key: cord-0931107-2t27je00
authors: Kumar, Saurabh; Sharma, Vinit; Priya, Kanu
title: Battle against COVID-19: Efficacy of Convalescent Plasma as an emergency therapy
date: 2020-06-02
journal: Am J Emerg Med
DOI: 10.1016/j.ajem.2020.05.101
sha: 6545363cbc0ab7e8e4e428f88dc5c2eb72d9bc8b
doc_id: 931107
cord_uid: 2t27je00

nan

. CP transfusion improves clinical symptoms and reduces the mortality rate [4] .

A previous exploratory study on SARS and severe influenza performed in 2014, which included 32 separate studies, identified a reduction in mortality rate after CP transfusion. The study showed pooled odds of mortality reduced after CP therapy compared to the placebo or no treatment (OR, 0.25; 95% CI, 0.14-0.45; I2= 0%) [5] Phylogenetic and molecular sequencing-based studies suggest the similarity between the present COVID-19 virus and previously reported SARS and MERS viruses.

Therefore, CP transfusion could be an effective therapy against COVID-19 (Table 1) .

Recently published article on ten critically ill COVID-19 patients transfused with a single (Table 2) . Recently FDA has approved the use of CP therapy for critically ill COVID-19 patients [14, 15] .

In CP therapy, passive immunization takes place where antibodies act as an active agent for a specific pathogen. CP antibodies exert their therapeutic effect through different mechanisms. Antibody neutralizes the viral pathogenesis by directly binding to the epitope of a virus. Other modes of action include antibody-dependent cellular cytotoxicity (ADCC), and activation of the complement system [16] . The serum of Journal Pre-proof J o u r n a l P r e -p r o o f 4 recovered patients will develop a humoral immune response in terms of the IgG antibody against various epitopes of the COVID-19 virus (Fig. 1) . The receptor-binding domain (RBD) of this virus acts as both an antibody epitope and a binding site for ACE-2 (Angiotensin-converting enzyme-2) receptor, which is known as a significant entry receptor for COVID-19 to display its toxicity. The IgG derived from plasma of recovered patients has the potential to compete with ACE-2 receptors for binding with RBD of COVID-19, and it might neutralize the infection caused by the virus [17] .

There are minimal studies to report the adverse events caused by CP therapy, and one such incident occurred during the Ebola outbreak. It could be due to a lack of the neutralizing antibody titration data. Of the 99 patients studied, 8% showed minor problems, with 5% having increased temperature, and 4% reported itching/body rash [18] . Two separate studies on patients of Ebola [18] , and MERS [19] In conclusion, an increase in the number of deaths and a lack of potential effective antiviral therapy against COVID-19 urges an emergency approach that may contribute to saving lives. It is essential to check the required optimal doses, the concentration of nAb titers, treatment points, and the severity of the diseases before the transfusion. J o u r n a l P r e -p r o o f Journal Pre-proof Figure 1 

Challenges of convalescent plasma infusion therapy in Middle East respiratory coronavirus infection: a single centre experience

Convalescent plasma treatment reduced mortality in patients with severe pandemic influenza A (H1N1) 2009 virus infection

Use of convalescent plasma therapy in SARS patients in Hong Kong

Treatment with convalescent plasma for critically ill patients with SARS-CoV-2 infection

Convalescent Plasma 13

Use of convalescent plasma therapy in two COVID-19 patients with acute respiratory distress syndrome in Korea

Covid-19: FDA approves use of convalescent plasma to treat critically ill patients

Convalescent Plasma To Treat Coronavirus Disease 2019 (Covid-19): Considerations For Clinical Trial Design

Deployment of convalescent plasma for the prevention and treatment of COVID-19

Convalescent Plasma as a plausible therapeutic option in nCOVID-19-A Review

Evaluation of convalescent plasma for Ebola virus disease in Guinea

Possible transfusion-related acute lung injury following convalescent plasma transfusion in a patient with Middle East respiratory syndrome