Mondor de Recherche Biomédicale (Mondor Biomedical Research Institute) (IMRB), Creteil, France & Laboratory of Excellence GR-Ex, Paris, France
| | - Pierre Gallian
- Etablissement Français du Sang, La Plaine, St Denis, France,UMR “Unité des Virus Emergents” (Emerging Virus Unit), Aix-Marseille University - IRD 190 - INSERM 1207 - IRBA - EFS - IHU Méditerranée Infection, Marseille, France
| | - Jean Laurent Casanova
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale U1163 (National Institute for Health and Medical Research), Necker Hospital for Sick Children, Paris, France,University of Paris, Imagine Institute, Paris, France,St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA,Howard Hughes Medical Institute, New York, NY, USA
| | - Sophie Susen
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, CNRS, U1011- EGID, F-59000 Lille, France,Centre National de la Recherche Scientifique (National Scientific Research Centre), Surgical Critical Care, Department of Anaesthesiology and Critical Care, U1019 - Unité Mixte de Recherche 9017 (Mixed Research Unit 9017) – Lille Centre for Infection and Immunity, France
| | - Pascal Morel
- Etablissement Français du Sang, La Plaine, St Denis, France
| | - Karine Lacombe
- Sorbonne University, Inserm IPLESP, Infectious Diseases Department, Saint-Antoine Hospital, APHP (University Hospital Trust), Paris, France
| | - Paul Bastard
- Etablissement Français du Sang, La Plaine, St Denis, France,Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale U1163 (National Institute for Health and Medical Research), Necker Hospital for Sick Children, Paris, France,St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA
| | - Pierre Tiberghien
- Etablissement Français du Sang, La Plaine, St Denis, France,UMR RIGHT U1098, INSERM, Etablissement Français du Sang, University of Franche-Comté, Besançon, France
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43
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Sharun K, Tiwari R, Yatoo MI, Natesan S, Megawati D, Singh KP, Michalak I, Dhama K. A comprehensive review on pharmacologic agents, immunotherapies and supportive therapeutics for COVID-19. NARRA J 2022; 2:e92. [PMID: 38449903 PMCID: PMC10914132 DOI: 10.52225/narra.v2i3.92] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/06/2022] [Indexed: 03/08/2024]
Abstract
The emergence of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has affected many countries throughout the world. As urgency is a necessity, most efforts have focused on identifying small molecule drugs that can be repurposed for use as anti-SARS-CoV-2 agents. Although several drug candidates have been identified using in silico method and in vitro studies, most of these drugs require the support of in vivo data before they can be considered for clinical trials. Several drugs are considered promising therapeutic agents for COVID-19. In addition to the direct-acting antiviral drugs, supportive therapies including traditional Chinese medicine, immunotherapies, immunomodulators, and nutritional therapy could contribute a major role in treating COVID-19 patients. Some of these drugs have already been included in the treatment guidelines, recommendations, and standard operating procedures. In this article, we comprehensively review the approved and potential therapeutic drugs, immune cells-based therapies, immunomodulatory agents/drugs, herbs and plant metabolites, nutritional and dietary for COVID-19.
