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Research Article

Effectiveness of convalescent plasma therapy in severe COVID-19 patients

View ORCID ProfileKai Duan, Bende Liu, Cesheng Li, View ORCID ProfileHuajun Zhang, Ting Yu, View ORCID ProfileJieming Qu, View ORCID ProfileMin Zhou, View ORCID ProfileLi Chen, Shengli Meng, Yong Hu, Cheng Peng, Mingchao Yuan, View ORCID ProfileJinyan Huang, Zejun Wang, Jianhong Yu, Xiaoxiao Gao, Dan Wang, View ORCID ProfileXiaoqi Yu, View ORCID ProfileLi Li, Jiayou Zhang, Xiao Wu, Bei Li, View ORCID ProfileYanping Xu, Wei Chen, Yan Peng, Yeqin Hu, Lianzhen Lin, Xuefei Liu, Shihe Huang, Zhijun Zhou, Lianghao Zhang, Yue Wang, Zhi Zhang, Kun Deng, Zhiwu Xia, Qin Gong, Wei Zhang, Xiaobei Zheng, Ying Liu, Huichuan Yang, Dongbo Zhou, Ding Yu, Jifeng Hou, Zhengli Shi, Saijuan Chen, Zhu Chen, Xinxin Zhang, and View ORCID ProfileXiaoming Yang
  1. aChina National Biotec Group Company Limited, 100029 Beijing, China;
  2. bNational Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Products Co. Ltd., 430207 Wuhan, China;
  3. cFirst People’s Hospital of Jiangxia District, 430200 Wuhan, China;
  4. dSinopharm Wuhan Plasma-derived Biotherapies Co., Ltd, 430207 Wuhan, China;
  5. eKey Laboratory of Special Pathogens, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Chinese Academy of Sciences, 430071 Wuhan, China;
  6. fWuHan Jinyintan Hospital, 430023 Wuhan, China;
  7. gDepartment of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 200025 Shanghai, China;
  8. hNational Research Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 200025 Shanghai, China;
  9. iInstitute of Respiratory Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 200025 Shanghai, China;
  10. jClinical Research Center, Department of Gastroenterology, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, 200018 Shanghai, China;
  11. kWuhan Blood Center, 430030 Wuhan, China;
  12. lState Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, National Research Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 200025 Shanghai, China;
  13. mResearch Laboratory of Clinical Virology, Ruijin Hospital and Ruijin Hospital North, National Research Center for Translational Medicine, Shanghai Jiao Tong University School of Medicine, 200025 Shanghai, China;
  14. nNational Institute for Food and Drug Control of China, 102629 Beijing, China

