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Challenges of convalescent plasma infusion therapy in Middle East respiratory coronavirus infection: a single centre experience.
Antivir Ther. 2018; 23(7):617-622.AT

Abstract

BACKGROUND

The effects of convalescent plasma (CP) infusion, one of the treatment options for severe Middle East respiratory syndrome coronavirus (MERS-CoV) infections, have not yet been evaluated.

METHODS

Serological responses of CP-infused MERS patients during the 2015 Korean MERS outbreak at a tertiary care centre were evaluated. Serological activity was evaluated with anti-MERS-CoV enzyme-linked immunosorbent assay (ELISA) immunoglobulin (Ig)G, ELISA IgA, immunofluorescence assay IgM and plaque reduction neutralization test (PRNT). Donor plasma and one or two recipient's serum samples per week of illness including one taken the day after each CP infusion were evaluated. For sensitivity and specificity analysis of ELISA IgG in predicting neutralization activity, a data set of 138 previously evaluated MERS-CoV-infected patients was used.

RESULTS

Three of thirteen MERS patients with respiratory failure received four CP infusions from convalesced MERS-CoV-infected patients, and only two of them showed neutralizing activity. Donor plasma with a PRNT titre 1:80 demonstrated meaningful serological response after CP infusion, while that with a PRNT titre 1:40 did not. ELISA IgG predicted neutralization activity of a PRNT titre ≥1:80 with more than 95% specificity at a cutoff optical density (OD) ratio of 1.6, and with 100% specificity at an OD ratio of 1.9.

CONCLUSIONS

For effective CP infusion in MERS, donor plasma with a neutralization activity of a PRNT titre ≥1:80 should be used. ELISA IgG could substitute for the neutralization test in resource-limited situations.

Authors+Show Affiliations

Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Present address: Division of Infectious Diseases, Department of Internal Medicine, Armed Forces Capital Hospital, Seongnam, Republic of Korea.Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.Asia Pacific Foundation for Infectious Diseases (APFID), Seoul, Republic of Korea.Asia Pacific Foundation for Infectious Diseases (APFID), Seoul, Republic of Korea.Division of Infectious Diseases, Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.Institute of Virology, Charité Universitätsmedizin Berlin, Berlin, Germany. German Centre for Infection Research, Braunschweig, Germany.Institute of Virology, Charité Universitätsmedizin Berlin, Berlin, Germany. German Centre for Infection Research, Braunschweig, Germany.Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Asia Pacific Foundation for Infectious Diseases (APFID), Seoul, Republic of Korea.Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Asia Pacific Foundation for Infectious Diseases (APFID), Seoul, Republic of Korea.Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

Pub Type(s)

Case Reports
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29923831

Citation

Ko, Jae-Hoon, et al. "Challenges of Convalescent Plasma Infusion Therapy in Middle East Respiratory Coronavirus Infection: a Single Centre Experience." Antiviral Therapy, vol. 23, no. 7, 2018, pp. 617-622.
Ko JH, Seok H, Cho SY, et al. Challenges of convalescent plasma infusion therapy in Middle East respiratory coronavirus infection: a single centre experience. Antivir Ther. 2018;23(7):617-622.
Ko, J. H., Seok, H., Cho, S. Y., Ha, Y. E., Baek, J. Y., Kim, S. H., Kim, Y. J., Park, J. K., Chung, C. R., Kang, E. S., Cho, D., Müller, M. A., Drosten, C., Kang, C. I., Chung, D. R., Song, J. H., & Peck, K. R. (2018). Challenges of convalescent plasma infusion therapy in Middle East respiratory coronavirus infection: a single centre experience. Antiviral Therapy, 23(7), 617-622. https://doi.org/10.3851/IMP3243
Ko JH, et al. Challenges of Convalescent Plasma Infusion Therapy in Middle East Respiratory Coronavirus Infection: a Single Centre Experience. Antivir Ther. 2018;23(7):617-622. PubMed PMID: 29923831.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Challenges of convalescent plasma infusion therapy in Middle East respiratory coronavirus infection: a single centre experience. AU - Ko,Jae-Hoon, AU - Seok,Hyeri, AU - Cho,Sun Young, AU - Ha,Young Eun, AU - Baek,Jin Yang, AU - Kim,So Hyun, AU - Kim,Yae-Jean, AU - Park,Jin Kyeong, AU - Chung,Chi Ryang, AU - Kang,Eun-Suk, AU - Cho,Duck, AU - Müller,Marcel A, AU - Drosten,Christian, AU - Kang,Cheol-In, AU - Chung,Doo Ryeon, AU - Song,Jae-Hoon, AU - Peck,Kyong Ran, Y1 - 2018/06/20/ PY - 2018/06/07/accepted PY - 2018/6/21/pubmed PY - 2019/9/26/medline PY - 2018/6/21/entrez SP - 617 EP - 622 JF - Antiviral therapy JO - Antivir Ther VL - 23 IS - 7 N2 - BACKGROUND: The effects of convalescent plasma (CP) infusion, one of the treatment options for severe Middle East respiratory syndrome coronavirus (MERS-CoV) infections, have not yet been evaluated. METHODS: Serological responses of CP-infused MERS patients during the 2015 Korean MERS outbreak at a tertiary care centre were evaluated. Serological activity was evaluated with anti-MERS-CoV enzyme-linked immunosorbent assay (ELISA) immunoglobulin (Ig)G, ELISA IgA, immunofluorescence assay IgM and plaque reduction neutralization test (PRNT). Donor plasma and one or two recipient's serum samples per week of illness including one taken the day after each CP infusion were evaluated. For sensitivity and specificity analysis of ELISA IgG in predicting neutralization activity, a data set of 138 previously evaluated MERS-CoV-infected patients was used. RESULTS: Three of thirteen MERS patients with respiratory failure received four CP infusions from convalesced MERS-CoV-infected patients, and only two of them showed neutralizing activity. Donor plasma with a PRNT titre 1:80 demonstrated meaningful serological response after CP infusion, while that with a PRNT titre 1:40 did not. ELISA IgG predicted neutralization activity of a PRNT titre ≥1:80 with more than 95% specificity at a cutoff optical density (OD) ratio of 1.6, and with 100% specificity at an OD ratio of 1.9. CONCLUSIONS: For effective CP infusion in MERS, donor plasma with a neutralization activity of a PRNT titre ≥1:80 should be used. ELISA IgG could substitute for the neutralization test in resource-limited situations. SN - 2040-2058 UR - https://www.unboundmedicine.com/medline/citation/29923831/full_citation DB - PRIME DP - Unbound Medicine ER -