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Published in: Journal of Clinical Immunology 3/2021

01-04-2021 | SARS-CoV-2 | Original Article

Plasma Exchange to Rescue Patients with Autoantibodies Against Type I Interferons and Life-Threatening COVID-19 Pneumonia

Authors: Nicolas de Prost, Paul Bastard, Romain Arrestier, Slim Fourati, Mathieu Mahévas, Sonia Burrel, Karim Dorgham, Guy Gorochov, Yacine Tandjaoui-Lambiotte, Iname Azzaoui, Ignacio Fernandes, Alain Combes, Jean-Laurent Casanova, Armand Mekontso-Dessap, Charles-Edouard Luyt

Published in: Journal of Clinical Immunology | Issue 3/2021

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Abstract

Purpose

To report four cases of life-threatening COVID-19 pneumonia in patients with high blood concentrations of neutralizing autoantibodies against type I interferons (IFNs), who were treated with plasma exchange (PE) as a rescue therapy.

Methods

Prospective case series, which included patients, diagnosed with RT-PCR-confirmed SARS-CoV-2 infection and positive autoantibodies against type I IFNs in two French intensive care units (ICUs) between October 8 and November 14, 2020. Six critically ill COVID-19 patients with no anti-IFN antibodies were used as controls. Anti-IFN autoantibodies and IFN concentrations, together with the levels of anti-SARS-CoV-2 antibodies, were measured sequentially in serum. Viral load was determined in the upper and lower respiratory tract. Patients were followed during hospital stay.

Results

Three men and one woman were included. Three of the patients had four PE sessions each, while another had three PE sessions. PE decreased the concentrations of autoantibodies against type I IFN in all four patients, whereas anti-SARS-CoV-2 antibody levels remained stable. Autoantibodies against type I IFN levels were high in tracheal aspirates of one patient and decreased after three PE sessions. By contrast, anti-IFN autoantibodies were not detected in tracheal aspirates from five control patients without detectable anti-IFN autoantibodies in serum. During PE, serum IFN-α levels slightly increased in three out of four patients, and upper respiratory tract viral load decreased in all patients. All patients were alive at day 28 of ICU admission. Two patients eventually died in the ICU, while the two survivors were discharged from the ICU at days 50 and 66.

Conclusions

PE efficiently removes autoantibodies against type I IFNs, including those detected in tracheal aspirates, without affecting anti-SARS-CoV-2 antibody levels, in patients with life-threatening COVID-19 pneumonia. The clinical benefit of PE in patients with autoantibodies against type I IFNs should be tested in a larger study.
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Metadata
Title
Plasma Exchange to Rescue Patients with Autoantibodies Against Type I Interferons and Life-Threatening COVID-19 Pneumonia
Authors
Nicolas de Prost
Paul Bastard
Romain Arrestier
Slim Fourati
Mathieu Mahévas
Sonia Burrel
Karim Dorgham
Guy Gorochov
Yacine Tandjaoui-Lambiotte
Iname Azzaoui
Ignacio Fernandes
Alain Combes
Jean-Laurent Casanova
Armand Mekontso-Dessap
Charles-Edouard Luyt
Publication date
01-04-2021
Publisher
Springer US
Published in
Journal of Clinical Immunology / Issue 3/2021
Print ISSN: 0271-9142
Electronic ISSN: 1573-2592
DOI
https://doi.org/10.1007/s10875-021-00994-9

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