Antibody-dependent enhancement and SARS-CoV-2 vaccines and therapies

Nat Microbiol. 2020 Oct;5(10):1185-1191. doi: 10.1038/s41564-020-00789-5. Epub 2020 Sep 9.

Abstract

Antibody-based drugs and vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are being expedited through preclinical and clinical development. Data from the study of SARS-CoV and other respiratory viruses suggest that anti-SARS-CoV-2 antibodies could exacerbate COVID-19 through antibody-dependent enhancement (ADE). Previous respiratory syncytial virus and dengue virus vaccine studies revealed human clinical safety risks related to ADE, resulting in failed vaccine trials. Here, we describe key ADE mechanisms and discuss mitigation strategies for SARS-CoV-2 vaccines and therapies in development. We also outline recently published data to evaluate the risks and opportunities for antibody-based protection against SARS-CoV-2.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Animals
  • Antibodies, Monoclonal / administration & dosage
  • Antibodies, Neutralizing / administration & dosage
  • Antibodies, Viral / administration & dosage
  • Antibodies, Viral / immunology
  • Antibody-Dependent Enhancement* / immunology
  • Betacoronavirus* / immunology
  • COVID-19
  • COVID-19 Vaccines
  • Coronavirus Infections / drug therapy
  • Coronavirus Infections / immunology*
  • Coronavirus Infections / prevention & control
  • Coronavirus Infections / therapy*
  • Humans
  • Immunization, Passive / adverse effects
  • In Vitro Techniques
  • Models, Immunological
  • Pandemics / prevention & control
  • Pneumonia, Viral / immunology*
  • Pneumonia, Viral / prevention & control
  • Pneumonia, Viral / therapy*
  • Respiratory Tract Diseases / etiology
  • Respiratory Tract Diseases / immunology
  • Risk Factors
  • SARS-CoV-2
  • Safety
  • Viral Vaccines / adverse effects*
  • Viral Vaccines / immunology

Substances

  • Antibodies, Monoclonal
  • Antibodies, Neutralizing
  • Antibodies, Viral
  • COVID-19 Vaccines
  • Viral Vaccines

Supplementary concepts

  • COVID-19 drug treatment
  • COVID-19 serotherapy