Tag: apheresis

A multimodal approach for treating post-acute infectious syndrome

Abstract:

Long-term complications, such as extensive fatigue and cognitive issues, are known from various infections, including SARS-CoV-2, influenza
virus, or Borrelia burgdorferi. The pathology is mostly unknown and differs between patients. Unfortunately, there is currently no common and
effective treatment. In this perspective, we imply that post-acute infectious syndromes are due to a variety of factors, including among others
diminished tissue perfusion, tissue infiltration by viruses, inflammation, and oxidative stress, and that not one specific biomarker can be used
to measure these syndromes. Thus, we suggest that a score based on a number of criteria/factors should be used to assess post-acute infectious
syndromes.

Consequently, probably not one single treatment can be used to treat this group of patients, and we suggest a multimodal
treatment regimen comprising a combination of pharmacotherapy, such as metformin and naltrexone with anti-inflammatory effects,
alongside physical therapies such as extracorporeal apheresis and transcutaneous neurotherapy. This combined approach aims to reduce
biomarker levels and enhance cognitive functions. This implies that a reset of the systems can be achieved by a multimodal approach based on a
score for post-acute infectious syndromes.

Source:  Charlotte Steenblock, Nicole Toepfner, Yannick P. Kok, Philip Mavberg, Horst Bruckmoser, Alfons Breu, Johannes Korth, Harald Heidecke, Milo A. Puhan, and Stefan R. Bornstein. A multimodal approach for treating post-acute infectious syndrome. Brain Medicine (2024) 1, 1–7; doi: https://doi.org/10.61373/bm024p.0064; Published online: 30 August 2024. https://bm.genomicpress.com/wp-content/uploads/2024/08/BM0064-Steenblock-2024.pdf (Full text)

Observational Study of Repeat Immunoadsorption (RIA) in Post-COVID ME/CFS Patients with Elevated ß2-Adrenergic Receptor Autoantibodies—An Interim Report

Abstract:

There is increasing evidence for an autoimmune aetiology in post-infectious Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). SARS-CoV-2 has now become the main trigger for ME/CFS. We have already conducted two small proof-of-concept studies on IgG depletion by immunoadsorption (IA) in post-infectious ME/CFS, which showed efficacy in most patients.
This observational study aims to evaluate the efficacy of IA in patients with post-COVID-19 ME/CFS. The primary objective was to assess the improvement in functional ability. Due to the urgency of finding therapies for post-COVID-Syndrome (PCS), we report here the interim results of the first ten patients, with seven responders defined by an increase of between 10 and 35 points in the Short-Form 36 Physical Function (SF36-PF) at week four after IA. The results of this observational study will provide the basis for patient selection for a randomised controlled trial (RCT), including sham apheresis, and for an RCT combining IA with B-cell depletion therapy. Trial registration number: NCT05629988.
Source: Stein E, Heindrich C, Wittke K, Kedor C, Kim L, Freitag H, Krüger A, Tölle M, Scheibenbogen C. Observational Study of Repeat Immunoadsorption (RIA) in Post-COVID ME/CFS Patients with Elevated ß2-Adrenergic Receptor Autoantibodies—An Interim Report. Journal of Clinical Medicine. 2023; 12(19):6428. https://doi.org/10.3390/jcm12196428 https://www.mdpi.com/2077-0383/12/19/6428 (Full text)

Immune Adsorption for the Treatment of Fatigue-Dominant Long-/Post-COVID Syndrome

Introduction:

Following an infection with SARS-CoV-2, a relevant proportion of patients suffer from fatigue-dominant long-/post-COVID syndrome. In 57% of patients with long-/post-COVID syndrome, who were treated in a university hospital, increased levels of autoantibodies (AABs) to G-protein-coupled neurotransmitter receptors (including ß-adrenergic and muscarinic) were detected ().

Reduction of ß-adrenergic AABs by immunoadsorption therapy was associated with clinical improvement in patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) (). Increasingly, reports of individual cases of successful treatment of long/post-COVID syndrome with the help of apheresis techniques have been widely disseminated via social media. By contrast, cases or studies with negative outcomes are much less likely to receive proper attention. Given the overall lack of data to date, medical societies are calling for a broader scientific basis, to which we would like to contribute with this case series.

Source: Ruhe J, Giszas B, Schlosser M, Reuken PA, Wolf G, Stallmach A. Immune Adsorption for the Treatment of Fatigue-Dominant Long-/Post-COVID Syndrome: A Series of Cases With Standardized Individual Experimental Therapy. Dtsch Arztebl Int. 2023 Jul;120(29-30):499–500. doi: 10.3238/arztebl.m2023.0073. Epub 2023 Jul 24. PMCID: PMC10511006. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10511006/ (Full text)

Clinical improvement of Long-COVID is associated with reduction in autoantibodies, lipids, and inflammation following therapeutic apheresis

Abstract:

In the aftermath of the COVID-19 pandemic, we are witnessing an unprecedented wave of post-infectious complications. Most prominently, millions of patients with Long-Covid complain about chronic fatigue and severe post-exertional malaise. Therapeutic apheresis has been suggested as an efficient treatment option for alleviating and mitigating symptoms in this desperate group of patients. However, little is known about the mechanisms and biomarkers correlating with treatment outcomes.

