Antibodies are usually associated with a healthy immune system fighting an infection. That’s mostly true, but there is a saying from Paracelsus, The Dose Makes the Poison. Anything in excess can be poisonous.
Too much food, water, coffee, sugar, or mostly too much of anything are unhealthy. It is the same with antibodies against COVID-19. Particularly the immune globulin G or IgG against the spike protein of the SARS-CoV-2.
Research from Amsterdam available in a preprint on BioRxiv is entitled, Anti-SARS-CoV-2 IgG from severely ill COVID-19 patients promotes macrophage hyper-inflammatory responses.
In it, they measured the levels of IgG from patients who are severely ill with COVID-19. What they found is that the high levels of IgG stimulate a type of white blood cell called a macrophage in a bad way.
Macrophages typically detect and destroy microbes and release molecules or cytokines that activate other cells to fight infection.
In severely ill COVID-19 patients, the high levels of IgG make the macrophages produce more pro-inflammatory cytokines like the interleukin or IL-6, IL-8, and tumor necrosis factor or TNF that cause the COVID-19 to be worse instead of better.
The excessive production of cytokines causes a severe inflammatory reaction in the body known as the cytokine storm. One of the features of the cytokine storm is pulmonary edema or flooding of the lungs.
Pulmonary edema happens when the integrity of the blood vessels are compromised such that the fluids leak out of the blood vessels and occupy the air spaces or alveoli that is essential for air exchange.
This causes the person to drown in their own fluids unless they get intubated and hooked to a mechanical ventilator.
Small blood clots also from within the blood vessels and start to block the flow of blood to all the organs resulting in multi-system organ failure.
This situation is similar to SARS in 2003, another coronavirus. The SARS coronavirus also causes severe inflammation and lung injury through IgG antibodies.
At this stage, definitive treatment is available, but the study mentioned a potential candidate.
Fostamatinib
In the same study, fostamatinib was used to block the Fc part of the IgG with success. Fostamatinib is a Food and Drug Approved and European Medicines Agency approved drug for the treatment of immune thrombocytopenia. A quote from the authors,
Strikingly, R406, the active component of fostamatinib, almost completely blocked the proinflammatory cytokine production induced by the anti-Spike IgG from severe COVI-19 patients.
This news is quite encouraging since there is no definitive treatment yet against the cytokine storm. Hopefully, more research about fostamatinib will be done in the future. Another is for fostamatinib to be used compassionately for severely ill COVID-19 patients.
How this study Aligns with Other Studies about IgG
This study is in agreement with other articles about IgG featured on this website.
Studies mostly show that the levels of IgG are low in mild patients. Even undetected in asymptomatic patients, as discussed here, The Rise and Fall of Antibodies in Mild and Asymptomatic COVID-19.
In very mild or asymptomatic cases, the other type of immune globulin seen in the lining of the respiratory tract called IgA takes care of the COVID-19 infection adequately.
If the IgAs do their job well, they prevent the SARS-CoV-2 from attaching to the lining of the respiratory tract and stops the infection before it starts.
This results in a mild immune response such that IgGs against COVID-19 are not even produced and thus undetected in the antibody test. This is presented in The total number of COVID-19 is much Higher.
In the article, Protective Antibodies Against Coronaviruses are Short-Lived, two studies show that IgG levels against the SARS-CoV-2 only last for 6 months.
In a Canadian study about convalescent plasma among COVID-19 survivors, they found that the blood should be donated before the sixth week after symptom onset of the donor to maintain its effectiveness. The study source of that is in The Rise and Fall of Antibodies in Mild and Asymptomatic COVID-19.
To know more about convalescent plasma, check this: How to Beat a Pandemic Just like in the Movies.
Knowledge about Covid-19 is rapidly evolving. Information may update as new researches are done. Stay current by subscribing.
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Image Credit: Pulmonary edema By Hellerhoff – Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=12228135
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