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A role for Nucleocapsid-specific antibody function in Covid-19 Convalescent plasma therapy

Herman, J. D.; Wang, C.; Burke, J. S.; Zur, Y.; Compere, H.; Kang, J.; Macvicar, R.; Shin, S.; Frank, I.; Siegel, D.; Tebas, P.; Choi, G. H.; Shaw, P. A.; Yoon, H.; Pirofski, L.-a.; Juelg, B.; Bar, K. J.; Lauffenburger, D.; Alter, G.

2022-02-22 infectious diseases
10.1101/2022.02.19.22271230 medRxiv
Show abstract

COVID-19 convalescent plasma (CCP), a passive polyclonal antibody therapeutic, has exhibited mixed results in the treatment of COVID-19. Given that the therapeutic effect of CCP may extend beyond the ability of SARS-CoV-2-specific antibody binding and neutralization to influence the evolution of the endogenous antibody response, we took a systematic and comprehensive approach to analyze SARS-CoV-2 functional antibody profiles of participants in a randomized controlled trial of CCP treatment of individuals hospitalized with COVID-19 pneumonia where CCP was associated with both decreased mortality and improved clinical severity. Using systems serology, we found that the clinical benefit of CCP is related to a shift towards reduced inflammatory Spike (S) responses and enhanced Nucleocapsid (N) humoral responses. We found CCP had the greatest clinical benefit in participants with low pre-existing anti-SARS-CoV-2 antibody function, rather than S or N antibody levels or participant demographic features. Further, CCP induced immunomodulatory changes to recipient humoral profiles persisted for at least two months, marked by the selective evolution of anti-inflammatory Fc-glycan profiles and persistently expanded nucleocapsid-specific humoral immunity following CCP therapy. Together, our findings identify a novel mechanism of action of CCP, suggest optimal patient characteristics for CCP treatment, identify long-last immunomodulatory effects of CCP, and provide guidance for development of novel N-focused antibody therapeutics for severe COVID-19 hyperinflammation.

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