2) The Fc receptors trigger a cascade of events that leads to interferon stimulated gene expression, a strong antiviral agent. In order for ADE to occur, viruses have to evolve to surpass ISG. 

Second requirement for ADE to occur 

In vitro observations have demonstrated that antibodies can bind to the spike protein of coronaviruses, leading to FC-receptor mediated entry of coronaviruses (the first requirement for ADE). However, de Alwis et al. state that caution must be used when interpreting in vitro observations because ADE has been associated with a very few diseases. 

In vitro ADE from Coronaviruses

1) An antibody bound virus has to bind to a receptor responsible for activating Fc, which leads to Fc-receptor mediated endocytosis or pahgocytosis. This allows the virus to enter into mononuclear cells, macrophages and dendritic cells that express the Fc receptor. 

Santa Clara University

Antibody-dependent enhancement occurs when the antibodies the viruses bind to on the host cell permit increased entry and replication of the virus. This process has been observed in: yellow fever, zika virus, and the novel coronavirus.
ADE affects vaccine development by being a possible unforeseen phenomenon that could cause the vaccine to worsen the patient's condition rather than providing an inflammatory response.

de Alwis, R., Chen, S., Gan, E. S., & Ooi, E. E. (2020). Impact of immune enhancement on Covid-19 polyclonal hyperimmune globulin therapy and vaccine development. EBioMedicine, 55, 102768. https://doi.org/10.1016/j.ebiom.2020.102768

Impact of immune enhancement on Covid-19 polyclonal hyperimmune globulin therapy and vaccine development.

Examples of Vaccinations that have Led to ADE

First Requirement for ADE to occur 

Furthers studies need to be conducted to see if ADE plays a role in the pathogenesis of SARS-CoV-2. However, in-vitro studies highlight the possibility of ADE after infection with coronavirus. 

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