Targeting Cytokine Storm in COVID-19: A Role of Online Hemodiafiltration with Asymmetric Cellulose Triacetate in Maintenance Hemodialysis Patients—A Report of 10 Cases

Early reports have suggested that maintenance hemodialysis (MHD) patients could be more susceptible to a severe course of COVID-19. Among the therapeutic approaches, the use of drugs that reduce the cytokine storm characteristic of this disease has been proposed. Some dialyzers, such as the new generation of asymmetric cellulose triacetate (ATA) membranes, could favor the effective elimination of medium-sized molecules and other inflammatory mediators. In this case series, we describe in depth the clinical, analytical, and radiological details, therapeutic aspects, and outcomes of the case series of 10 MHD patients of our dialysis unit, who tested positive for SARS-CoV-2 from 5 October to 30 November 2020. Furthermore, we evaluate the removal of hyperinflammatory parameters with the ATA membrane in postdilution online hemodiafiltration (OL-HDF) in these patients through a variety of biomarkers of systemic inflammation from the diagnosis until stripping. Biochemical blood analysis was carried out at baseline and at days 7 and 14 after diagnosis, respectively. 50% of the patients presented COVID-19 pneumonia and required hospital admission. Median hospitalization time was 21 days. A total of 4 patients developed severe pneumonia (3 of them died) and 1 patient developed moderate pneumonia. Patients who died (n = 3) were more likely to present bilateral pneumonia (100% vs 14.3%) at diagnosis and less reduction in interleukin 6 (IL-6) at day 14, as compared to those who survived. The use of the ATA membrane could be considered a therapeutic option, due to its immunomodulatory effect in MHD patients with SARS-CoV-2 infection, especially at the beginning of the disease, where the inflammatory component is predominant.

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COVID-19 and Hyperinflammation: Role of Steroid in Mild Disease

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2020/v32i2330712 ◽

2020 ◽

pp. 18-22

Author(s):

Jhasaketan Meher ◽

Manish Kumar Nayak

Keyword(s):

Immune Response ◽

Wide Spectrum ◽

Case Series ◽

Public Health Problem ◽

Major Public Health Problem ◽

Cytokine Storm ◽

Multiorgan Dysfunction ◽

Mild Disease ◽

Persistent Symptoms

Current COVID-19 has become a major public health problem because of its pandemicity, with wide spectrum of disease manifestation. SARS-COV-2 can have a varied clinical manifestation ranging from asymptomatic, mild symptomatic to severe disease like acute respiratory distress syndrome, cytokine storm, and multiorgan dysfunction. It has been described in literature that cytokine storm/hyperinflammation arises as result of dysregulated immune response leading to excessive release of various cytokines which causes multiorgan dysfunction. But there is paucity of literature describing the immune response and hyperinflammation in mild disease which may cause unremitting symptoms. Here we describe a case series of three patients with mild disease, who had persistent symptoms beyond 1 week and managed with low dose steroid after confirming it to be hyperinflammation. So it is imperative to detect the hyperinflammatory phase to halt the disease progression. Also we have discussed the role of immune system and role of steroid in COVID-19.

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The role of hydroxychloroquine sulfate in the geriatric patient with coronavirus disease 2019 (COVID-19). What is useful to know for the geriatrician?

Geriatric Care ◽

10.4081/gc.2020.9015 ◽

2020 ◽

Vol 6 (2) ◽

Cited By ~ 1

Author(s):

Ciro Manzo

Keyword(s):

Therapeutic Option ◽

Case Series ◽

The Elderly ◽

Hospital Treatment ◽

Viral Loads ◽

Beneficial Effects ◽

Study Protocols ◽

Therapeutic Study

The role of hydroxychroloquine (HCQ) sulfate as therapeutic option in coronavirus disease 2019 (COVID-19) patients aroused great interest and hope, so much so as to authorize several studies in the world. Despite the beneficial effects demonstrated in vitro and in some case-series, doubts remain about its clinical use, so that at present more than 20 different therapeutic study protocols have been proposed. Very recently, a protocol has been authorized by the Italian Medicines Agency (AIFA), in order to evaluate the efficacy of out-of-hospital treatment with HCQ in the reducing viral loads and need for hospitalization in symptomatic COVID-19 infected patients who are confined at home. The article describes lights and shadows of HCQ therapy in the elderly and geriatric patients affected by COVID-19, and suggests that the geriatrician should use HCQ only after careful patient selection and be aware of its pharmacokinetic properties and adverse effects, before better-designed studies determine their benefit, if any, in treating COVID-19.

