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.

Pathophysiological, immunological, and inflammatory features of long COVID

“…Another category of autoantibodies targets G-protein coupled receptors (GPCRs), which have been implicated in cardiovascular and neurological development (345). In long COVID patients, a1 adrenergic receptor (a 1 AdR), b 1 AdR, and b 2 AdR and the muscarinic acetylcholine receptors M 2 (M 2 AChR), M 3 AChR, and M 4 AChR were the most found and correlates with the severity of the neurological symptoms (345)(346)(347).…”

Neurologische Langzeitfolgen von COVID-19

“…Der Bedarf an belastbarer Evidenz ist groß, der Kenntnisstand allerdings weiterhin gering, die vorliegende Ergebnisse teils widersprüchlich. In einer deutschen Studie unterliefen 123 Teilnehmende mit Fatigue-Beschwerden nach einer COVID-19-Erkrankung ein spezielles therapeutisches Aphereseverfahren, bei dem Autoantikörper, Entzündungsmediatoren wie Zytokine, Lipidproteine und andere Moleküle herausgefiltert werden sollen [73]. Mittels Selbsteinschätzungsfragebögen wurde anschließend eine Besserung der Symptomatik ermittelt [73].…”

Coronavirus disease 2019 (COVID-19) pandemic and autoimmune rheumatic diseases: Outcomes and prospects

“…Предварительные результаты свидетельствуют об определенной положительной динамике клинических и лабораторных нарушений у пациентов с длительным COVID на фоне терапевтического афереза [301].…”