Mount Sinai to Begin the Transfer of COVID-19 Antibodies into
Critically Ill Patients
Mar 24, 2020
https://inside.mountsinai.org/blog/mount-sinai-to-begin-the-transfer-of-covid-19-antibodies-into-critically-ill-patients/
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
Dennis 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
Florian
Krammer, PhD, Professor of Microbiology, in collaboration with
Viviana 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.