Immunomodulation Effect of Convalescent Plasma Therapy in Severe – Critical COVID-19 Patients

Abstract

Introduction

Convalescent plasma therapy (CPT) is an alternative therapy for managing COVID-19, but its use is still controversial.

Objective

Analyzing the effectiveness of CPT in modulating immune responses based on SARS-COV-2 anti-spike protein receptor-binding domain (s-RBD) IgG, inflammatory cytokines (IL-6 and IL-4), and mortality in severe-critical COVID-19 patients.

Methods

This study was an observational analytical with a prospective cohort design. The number of participants was 39 patients from June to December 2020. The participants received CPT and was tested for blood analysis such as IL-4, IL-6 and s-RBD IgG. The data were taken a day before CPT, 1st day, 2nd day, and 7th day after CPT. The analysis included Friedman, Pearson correlation, and Mann–Whitney test which is significant if p <0.05.

Results

The value of participant’s s-RBD IgG before CPT was 91.49 (0.43–3074.73) AU/mL and the 7th day post-CPT, s-RBD IgG value of 1169.79 (6.48–5577.91) AU/mL (p <0.001). The IL-4 value before CPT was 1.78 (0.85–5.21) ng/mL and the 7th day post-CPT, IL-4 value of 1.97 (0.87–120.30) ng/mL (p = 0.401). The condition was also found in IL-6 value, in which the IL-4 value participant before CPT was 109.61 (0.73–4701.63) ng/mL and the 7th day post-CPT, IL-6 value of 1.97 (0.87–120.30) ng/mL (p = 0.401). No significant correlation found between increased s-RBD IgG level with increased IL-4 and decreased IL-6 before and after CPT in severe-critical COVID-19 patients (p >0.05). No significant correlation was also found between increased s-RBD IgG levels, IL-4 too, and decreased IL-6 after CPT therapy between deceased and alive patients, both in 1st, 2nd, and 7th days (p >0.05).

Conclusion

No correlation between the increase in s-RBD IgG levels and changes in IL-4 and IL-6 levels. Changes in s-RBD IgG, IL-4, and IL-6 levels are not associated with mortality in severe-critical COVID-19 degree post CPT recipients.

Keywords:

• convalescent plasma
• COVID-19
• infectious disease
• s-RBD

Ethical Approval

This study has been reviewed by the Health Research Ethics Committee of Dr Soetomo General Academic Hospital, Surabaya, Indonesia (0073/KEPK/IX/2020).

Consent

All participants received an explanation regarding the rights and obligations during study. Written informed consent was obtained from the participant or guardian for publication of the study based on Declaration of Helsinki.

Acknowledgment

We would like to thank our editor, “Fis Citra Ariyanto” and all the laboratory technician staff of the Clinical Pathology Laboratory in Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.

Disclosure

The authors report no conflicts of interest in this work.