scholarly journals Effective use of monoclonal antibodies for treatment of persistent COVID-19 infection in a patient on rituximab

2021 ◽  
Vol 14 (8) ◽  
pp. e243469
Author(s):  
Carlos X Rabascall ◽  
Becky X Lou ◽  
Brianne Navetta-Modrov ◽  
Stella S Hahn
Keyword(s):  
Monoclonal Antibodies ◽  
Symptom Onset ◽  
Severe Disease ◽  
Therapeutic Window ◽  
Immunosuppressed Patient ◽  
Unique Case ◽  
Risk Of Progression ◽  
Immunosuppressed Patients ◽  
Effective Use ◽  
Potential Use

As we are over a year into the COVID-19 pandemic, we have made many forward strides in therapeutics. These treatments, such as monoclonal antibodies, have help mitigate the detrimental and often fatal consequences of COVID-19. The current indication for the use of monoclonal antibodies is mild to moderate COVID-19 infection within 10 days of symptom onset in those who are at high risk of progression to severe disease. However, their role in patients with prolonged symptoms is not clear. We present a unique case of monoclonal antibodies use after 54 days of symptom onset in an immunosuppressed patient with persistent COVID-19 infection despite standard treatment. This case illustrates the potential use of monoclonal antibodies outside of the current recommended therapeutic window in immunosuppressed patients, who may have difficulty with viral clearance.

scholarly journals Monoclonal Antibodies against SARS-CoV-2: Current Scenario and Future Perspectives

2021 ◽  
Vol 14 (12) ◽  
pp. 1272
Author(s):  
Eugenia Quiros-Roldan ◽  
Silvia Amadasi ◽  
Isabella Zanella ◽  
Melania Degli Antoni ◽  
Samuele Storti ◽  
...  
Keyword(s):  
Monoclonal Antibodies ◽  
Therapeutic Potential ◽  
Severe Disease ◽  
Medical Field ◽  
Moderate Disease ◽  
Critical Issues ◽  
Risk Of Progression ◽  
Current Scenario ◽  
Manufacturing Techniques ◽  
Insight Into

Monoclonal antibodies (mAbs) have been known since the 1970s. However, their therapeutic potential in the medical field has recently emerged, with the advancement of manufacturing techniques. Initially exploited mainly in the oncology field, mAbs have become increasingly relevant in Infectious Diseases. Numerous mAbs have been developed against SARS-CoV 2 and have proven their effectiveness, especially in the management of the mild-to-moderate disease. In this review, we describe the monoclonal antibodies currently authorized for the treatment of the coronavirus disease 19 (COVID-19) and offer an insight into the clinical trials that led to their approval. We discuss the mechanisms of action and methods of administration as well as the prophylactic and therapeutic labelled indications (both in outpatient and hospital settings). Furthermore, we address the critical issues regarding mAbs, focusing on their effectiveness against the variants of concern (VoC) and their role now that a large part of the population has been vaccinated. The purpose is to offer the clinician an up-to-date overview of a therapeutic tool that could prove decisive in treating patients at high risk of progression to severe disease.

scholarly journals Early Fever Is Associated With Clinical Outcomes in Patients With Coronavirus Disease

2021 ◽  
Vol 9 ◽  
Author(s):  
Feng-ming Ding ◽  
Yun Feng ◽  
Lei Han ◽  
Yan Zhou ◽  
Yong Ji ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Critically Ill ◽  
Symptom Onset ◽  
Critically Ill Patients ◽  
Severe Disease ◽  
Multivariable Analysis ◽  
Reactive Protein ◽  
Increased Temperature ◽  
Kaplan Meier ◽  
Image Improvement

Fever is one of the typical symptoms of coronavirus disease (COVID-19). We aimed to investigate the association between early fever (EF) and clinical outcomes in COVID-19 patients. A total of 1,014 COVID-19 patients at the Leishenshan Hospital were enrolled and classified into the EF and non-EF groups based on whether they had fever within 5 days of symptom onset. Risk factors for clinical outcomes in patients with different levels of disease severity were analyzed using multivariable analyses. Time from symptom onset to symptom alleviation, CT image improvement, and discharge were longer for patients with moderate and severe disease in the EF group than in the non-EF group. Multivariable analysis showed that sex, EF, eosinophil number, C-reactive protein, and IL-6 levels were positively correlated with the time from symptom onset to hospital discharge in moderate cases. The EF patients showed no significant differences in the development of acute respiratory distress syndrome, compared with the non-EF patients. The Kaplan–Meier curve showed no obvious differences in survival between the EF and non-EF patients. However, EF patients with increased temperature showed markedly lower survival than the non-EF patients with increased temperature. EF had no significant impact on the survival of critically ill patients, while an increase in temperature was identified as an independent risk factor. EF appears to be a predictor of longer recovery time in moderate/severe COVID-19 infections. However, its value in predicting mortality needs to be considered for critically ill patients with EF showing increasing temperature.

scholarly journals Analytical and diagnostic performances of a high-throughput immunoassay for SARS-CoV-2 IgM and IgG

