Since the global pandemic of the SARS-CoV-2 virus started, the need for an effective drug became apparent, since there was no possibility of vaccination when the virus appeared. Soon after the outbreak of the epidemic in China, the convalescent plasma of patients who had recovered began to be used, and relatively quickly the first monoclonal antibodies (mAb) against SARS-CoV-2, such as Bamlanivimab, Casirivimab and Imdevimab, were approved for use. Many other mAbs for the treatment of COVID-19 are still in development, in the approval process or already on the market. Monoclonal antibodies can work in two ways. Those that are specific to the virus, or for protein S, they neutralize the SARS-CoV-2 virus, which therefore cannot attach to target cells or to the ACE2 receptor. Another group of mAbs are cytokine-specific antibodies that trigger various effector functions in the recipient and regulate the cytokine storm. In most cases, neutralizing mAbs are more effective in the early stages of the disease, while mAbs that inhibit inflammatory cytokines are more effective in the later stages. The greatest limitation and challenge in the development of virus-specific neutralizing mAbs are mutations in the virus at sites where mAbs recognize viruses, as this can cause the ineffectivness of mAbs. Therefore, it is important to follow different variants of the virus and develop effective mAbs that could protect people with higher risk for more severe development of the disease and those who cannot be vaccinated for medical reasons.
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