A Report on the First 7 Sequential Patients Treated Within the C-Reactive Protein Apheresis in COVID (CACOV) Registry

Abstract

Case series Patients: 7 Final Diagnosis: COVID-19 disease Symptoms: Fever • dypspnea Medication: Standard of care Clinical Procedure: C-reactive protein apheresis Specialty: Immunology • Infectious Diseases Objective: Unusual clinical course Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-induced pneumonia is a disease with high mortality and, still, no effective treatment. Excessively elevated C-reactive protein (CRP) plasma levels inversely correlate with prognosis. As CRP, via complement and macrophage activation, can cause organ damage in COVID-19, we have recently introduced selective CRP apheresis as a potentially effective treatment. Now, we report on the first patients with severe SARS-CoV-2-induced pneumonia treated within the “ C -reactive protein A pheresis in COV ID” ( CACOV ) registry. Case Reports: Seven sequential hospitalized patients with documented COVID-19, strongly elevated CRP plasma levels, and respiratory failure were treated by selective CRP apheresis in addition to standard therapy after having given their informed consent for inclusion in the CACOV registry. We performed 2-8 CRP apheresis sessions via either peripheral or central venous access depending on clinical course and CRP plasma levels. CRP apheresis, in COVID-19, reduced CRP plasma levels by approximately 50–90%, and it was thus highly effective, feasible, and safe. Despite severe radiological lung involvement in all our patients, only 2 patients finally required intubation, and none required extracorporeal membrane oxygenation (ECMO). All 7 patients were discharged from our 2 hospitals in good clinical condition. Conclusions: Selective CRP apheresis, starting early after patient admission, may be an effective treatment of SARS-CoV-2-induced pneumonia. SARS-COV-2 can cause organ damage and multiple organ failure predominantly by an excessive CRP-mediated autoimmune response of the ancient innate immune system. Further registry data and randomized trials are needed.

Special Issue “C-Reactive Protein and Cardiovascular Disease: Clinical Aspects”

“…Additionally, the 50% mortality rate within 12 months of hospitalisation was not seen in this severe cohort. A case series from the same registry (CACOV) with almost the same outcome was recently reported from another hospital [15]. The report by Esposito et al spectacularly confirms that oxygen-deprived cells get the problem of being disposed of because of CRP, and this actually does not happen when a sufficient amount of CRP is removed from the blood plasma.…”

Targeting C-Reactive Protein by Selective Apheresis in Humans: Pros and Cons

“…The most important clinical concern about CRP targeting is the danger of immunosuppression with consecutive bacterial or viral infection and sepsis. Interestingly, in spite of significant reduction of CRP plasma levels via CRP apheresis in both disease entities, we have not observed such effects in our patients suffering from acute myocardial infarction or COVID-19 disease [ 5 , 7 , 80 , 81 , 82 ]. Thus, either CRP is not crucial in immune defense against microbial pathogens or the remaining CRP plasma levels after CRP apheresis are still sufficient.…”

“…This innovative therapeutic approach for the early phase of severe COVID-19 is currently being used in three German hospitals. Three of the treated cases and one case series have already been published [ 7 , 80 , 81 , 82 ] and another publication on a case series has been submitted and can be viewed as a preprint ( ; 16 March 2022). In the case series by Esposito et al, there is a marked improvement in COVID-19 pneumonia on imaging performed before and after CRP apheresis.…”

CRP-Apherese bei akutem Myokardinfarkt bzw. COVID-19

“…Dieses innovative therapeutische Verfahren für die Frühphase von COVID-19 wird derzeit vielversprechend in 3 deutschen Kliniken eingesetzt. Drei der behandelten Fälle und eine Fallserie wurden bereits publiziert [ 61 , 63 , 77 , 78 ] und eine weitere Publikation zu einer Fallserie ist eingereicht (persönliche Kommunikation). Zur breiteren Verwendung der CRP-Apherese bei COVID-19 fehlt jedoch derzeit eine größere klinische Studie, wobei eine investigatorinitiierte Studie von der Universitätsklinik Essen kürzlich angemeldet wurde [ 21 ].…”