The price of immunoglobulin G has been hyped up to tens of thousands of yuan. Do we really need to stock up some during the peak of the epidemic?

The continued development of the COVID-19 pandemic has made many people feel uneasy.

From the early rush to buy antipyretics and cough medicines, to the later scramble to buy the so-called "special COVID-19 medicine" everywhere, many people are now frantically buying immunoglobulin G through abnormal channels as a life-saving COVID-19 drug, resulting in a surge in demand for this drug.

Antipyretic and cough medicine is a must-have for every family, so you can prepare some. However, it is probably unnecessary to stock up on "C-balls", and there may be risks if they are abused. What is going on? Let me explain it to you in detail.

01

What exactly is “C-ball”?

Immunoglobulin G is actually a popular name. Professionally, it is called "intravenous human immunoglobulin" (IVIG) or "intravenous human blood immunoglobulin G", abbreviated as "G ball", "intravenous G ball", etc. G ball is essentially a mixture of multiple human immunoglobulins (Immunoglobulin, Ig).

So what is immunoglobulin? We can roughly think of it as "immunoglobulin ≈ antibody", which is the main substance for the human body to respond to foreign antigens (such as bacteria, viruses and other toxins or foreign substances). Antibodies are specific when binding to antigens, that is, a certain antibody can bind to one or more antigens very efficiently and tightly. Because of this characteristic, antibodies play an important role in the human body's immune defense process.

Antibodies can bind to antigens on the surface of pathogens (including bacteria, viruses, etc.), which creates favorable conditions for our immune system to resist and eliminate these bad guys. For example, when some viruses invade our cells, they need to use surface antigens to bind to surface receptors on host cells. However, if the antigen is first bound by antibodies, it is like a door key being covered with a set, and it can no longer be inserted into the keyhole and open the door. In this way, the virus cannot enter the cell to reproduce and destroy it.

Antibodies can also "capture" viruses and gather them into small clusters (microscopic scale) of immune complexes, making it more difficult for the viruses to spread in the body and easier for them to be cleared away in piles by macrophages.

There are also some antibodies that can attach to invaders and act as markers to guide other weapons of the immune system (such as complement, macrophages, etc.) to attack invaders more efficiently. In addition, antibodies have many other functions, such as regulating the immune system, inhibiting inflammation, etc., which will not be elaborated here.

How does the C ball work?

Every time our human body is infected with a pathogen or vaccinated with a vaccine, some specific antibodies will be produced in the plasma. When making immunoglobulins, thousands of human plasmas are needed, and after inactivation and pH adjustment, immunoglobulins containing tens of thousands of antibodies are made. If used correctly, these antibodies enter the patient's body and will act like a powerful new force, quickly clearing out common pathogens and stabilizing the immune system. They can be used to resist serious infections of bacteria and viruses, regulate the patient's immune system, and improve allergies.

02

Can immunoglobulin G really treat COVID-19 infection?

After reading this, you may be confused. Since immunoglobulin can be used to prevent and treat serious infections, it should also be effective against the new coronavirus. So many people are stockpiling it, so why do you say it is "not necessary"?

In clinical practice, immunoglobulin G can be used for severe infections, immunodeficiency diseases, and autoimmune diseases, such as viral hepatitis, severe lupus erythematosus, neonatal sepsis, Kawasaki disease, etc. Perhaps it is because of this that it has become a "life-saving magic drug" in everyone's mind, thinking that it can be used in any situation and that it can prevent or treat COVID-19, but this is not the case.

The antibodies in immunoglobulin G are not specifically targeted at the new coronavirus, and it is almost impossible for them to play a "final" role in the "battle" against the new coronavirus infection. Moreover, immunoglobulin G is a special drug, with an adverse reaction rate of about 5%-15%, and a serious adverse reaction rate of 2%-6%. Mild adverse reactions may cause headaches or allergies, and severe adverse reactions may cause acute renal failure and other problems. It can be seen that immunoglobulin G is not something that can be used casually.

Some friends may be very confused, saying that many new coronavirus diagnosis and treatment plans clearly state intravenous immunoglobulin (Ig), so why do they say it is not very useful?

There are several reasons.

First of all, the effectiveness of immunoglobulin G in the treatment of COVID-19 infection is still controversial, and some people get injected in advance in order to "prevent" COVID-19, which may bring health risks and the risk of contracting blood-borne diseases.

Secondly, we can take a look at these diagnosis and treatment plans. In almost all the content related to immunoglobulin, we can find more than one "severe" word, such as "severe or critical patients", "serious disease X", etc. This is because some medical teams have made attempts and efforts to minimize the possibility of critical illness and death of patients based on previous experience in rescuing severe viral infections, when there is currently no high-quality research on the effectiveness of immunoglobulin for the treatment of new coronavirus infections. Therefore, immunoglobulin should not be regarded as a panacea.

Some people may say that the national "ninth edition plan" recommends the use of immunoglobulin. Is this the same as immunoglobulin G?

Of course not!

Gamma globulin is an antibody extracted from the plasma of healthy people. COVID-19 human immunoglobulin is obtained from the convalescent plasma of a large number of blood donors infected with the new coronavirus. It is a specific antibody for the new coronavirus and is different from gamma globulin. Injection of COVID-19 immunoglobulin in an emergency can indeed have a good effect. However, this also needs to be judged by the doctor. It should not be used casually for patients with high-risk factors, rapid disease progression, high viral load, etc.

So, after reading this, you should understand that there is actually not much point in hoarding C balls, and C balls cannot be used at will.

References:

[1]Müller, L., Benedetto, SD & Pawelec, G. Encyclopedia of Gerontology and Population Aging. 1–12 (2019) doi:10.1007/978-3-319-69892-2_68-1.

[2]Radosevich, M. & Burnouf, T. Intravenous immunoglobulin G: trends in production methods, quality control and quality assurance. Vox Sang 98, 12–28 (2010).

[3]https://www.covid19treatmentguidelines.nih.gov/therapies/miscellaneous-drugs/intravenous-immunoglobulin/

[4] Novel Coronavirus Pneumonia Diagnosis and Treatment Plan (Trial Version 9)

[5] Uptodate: COVID-19: Convalescent plasma and hyperimmune globulin

Author: Xie Wangshi, Master of Pharmacology, Jinan University

Review | Tang Qin, Chief Researcher, Science Popularization Department, Chinese Medical Association