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COVID-19 convalescent plasma composition and immunological effects in severe patients

  • Acosta-Ampudia, Yeny1
  • Monsalve, Diana M.1
  • Rojas, Manuel1
  • Rodríguez, Yhojan1, 2
  • Gallo, Juan Esteban3
  • Salazar-Uribe, Juan Carlos4
  • Santander, María José5
  • Cala, Mónica P.5
  • Zapata, Wildeman6
  • Zapata, María Isabel6
  • Manrique, Rubén7
  • Pardo-Oviedo, Juan Mauricio8
  • Camacho, Bernardo9
  • Ramírez-Santana, Carolina1
  • Anaya, Juan-Manuel1, 2
  • 1 Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
  • 2 Clínica del Occidente, Bogota, Colombia
  • 3 GenomaCES, Universidad CES, Medellin, Colombia
  • 4 Research Group in Statistics, Universidad Nacional de Colombia, Medellin, Colombia
  • 5 Metabolomics Core Facility-MetCore, Vicepresidency for Research, Universidad de los Andes, Bogota, Colombia
  • 6 Grupo Inmunovirología, Facultad de Medicina, Universidad de Antioquia, Medellin, Colombia
  • 7 Epidemiology and Biostatistics Research Group, Universidad CES, Medellin, Colombia
  • 8 Hospital Universitario Mayor Méderi, Universidad del Rosario, Bogota, Colombia
  • 9 Instituto Distrital de Ciencia Biotecnología e Investigación en Salud, IDCBIS, Bogota, Colombia
Published Article
Journal of Autoimmunity
Publication Date
Jan 22, 2021
DOI: 10.1016/j.jaut.2021.102598
PMID: 33524876
PMCID: PMC7826092
PubMed Central


Convalescent plasma (CP) has emerged as a treatment for COVID-19. However, the composition and mechanism of action are not fully known. Therefore, we undertook a two-phase controlled study in which, first the immunological and metabolomic status of recovered and severe patients were evaluated. Secondly, the 28-day effect of CP on the immune response in severe patients was assessed. Nineteen recovered COVID-19 patients, 18 hospitalized patients with severe disease, and 16 pre-pandemic controls were included. Patients with severe disease were treated with CP transfusion and standard therapy (i.e., plasma recipients, n = 9) or standard therapy alone (n = 9). Clinical and biological assessments were done on day 0 and during follow-up on days 4, 7, 14, and 28. Clinical parameters, viral load, total immunoglobulin (Ig) G and IgA anti-S1-SARS-CoV-2 antibodies, neutralizing antibodies (NAbs), autoantibodies, cytokines, T and B cells, and metabolomic and lipidomic profiles were examined. Total IgG and IgA anti-S1-SARS-CoV-2 antibodies were key factors for CP selection and correlated with NAbs. In severe COVID-19 patients, mostly interleukin (IL)-6 ( P  = <0.0001), IL-10 ( P  = <0.0001), IP-10 ( P  = <0.0001), fatty acyls and glycerophospholipids were higher than in recovered patients. Latent autoimmunity and anti–IFN–α antibodies were observed in both recovered and severe patients. COVID-19 CP induced an early but transient cytokine profile modification and increases IgG anti-S1-SARS-CoV-2 antibodies. At day 28 post-transfusion, a decrease in activated, effector and effector memory CD4+ ( P  < 0.05) and activated and effector CD8+ ( P  < 0.01) T cells and naïve B cells ( P  = 0.001), and an increase in non-classical memory B cells ( P =<0.0001) and central memory CD4+ T cells ( P  = 0.0252) were observed. Moreover, IL-6/IFN-γ ( P  = 0.0089) and IL-6/IL-10 ( P  = 0.0180) ratios decreased in plasma recipients compared to those who received standard therapy alone. These results may have therapeutic implications and justify further post-COVID-19 studies.

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