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However, deviations from a directly proportional relationship between in vitro activity and in vivo activity are seen for some antibodies, for example for antibodies to HIV 10,11,12 and influenza virus 13 and for a combination of SARS-CoV-2 nAbs 14

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Environmental factors such as heavy metal toxicity [1012], sub-clinical viral infections [13] and gastro-intestinal pathology [14, 15], as well as endogenous toxins produced by metabolic processes [16], hormones (reviewed in [17]) and gastro-intestinal bacteria [18, 19] have also been suggested as playing a role in the aetiology of the disorder, although none of these have been thoroughly investigated