Here, we have analyzed in different cohorts of Long-Covid patients specific biomarkers before and after therapeutic apheresis. In patients that reported a significant improvement following two cycles of therapeutic apheresis, there was a significant reduction in neurotransmitter autoantibodies, lipids, and inflammatory markers. Furthermore, we observed a 70% reduction in fibrinogen, and following apheresis, erythrocyte rouleaux formation and fibrin fibers largely disappeared as demonstrated by dark field microscopy.

This is the first study demonstrating a pattern of specific biomarkers with clinical symptoms in this patient group. It may therefore form the basis for a more objective monitoring and a clinical score for the treatment of Long-Covid and other postinfectious syndromes.

Source: Achleitner, M., Steenblock, C., Dänhardt, J. et al. Clinical improvement of Long-COVID is associated with reduction in autoantibodies, lipids, and inflammation following therapeutic apheresis. Mol Psychiatry (2023). https://doi.org/10.1038/s41380-023-02084-1 https://www.nature.com/articles/s41380-023-02084-1 (Full text)

Post COVID and Apheresis – Where are we Standing?

Abstract:

A continual increase in cases of Long/Post COVID constitutes a medical and socioeconomic challenge to health systems around the globe. While the true extent of this problem cannot yet be fully evaluated, recent data suggest that up to 20% of people with confirmed SARS-CoV-2 suffer from clinically relevant symptoms of Long/Post COVID several weeks to months after the acute phase. The clinical presentation is highly variable with the main symptoms being chronic fatigue, dyspnea, and cognitive symptoms. Extracorporeal apheresis has been suggested to alleviate symptoms of Post/COVID. Thus, numerous patients are currently treated with apheresis.

However, at present there is no data from randomized controlled trials available to confirm the efficacy. Therefore, physicians rely on the experience of practitioners and centers performing this treatment. Here, we summarize clinical experience on extracorporeal apheresis in patients with Post/COVID from centers across Germany.

Source: Steenblock C, Walther R, Tselmin S, Jarzebska N, Voit-Bak K, Toepfner N, Siepmann T, Passauer J, Hugo C, Wintermann G, Julius U, Barbir M, Khan TZ, Puhan MA, Straube R, Hohenstein B, Bornstein SR, Rodionov RN. Post COVID and Apheresis – Where are we Standing? Horm Metab Res. 2022 Nov;54(11):715-720. doi: 10.1055/a-1945-9694. Epub 2022 Sep 16. PMID: 36113501. https://www.thieme-connect.de/products/ejournals/html/10.1055/a-1945-9694 (Full text)

Long Covid and Apheresis – Where are we Standing?

Abstract:

A continual increase in cases of Long Covid constitutes a medical and socioeconomic challenge to health systems around the globe. While the true extent of this problem cannot yet be fully evaluated, recent data suggests that up to 20% of people with confirmed with SARS-CoV-2 suffer from clinically relevant symptoms of Long Covid several weeks to months after the acute phase. The clinical presentation is highly variable with the main symptoms being chronic fatigue, dyspnea and cognitive symptoms. Extracorporeal apheresis has been suggested to alleviate symptoms of Long Covid. Thus, numerous patients are currently treated with apheresis. However, at present there is no data from randomized controlled trials available to confirm the efficacy. Therefore, physicians rely on the experience of practitioners and centers performing this treatment. Here, we summarize clinical experience on extracorporeal apheresis in patients with Long Covid from centers across Germany.

Source: Steenblock C, Walther R, Tselmin S, Jarzebska N, Voit-Bak K, Toepfner N, Siepmann T, Passauer J, Hugo C, Wintermann G, Julius U, Babir M, Khan TZ, Puhan MA, Straube R, Hohenstein B, Bornstein SR, Rodionov R. Long Covid and Apheresis – Where are we Standing? Horm Metab Res. 2022 Sep 16. doi: 10.1055/a-1945-9694. Epub ahead of print. PMID: 36113501.  https://pubmed.ncbi.nlm.nih.gov/36113501/

COVID-19 and Therapeutic Apheresis

Abstract:

The COVID-19 pandemic, caused by the SARS-CoV-2 virus, is an unprecedented challenge for the global community. The pathogenesis of COVID-19, its complications and long term sequelae (so called Long/Post-COVID) include, in addition to the direct virus-induced tissues injury, multiple secondary processes, such as autoimmune response, impairment of microcirculation, and hyperinflammation. Similar pathological processes, but in the settings of neurological, cardiovascular, rheumatological, nephrological, and dermatological diseases can be successfully treated by powerful methods of Therapeutic Apheresis (TA).

We describe here the rationale and the initial attempts of TA treatment in severe cases of acute COVID-19. We next review the evidence for the role of autoimmunity, microcirculatory changes and inflammation in pathogenesis of Long/Post COVID and the rationale for targeting those pathogenic processes by different methods of TA. Finally, we discuss the impact of COVID-19 pandemic on patients, who undergo regular TA treatments due to their underlying chronic conditions, with the specific focus on the patients with inherited lipid diseases being treated at the Dresden University Apheresis Center.

Source: Tselmin S, Julius U, Jarzebska N, Rodionov R. COVID-19 and Therapeutic Apheresis. Horm Metab Res. 2022 Aug;54(8):571-577. doi: 10.1055/a-1864-9482. Epub 2022 Aug 9. PMID: 35944525.  https://pubmed.ncbi.nlm.nih.gov/35944525/