Subscribe to RSS
DOI: 10.1055/a-1945-9694
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.
Publication History
Received: 12 August 2022
Accepted after revision: 16 September 2022
Accepted Manuscript online:
16 September 2022
Article published online:
27 October 2022
© 2022. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 National Institute for Health and Care Excellence: Clinical Guidelines. In, COVID-19 rapid guideline: managing the long-term effects of COVID-19. London: National Institute for Health and Care Excellence (NICE) Copyright NICE. 2020
- 2 Huang L, Li X, Gu X. et al. Health outcomes in people 2 years after surviving hospitalisation with COVID-19: a longitudinal cohort study. Lancet Respir Med 2022; 10: 863-876
- 3 Bornstein SR, Cozma D, Kamel M. et al. Long-COVID, metabolic and endocrine disease. Horm Metab Res 2022; 54: 562-566
- 4 Choutka J, Jansari V, Hornig M. et al. Unexplained post-acute infection syndromes. Nat Med 2022; 28: 911-923
- 5 Joob B, Wiwanitkit V. Blood viscosity of COVID-19 patient: a preliminary report. Am J Blood Res 2021; 11: 93-95
- 6 Kubánková M, Hohberger B, Hoffmanns J. et al. Physical phenotype of blood cells is altered in COVID-19. Biophys J 2021; 120: 2838-2847
- 7 Kanczkowski W, Beuschlein F, Bornstein SR. Is there a role for the adrenal glands in long COVID?. Nat Rev Endocrinol 2022; 18: 451-452
- 8 Kanczkowski W, Evert K, Stadtmuller M. et al. COVID-19 targets human adrenal glands. Lancet Diabetes Endocrinol 2022; 10: 13-16
- 9 Paul T, Ledderose S, Bartsch H. et al. Adrenal tropism of SARS-CoV-2 and adrenal findings in a post-mortem case series of patients with severe fatal COVID-19. Nat Commun 2022; 13: 1589
- 10 Bornstein SR, Voit-Bak K, Donate T. et al. Chronic post-COVID-19 syndrome and chronic fatigue syndrome: Is there a role for extracorporeal apheresis?. Mol Psychiatry 2022; 27: 34-37
- 11 Abbasi K. Long covid and apheresis: a miracle cure sold on a hypothesis of hope. BMJ 2022; 378: o1733
- 12 Davies M. Long covid patients travel abroad for expensive and experimental “blood washing”. BMJ 2022; 378: o1671
- 13 Bechmann N, Barthel A, Schedl A. et al. Sexual dimorphism in COVID-19: potential clinical and public health implications. Lancet Diabetes Endocrinol 2022; 10: 221-230
- 14 Torjesen I. Covid-19: Middle aged women face greater risk of debilitating long term symptoms. BMJ 2021; 372: n829
- 15 Honigsbaum M. “An inexpressible dread”: psychoses of influenza at fin-de-siècle. The Lancet 2013; 381: 988-989
- 16 Stefano GB. Historical insight into infections and disorders associated with neurological and psychiatric sequelae similar to long COVID. Med Sci Monit 2021; 27: e931447
- 17 Poenaru S, Abdallah SJ, Corrales-Medina V. et al. COVID-19 and post-infectious myalgic encephalomyelitis/chronic fatigue syndrome: a narrative review. Ther Adv Infect Dis 2021; 8 20499361211009385
- 18 Steenblock C, Schwarz PEH, Perakakis N. et al. The interface of COVID-19, diabetes, and depression. Discov Ment Health 2022; 2: 5
- 19 Sotzny F, Blanco J, Capelli E. et al. Myalgic encephalomyelitis/chronic fatigue syndrome – evidence for an autoimmune disease. Autoimmun Rev 2018; 17: 601-609
- 20 Berger G. Escape of pathogens from the host immune response by mutations and mimicry. Possible means to improve vaccine performance. Med Hypotheses 2015; 85: 664-669
- 21 Segal Y, Shoenfeld Y. Vaccine-induced autoimmunity: the role of molecular mimicry and immune crossreaction. Cell Mol Immunol 2018; 15: 586-594
- 22 Loebel M, Grabowski P, Heidecke H. et al. Antibodies to beta adrenergic and muscarinic cholinergic receptors in patients with chronic fatigue syndrome. Brain Behav Immun 2016; 52: 32-39
