Survivor plasma shows promise
Can it combat infections of COVID-19 variants?
WOODLAND PARK, N.J. – Survivors of COVID-19 who produce lots of disease-fighting antibodies carry within them a weapon in the fight to prevent severe complications from the coronavirus.
Their antibody-rich blood plasma helps block the virus, when transfused early into newly diagnosed patients – and may even be helpful against infections with new variants of the coronavirus.
If an outbreak caused by a variant of the coronavirus occurs in a community, its survivors could become the medicine chest for others who fall sick, a New Jersey researcher said.
“They essentially have the treatment for the variants in their body,” said Dr. Michele Donato, lead researcher at Hackensack University Medical Center for a group of studies about COVID-19 survivors’ blood plasma. “The plasma contains the antibodies of the virus that’s in the community at that time.”
Recovered patients would be able to donate plasma after they have been symptom-free for two weeks, and the plasma would be ready to deploy in three days, she said. “Collection of plasma is a very low-tech, easy process.”
Experience with hospitalized patients at Hackensack University Medical Center revealed two factors essential to the success of such treatment, according to a study published last week in JCI Insight, the journal of the American Society for Clinical Investigation:
h The plasma should come from “super donors,” those with higherthan-average levels of antibodies. Those donors haven’t necessarily had a more severe case of the disease, but analysis of their blood shows the presence of more antibodies.
h The plasma should be transfused into sick patients as early as possible
in the course of the illness. Patients sick enough to be placed on ventilators did not show a significant benefit from the treatment.
Hackensack’s study of 51 hospital patients during the early weeks of the pandemic in March and April 2020 echoed findings from a larger study by the Mayo Clinic, published in the New England Journal of Medicine last month.
That study of more than 3,000 hospital patients who weren’t sick enough to need a ventilator and who received transfusions containing higher levels of antibodies showed they had a lower risk of death than similar patients whose transfusions contained fewer antibodies.
The role of blood plasma in treating disease – an idea more than a century old – received media attention in the first wave of the pandemic. Hundreds of COVID-19 survivors flooded phone lines to volunteer as donors to help treat the most critically ill, and Hackensack’s research was featured on “60 Minutes,” the CBS news show.
Donato and her team have pivoted away from the focus on hospital patients to treat people with COVID-19 before they are in a hospital.
The researchers infuse plasma from super donors into high-risk patients within four days of their first signs of illness. The goal is to see if the treatment prevents the need for hospitalizations.
The U.S. Department of Defense provided $5.5 million to fund the research.
Researchers plan to enroll up to 300 patients in the study, but if early results show clear evidence that the plasma therapy works, it could end with as few as 150 patients.
Robert Gelman, an accountant who founded a consulting practice for attorneys, is one of 21 patients recruited for the new Hackensack study.
He developed a fever and cough a few days before Thanksgiving and received a positive test result Nov. 24.
As luck would have it, Donato is a family friend of Gelman.
When he asked her for advice, she thought he would be eligible for her study.
Gelman drove to Hackensack from his Livingston home and received the plasma infusion Nov. 25, the day before Thanksgiving.
It took most of the day, he said, but part of that time was spent determining his blood type.
Plasma is a blood product, so the blood type of the donor must match that of the recipient, unless its the rare Type AB, known as the universal plasma donor.
Gelman slept most of Thanksgiving, the day after the transfusion.
During his bout with COVID-19, the 59-year-old was never more than “mildly sick,” he said, and “by Friday, I felt better. Within a week, I was recovered.” His sense of taste and smell, which had disappeared on Thanksgiving, returned.
Plasma vs. monoclonal antibodies
Blood plasma works in a similar way to the monoclonal antibodies that have been granted emergency authorization by the Food and Drug Administration for treatment of COVID-19.
For both treatments, timing is important: The earlier in the course of the disease they are given, the better the result.
“The earlier you block the virus, the less damage the virus will cause in the body,” Donato said.
In the initial stage of infection, the body strives to fight the virus by developing antibodies.
In the second stage, when the virus causes an inflammatory response in the lungs or other organs, complications set in. The transfused antibodies boost the newly infected patient’s immune response and help to fight the virus while the body marshals its own antibodies. Once the inflammatory syndrome has set in, it may be too late.
There are important differences between the plasma therapy study and practices for infusing monoclonal antibodies.
Participants in the blood plasma study have a 50% chance of receiving a placebo.
If placebo recipients become so sick they are hospitalized, the study is designed so they can then receive the antibody-rich plasma.
The monoclonal antibodies are given to eligible patients without a placebo control group.
The antibodies contained in the plasma are not the standardized monoclonal antibodies mass-produced by Regeneron or Eli Lilly.
They are individual blood products, produced in one person’s body, to fight a specific infection, so they may contain a response to a viral variant.
‘Paying it forward’
Gelman has completely recovered, he said this week.
He’s grateful not only that he was accepted into the study, but that he didn’t receive the placebo.
“When something happens, and you’re not feeling well, you realize every day is a gift,” he said. “There’s nothing better than a good, average day.”
There’s another chapter to the story. As Gelman began his recovery on Thanksgiving Day, his wife, Lori, and two of their three children began to feel sick. They were tested for COVID-19 the next day, and the three – ages 53, 22, and 18 – tested positive. Their 25-yearold son, “who sat at the same table with us, eating dinner every night,” did not get sick, Gelman said.
None of them was eligible for the study. All recovered without hospitalization, after varying levels of illness. Once it was over, Gelman said, “We decided as a family that I was so fortunate to have gotten the plasma, we needed to pay it forward.”