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Affiliation(s)
- Khan Sharun
- Division of Surgery, ICAR-Indian Veterinary Research Institute, Izatnagar, India
| | - Ruchi Tiwari
- Department of Veterinary Microbiology and Immunology, College of Veterinary Sciences, UP Pandit Deen Dayal Upadhayay Pashu Chikitsa Vigyan Vishwavidyalay Evum Go-Anusandhan Sansthan (DUVASU), Mathura, India
| | - Mohd I. Yatoo
- Division of Veterinary Clinical Complex, Faculty of Veterinary Sciences and Animal Husbandry, Shuhama, Alusteng Srinagar, Sher-E-Kashmir University of Agricultural Sciences and Technology of Kashmir, Shalimar, Jammu and Kashmir, India
| | - Senthilkumar Natesan
- Department of Infectious Diseases, Indian Institute of Public Health Gandhinagar, Opp to Airforce station HQ, Gandhinagar, India
| | - Dewi Megawati
- Department of Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Warmadewa University, Denpasar, Indonesia
- Department of Medical Microbiology and Immunology, University of California, Davis, California, USA
| | - Karam P. Singh
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, India
| | - Izabela Michalak
- Faculty of Chemistry, Department of Advanced Material Technologies, Wrocław University of Science and Technology, Wrocław, Poland
| | - Kuldeep Dhama
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, India
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Chastain DB, Patel VS, Jefferson AM, Osae SP, Chastain JS, Henao-Martínez AF, Franco-Paredes C, Young HN. Distribution of age, sex, race, and ethnicity in COVID-19 clinical drug trials in the United States: A review. Contemp Clin Trials 2022; 123:106997. [PMID: 36368481 PMCID: PMC9642036 DOI: 10.1016/j.cct.2022.106997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 10/28/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND COVID-19 quickly overwhelmed the world, but disproportionately affects certain communities, particularly minority groups. Despite overrepresentation among COVID-19 cases and death, minority groups were underrepresented in some of the early COVID-19 clinical trials. OBJECTIVE To assess and compare the demographic characteristics of COVID-19 clinical trial participants to national COVID-19 data. METHODS PubMed was searched from December 1, 2019 to November 24, 2020, for randomized controlled trials evaluating a pharmacologic treatment for COVID-19 patients from one or more U.S. sites written in the English language following the PRISMA checklist. Descriptive statistics were calculated to characterize patient demographics enrolled in the included clinical trials, as well as for comparison with national COVID-19 data. RESULTS A total of 4472 records were identified, of which 16 studies were included. The median number of participants was higher in studies of nonhospitalized patients compared to those of hospitalized patients (n = 452 [range 20-1062] vs n = 243 [152-2795]). Ten (63%) studies reported mean or median ages of 50 years or older among all study arms. Males comprised more than half of the study cohort in ten (63%) studies. Race and ethnicity were reported separately in four (25%) studies but were combined when reported in five (31%) studies, while six (38%) reported only race or ethnicity. Proportional representation based on age, sex, race, and ethnicity was evident in some trials, but not in others, when compared to national data. CONCLUSION Overall, participants often did not reflect the actual population with COVID-19 and demographic characteristics were inconsistently reported.
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Affiliation(s)
| | | | | | - Sharmon P Osae
- University of Georgia College of Pharmacy, Albany, GA 31701, USA.
| | | | - Andrés F Henao-Martínez
- Division of Infectious Diseases, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, USA.
| | | | - Henry N Young
- University of Georgia College of Pharmacy, Athens, GA 30602, USA.
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45