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PNAS April 28, 2020 117 (17) 9490-9496; first published April 6, 2020; https://doi.org/10.1073/pnas.2004168117
Kai Duan
aChina National Biotec Group Company Limited, 100029 Beijing, China;
bNational Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Products Co. Ltd., 430207 Wuhan, China;
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Bende Liu
cFirst People’s Hospital of Jiangxia District, 430200 Wuhan, China;
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Cesheng Li
dSinopharm Wuhan Plasma-derived Biotherapies Co., Ltd, 430207 Wuhan, China;
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Huajun Zhang
eKey Laboratory of Special Pathogens, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Chinese Academy of Sciences, 430071 Wuhan, China;
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Ting Yu
fWuHan Jinyintan Hospital, 430023 Wuhan, China;
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Jieming Qu
gDepartment of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 200025 Shanghai, China;
hNational Research Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 200025 Shanghai, China;
iInstitute of Respiratory Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 200025 Shanghai, China;
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  • ORCID record for Jieming Qu
Min Zhou
gDepartment of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 200025 Shanghai, China;
hNational Research Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 200025 Shanghai, China;
iInstitute of Respiratory Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 200025 Shanghai, China;
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  • ORCID record for Min Zhou
Li Chen
jClinical Research Center, Department of Gastroenterology, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, 200018 Shanghai, China;
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Shengli Meng
bNational Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Products Co. Ltd., 430207 Wuhan, China;
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Yong Hu
dSinopharm Wuhan Plasma-derived Biotherapies Co., Ltd, 430207 Wuhan, China;
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Cheng Peng
eKey Laboratory of Special Pathogens, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Chinese Academy of Sciences, 430071 Wuhan, China;
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Mingchao Yuan
kWuhan Blood Center, 430030 Wuhan, China;
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Jinyan Huang
lState Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, National Research Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 200025 Shanghai, China;
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Zejun Wang
bNational Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Products Co. Ltd., 430207 Wuhan, China;
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Jianhong Yu
dSinopharm Wuhan Plasma-derived Biotherapies Co., Ltd, 430207 Wuhan, China;
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Xiaoxiao Gao
eKey Laboratory of Special Pathogens, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Chinese Academy of Sciences, 430071 Wuhan, China;
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Dan Wang
kWuhan Blood Center, 430030 Wuhan, China;
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Xiaoqi Yu
mResearch Laboratory of Clinical Virology, Ruijin Hospital and Ruijin Hospital North, National Research Center for Translational Medicine, Shanghai Jiao Tong University School of Medicine, 200025 Shanghai, China;
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Li Li
bNational Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Products Co. Ltd., 430207 Wuhan, China;
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Jiayou Zhang
bNational Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Products Co. Ltd., 430207 Wuhan, China;
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Xiao Wu
dSinopharm Wuhan Plasma-derived Biotherapies Co., Ltd, 430207 Wuhan, China;
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Bei Li
eKey Laboratory of Special Pathogens, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Chinese Academy of Sciences, 430071 Wuhan, China;
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Yanping Xu
gDepartment of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 200025 Shanghai, China;
hNational Research Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 200025 Shanghai, China;
iInstitute of Respiratory Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 200025 Shanghai, China;
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Wei Chen
bNational Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Products Co. Ltd., 430207 Wuhan, China;
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Yan Peng
dSinopharm Wuhan Plasma-derived Biotherapies Co., Ltd, 430207 Wuhan, China;
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Yeqin Hu
bNational Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Products Co. Ltd., 430207 Wuhan, China;
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Lianzhen Lin
dSinopharm Wuhan Plasma-derived Biotherapies Co., Ltd, 430207 Wuhan, China;
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Xuefei Liu
gDepartment of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 200025 Shanghai, China;
hNational Research Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 200025 Shanghai, China;
iInstitute of Respiratory Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 200025 Shanghai, China;
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Shihe Huang
bNational Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Products Co. Ltd., 430207 Wuhan, China;
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Zhijun Zhou
dSinopharm Wuhan Plasma-derived Biotherapies Co., Ltd, 430207 Wuhan, China;
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Lianghao Zhang
bNational Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Products Co. Ltd., 430207 Wuhan, China;
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Yue Wang
dSinopharm Wuhan Plasma-derived Biotherapies Co., Ltd, 430207 Wuhan, China;
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Zhi Zhang
bNational Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Products Co. Ltd., 430207 Wuhan, China;
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Kun Deng
dSinopharm Wuhan Plasma-derived Biotherapies Co., Ltd, 430207 Wuhan, China;
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Zhiwu Xia
bNational Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Products Co. Ltd., 430207 Wuhan, China;
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Qin Gong
dSinopharm Wuhan Plasma-derived Biotherapies Co., Ltd, 430207 Wuhan, China;
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Wei Zhang
dSinopharm Wuhan Plasma-derived Biotherapies Co., Ltd, 430207 Wuhan, China;
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Xiaobei Zheng
dSinopharm Wuhan Plasma-derived Biotherapies Co., Ltd, 430207 Wuhan, China;
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Ying Liu
dSinopharm Wuhan Plasma-derived Biotherapies Co., Ltd, 430207 Wuhan, China;
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Huichuan Yang
aChina National Biotec Group Company Limited, 100029 Beijing, China;
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Dongbo Zhou
aChina National Biotec Group Company Limited, 100029 Beijing, China;
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Ding Yu
aChina National Biotec Group Company Limited, 100029 Beijing, China;
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Jifeng Hou
nNational Institute for Food and Drug Control of China, 102629 Beijing, China
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Zhengli Shi
eKey Laboratory of Special Pathogens, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Chinese Academy of Sciences, 430071 Wuhan, China;
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Saijuan Chen
lState Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, National Research Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 200025 Shanghai, China;
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Zhu Chen
lState Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, National Research Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 200025 Shanghai, China;
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  • For correspondence: zchen@stn.sh.cn zhangx@shsmu.edu.cn yangxiaoming@sinopharm.com
Xinxin Zhang
mResearch Laboratory of Clinical Virology, Ruijin Hospital and Ruijin Hospital North, National Research Center for Translational Medicine, Shanghai Jiao Tong University School of Medicine, 200025 Shanghai, China;
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  • For correspondence: zchen@stn.sh.cn zhangx@shsmu.edu.cn yangxiaoming@sinopharm.com
Xiaoming Yang
aChina National Biotec Group Company Limited, 100029 Beijing, China;
bNational Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Products Co. Ltd., 430207 Wuhan, China;
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  • ORCID record for Xiaoming Yang
  • For correspondence: zchen@stn.sh.cn zhangx@shsmu.edu.cn yangxiaoming@sinopharm.com
  1. Contributed by Zhu Chen, March 18, 2020 (sent for review March 5, 2020; reviewed by W. Ian Lipkin and Fusheng Wang)