2020 ◽  
Author(s):  
Andrea Padoan ◽  
Chiara Cosma ◽  
Paolo Zaupa ◽  
Mario Plebani
Keyword(s):  
Sensitivity And Specificity ◽  
Symptom Onset ◽  
Severe Disease ◽  
Onset Time ◽  
Time Frame ◽  
Serum Samples ◽  
Time Period ◽  
Analytical Imprecision ◽  
Range Of Values

BackgroundAbstractReliable SARS-CoV-2 serological assays are required for diagnosing infections, for the serosurveillance of past exposures and for assessing the response to future vaccines. In this study, the analytical and clinical performances of a chemiluminescent immunoassays for SARS-CoV-2 IgM and IgG detection (Mindray CL-1200i), targeting Nucleocapsid (N) and receptor binding domain (RBD) portion of the Spike protein, were evaluated.MethodsPrecision and linearity were evaluated using standardized procedures. A total of 157 leftover serum samples from 81 hospitalized confirmed COVID-19 patients (38 with moderate and 43 with severe disease) and 76 SARS-CoV-2 negative subjects (44 healthcare workers, 20 individuals with rheumatic disorders, 12 pregnant women) were included in the study. In an additional series of 44 SARS-CoV-2 positive, IgM and IgG time kinetics were also evaluated in a time-period of 38 days.ResultsPrecision was below or equal to 4% for both IgM and IgG, in all the studied levels, whilst a slightly significant deviation from linearity was observed for both assays in the range of values covering the manufacturer’s cut-off. Considering a time frame ≥ 12 days post symptom onset, sensitivity and specificity for IgM were 92.3% (95%CI:79.1%-98.4%) and 92.1% (95%CI:83.6%-97.0%). In the same time frame, sensitivity and specificity for IgG were 100% (95%CI:91.0%-100%) and 93.4% (95%CI:85.3%-97.8%). The assays agreement was 73.9% (Cohen’s kappa of 0.373). Time kinetics showed a substantial overlapping of IgM and IgG response, the latter values being elevated up to 38 days from symptoms onset.ConclusionsAnalytical imprecision is satisfactory as well as the linearity, particularly when taking into account the fact that both assays are claimed to be qualitative. Diagnostic sensitivity of IgG was excellent, especially considering specimens collected ≥12 days post symptom onset. Time kinetics suggest that IgM and IgG are detectable early in the course of infection, but the role of SARS-CoV-2 antibodies in clinical practice still requires further evaluations.

scholarly journals A stem-loop RNA RIG-I agonist confers prophylactic and therapeutic protection against acute and chronic SARS-CoV-2 infection in mice

2021 ◽  
Author(s):  
Tianyang Mao ◽  
Benjamin Israelow ◽  
Carolina Lucas ◽  
Chantal B. F. Vogels ◽  
Olga Fedorova ◽  
...  
Keyword(s):  
Therapeutic Potential ◽  
Severe Disease ◽  
Adaptive Immune System ◽  
Type I ◽  
Dependent Manner ◽  
Protective Capacity ◽  
Viral Control ◽  
Stem Loop ◽  
Immunodeficient Mice ◽  
Immunosuppressed Patients

As SARS-CoV-2 continues to cause morbidity and mortality around the world, there is an urgent need for the development of effective medical countermeasures. Here, we assessed the antiviral capacity of a minimal RIG-I agonist, stem-loop RNA 14 (SLR14), in viral control, disease prevention, post-infection therapy, and cross-variant protection in mouse models of SARS-CoV-2 infection. A single dose of SLR14 prevented viral replication in the lower respiratory tract and development of severe disease in a type I interferon (IFN-I) dependent manner. SLR14 demonstrated remarkable protective capacity against lethal SARS-CoV-2 infection when used prophylactically and retained considerable efficacy as a therapeutic agent. In immunodeficient mice carrying chronic SARS-CoV-2 infection, SLR14 elicited near-sterilizing innate immunity by inducing IFN-I responses in the absence of the adaptive immune system. In the context of infection with variants of concern (VOC), SLR14 conferred broad protection and uncovered an IFN-I resistance gradient across emerging VOC. These findings demonstrate the therapeutic potential of SLR14 as a host-directed, broad-spectrum antiviral for early post-exposure treatment and for treatment of chronically infected immunosuppressed patients.

Possibility of using recombinant monoclonal antibodies in the treatment of the coronavirus infection

2021 ◽  
pp. 8-13
Author(s):  
Vladimir Anatolievich Klimov
Keyword(s):  
Monoclonal Antibodies ◽  
Plasma Cells ◽  
Polyclonal Antibodies ◽  
Fatal Outcome ◽  
Humoral Response ◽  
Specific Protein ◽  
Pathological Process ◽  
Human Immune System ◽  
Risk Of Progression ◽  
Severe Degree

Monoclonal antibodies are successfully used to treat a number of viral diseases; they are produced by the plasma cells of the human immune system and are the result of a natural humoral response to the ingress of a certain antigen. Antibodies designed to target only one specific protein — in this case, the protein of the virus that causes COVID-19 — are called «monoclonal». Their purpose is to block the COVID-19 virus and prevent its penetration and replication in human cells, and their ultimate focus is on combating infectious manifestations. They are believed to cause fewer undesirable effects than convalescent plasma, which is essentially a complex of polyclonal antibodies and circulating immune complexes. Monoclonal antibodies can be synthesized in the laboratory using the blood serum of patients who have undergone this disease as a starting material. The use of monoclonal antibodies is indicated for patients with a mild and moderate form of the disease at a high risk of progression of the pathological process to a severe degree, which implies the need for hospitalization and a high probability of a fatal outcome.

