Antibody-based immunotherapeutics and use of convalescent plasma to counter COVID-19: advances and prospects

ABSTRACT

Introduction

Coronavirus disease 2019 (COVID-19) has spread to several countries globally. Currently, there is no specific drug or vaccine available for managing COVID-19. Antibody-based immunotherapeutic strategies using convalescent plasma, monoclonal antibodies (mAbs), neutralizing antibodies (NAbs), and intravenous immunoglobulins have therapeutic potential.

Areas covered

This review provides the current status of the development of various antibody-based immunotherapeutics such as convalescent plasma, mAbs, NAbs, and intravenous immunoglobulins against COVID-19. The review also highlights their advantages, disadvantages, and clinical utility for the treatment of COVID-19 patients.

Expert opinion

In a pandemic situation such as COVID-19, the development of new drugs should focus on and expedite the strategies where safety and efficacy are proven. Antibody-based immunotherapeutic approaches such as convalescent plasma, intravenous immunoglobulins, and mAbs have a proven record of safety and efficacy and are in use for decades. Some of them are already being used to manage COVID-19 patients and found to be useful. However, the mAbs with virus neutralization potential is the need of the hour during this COVID-19 pandemic to be more specific and virus targeted. The research and investment need to be accelerated to bring them into clinical use for prophylactic and therapeutic purposes against COVID-19.

KEYWORDS:

• COVID-19
• SARS-CoV-2
• coronavirus
• immunotherapeutics
• immunoglobulin
• convalescent plasma
• neutralizing antibodies
• monoclonal antibodies

Article highlights

• Vaccines are needed to induce active immunity against SARS-COV-2; however, it may take a long time to get approval and to make it available in the commercial market.

• The gap produced due to the lack of an efficient vaccine against SARS-CoV-2 can be bridged using antibody-based immunotherapeutics for inducing short term immunity.

• Antibody-based immunotherapeutics strategies such as convalescent plasma, monoclonal antibodies (MAbs), neutralizing antibodies (NAbs), and intravenous immunoglobulins (IVIg) have potential therapeutic application against COVID-19.

• Convalescent plasma therapy is already used for managing COVID-19 patients; however, the neutralization potential of plasma needs to be tested to prove its therapeutic utility.

• Approved MAbs against IL-6, IL-6R are used for treating COVID-19 induced pathological conditions such as cytokine storm or cytokine release syndrome.

• Even though SARS-CoV and SARS-CoV-2 share high similarity in their domains, SARS-CoV-2-specific immunotherapeutic approaches are required due to the limited cross-reactivity between these two closely related coronaviruses.

• Monoclonal antibody-based immunotherapeutics are highly specific against the virus and safer compared to plasma therapy. Many monoclonal antibodies against the SARS-COV-2 are under development for the clinical use to treat COVID-19 patients.

• Monoclonal antibodies against the receptor-binding domain of the S1 subunit of spike protein show virus neutralization potential. There is a need for expediting the research to develop new MAbs and bringing the existing SARS-COV-2 specific MAbs into the clinic as quickly as possible.

• This box summarizes key points contained in the article.

Acknowledgments

All the authors acknowledge and thank their respective Institutes and Universities.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper is not Funded.