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 Table of Contents 
Year : 2020  |  Volume : 9  |  Issue : 5  |  Page : 2589-2590  

Is there antibody-dependent enhancement in SARS Coronavirus 2?

1 Senior Resident, AIIMS, New Delhi, India
2 Assistant Professor, Department of Infectious Diseases, KMC, Manipal, Karnataka, India
3 Assistant Professor, Department of Medicine, Lady Hardinge Medical College and Dr. RML PGIMER, New Delhi, India
4 Additional Professor, AIIMS, New Delhi, India
5 Professor, Department of Medicine, AIIMS, New Delhi, India

Date of Submission04-Apr-2020
Date of Decision26-Apr-2020
Date of Acceptance08-May-2020
Date of Web Publication31-May-2020

Correspondence Address:
Dr. Manish Soneja
Department of Medicine, AIIMS, New Delhi - 110 029
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jfmpc.jfmpc_540_20

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How to cite this article:
Kumar R, Gupta N, Kodan P, Mittal A, Soneja M, Wig N. Is there antibody-dependent enhancement in SARS Coronavirus 2?. J Family Med Prim Care 2020;9:2589-90

How to cite this URL:
Kumar R, Gupta N, Kodan P, Mittal A, Soneja M, Wig N. Is there antibody-dependent enhancement in SARS Coronavirus 2?. J Family Med Prim Care [serial online] 2020 [cited 2021 Sep 27];9:2589-90. Available from: https://www.jfmpc.com/text.asp?2020/9/5/2589/285135

Dear Editor,

As primary care physicians across the world cater to ongoing outbreak due to COVID-19 pandemic, it is perplexing to see the geographical discrepancy in the number of severe cases as well as deaths across countries. Although there are other significant factors, we raise a pertinent question, whether antibody-dependent enhancement (ADE) is a possible contributing factor.

When a virus enters the host, several types of antibodies are formed. Some of these antibodies are neutralising, which hinders the replication of the virus by inhibiting essential steps such as the interaction of the virus with the host cell receptor. In some viruses, such as flaviviruses, enhancing antibodies are being described, which may facilitate the entry of the virus into the host cells. This immune-mediated enhancement of entry and pathogenesis is termed as ADE.[1] ADE can be mediated by Fc receptors or complement receptors.[1] Besides, ADE has been associated with increased severity. Such an effect has been well-characterised with dengue, where antibody to one serotype enhances the severity of infection due to another serotype.

In coronaviruses, it has been suggested that the severity of severe acute respiratory syndrome (SARS) could have been partly due to ADE to other human coronaviruses such as 229E. In-vitro studies have shown that antibodies against SARS-CoV-1 at high dilutions resulted in ADE. However, ADE could not be demonstrated in vaccine models of rhesus macaques. Reports of ADE have also been described for the Middle East respiratory syndrome as well.[2],[3],[4]

In COVID-19, several reasons, such as higher median age has been put forward to explain a higher percentage of severity and mortality in certain regions. Whether ADE can serve as a possible explanation for the uneven geographic distribution of severity and mortality remains to be seen. Individuals in these areas may have been primed with pre-existing locally circulating human coronaviruses and ADE to these coronaviruses may have some role in the increased severity of COVID-19. The prevalence of four human coronaviruses (HCoV-OC43, 229E, NL63 and HKU1) before COVID-19 outbreak in regions with high reported mortality are as follows: 2.4% (Spain), 5.5% (Iran), 9.3% (France), Italy (10.5%) and China (23%).[5],[6],[7],[8],[9] There is a need for serological surveys of human coronaviruses in serum samples of COVID-19 affected patients (mild and severe) to understand whether there is a correlation between pre-existing strain-specific antibodies to locally circulating human coronaviruses and severity of COVID 19. Convalescent plasma therapy from patients who have recovered from COVID-19 has been tried in several case series as a treatment with good results.[10] Vaccine trials across the world will start in the coming months.

Besides, understanding its possible role in severity, knowledge of ADE will be helpful for the primary care physicians to understand the safety and efficacy of convalescent plasma therapy and vaccines for COVID-19.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Morrone SR, Lok SM. Structural perspectives of antibody-dependent enhancement of infection of dengue virus. Curr Opin Virol 2019;36:1-8.  Back to cited text no. 1
Luo F, Liao FL, Wang H, Tang HB, Yang ZQ, Hou W. Evaluation of antibody-dependent enhancement of SARS-CoV infection in rhesus macaques immunized with an inactivated SARS-CoV vaccine. Virol Sin 2018;33:201-4.  Back to cited text no. 2
Jaume M, Yip MS, Cheung CY, Leung HL, Li PH, Kien F, et al. Anti-severe acute respiratory syndrome Coronavirus spike antibodies trigger infection of human immune cells via a pH- and cysteine protease-independent Fc R pathway. J Virol 2011;85:10582-97.  Back to cited text no. 3
Wan Y, Shang J, Sun S, Tai W, Chen J, Geng Q, et al. Molecular mechanism for antibody-dependent enhancement of Coronavirus entry. J Virol 2019;94:e02015-19.  Back to cited text no. 4
Cui L-J, Zhang C, Zhang T, Lu R-J, Xie Z-D, Zhang L-L, et al. Human coronaviruses HCoV-NL63 and HCoV-HKU1 in hospitalised children with acute respiratory infections in Beijing, China. Adv Virol 2011;2011:1-6.  Back to cited text no. 5
Madhi A, Ghalyanchilangeroudi A, Soleimani M. Evidence of human coroanvirus (229E), in patients with respiratory infection, Iran, 2015: The first report. Iran J Microbiol 2016;8:316-20.  Back to cited text no. 6
Ramón J, Vila J, Andrés C, Castillo C, Gimferrer L, Piñana M, et al. Molecular epidemiology of circulating human coronaviruses in children at a Tertiary hospital in Catalonia (Spain) from 2014 to 2016. J Clin Virol 2016;82:S124.  Back to cited text no. 7
Gerna G, Campanini G, Rovida F, Percivalle E, Sarasini A, Marchi A, et al. Genetic variability of human coronavirus OC43-, 229E-, and NL63-like strains and their association with lower respiratory tract infections of hospitalised infants and immunocompromised patients. J Med Virol 2006;78:938-49.  Back to cited text no. 8
Vabret A, Mourez T, Dina J, van der Hoek L, Gouarin S, Petitjean J, et al. Human coronavirus NL63, France. Emerg Infect Dis 2005;11:1225-9.  Back to cited text no. 9
Ahn JY, Sohn Y, Lee SH, Cho Y, Hyun JH, Baek YJ, et al. Use of convalescent plasma therapy in two COVID-19 patients with acute respiratory distress syndrome in Korea. J Korean Med Sci 2020;35:e149.  Back to cited text no. 10

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