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Manzini PM, Ciccone G, De Rosa FG, Cavallo R, Ghisetti V, D’Antico S, Galassi C, Saccona F, Castiglione A, Birocco N, Francisci T, Hu H, Pecoraro C, Danielle F, Labanca L, Bordiga AM, Lorenzi M, Camisasca G, Giachino O, Pagliarino M, Ottone P, Scuvera ITD, Guaschino R, Freilone R, Berti P, Pittaluga F, Avolio M, Costa C, Raso S, Nucci A, Milan M, Baffa A, Russo A, Tornello A, Maddalena L, Delios G, Marletto FP, De Micheli AG, Mattei A, Baldassano S, Canta F, Russo ML, Bergamo D, Vitale F, Liccardi MM, Chinaglia A, Calcagno A, Converso M, Aldieri C, Libanore V, Blangetti I, Benedetti V, Mitola B, Scozzari G, Valfrè A, Rizzioli G, D’Amato T, Crocillà C, Naselli S, Granero V, Cornagliotto G, Lucania G, Scaglia C, Ferro F, Solimine C, Ricotti M, Gilestro C, Roncato R, Palladino A, Ongaro D, Poggio GA, Chiappero C, Pinna SM, Scabini S, Vischia F, Gregoretti MG, Lupia E, Brazzi L, Albera C, Scaglione L, Gallo V, Norbiato C, Albiani R, Sini BL, Fassiola A, Locatelli A, Di Perri G, Navarra M, Gardini I, Ciardiello A, La Grotta R, De Rosa A, Pasquino P, Fiore G, Franza O, Artoni P, Meinardi S, Calosso L, Molino P, Veglio MG, Beltramo T, Camerini O, Giancaspero K, Napoli F, Perboni A, Messa E, Buffolo F, Pagnozzi F, Bertone S, Lutri L, Gravante U, Sacchetti P, Pavan A, Castenetto E, Novelli M, Tucciarone M, Ocello P, Guido G, Frascaroli C, Vivenza DML, Patti F, Lorenzelli L, Balduzzi G, Ratti D, Mazzucco L, Balbo V, Pollis F, Leoncino S, Lupo C, Romano D, Ziccardi S, Marmifero M, Chichino G, Salio M, Aiosa G, Boverio R, Avonto I, Ghiotto S, Balbo R, Nico V, Aguzzi C, Pellegrino MC, Prucca M, Longa LA, Perotti L, Piovano F, Ambrogio L, Formica M, Monge E, Arena F, Barzaghi N, Tavera S, Canepari M, Strani G, Pomero F, Cianci MG, Gianarda M, Ruscitto L, De Martino D, Macchi S, Montagnana M, Grandinetti V, Magnani S, Radin E, Pellu V, Meucci M, Noè E, Torti P, Montagnani L, Doveri G, Giustetto G, Avdis C, Prina M, Eliantonio F, Lemut F, Semino G, Spidalieri P, Vallino D, Prota R, Buono G, Segala V, Milia MG, Aprà F, Livigni S, Manno E, Caula G, Vitali E, Liuzzi N, Pastorelli M, Caironi P, Gamna F, Scapino B, Gurioli L, Magro E, Roberti G, Santamaria GM, Daffonchio A, Varese P, Ghiazza G, Girino M, Pelazza C, Racca F, Grillo M, Del Bono V, Gianotto G, Aluffi E, Ravera E. Convalescent or standard plasma versus standard of care in the treatment of COVID-19 patients with respiratory impairment: short and long-term effects. A three-arm randomized controlled clinical trial. BMC Infect Dis 2022; 22:879. [PMID: 36418984 PMCID: PMC9682750 DOI: 10.1186/s12879-022-07716-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 08/30/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The efficacy of early treatment with convalescent plasma in patients with COVID-19 is debated. Nothing is known about the potential effect of other plasma components other than anti-SARS-CoV-2 antibodies. METHODS To determine whether convalescent or standard plasma would improve outcomes for adults in early phase of Covid19 respiratory impairment we designed this randomized, three-arms, clinical trial (PLACO COVID) blinded on interventional arms that was conducted from June 2020 to August 2021. It was a multicentric trial at 19 Italian hospitals. We enrolled 180 hospitalized adult patients with COVID-19 pneumonia within 5 days from the onset of respiratory distress. Patients were randomly assigned in a 1:1:1 ratio to standard of care (n = 60) or standard of care + three units of standard plasma (n = 60) or standard of care + three units of high-titre convalescent plasma (n = 60) administered on days 1, 3, 5 after randomization. Primary outcome was 30-days mortality. Secondary outcomes were: incidence of mechanical ventilation or death at day 30, 6-month mortality, proportion of days with mechanical ventilation on total length of hospital stay, IgG anti-SARS-CoV-2 seroconversion, viral clearance from plasma and respiratory tract samples, and variations in Sequential Organ Failure Assessment score. The trial was analysed according to the intention-to-treat principle. RESULTS 180 patients (133/180 [73.9%] males, mean age 66.6 years [IQR 57-73]) were enrolled a median of 8 days from onset of symptoms. At enrollment, 88.9% of patients showed moderate/severe respiratory failure. 30-days mortality was 20% in Control arm, 23% in Convalescent (risk ratio [RR] 1.13; 95% confidence interval [CI], 0.61-2.13, P = 0.694) and 25% in Standard plasma (RR 1.23; 95%CI, 0.63-2.37, P = 0.544). Time to viral clearance from respiratory tract was 21 days for Convalescent, 28 for Standard plasma and 23 in Control arm but differences were not statistically significant. No differences for other secondary endpoints were seen in the three arms. Serious adverse events were reported in 1.7%, 3.3% and 5% of patients in Control, Standard and Convalescent plasma arms respectively. CONCLUSIONS Neither high-titer Convalescent nor Standard plasma improve outcomes of COVID-19 patients with acute respiratory failure. Trial Registration Clinicaltrials.gov Identifier: NCT04428021. First posted: 11/06/2020.
