Individual patient and donor seroprofiles in convalescent plasma treatment of COVID-19 in REMAP-CAP clinical trial

Visa Nurmi; Richard Mayne; Chanice Knight; Hannia L. Almonacid-Mendoza; Shannah Secret; Lise Estcourt; Jussi Hepojoki; Tonći Šuštić; Abigail A. Lamikanra; Hoi Pat Tsang; David K. Menon; Manu Shankar-Hari; C. Ellen van der Schoot; Gestur Vidarsson; David J. Roberts; Peter Simmonds; Klaus Hedman; Heli Harvala

doi:10.1016/j.jinf.2025.106412

Individual patient and donor seroprofiles in convalescent plasma treatment of COVID-19 in REMAP-CAP clinical trial

Visa Nurmi^*, Richard Mayne, Chanice Knight, Hannia L. Almonacid-Mendoza, Shannah Secret, Lise Estcourt, Jussi Hepojoki, Tonći Šuštić, Abigail A. Lamikanra, Hoi Pat Tsang, David K. Menon, Manu Shankar-Hari, C. Ellen van der Schoot, Gestur Vidarsson, David J. Roberts, Peter Simmonds, Klaus Hedman, Heli Harvala

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Objectives: Convalescent plasma (CP) treatment of COVID-19 has shown significant therapeutic effect only when administered early. We investigated the importance of patient and CP seroprofiles on treatment outcome in REMAP-CAP CP trial. Methods: We evaluated neutralising antibodies (nAb), anti-spike (S) IgM, IgG, IgG avidity, IgG fucosylation and respiratory viral loads in a sub-set of patients (n=80) and controls (n=51) before and after transfusion, comparing them to those in the CP units (n=157) they received. Results: Most patients were SARS-CoV-2 seropositive pre-transfusion (72% nAb; 89% S-IgG seropositivity). The majority (80%) had higher pre-transfusion S-IgG levels (median 1.7×10⁶ arbitrary units (AU); 56%) or S-IgG production rates (median 1.1×10⁶ AU/day; 64%) than they received from CP (median 2.2×10⁵ AU). Only 22% of the patients demonstrated significant (median 24-fold) increase in their S-IgG levels acquired from transfusion. Better outcomes, measured by organ support-free days, were associated with increase in S-IgM levels (p=0.007), decreased S-IgG fucosylation (p<0.001), lower patient age (p<0.001) but not with receiving CP (p=0.337). Conclusions: Based on our data, increased S-antibody levels linked to transfused CP were only observed in pre-seroconversion or immunodeficient patients lacking their own SARS-CoV-2 antibodies, representing the groups where CP treatment has previously shown most benefit.

Original language	English
Article number	106412
Journal	Journal Of Infection
Volume	90
Issue number	2
DOIs	https://doi.org/10.1016/j.jinf.2025.106412
Publication status	Published - Feb 2025

Bibliographical note

Publisher Copyright:
© 2025 The Authors

Funding

This work was supported by Support-E (HH, DJR, LE); RECPLAS NIHR (DJR, LE); Academy of Finland (JH); Finnish Society for Study of Infectious Diseases (VN); Foundation for Research on Viral Diseases (VN); NHS Blood and Transplant (HH, DJR, LE, AAL, HPT); Sigrid Jus\u00E9lius Foundation (VN, KH); Magnus Ehrnrooth Foundation (VN, KH); The Medical Society of Finland (VN, KH) This work was supported by SUPPORT-E Project (HH, DJR, LE); National Institute for Heath and Care Research, COVID-19-RECPLAS (DJR, LE); Research Council of Finland (JH); Finnish Society for Study of Infectious Diseases (VN); Finnish Foundation for Research on Viral Diseases (VN); NHS Blood and Transplant (HH, DJR, LE, AAL, HPT); Sigrid Jus\u00E9lius Foundation (VN, KH); Magnus Ehrnrooth Foundation (VN, KH); Societatis Medicorum Fennicae - The Medical Society of Finland (VN, KH).

