The Effect of Intravenous Autologous Activated Platelet-Rich Plasma Therapy on “Profibrotic Cytokine” IL-1β Levels in Severe and Critical COVID-19 Patients: A Preliminary Study

Abstract

Introduction. Elevated concentration of proinflammatory cytokines followed by hyperinflammation is one of the hallmarks of severe and critical COVID-19. In the short term, this may result in ARDS and lung injury; subsequently, this may cause pulmonary fibrosis—a disease with poor prognosis—in the long run. Among the cytokines, interleukin-1β (IL-1β) is one of the most overexpressed in COVID-19. We speculate that administration of intravenous activated autologous platelet-rich plasma (aaPRP), which contains interleukin-1 receptor antagonist (IL-1RA), would lower IL-1β levels and benefit the severe and critical COVID-19 patients. Methods. After acquiring ethical clearance, we recruited 12 adult COVID-19 patients of both sexes from the Koja Regional Hospital (Jakarta, Indonesia) ICU. After selection, seven patients were included and divided into two groups, severe and critical. In addition to three doses of aaPRP, both groups received the same treatment of antiviral, steroid, and antibiotics. Quantification of plasma IL-1β levels was performed by beads multiplex assay a day before the first aaPRP administration and a day after the second and third aaPRP administration. PaO2/FiO2 ratio and lung injury scores were evaluated a day before and a day after each aaPRP administration. Results. Severe and critical patients’ initial plasma IL-1β concentration was 4.71 pg/mL and 3.095 pg/mL, respectively. After 2 treatments with aaPRP, severe patients’ plasma IL-1β concentration decreased 12.48 pg/mL, while critical patients’ plasma IL-1β concentration increased to 18.77 pg/mL. Furthermore, after 3 aaPRP treatments, significant amelioration of patients’ PaO2/FiO2 ratio from 71.33 mmHg at baseline to 144.97 mmHg was observed ( p < 0.05 ). However, no significant improvement in lung injury score was observed in severe and critical groups. All severe patients and one critical patient recovered. Conclusion. The use of aaPRP may prevent pulmonary fibrosis in severe COVID-19 patients through the reduction of patients’ plasma IL-1β concentration and the amelioration of PaO2/FiO2 ratio.

Platelet-Rich Plasma Treatment for Chronic Respiratory Disease

“…In a case series by Karina et al, activated platelet-rich plasma (aPRP) was administered to seven COVID-19 patients suffering from ARDS [ 22 ]. The aPRP was created using patients’ blood that was centrifuged, and the remaining plasma was combined with a calcium activator [ 22 ].…”

“…In a case series by Karina et al, activated platelet-rich plasma (aPRP) was administered to seven COVID-19 patients suffering from ARDS [ 22 ]. The aPRP was created using patients’ blood that was centrifuged, and the remaining plasma was combined with a calcium activator [ 22 ]. Before administration, blood clots were removed and the remaining solution was reinfused into patients on days one, three, and five while in the intensive care unit [ 22 ].…”

Efficacy of Activated Autologous Platelet-Rich Plasma in The Treatment of Diabetic Foot Ulcers: An Evidence-Based Brief Literature Review

“…To improve outcomes in DFU care, several adjuvant therapies have been proposed, among which is activated autologous platelet-rich plasma (aaPRP). Advances in biotechnology has enabled scientists to uti-lize platelets for a wide array of uses, such as alopecia 4 , tendinopathy 5 , and even cytokine storm [6][7][8] . By processing blood samples from the patients, various bioactive proteins which possess favorable properties such as regeneration, can be released 3, 9 .…”

Case Report on Adjunct Intravenous Autologous Activated Platelet-Rich Plasma Therapy in Severely Ill COVID-19 Patients

“…Based on previous studies, aaPRP is safe and capable of ameliorating inflammation as reflected by the lowering of the pro-inflammatory biomarker 4 . Additionally, it also has an anti-fibrotic effect, which is beneficial for COVID-19 patients at risk of pulmonary fibrosis 5 . With surges in COVID-19 cases and hospital collapses caused by the delta variant of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in Indonesia and other countries, aaPRP may reduce the length of stay, improve clinical outcome, and hasten hospital bed availability, making precious room for other patients.…”