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Affiliation(s)
- Paola Maria Manzini
- Transfusion Medicine and Blood Establishment, University Hospital City of Science and Health Turin, Corso Bramante 88, 10126 Turin, Italy
| | - Giovannino Ciccone
- grid.420240.00000 0004 1756 876XUnit of Clinical Epidemiology, University Hospital City of Science and Health Turin, CPO Piemonte, Turin, Italy
| | - Francesco Giuseppe De Rosa
- grid.7605.40000 0001 2336 6580Department of Medical Science, University of Turin Faculty of Medicine and Surgery, Turin, Italy
| | - Rossana Cavallo
- Laboratory of Microbiology and Virology, University Hospital City of Science and Health Turin, Turin, Italy
| | - Valeria Ghisetti
- grid.413671.60000 0004 1763 1028Laboratory of Microbiology and Virology, Amedeo di Savoia Hospital, Turin, Italy
| | - Sergio D’Antico
- Transfusion Medicine and Blood Establishment, University Hospital City of Science and Health Turin, Corso Bramante 88, 10126 Turin, Italy
| | - Claudia Galassi
- grid.420240.00000 0004 1756 876XUnit of Clinical Epidemiology, University Hospital City of Science and Health Turin, CPO Piemonte, Turin, Italy
| | - Fabio Saccona
- grid.420240.00000 0004 1756 876XUnit of Clinical Epidemiology, University Hospital City of Science and Health Turin, CPO Piemonte, Turin, Italy
| | - Anna Castiglione
- grid.420240.00000 0004 1756 876XUnit of Clinical Epidemiology, University Hospital City of Science and Health Turin, CPO Piemonte, Turin, Italy
| | - Nadia Birocco
- Oncology Department, University Hospital City of Science and Health Turin, Turin, Italy
| | - Tiziana Francisci
- Transfusion Medicine and Blood Establishment, University Hospital City of Science and Health Turin, Corso Bramante 88, 10126 Turin, Italy
| | - Huijing Hu
- Transfusion Medicine and Blood Establishment, University Hospital City of Science and Health Turin, Corso Bramante 88, 10126 Turin, Italy
| | - Clara Pecoraro
- Transfusion Medicine and Blood Establishment, University Hospital City of Science and Health Turin, Corso Bramante 88, 10126 Turin, Italy
| | - Franca Danielle
- Transfusion Medicine and Blood Establishment, University Hospital City of Science and Health Turin, Corso Bramante 88, 10126 Turin, Italy
| | - Luciana Labanca
- Transfusion Medicine and Blood Establishment, University Hospital City of Science and Health Turin, Corso Bramante 88, 10126 Turin, Italy
| | - Anna Maria Bordiga
- Transfusion Medicine and Blood Establishment, University Hospital City of Science and Health Turin, Corso Bramante 88, 10126 Turin, Italy
| | - Marco Lorenzi
- Immunohematology and Transfusion Medicine, S Croce and Carle Cuneo Hospital District, Cuneo, Italy
| | - Giovanni Camisasca
- Transfusion Medicine and Blood Establishment, Holy Trinity Hospital Borgomanero, Borgomanero, Italy
| | - Osvaldo Giachino
- grid.415044.00000 0004 1760 7116Transfusion Medicine, San Giovanni Bosco Hospital, Turin, Italy
| | - Mauro Pagliarino
- Maternal, Pediatric and Trauma Transfusion Medicine, University Hospital City of Science and Health Turin, Turin, Italy
| | - Piero Ottone
- grid.415081.90000 0004 0493 6869Transfusion Medicine, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | | | - Roberto Guaschino
- Transfusion Medicine, Saints Anthony and Biagio and Cesare Arrigo Alessandria National Hospital, Alessandria, Italy
| | | | - Pierluigi Berti
- Immunohematology and Transfusion Medicine, Umberto Parini Hospital, Aosta, Italy
| | - Fabrizia Pittaluga
- Laboratory of Microbiology and Virology, University Hospital City of Science and Health Turin, Turin, Italy
| | - Maria Avolio
- Laboratory of Microbiology and Virology, University Hospital City of Science and Health Turin, Turin, Italy
| | - Cristina Costa
- Laboratory of Microbiology and Virology, University Hospital City of Science and Health Turin, Turin, Italy
| | - Samuele Raso
- Maternal, Pediatric and Trauma Transfusion Medicine, University Hospital City of Science and Health Turin, Turin, Italy
| | - Aurora Nucci
- Maternal, Pediatric and Trauma Transfusion Medicine, University Hospital City of Science and Health Turin, Turin, Italy