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Significance

COVID-19 is currently a big threat to global health. However, no specific antiviral agents are available for its treatment. In this work, we explore the feasibility of convalescent plasma (CP) transfusion to rescue severe patients. The results from 10 severe adult cases showed that one dose (200 mL) of CP was well tolerated and could significantly increase or maintain the neutralizing antibodies at a high level, leading to disappearance of viremia in 7 d. Meanwhile, clinical symptoms and paraclinical criteria rapidly improved within 3 d. Radiological examination showed varying degrees of absorption of lung lesions within 7 d. These results indicate that CP can serve as a promising rescue option for severe COVID-19, while the randomized trial is warranted.

Abstract

Currently, there are no approved specific antiviral agents for novel coronavirus disease 2019 (COVID-19). In this study, 10 severe patients confirmed by real-time viral RNA test were enrolled prospectively. One dose of 200 mL of convalescent plasma (CP) derived from recently recovered donors with the neutralizing antibody titers above 1:640 was transfused to the patients as an addition to maximal supportive care and antiviral agents. The primary endpoint was the safety of CP transfusion. The second endpoints were the improvement of clinical symptoms and laboratory parameters within 3 d after CP transfusion. The median time from onset of illness to CP transfusion was 16.5 d. After CP transfusion, the level of neutralizing antibody increased rapidly up to 1:640 in five cases, while that of the other four cases maintained at a high level (1:640). The clinical symptoms were significantly improved along with increase of oxyhemoglobin saturation within 3 d. Several parameters tended to improve as compared to pretransfusion, including increased lymphocyte counts (0.65 × 109/L vs. 0.76 × 109/L) and decreased C-reactive protein (55.98 mg/L vs. 18.13 mg/L). Radiological examinations showed varying degrees of absorption of lung lesions within 7 d. The viral load was undetectable after transfusion in seven patients who had previous viremia. No severe adverse effects were observed. This study showed CP therapy was well tolerated and could potentially improve the clinical outcomes through neutralizing viremia in severe COVID-19 cases. The optimal dose and time point, as well as the clinical benefit of CP therapy, needs further investigation in larger well-controlled trials.

  • COVID-19
  • convalescent plasma
  • treatment outcome
  • pilot project

Footnotes

  • ↵1K. Duan, B. Liu, C.L., H.Z., T.Y., J.Q., M.Z., and L.C. contributed equally to this work.

