Use of human immunoglobulins as an anti-infective treatment: the experience so far and their possible re-emerging role

Abstract

Pooled human immunoglobulins (IGs) are prepared from plasma obtained from healthy donors as a concentrated antibody-containing solution. In addition, high-titer IGs (hyperimmune) against a specific pathogen can be obtained from vaccinated or convalescing donors. Currently, IGs can be used for the treatment of a variety of infections for which no specific therapy exists or that remain difficult to treat. Moreover, the recent pathogen outbreaks for which there is no approved treatment have renewed attention to the role of convalescent plasma and IGs. Areas covered: In this review, a historical perspective of the use of sera and IGs in humans as anti-infective agents (any viral, bacterial, parasitic infection), excluding immunodeficient patients, is presented from early development to the latest clinical studies. A Medline search was conducted to examine the peer-reviewed literature, with no date limits. Expert commentary: Human pooled plasma-derived IG products benefit from the polyclonal response of every individual donor and from the interindividual variability in such response. The trend to increased availability of vaccines for infectious diseases also opens new potential applications of hyperimmune IGs for emerging or re-emerging infectious diseases (e.g.: Ebola, Zika, Dengue), for the prevention and treatment in the general population, healthcare personnel and caregivers.

Cross-neutralization activity against SARS-CoV-2 is present in currently available intravenous immunoglobulins

“…The current critical situation demands an effective and reliable therapy that is immediately available to control the progression of the disease. Convalescent plasma or plasma-derived immunoglobulin (IG) (either polyvalent IG prepared from healthy donors or hyperimmune IG prepared from donors with high antibody titers against a specific antigen) have been historically used as a readily available therapeutic option in outbreaks of emerging or re-emerging infections 2 .…”

Currently available intravenous immunoglobulin (Gamunex®-C and Flebogamma®DIF) contains antibodies reacting against SARS-CoV-2 antigens

“…This critical situation demands a reliable therapy that is immediately available to control the spread of the disease. Convalescent plasma or plasma-derived immunoglobulin (IG), either polyvalent IG (prepared from pooled plasma from thousands of healthy donors) or hyperimmune IG (prepared from the plasma of donors with high titers of antibody against a specific antigen), have been historically used as the fastest therapeutic option in outbreaks of emergent or re-emergent infections [3].…”

Adjuvant treatment of severe varicella pneumonia with intravenous varicella zoster virus-specific immunoglobulins

“…Passive immunotherapy is currently recommended in several bacterial and viral infections for the protection of seronegative hosts, either as prophylaxis or treatment (Bozzo and Jorquera, 2017). Timing is crucial: immunoglobulins are highly effective in the early post-exposure period and their efficacy then generally decreases with disease progression (Slifka and Amanna, 2018).…”

“…Timing is crucial: immunoglobulins are highly effective in the early post-exposure period and their efficacy then generally decreases with disease progression (Slifka and Amanna, 2018). Yet, when initiated shortly after symptom onset, passive immunotherapy can be highly successful for severe or even life-threatening infections such as hemorrhagic fever, tetanus, and botulism (Bozzo and Jorquera, 2017). Depending on the type of infectious disease, standard (non-specific) or hyperimmune (high-titer IgG-specific) immunoglobulins can be administered.…”