| | - Massimo Milan
- grid.415044.00000 0004 1760 7116Transfusion Medicine, San Giovanni Bosco Hospital, Turin, Italy
| | - Alessandra Baffa
- grid.415044.00000 0004 1760 7116Transfusion Medicine, San Giovanni Bosco Hospital, Turin, Italy
| | - Alessandra Russo
- grid.415044.00000 0004 1760 7116Transfusion Medicine, San Giovanni Bosco Hospital, Turin, Italy
| | - Antonella Tornello
- Immunohematology and Transfusion Medicine, S Croce and Carle Cuneo Hospital District, Cuneo, Italy ,Immunohematology and Transfusion Medicine, ASL CN1 Mondovì, Mondovì, Italy
| | - Laura Maddalena
- Immunohematology and Transfusion Medicine, S Croce and Carle Cuneo Hospital District, Cuneo, Italy
| | | | - Fabio Paolo Marletto
- Immunohematology and Transfusion Medicine, Umberto Parini Hospital, Aosta, Italy
| | - Anna Grazia De Micheli
- Medical Emergency Division, University Hospital City of Science and Health Turin, Turin, Italy
| | - Alessio Mattei
- Pulmunology Unit, University Hospital City of Science and Health Turin, Turin, Italy
| | - Stefano Baldassano
- grid.7605.40000 0001 2336 6580Department of Clinical and Biological Science, Faculty of Medicine and Surgery, University of Turin, Turin, Italy
| | - Francesca Canta
- Infectious Diseases Unit, University Hospital City of Science and Health Turin, Turin, Italy
| | - Maria Luisa Russo
- Internal Medicine Unit, Santa Croce Hospital of Moncalieri, Moncalieri, Italy
| | - Daniele Bergamo
- Internal Medicine Unit, Santa Croce Hospital of Moncalieri, Moncalieri, Italy
| | - Francesco Vitale
- grid.414700.60000 0004 0484 5983Internal Medicine Unit, Ordine Mauriziano Di Torino Hospital, Turin, Italy
| | | | | | - Andrea Calcagno
- grid.7605.40000 0001 2336 6580Infectious Diseases Unit, Department of Medical Sciences, University of Turin Faculty of Medicine and Surgery, Turin, Italy
| | - Marcella Converso
- grid.415044.00000 0004 1760 7116Intensive Care Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Chiara Aldieri
- Infectious Diseases, S Croce and Carle Cuneo Hospital District, Cuneo, Italy
| | - Valentina Libanore
- grid.492852.0Infectious Diseases Unit, Cardinal Massaia Hospital of Asti, Asti, Italy
| | | | | | - Barbara Mitola
- grid.414700.60000 0004 0484 5983Hospital Medical Direction, Ordine Mauriziano di Torino Hospital, Turin, Italy
| | - Gitana Scozzari
- grid.413005.30000 0004 1760 6850Molinette Hospital Medical Direction, University Hospital City of Science and Health Turin, Turin, Italy
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Delgado-Fernández M, García-Gemar GM, Fuentes-López A, Muñoz-Pérez MI, Oyonarte-Gómez S, Ruíz-García I, Martín-Carmona J, Sanz-Cánovas J, Castaño-Carracedo MÁ, Reguera-Iglesias JM, Ruíz-Mesa JD. Treatment of COVID-19 with convalescent plasma in patients with humoral immunodeficiency - Three consecutive cases and review of the literature. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2022; 40:507-516. [PMID: 36336380 PMCID: PMC9631336 DOI: 10.1016/j.eimce.2021.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/20/2021] [Indexed: 06/16/2023]
Abstract
Patients lacking humoral response have been suggested to develop a less severe COVID-19, but there are some reports with a prolonged, relapsing or deadly course. From April 2020, there is growing evidence on the benefits of COVID-19 convalescent plasma (CCP) for patients with humoral immunodeficiency. Most of them had a congenital primary immunodeficiency or were on treatment with anti CD20 antibodies. We report on three patients treated in our hospital and review thirty-one more cases described in the literature. All patients but three resolved clinical picture with CCP. A dose from 200 to 800ml was enough in most cases. Antibody levels after transfusion were negative or low, suggesting consumption of them in SARS-CoV-2 neutralization. These patients have a protracted clinical course shortened after CCP. CCP could be helpful for patients with humoral immunodeficiency. It avoid relapses and chronification. CCP should be transfused as early as possible in patients with COVID-19 and humoral immunodeficiency.
