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Eur J Immunol . B-Cell Remodeling and Regulatory Phenotypes During Acute COVID-19 Are Unaffected by Polyclonal Anti-SARS-CoV-2 Antibody XAV-19

tetano

Editor, Senior Moderator
Eur J Immunol

. 2026 Sep;56(9):e70284.
doi: 10.1002/eji.70284.

B-Cell Remodeling and Regulatory Phenotypes During Acute COVID-19 Are Unaffected by Polyclonal Anti-SARS-CoV-2 Antibody XAV-19​


Nicolas Degauque 1 , Richard Danger 1 , Hoa Le Mai 1 , Marion Cadoux 1 , Thi-Van-Ha Nguyen 1 , Gaëlle Tilly 1 , François Raffi 2 , Thomas Guimard 3 , Karine Lacombe 4 , Didier Laureillard 5 , Laurent Hocqueloux 6 , Vincent Dubee 7 , Florence Ader 8 9 , Cynthia Fourgeux 1 , Jérémie Poschmann 1 , Bernard Vanhove 10 , Odile Duvaux 10 , Benjamin Gaborit 1 2 , Sophie Brouard 1 ; POLYCOR study group

Affiliations Expand


Abstract​


Regulatory B cells (Bregs) are emerging as pivotal modulators of immune balance, yet their dynamics during severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and their response to passive antibody therapy remain largely unexplored. In the immunological sub-study of the randomized, placebo-controlled POLYCOR trial evaluating XAV-19, a glyco-humanized polyclonal anti-SARS-CoV-2 antibody, we performed longitudinal immune profiling of hospitalized COVID-19 patients using spectral flow cytometry, in vitro functional assays, and single-cell RNA sequencing. SARS-CoV-2 infection triggered a transient remodeling of the B-cell compartment, with expansion of activated B cells and plasmablasts, contraction of switched memory B cells, and enrichment of B cells expressing regulatory-associated markers, including PD-L1, CD9, granzyme B, and IL-10. Transcriptional analyses revealed dynamic reprogramming, characterized by downregulation of adhesion and costimulatory genes (CD27, ITGB7) and emergence of an interferon-driven memory B-cell signature (SOCS1, IFI27). In contrast, XAV-19 treatment preserved B-cell homeostasis, showing minimal impact on phenotype, function, and gene expression. Together, these findings uncover a transient regulatory adaptation of B cells during acute COVID-19 and demonstrate that XAV-19 therapy maintains immune equilibrium, reinforcing its safety and supporting the concept of immunologically neutral passive antibody therapy.

Keywords: B cell; severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2); viral infection.
 
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