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. 2020 May;55:102768.
doi: 10.1016/j.ebiom.2020.102768. Epub 2020 Apr 16.

Impact of Immune Enhancement on Covid-19 Polyclonal Hyperimmune Globulin Therapy and Vaccine Development

Free PMC article

Impact of Immune Enhancement on Covid-19 Polyclonal Hyperimmune Globulin Therapy and Vaccine Development

Ruklanthi de Alwis et al. EBioMedicine. .
Free PMC article


The pandemic spread of a novel coronavirus - SARS coronavirus-2 (SARS-CoV-2) as a cause of acute respiratory illness, named Covid-19, is placing the healthcare systems of many countries under unprecedented stress. Global economies are also spiraling towards a recession in fear of this new life-threatening disease. Vaccines that prevent SARS-CoV-2 infection and therapeutics that reduces the risk of severe Covid-19 are thus urgently needed. A rapid method to derive antiviral treatment for Covid-19 is the use of convalescent plasma derived hyperimmune globulin. However, both hyperimmune globulin and vaccine development face a common hurdle - the risk of antibody-mediated disease enhancement. The goal of this review is to examine the body of evidence supporting the hypothesis of immune enhancement that could be pertinent to Covid-19. We also discuss how this risk could be mitigated so that both hyperimmune globulin and vaccines could be rapidly translated to overcome the current global health crisis.

Keywords: COVID-19; Coronavirus; Polyclonal hyperimmune globulin; SARS-CoV-2; Vaccines.

Conflict of interest statement

Declaration of Competing Interest The authors declare no conflict of interest.


Fig. 1
Fig. 1
Mechanism of ADE and antibody mediated immunopathology. Left panel: For ADE, immune complex internalization is mediated by the engagement of activating Fc receptors on the cell surface. Co-ligation of inhibitory receptors then results in the inhibition of antiviral responses which leads to increased viral replication. Right panel: Antibodies can cause immunopathology by activating the complement pathway or antibody-dependent cellular cytotoxicity (ADCC). For both pathways, excessive immune activation results in the release of cytokines and chemokines, leading to enhanced disease pathology.

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