Case Report: Stepwise Anti-Inflammatory and Anti-SARS-CoV-2 Effects Following Convalescent Plasma Therapy With Full Clinical Recovery

Article Article scientifique Rapport de cas Case Report: Stepwise Anti-Inflammatory and Anti-SARS-CoV-2 Effects Following Convalescent Plasma Therapy With Full Clinical Recovery eng 2021 author Zimmerli Aurelia author Monti Matteo author Fenwick Craig author Eckerle Isabella Anne 894639 author Beigelman-Aubry Catherine author Pellaton Céline 644348 author Jaton Katia author Dumas Dominique author Stamm Gian-Marco author Infanti Laura author Andreu-Ullrich Heidrun author Germann Daphné 701598 author Mean Marie author Vollenweider Peter 724488 author Stadelmann Raphael author Prella Maura 564293 author Comte Denis 839841 author Guery Benoit author Gachoud David 506455 author Rufer Nathalie 28152 10.3389/fimmu.2021.613502 33968017 1664-3224 https://www.frontiersin.org/articles/10.3389/fimmu.2021.613502/full In these times of COVID-19 pandemic, concern has been raised about the potential effects of SARS-CoV-2 infection on immunocompromised patients, particularly on those receiving B-cell depleting agents and having therefore a severely depressed humoral response. Convalescent plasma can be a therapeutic option for these patients. Understanding the underlying mechanisms of convalescent plasma is crucial to optimize such therapeutic approach. Here, we describe a COVID-19 patient who was deeply immunosuppressed following rituximab (anti-CD20 monoclonal antibody) and concomitant chemotherapy for chronic lymphoid leukemia. His long-term severe T and B cell lymphopenia allowed to evaluate the treatment effects of convalescent plasma. Therapeutic outcome was monitored at the clinical, biological and radiological level. Moreover, anti-SARS-CoV-2 antibody titers (IgM, IgG and IgA) and neutralizing activity were assessed over time before and after plasma transfusions, alongside to SARS-CoV-2 RNA quantification and virus isolation from the upper respiratory tract. Already after the first cycle of plasma transfusion, the patient experienced rapid improvement of pneumonia, inflammation and blood cell counts, which may be related to the immunomodulatory properties of plasma. Subsequently, the cumulative increase in anti-SARS-CoV-2 neutralizing antibodies due to the three additional plasma transfusions was associated with progressive and finally complete viral clearance, resulting in full clinical recovery. In this case-report, administration of convalescent plasma revealed a stepwise effect with an initial and rapid anti-inflammatory activity followed by the progressive SARS-CoV-2 clearance. These data have potential implications for a more extended use of convalescent plasma and future monoclonal antibodies in the treatment of immunosuppressed COVID-19 patients. B-cell depletion Chronic SARS-CoV-2 infection Convalescent plasma therapy Neutralizing antibodies Severe immunosuppression Viral clearance Dewey 616 56 Département de médecine 221 false 1255 Virus émergents 993 Frontiers in Immunology 12 ffd0e0f3-f643-4409-82ab-498a971c9011 Article (Published version) Public fimmu-12-613502.pdf 1342797 application/pdf CC BY bce18286-1cd9-41e2-8f36-040d06b01d9b Supplemental data Public sarscov.pdf 143605 application/pdf CC BY openAccess Faculté de médecine / Section de médecine clinique / Département de médecine

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Case Report: Stepwise Anti-Inflammatory and Anti-SARS-CoV-2 Effects Following Convalescent Plasma Therapy With Full Clinical Recovery	Frontiers in Immunology			2021	245	105

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