suggests that the role of antibodies in the pathogenesis of highly-pathogenic coronaviruses is complex. Rhesus macaques immunized with vaccines containing SARS-CoV spike protein who developed high neutralizing anti-spike titers prior to inoculation with SARS-CoV developed more severe acute lung injury (ALI) than non-immunized controls, despite having lower viral loads.
[2] One possible explanation for these findings is that antibodies help to shift the burden of infection into macrophages and other immune cells, a process which has been shown to occur in vitro. [3] SARS-CoV infection of macrophages may then lead to changes at the transcriptional level that potentiate the exuberant and dysregulated innate immune response that typifies ALI in SARS. [4] This 