There are discussions that antibodies to SARS-like viruses might promote antibody-dependent infection (ADE). This would have big implications for vaccines / treatments, so I've been reading relevant papers in detail. Here are my thoughts (1/n).
I do *not* think there is good evidence for antibody-mediated SARS disease in humans. Instead, studies suggest pre-existing neutralizing antibodies are helpful. My conclusion is based on this list of papers, which includes links to papers & my notes (2/n) docs.google.com/document/d/1_v…
Where does idea of ADE for SARS come from? There is good evidence of ADE disease for cat coronavirus. Also, under certain (contrived?) cell-culture conditions antibodies can enhance coronavirus entry. But this is true for many viruses in contrived cell culture conditions. (3/n)
Finally, *some* studies find that patients who died of SARS had higher antibody titers. But this is confounded by the fact that higher antibodies titers are also likely to be correlated with higher viral titer and longer duration of infection. (4/n)
No controlled animal studies show pre-existing anti-SARS antibodies enhance disease; in fact, they all show the opposite--they reduce disease. Also, the (admittedly non-controlled) passive human serum transfer studies all concluded transferring anti-SARS antibodies helped. (5/n)
I caveat above with acknowledgment that although I've now read most relevant papers, I'm not true expert in SARS, and data are limited. But it's important to scrutinize suggestions of ADE critically, as it's existence in real human infections would have huge implications (6/n)
Finally, given importance of this topic it would be great to hear what SARS / antibody experts think. @florian_krammer @veeslerlab @McLellan_Lab @WardLab1 @FViromics? (7/n)