  • ↵2To whom correspondence may be addressed. Email: zchen{at}stn.sh.cn, zhangx{at}shsmu.edu.cn, or yangxiaoming{at}sinopharm.com.
  • Author contributions: Z.C., X. Zhang, and X. Yang designed research; S.M., Yong Hu, C.P., M.Y., Z.W., J.Y., X.G., D.W., L. Li, J.Z., X.W., B. Li, W.C., Y.P., Yeqin Hu, L. Lin, S.H., Z. Zhou, L.Z., Y.W., Z. Zhang, K. Deng, Z.X., Q.G., W.Z., X. Zheng, Y.L., H.Y., D.Z., D.Y., J. Hou, and Z.S. performed research; J. Huang, X. Yu, Y.X., X.L., S.C., and Z.C. analyzed data; and K. Duan, B. Liu, C.L., H.Z., T.Y., J.Q., M.Z., L.C., and Z.C. wrote the paper.

  • Reviewers: W.I.L., Columbia University; and F.W., Beijing 302 Hospital.

  • The authors declare no competing interest.

  • Data deposition: Detailed data on patients that support the findings of this study have been deposited in the Open Science Framework (https://osf.io/gahz5).

  • This article contains supporting information online at https://www.pnas.org/lookup/suppl/doi:10.1073/pnas.2004168117/-/DCSupplemental.

  • Copyright © 2020 the Author(s). Published by PNAS.

This open access article is distributed under Creative Commons Attribution License 4.0 (CC BY).

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Effectiveness of convalescent plasma therapy in severe COVID-19 patients
Kai Duan, Bende Liu, Cesheng Li, Huajun Zhang, Ting Yu, Jieming Qu, Min Zhou, Li Chen, Shengli Meng, Yong Hu, Cheng Peng, Mingchao Yuan, Jinyan Huang, Zejun Wang, Jianhong Yu, Xiaoxiao Gao, Dan Wang, Xiaoqi Yu, Li Li, Jiayou Zhang, Xiao Wu, Bei Li, Yanping Xu, Wei Chen, Yan Peng, Yeqin Hu, Lianzhen Lin, Xuefei Liu, Shihe Huang, Zhijun Zhou, Lianghao Zhang, Yue Wang, Zhi Zhang, Kun Deng, Zhiwu Xia, Qin Gong, Wei Zhang, Xiaobei Zheng, Ying Liu, Huichuan Yang, Dongbo Zhou, Ding Yu, Jifeng Hou, Zhengli Shi, Saijuan Chen, Zhu Chen, Xinxin Zhang, Xiaoming Yang
Proceedings of the National Academy of Sciences Apr 2020, 117 (17) 9490-9496; DOI: 10.1073/pnas.2004168117

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Effectiveness of convalescent plasma therapy in severe COVID-19 patients
Kai Duan, Bende Liu, Cesheng Li, Huajun Zhang, Ting Yu, Jieming Qu, Min Zhou, Li Chen, Shengli Meng, Yong Hu, Cheng Peng, Mingchao Yuan, Jinyan Huang, Zejun Wang, Jianhong Yu, Xiaoxiao Gao, Dan Wang, Xiaoqi Yu, Li Li, Jiayou Zhang, Xiao Wu, Bei Li, Yanping Xu, Wei Chen, Yan Peng, Yeqin Hu, Lianzhen Lin, Xuefei Liu, Shihe Huang, Zhijun Zhou, Lianghao Zhang, Yue Wang, Zhi Zhang, Kun Deng, Zhiwu Xia, Qin Gong, Wei Zhang, Xiaobei Zheng, Ying Liu, Huichuan Yang, Dongbo Zhou, Ding Yu, Jifeng Hou, Zhengli Shi, Saijuan Chen, Zhu Chen, Xinxin Zhang, Xiaoming Yang
Proceedings of the National Academy of Sciences Apr 2020, 117 (17) 9490-9496; DOI: 10.1073/pnas.2004168117
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