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Affiliation(s)
| | | | - Ana Fuentes-López
- Microbiology Department, Hospital Universitario Clínico San Cecilio, Granada, Spain
| | | | - Salvador Oyonarte-Gómez
- Director of "Red andaluza de Medicina transfusional, tejidos y células" del Sistema Sanitario Público de Andalucía, Spain
| | | | | | - Jaime Sanz-Cánovas
- Internal Medicine Department, Hospital Regional Universitario de Málaga, Spain
| | | | | | - Juan Diego Ruíz-Mesa
- Infectious Diseases Department, Hospital Regional Universitario de Málaga, Spain
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Impact of Convalescent Plasma Therapy in Hospitalized Patients With Severe COVID-19. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2022. [DOI: 10.1097/ipc.0000000000001161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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48
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Yaugel-Novoa M, Bourlet T, Paul S. Role of the humoral immune response during COVID-19: guilty or not guilty? Mucosal Immunol 2022; 15:1170-1180. [PMID: 36195658 PMCID: PMC9530436 DOI: 10.1038/s41385-022-00569-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/07/2022] [Accepted: 09/19/2022] [Indexed: 02/04/2023]
Abstract
Systemic and mucosal humoral immune responses are crucial to fight respiratory viral infections in the current pandemic of COVID-19 caused by the SARS-CoV-2 virus. During SARS-CoV-2 infection, the dynamics of systemic and mucosal antibody infections are affected by patient characteristics, such as age, sex, disease severity, or prior immunity to other human coronaviruses. Patients suffering from severe disease develop higher levels of anti-SARS-CoV-2 antibodies in serum and mucosal tissues than those with mild disease, and these antibodies are detectable for up to a year after symptom onset. In hospitalized patients, the aberrant glycosylation of anti-SARS-CoV-2 antibodies enhances inflammation-associated antibody Fc-dependent effector functions, thereby contributing to COVID-19 pathophysiology. Current vaccines elicit robust humoral immune responses, principally in the blood. However, they are less effective against new viral variants, such as Delta and Omicron. This review provides an overview of current knowledge about the humoral immune response to SARS-CoV-2, with a particular focus on the protective and pathological role of humoral immunity in COVID-19 severity. We also discuss the humoral immune response elicited by COVID-19 vaccination and protection against emerging viral variants.
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Affiliation(s)
- Melyssa Yaugel-Novoa
- CIRI—Centre International de Recherche en Infectiologie, Team GIMAP (Saint-Etienne), Inserm, U1111, CNRS, UMR5308, ENS Lyon, UJM, Université Claude Bernard Lyon 1, Lyon, France
| | - Thomas Bourlet
- CIRI—Centre International de Recherche en Infectiologie, Team GIMAP (Saint-Etienne), Inserm, U1111, CNRS, UMR5308, ENS Lyon, UJM, Université Claude Bernard Lyon 1, Lyon, France
| | - Stéphane Paul
- CIRI—Centre International de Recherche en Infectiologie, Team GIMAP (Saint-Etienne), Inserm, U1111, CNRS, UMR5308, ENS Lyon, UJM, Université Claude Bernard Lyon 1, Lyon, France,CIC Inserm 1408 Vaccinology, Saint-Etienne, France
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Grubovic Rastvorceva RM, Useini S, Stevanovic M, Demiri I, Petkovic E, Franchini M, Focosi D. Efficacy and Safety of COVID-19 Convalescent Plasma in Hospitalized Patients-An Open-Label Phase II Clinical Trial. Life (Basel) 2022; 12:1565. [PMID: 36295001 PMCID: PMC9605182 DOI: 10.3390/life12101565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 09/14/2022] [Accepted: 09/27/2022] [Indexed: 01/24/2023] Open
Abstract
Background: COVID-19 convalescent plasma (CCP) is an important antiviral option for selected patients with COVID-19. Materials and Methods: In this open-label, phase 2, clinical trial conducted from 30 April 2020 till 10 May 2021 in the Republic of North Macedonia, we evaluated the efficacy and safety of CCP in hospitalized patients. Treatment was with a single unit of CCP having an anti-RBD IgG concentration higher than 5 AU/mL. Results: There were 189 patients that completed the study, of which 65 (34.4%) had WHO 8-point clinical progression scale score of 3 (requiring hospital care but not oxygen support), 65 (34.4%) had a score of 4 (hospitalized and requiring supplemental oxygen by mask or nasal prongs), and 59 (31.2%) had a score of 5 (hospitalized and requiring supplemental oxygen by non-invasive ventilation or high-flow oxygen). Mean age was 57 years (range 22−94), 78.5% were males, 80.4% had elevated body mass index, and 70.9% had comorbidity. Following CCP transfusion, we observed clinical improvement with increase rates in oxygenation-free days of 32.3% and 58.5% at 24 h and seven days after CCP transfusion, a decline in WHO scores, and reduced progression to severe disease (only one patient was admitted to ICU after CCP transfusion). Mortality in the entire cohort was 11.6% (22/189). We recorded 0% mortality in WHO score 3 (0/65) and in patients that received CCP transfusion in the first seven days of disease, 4.6% mortality in WHO score 4 (3/65), and 30.5% mortality in WHO score 5 (18/59). Mortality correlated with WHO score (Chi-square 19.3, p < 0.001) and with stay in the ICU (Chi-square 55.526, p ≤ 0.001). No severe adverse events were reported. Conclusions: This study showed that early administration of CCP to patients with moderate disease was a safe and potentially effective treatment for hospitalized COVID-19 patients. The trial was registered at clinicaltrials.gov (NCT04397523).