- 23 Danilenko OV, Gavrilova NY, Churilov LP. Chronic fatigue exhibits heterogeneous autoimmunity characteristics which reflect etiology. Pathophysiology 2022; 29: 187-199
- 24 Fluge Ø, Bruland O, Risa K. et al. Benefit from B-lymphocyte depletion using the anti-CD20 antibody rituximab in chronic fatigue syndrome. A double-blind and placebo-controlled study. PLoS One 2011; 6: e26358
- 25 Fluge Ø, Risa K, Lunde S. et al. B-Lymphocyte depletion in myalgic encephalopathy/chronic fatigue syndrome. An open-label phase II study with rituximab maintenance treatment. PLoS One 2015; 10: e0129898
- 26 Fluge Ø, Rekeland IG, Lien K. et al. B-Lymphocyte depletion in patients with myalgic encephalomyelitis/chronic fatigue syndrome: a randomized, double-blind, placebo-controlled trial. Ann Intern Med 2019; 170: 585-593
- 27 Angileri F, Legare S, Marino Gammazza A. et al. Molecular mimicry may explain multi-organ damage in COVID-19. Autoimmun Rev 2020; 19: 102591
- 28 Mobasheri L, Nasirpour MH, Masoumi E. et al. SARS-CoV-2 triggering autoimmune diseases. Cytokine 2022; 154: 155873
- 29 Lucchese G, Floel A. Molecular mimicry between SARS-CoV-2 and respiratory pacemaker neurons. Autoimmun Rev 2020; 19: 102556
- 30 Bastard P, Rosen LB, Zhang Q. et al. Autoantibodies against type I IFNs in patients with life-threatening COVID-19. Science 2020; 370 eabd4585
- 31 Koning R, Bastard P, Casanova JL. et al. Autoantibodies against type I interferons are associated with multi-organ failure in COVID-19 patients. Intensive Care Med 2021; 47: 704-706
- 32 Troya J, Bastard P, Planas-Serra L. et al. Neutralizing autoantibodies to type I IFNs in>10% of patients with severe COVID-19 pneumonia hospitalized in Madrid, Spain. J Clin Immunol 2021; 41: 914-922
- 33 Byrne CJ, Khurana S, Kumar A. et al. Inflammatory signaling in hypertension: regulation of adrenal catecholamine biosynthesis. Front Endocrinol (Lausanne) 2018; 9: 343
- 34 Wallukat G, Hohberger B, Wenzel K. et al. Functional autoantibodies against G-protein coupled receptors in patients with persistent Long-COVID-19 symptoms. J Transl Autoimmun 2021; 4: 100100
- 35 Bynke A, Julin P, Gottfries CG. et al. Autoantibodies to beta-adrenergic and muscarinic cholinergic receptors in myalgic encephalomyelitis (ME) patients - A validation study in plasma and cerebrospinal fluid from two Swedish cohorts. Brain Behav Immun Health 2020; 7: 100107
- 36 Hraiech S, Bonnardel E, Guervilly C. et al. Herpes simplex virus and cytomegalovirus reactivation among severe ARDS patients under veno-venous ECMO. Ann Intensive Care 2019; 9: 142
- 37 Imlay H, Dasgupta S, Boeckh M. et al. Risk factors for cytomegalovirus reactivation and association with outcomes in critically ill adults with sepsis: a pooled analysis of prospective studies. J Infect Dis 2021; 223: 2108-2112
- 38 Imlay H, Limaye AP. Current understanding of cytomegalovirus reactivation in critical illness. J Infect Dis 2020; 221: S94-S102
- 39 Libert N, Bigaillon C, Chargari C. et al. Epstein-Barr virus reactivation in critically ill immunocompetent patients. Biomed J 2015; 38: 70-76
- 40 Gatto I, Biagioni E, Coloretti I. et al. Cytomegalovirus blood reactivation in COVID-19 critically ill patients: risk factors and impact on mortality. Intensive Care Med 2022; 48: 706-713
- 41 Meng M, Zhang S, Dong X. et al. COVID-19 associated EBV reactivation and effects of ganciclovir treatment. Immun Inflamm Dis 2022; 10: e597
- 42 Zubchenko S, Kril I, Nadizhko O. et al. Herpesvirus infections and post-COVID-19 manifestations: a pilot observational study. Rheumatol Int 2022; 42: 1523-1530
