Mount Sinai to Begin the Transfer of COVID-19 
Antibodies into Critically Ill Patients

Mar 24, 2020


Image from Florian Krammer lab. The main target 
on the surface of most coronaviruses is the spike 
protein or S. This is a model of the virus and a 
visualization of a crystal structure of the spike of SARS-CoV-2.

The Mount Sinai Health System this week plans to 
initiate a procedure known as plasmapheresis, 
where the antibodies from patients who have 
recovered from COVID-19 will be transferred into 
critically ill patients with the disease, with 
the expectation that the antibodies will neutralize it.

The process of using antibody-rich plasma from 
COVID-19 patients to help others was used 
successfully in China, according to a state-owned 
organization, which reported that some patients 
improved within 24 hours, with reduced 
inflammation and viral loads, and better oxygen levels in the blood.

Mount Sinai is collaborating with the New York 
Blood Center and the New York State Department of 
Health’s Wadsworth Center laboratory in Albany, 
with guidance from the U.S. Food and Drug 
Administration, and expects to begin implementing 
the treatment later this week.

“We are hoping to identify patients who can 
provide the antibodies,” says 
S. Charney, MD, Anne and Joel Ehrenkranz Dean of 
the Icahn School of Medicine at Mount Sinai, and 
President for Academic Affairs, Mount Sinai 
Health System. “We are at the front lines in 
fighting this pandemic and making discoveries that will help our patients.”

Late last week, researchers at the Icahn School 
of Medicine, in collaboration with scientists in 
Australia and Finland, were among the first to 
create an antibody test that detects the 
disease’s antibodies in a person’s blood. 
Development of the enzyme-linked immunosorbent 
assay (ELISA) was led by 
Krammer, PhD, Professor of Microbiology, in 
collaboration with 
A. Simon, MD, PhD, Professor of Microbiology and 
Medicine (Infectious Diseases). Dr. Krammer, a 
renowned influenza researcher, recently made this 
so-called recipe available to other laboratories 
around the world so they can replicate it during 
the pandemic. In January, his lab was quickly 
retooled to begin studying COVID-19.

In addition to its widespread use in 
plasmapheresis, the antibody test will provide 
experts with an accurate infection rate so they 
can track the trajectory of the disease. The test 
will help identify health care workers who are 
already immune to the disease, who can work 
directly with infectious patients, and it can 
also help scientists understand how the human 
immune system reacts to the virus.

The new assay uses recombinant or manufactured 
antigens from the spike protein on the surface of 
the SARS-CoV-2 virus. That protein helps the 
virus enter cells, and it is a key target in the 
immune reaction against the virus, as the body 
creates antibodies that recognize the protein and 
seek to destroy the virus. The researchers also 
isolated the short piece of the spike protein 
called the receptor-binding domain (RBD), which 
the virus uses to attach to cells it tries to 
invade. The scientists then used cell lines to 
produce large quantities of the altered spike proteins and RBDs.

According to Dr. Krammer and his co-authors, the 
assay is “sensitive and specific,” and allows for 
the screening and identification of COVID-19 in 
human plasma/serum as soon as three days after 
the onset of symptoms. The antibodies were 
derived from three patients who had the disease. 
The study’s control participants­who did not have 
COVID-19 but had other viruses, including the 
common cold­ranged in age from 20 to 70.

Dr. Krammer says his preliminary findings also 
show that humans have no natural immunity to the 
SARS-CoV-2 virus, which would help explain why it 
spreads so quickly. But once the antibody sets in 
humans do become protected. He also says that at 
this early stage in the research, there is no 
evidence that people can lose their immunity and become re-infected.