Funders	Funder number
Foundation for Research on Viral Diseases
Magnus Ehrnroothin Säätiö
Finnish Foundation for Research on Viral Diseases
RECPLAS NIHR
Research Council of Finland
Finnish Society for Study of Infectious Diseases
Societatis Medicorum Fennicae - The Medical Society of Finland
Medical Society of Finland
Sigrid Juséliuksen Säätiö
National Institute for Health and Care Research	COVID-19-RECPLAS

Keywords

Antibodies
Convalescent plasma treatment
COVID-19
Critical care
Infectious diseases
SARS-CoV-2
Serology
Transfusion medicine
Virology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1016/j.jinf.2025.106412Licence: CC BY

1-s2.0-S0163445325000064-mainFinal published version, 6.11 MBLicence: CC BY

Cite this

Nurmi, V., Mayne, R., Knight, C., Almonacid-Mendoza, H. L., Secret, S., Estcourt, L., Hepojoki, J., Šuštić, T., Lamikanra, A. A., Tsang, H. P., Menon, D. K., Shankar-Hari, M., van der Schoot, C. E., Vidarsson, G., Roberts, D. J., Simmonds, P., Hedman, K., & Harvala, H. (2025). Individual patient and donor seroprofiles in convalescent plasma treatment of COVID-19 in REMAP-CAP clinical trial. Journal Of Infection, 90(2), Article 106412. https://doi.org/10.1016/j.jinf.2025.106412

@article{bd0b17ed61584e81b7c9d2b9ec6d59b5,

title = "Individual patient and donor seroprofiles in convalescent plasma treatment of COVID-19 in REMAP-CAP clinical trial",

abstract = "Objectives: Convalescent plasma (CP) treatment of COVID-19 has shown significant therapeutic effect only when administered early. We investigated the importance of patient and CP seroprofiles on treatment outcome in REMAP-CAP CP trial. Methods: We evaluated neutralising antibodies (nAb), anti-spike (S) IgM, IgG, IgG avidity, IgG fucosylation and respiratory viral loads in a sub-set of patients (n=80) and controls (n=51) before and after transfusion, comparing them to those in the CP units (n=157) they received. Results: Most patients were SARS-CoV-2 seropositive pre-transfusion (72\% nAb; 89\% S-IgG seropositivity). The majority (80\%) had higher pre-transfusion S-IgG levels (median 1.7×106 arbitrary units (AU); 56\%) or S-IgG production rates (median 1.1×106 AU/day; 64\%) than they received from CP (median 2.2×105 AU). Only 22\% of the patients demonstrated significant (median 24-fold) increase in their S-IgG levels acquired from transfusion. Better outcomes, measured by organ support-free days, were associated with increase in S-IgM levels (p=0.007), decreased S-IgG fucosylation (p<0.001), lower patient age (p<0.001) but not with receiving CP (p=0.337). Conclusions: Based on our data, increased S-antibody levels linked to transfused CP were only observed in pre-seroconversion or immunodeficient patients lacking their own SARS-CoV-2 antibodies, representing the groups where CP treatment has previously shown most benefit.",

keywords = "Antibodies, Convalescent plasma treatment, COVID-19, Critical care, Infectious diseases, SARS-CoV-2, Serology, Transfusion medicine, Virology",

author = "Visa Nurmi and Richard Mayne and Chanice Knight and Almonacid-Mendoza, \{Hannia L.\} and Shannah Secret and Lise Estcourt and Jussi Hepojoki and Ton{\'c}i {\v S}u{\v s}ti{\'c} and Lamikanra, \{Abigail A.\} and Tsang, \{Hoi Pat\} and Menon, \{David K.\} and Manu Shankar-Hari and \{van der Schoot\}, \{C. Ellen\} and Gestur Vidarsson and Roberts, \{David J.\} and Peter Simmonds and Klaus Hedman and Heli Harvala",

note = "Publisher Copyright: {\textcopyright} 2025 The Authors",

year = "2025",

month = feb,

doi = "10.1016/j.jinf.2025.106412",

language = "English",

volume = "90",

journal = "Journal Of Infection",

issn = "0163-4453",

publisher = "W.B. Saunders Ltd",

number = "2",

}

Nurmi, V, Mayne, R, Knight, C, Almonacid-Mendoza, HL, Secret, S, Estcourt, L, Hepojoki, J, Šuštić, T, Lamikanra, AA, Tsang, HP, Menon, DK, Shankar-Hari, M, van der Schoot, CE, Vidarsson, G, Roberts, DJ, Simmonds, P, Hedman, K & Harvala, H 2025, 'Individual patient and donor seroprofiles in convalescent plasma treatment of COVID-19 in REMAP-CAP clinical trial', Journal Of Infection, vol. 90, no. 2, 106412. https://doi.org/10.1016/j.jinf.2025.106412

TY - JOUR

T1 - Individual patient and donor seroprofiles in convalescent plasma treatment of COVID-19 in REMAP-CAP clinical trial

AU - Nurmi, Visa

AU - Mayne, Richard

AU - Knight, Chanice

AU - Almonacid-Mendoza, Hannia L.