Surgical Management of Benign and Malignant Colorectal Disease in the Immunocompromised Patient

2017 ◽  
Author(s):  
Cindy Kin ◽  
Amy Lightner ◽  
Mark Welton
Keyword(s):  
Preoperative Evaluation ◽  
Disease Process ◽  
Underlying Disease ◽  
Colorectal Disease ◽  
Immunosuppressed Patient ◽  
Neutropenic Enterocolitis ◽  
Anal Squamous Cell Carcinoma ◽  
Benign Colorectal Disease ◽  
Immunosuppressed Patients ◽  
Inflammatory Bowel

Patients who are immunosuppressed either due to an underlying disease process or medications to treat a disease require important perioperative considerations. Preoperative evaluation mandates a higher index of suspicion for pathology given that peritoneal and systemic markers of illness may be masked. Intraoperatively, consideration should be given for diversion more frequently than in a nonimmunosuppressed patient. Postoperatively, patients should be managed in a multidisciplinary fashion. This review largely focuses on the immunosuppressive mediations used for the treatment of inflammatory bowel disease, benign colorectal disease in an immunosuppressed patient, and colorectal malignancies in immunosuppressed patients to highlight important considerations for this patient population. This review contains 4 figures, 5 tables, and 78 references. Key words: anal squamous cell carcinoma, appendicitis versus typhlitis, biologic therapy, corticosteroids, human papillomavirus, immunosuppression, neutropenic enterocolitis 

Diagnosis of Polyoma Virus Infection In Renal Transplant Recipients

1999 ◽  
Vol 5 (S2) ◽  
pp. 1166-1167
Author(s):  
J. A. C. King ◽  
D. N. Howell ◽  
J. A. Tucker ◽  
R. P. Lowry
Keyword(s):  
Renal Transplant ◽  
Virus Infection ◽  
Renal Transplant Patient ◽  
Bk Virus ◽  
Polyoma Virus ◽  
Immunosuppressed Patient ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Immunosuppressed Patients ◽  
Cadaver Kidney

BK polyoma virus is a 40-45 nm DNA virus that was first identified in the urine of an immunosuppressed patient in 1971. BK virus infection often occurs in childhood and is subclinical. The majority of adults have antibodies to the virus. Asymptomatic viruria, ureteral ulceration, and ureteral stenosis have been described with infection in immunosuppressed patients. Renal graft dysfunction and interstitial nephritis have been associated with BK virus. Differentiation between rejection and infection is important. We report a case of a renal transplant patient with BK polyoma virus infection. This case illustrates the variety of methods that can be used for identification of BK polyoma virus.The patient, a 52 year old female, presented with an asymptomatic rise in serum creatinine (1.4 to 2.1 mg/dl). Her past medical history was significant for a cadaver kidney transplant two years prior for polycystic kidney disease.

scholarly journals Association between incubation period and clinical characteristics of patients with COVID-19

2020 ◽  
Vol 48 (9) ◽  
pp. 030006052095683
Author(s):  
Yeyu Cai ◽  
Jiayi Liu ◽  
Haitao Yang ◽  
Mian Wang ◽  
Qingping Guo ◽  
...  
Keyword(s):  
Incubation Period ◽  
Disease Severity ◽  
Symptom Onset ◽  
Clinical Characteristics ◽  
Characteristic Curve ◽  
Severe Disease ◽  
Receiver Operator Characteristic Curve ◽  
Hunan Province ◽  
Laboratory Findings ◽  
Incubation Periods

Purpose To investigate associations between the clinical characteristics and incubation periods of patients infected with coronavirus disease 2019 (COVID-19) in Wuhan, China. Methods Complete clinical and epidemiological data from 149 patients with COVID-19 at a hospital in Hunan Province, China, were collected and retrospectively analyzed. Results Analysis of the distribution and receiver operator characteristic curve of incubation periods showed that 7 days was the optimal cut-off value to assess differences in disease severity between groups. Patients with shorter (≤7 days) incubation periods (n = 79) had more severe disease, longer durations of hospitalization, longer times from symptom onset to discharge, more abnormal laboratory findings, and more severe radiological findings than patients with longer (>7 days) incubation periods. Regression and correlation analyses also showed that a shorter incubation period was associated with longer times from symptom onset to discharge. Conclusion The associations between the incubation periods and clinical characteristics of COVID-19 patients suggest that the incubation period may be a useful marker of disease severity and prognosis.

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