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Affiliation(s)
- Rada M. Grubovic Rastvorceva
- Institute for Transfusion Medicine of RNM, 1000 Skopje, North Macedonia
- Faculty of Medical Sciences, University Goce Delcev, 2000 Stip, North Macedonia
| | - Sedula Useini
- Institute for Transfusion Medicine of RNM, 1000 Skopje, North Macedonia
| | - Milena Stevanovic
- University Clinic for Infectious Diseases, 1000 Skopje, North Macedonia
| | - Ilir Demiri
- University Clinic for Infectious Diseases, 1000 Skopje, North Macedonia
| | - Elena Petkovic
- Institute for Transfusion Medicine of RNM, 1000 Skopje, North Macedonia
| | | | - Daniele Focosi
- North-Western Tuscany Blood Bank, Pisa University Hospital, 56124 Pisa, Italy
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50
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Cardiovascular Factors Associated with COVID-19 from an International Registry of Primarily Japanese Patients. Diagnostics (Basel) 2022; 12:diagnostics12102350. [PMID: 36292038 PMCID: PMC9600010 DOI: 10.3390/diagnostics12102350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 09/17/2022] [Accepted: 09/23/2022] [Indexed: 11/17/2022] Open
Abstract
Aims: We developed an international registry to examine cardiovascular complications of COVID-19. Methods: A REDCap form was created in March 2020 at Mayo Clinic in collaboration with the International Society of Cardiomyopathy, Myocarditis and Heart Failure (ISCMF) and data were entered from April 2020 through April 2021. Results: Of the 696 patients in the COVID-19 Registry, 411 (59.2%) were male and 283 (40.8%) were female, with a sex ratio of 1.5:1 male to female. In total, 95.5% of the patients were from Japan. The average age was 52 years with 31.5% being >65 years of age. COVID-19 patients with a history of cardiovascular disease (CVD) had more pre-existing conditions including type II diabetes (p < 0.0001), cancer (p = 0.0003), obesity (p = 0.001), and kidney disease (p = 0.001). They also had a greater mortality of 10.1% compared to 1.7% in those without a history of CVD (p < 0.0001). The most common cardiovascular conditions in patients with a history of CVD were hypertension (33.7%), stroke (5.7%) and arrhythmias (5.1%). We found that troponin T, troponin I, brain natriuretic peptide (BNP), N-terminal pro-BNP (NT-proBNP), C-reactive protein (CRP), IL-6 and lambda immunoglobulin free light chains (Ig FLC) were elevated above reference levels in patients with COVID-19. Myocarditis is known to occur mainly in adults under the age of 50, and when we examined biomarkers in patients that were ≤50 years of age and had no history of CVD we found that a majority of patients had elevated levels of troponin T (71.4%), IL-6 (59.5%), creatine kinase/CK-MB (57.1%), D-dimer (57.8%), kappa Ig FLC (75.0%), and lambda Ig FLC (71.4%) suggesting myocardial injury and possible myocarditis. Conclusions: We report the first findings to our knowledge of cardiovascular complications from COVID-19 in the first year of the pandemic in a predominantly Japanese population. Mortality was increased by a history of CVD and pre-existing conditions including type II diabetes, cancer, obesity, and kidney disease. Our findings indicate that even in cases where no abnormalities are found in ECG or ultrasound cardiography that myocardial damage may occur, and cardiovascular and inflammatory biomarkers may be useful for the diagnosis.
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