AU - Secret, Shannah

AU - Estcourt, Lise

AU - Hepojoki, Jussi

AU - Šuštić, Tonći

AU - Lamikanra, Abigail A.

AU - Tsang, Hoi Pat

AU - Menon, David K.

AU - Shankar-Hari, Manu

AU - van der Schoot, C. Ellen

AU - Vidarsson, Gestur

AU - Roberts, David J.

AU - Simmonds, Peter

AU - Hedman, Klaus

AU - Harvala, Heli

PY - 2025/2

Y1 - 2025/2

N2 - Objectives: Convalescent plasma (CP) treatment of COVID-19 has shown significant therapeutic effect only when administered early. We investigated the importance of patient and CP seroprofiles on treatment outcome in REMAP-CAP CP trial. Methods: We evaluated neutralising antibodies (nAb), anti-spike (S) IgM, IgG, IgG avidity, IgG fucosylation and respiratory viral loads in a sub-set of patients (n=80) and controls (n=51) before and after transfusion, comparing them to those in the CP units (n=157) they received. Results: Most patients were SARS-CoV-2 seropositive pre-transfusion (72% nAb; 89% S-IgG seropositivity). The majority (80%) had higher pre-transfusion S-IgG levels (median 1.7×106 arbitrary units (AU); 56%) or S-IgG production rates (median 1.1×106 AU/day; 64%) than they received from CP (median 2.2×105 AU). Only 22% of the patients demonstrated significant (median 24-fold) increase in their S-IgG levels acquired from transfusion. Better outcomes, measured by organ support-free days, were associated with increase in S-IgM levels (p=0.007), decreased S-IgG fucosylation (p<0.001), lower patient age (p<0.001) but not with receiving CP (p=0.337). Conclusions: Based on our data, increased S-antibody levels linked to transfused CP were only observed in pre-seroconversion or immunodeficient patients lacking their own SARS-CoV-2 antibodies, representing the groups where CP treatment has previously shown most benefit.

AB - Objectives: Convalescent plasma (CP) treatment of COVID-19 has shown significant therapeutic effect only when administered early. We investigated the importance of patient and CP seroprofiles on treatment outcome in REMAP-CAP CP trial. Methods: We evaluated neutralising antibodies (nAb), anti-spike (S) IgM, IgG, IgG avidity, IgG fucosylation and respiratory viral loads in a sub-set of patients (n=80) and controls (n=51) before and after transfusion, comparing them to those in the CP units (n=157) they received. Results: Most patients were SARS-CoV-2 seropositive pre-transfusion (72% nAb; 89% S-IgG seropositivity). The majority (80%) had higher pre-transfusion S-IgG levels (median 1.7×106 arbitrary units (AU); 56%) or S-IgG production rates (median 1.1×106 AU/day; 64%) than they received from CP (median 2.2×105 AU). Only 22% of the patients demonstrated significant (median 24-fold) increase in their S-IgG levels acquired from transfusion. Better outcomes, measured by organ support-free days, were associated with increase in S-IgM levels (p=0.007), decreased S-IgG fucosylation (p<0.001), lower patient age (p<0.001) but not with receiving CP (p=0.337). Conclusions: Based on our data, increased S-antibody levels linked to transfused CP were only observed in pre-seroconversion or immunodeficient patients lacking their own SARS-CoV-2 antibodies, representing the groups where CP treatment has previously shown most benefit.

KW - Antibodies

KW - Convalescent plasma treatment

KW - COVID-19

KW - Critical care

KW - Infectious diseases

KW - SARS-CoV-2

KW - Serology

KW - Transfusion medicine

KW - Virology

UR - https://www.scopus.com/pages/publications/85215609307

U2 - 10.1016/j.jinf.2025.106412

DO - 10.1016/j.jinf.2025.106412

M3 - Article

C2 - 39798805

AN - SCOPUS:85215609307

SN - 0163-4453

VL - 90

JO - Journal Of Infection

JF - Journal Of Infection

IS - 2

M1 - 106412

ER -

Individual patient and donor seroprofiles in convalescent plasma treatment of COVID-19 in REMAP-CAP clinical trial

Abstract

Bibliographical note

Funding

Keywords

UN SDGs

Access to Document

Other files and links

Fingerprint

Cite this