- 43 Aldhaleei WA, Alnuaimi A, Bhagavathula AS. COVID-19 Induced hepatitis B virus reactivation: a novel case from the United Arab Emirates. Cureus 2020; 12: e8645
- 44 Rodríguez-Tajes S, Miralpeix A, Costa J. et al. Low risk of hepatitis B reactivation in patients with severe COVID-19 who receive immunosuppressive therapy. J Viral Hepat 2021; 28: 89-94
- 45 Shariq M, Sheikh JA, Quadir N. et al. COVID-19 and tuberculosis: the double whammy of respiratory pathogens. Eur Respir Rev 2022; 31: 210264
- 46 Walitt B, Johnson TP. The pathogenesis of neurologic symptoms of the postacute sequelae of severe acute respiratory syndrome coronavirus 2 infection. Curr Opin Neurol 2022; 35: 384-391
- 47 Al-Kuraishy HM, Al-Gareeb AI, El-Bouseary MM. et al. Hyperviscosity syndrome in COVID-19 and related vaccines: exploring of uncertainties. Clin Exp Med 2022; 1-10
- 48 Preiser JC. Oxidative stress. JPEN J Parenter Enteral Nutr 2012; 36: 147-154
- 49 Carr AC, Maggini S. Vitamin C and immune function. Nutrients 2017; 9: 1211
- 50 Jensen IJ, McGonagill PW, Berton RR. et al. Prolonged reactive oxygen species production following septic insult. Immunohorizons 2021; 5: 477-488
- 51 Vollbracht C, Kraft K. Feasibility of vitamin C in the treatment of post viral fatigue with focus on long COVID, based on a systematic review of IV vitamin C on fatigue. Nutrients 2021; 13: 1154
- 52 Pierce JD, Shen Q, Cintron SA. et al. Post-COVID-19 syndrome. Nurs Res 2022; 71: 164-174
- 53 Crook H, Raza S, Nowell J. et al. Long covid-mechanisms, risk factors, and management. BMJ 2021; 374: n1648
- 54 Matta J, Wiernik E, Robineau O. et al. Association of self-reported COVID-19 infection and SARS-CoV-2 serology test results with persistent physical symptoms among French adults during the COVID-19 pandemic. JAMA Intern Med 2022; 182: 19-25
- 55 Yang C, Zhao H, Tebbutt SJ. A glimpse into long COVID and symptoms. Lancet Respir Med 2022; 10: e81
- 56 Julius U. History of lipidology and lipoprotein apheresis. Atheroscler Suppl 2017; 30: 1-8
- 57 Julius U, Parhofer KG, Heibges A. et al. Dextran-sulfate-adsorption of atherosclerotic lipoproteins from whole blood or separated plasma for lipid-apheresis-comparison of performance characteristics with DALI and lipidfiltration. J Clin Apher 2007; 22: 215-223
- 58 Straube R, Muller G, Voit-Bak K. et al. Metabolic and non-metabolic peripheral neuropathy: is there a place for therapeutic apheresis?. Horm Metab Res 2019; 51: 779-784
- 59 Zanetti M, Zenti M, Barazzoni R. et al. HELP LDL apheresis reduces plasma pentraxin 3 in familial hypercholesterolemia. PLoS One 2014; 9: e101290
- 60 Kopprasch S, Bornstein SR, Schwarz PE. et al. Single whole blood dextran sulfate adsorption favorably affects systemic oxidative balance in lipoprotein apheresis patients. Atheroscler Suppl 2013; 14: 157-160
- 61 Kopprasch S, Graessler J, Bornstein SR. Beyond lowering circulating LDL: apheresis-induced changes of systemic oxidative stress markers by four different techniques. Atheroscler Suppl 2009; 10: 34-38
- 62 Grassler J, Kopprasch S, Passauer J. Differential effects of lipoprotein apheresis by lipidfiltration or dextran sulfate adsorption on lipidomic profile. Atheroscler Suppl 2013; 14: 151-155
- 63 Julius U, Siegert G, Kostka H. et al. Effects of different lipoprotein apheresis methods on serum protein levels. Atheroscler Suppl 2015; 18: 95-102
- 64 Yin X, Takov K, Straube R. et al. Precision medicine approach for cardiometabolic risk factors in therapeutic apheresis. Horm Metab Res 2022; 54: 238-249
- 65 Hohenstein B, Passauer J, Ziemssen T. et al. Immunoadsorption with regenerating systems in neurological disorders – A single center experience. Atheroscler Suppl 2015; 18: 119-123