Marovich M et al JAMA June 15, 2020
Reviewed by Miriam Davis, PhD Essential Clinical Aspects June 22, 2020
Neutralizing antibodies against SARS-CoV-2 have the potential to be useful for the prevention and treatment of COVID-19, according to an open study published in JAMA.
Several antibodies against SARS-CoV-2 are about to enter clinical studies this summer.
Monoclonal antibodies have received less attention than vaccines, new antiviral agents, and convalescent plasma.
Achieving the therapeutic or prophylactic efficacy of monoclonal antibodies would be an important milestone in the control of the COVID-19 pandemic.
Almost all developing neutralizing monoclonal antibodies specifically target the SARS-CoV-2 spike glycoprotein that is involved in the entry of the virus into host cells.
Antibodies are planned to block the binding of this protein to the host's angiotensin-converting enzyme receptor 2.
Almost all eligible neutralizing antibodies target the receptor binding domain on the spike protein, although other spike epitopes may be of interest.
It is expected that a single infusion can be used for therapeutic purposes because almost all antibodies have a long half-life of almost three weeks; the half-life could be prolonged by modifying the Fc region of the antibody.
One challenge is the unknown bioavailability of IgG administered by passive infusion into the tissues affected by the disease, particularly the lungs.
Another challenge is that in severe COVID-19, virus entry and replication may be of less clinical importance than reactive inflammation and coagulopathy.