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Autoimmune Disorders & COVID-19

Medicines ◽

10.3390/medicines8100055 ◽

2021 ◽

Vol 8 (10) ◽

pp. 55

Author(s):

Leonardo Freire-de-Lima ◽

Aline Miranda Scovino ◽

Camilla Cristie Barreto Menezes ◽

Leonardo Marques da Fonseca ◽

Jhenifer Santos dos Reis ◽

...

Keyword(s):

Immune System ◽

Respiratory Failure ◽

Autoimmune Disease ◽

Severe Pneumonia ◽

Type I ◽

Cytokine Storm ◽

Immunological Mechanisms ◽

The World ◽

Inflammatory Syndrome

Coronavirus disease 2019 (COVID-19) can progress to severe pneumonia with respiratory failure and is aggravated by the deregulation of the immune system causing an excessive inflammation including the cytokine storm. Since 2019, several studies regarding the interplay between autoimmune diseases and COVID-19 infections is increasing all over the world. In addition, thanks to new scientific findings, we actually know better why certain conditions are considered a higher risk in both situations. There are instances when having an autoimmune disease increases susceptibility to COVID-19 complications, such as when autoantibodies capable of neutralizing type I IFN are present, and other situations in which having COVID-19 infection precedes the appearance of various autoimmune and autoinflammatory diseases, including multisystem inflammatory syndrome in children (MIS-C), Guillain-Barré syndrome, and Autoimmune haemolytic anaemia (AIHA), thus, adding to the growing mystery surrounding the SARS-CoV-2 virus and raising questions about the nature of its link with autoimmune and autoinflammatory sequelae. Herein, we discuss the role of host and virus genetics and some possible immunological mechanisms that might lead to the disease aggravation.

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Multisystem Inflammatory Syndrome in an Adult (MIS-A) Successfully Treated with Anakinra and Glucocorticoids

Microorganisms ◽

10.3390/microorganisms9071393 ◽

2021 ◽

Vol 9 (7) ◽

pp. 1393

Author(s):

Paolo Cattaneo ◽

Alessandro Volpe ◽

Chiara Simona Cardellino ◽

Niccolò Riccardi ◽

Giulia Bertoli ◽

...

Keyword(s):

Kawasaki Disease ◽

Clinical Picture ◽

Toxic Shock Syndrome ◽

Case Series ◽

Biologic Agents ◽

Diagnostic Process ◽

Cytokine Storm ◽

Toxic Shock ◽

Inflammatory Syndrome

During the current SARS-CoV-2 pandemic, a novel syndrome termed “multisystem inflammatory syndrome in children” (MIS-C) has emerged. MIS-C was linked to COVID-19 and shared some features with Kawasaki disease and Toxic Shock Syndrome, with a common pathogenetic substrate of hyperinflammation and cytokine storm. Lately, MIS was also described in adults (≥21 years of age) and named “MIS-A”. There is no consensus about the treatment of MIS-A; successful use of glucocorticoids and immunoglobulins has been reported in case series, but more solid evidence is lacking. Furthermore, the role of biologic agents with proven benefits against COVID-19, MIS-C, or Kawasaki disease is still unexplored. In this report, we detail the clinical picture and the diagnostic process that led to the diagnosis of MIS-A in a 27-year-old man, focusing on its treatment with anakinra and glucocorticoids, which resulted in full recovery. To our knowledge, this is the first report of the successful use of anakinra for MIS-A, a drug that has already proven useful in the treatment of refractive cases of MIS-C. Anakinra may also play a pivotal role for the treatment of MIS-A.

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The Role of Hemoperfusion in COVID-19 Infection: A Case Series

Archives of Anesthesia and Critical Care ◽

10.18502/aacc.v7i3.6912 ◽

2021 ◽

Author(s):

Ali Amirsavadkouhi ◽

Alireza Jahangirifard ◽

Reza Shahrami ◽

Saeid Safari ◽

Faezeh Feizabadi ◽

...

Keyword(s):

Medical Records ◽

Medical Condition ◽

Case Series ◽

Severe Infection ◽

Multiple Organ ◽

Pathological Process ◽

Rapid Expansion ◽

Cytokine Storm ◽

Cytokine Levels

The rapid expansion of a novel human infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has evolved into a pandemic, affecting thousands of people world wild. Some patients with coronavirus disease 2019 (COVID-19) develop severe infection, which may progress to acute respiratory distress syndrome, multiple organ failure, and death. Increasing studies indicate that abnormal elevation of cytokine levels in response to SARS-CoV-2 may contribute to the pathological process that leads mortality of COVID-19. Thus, application of extracorporeal hemoperfusion (HP) for removal of excessive cytokines from the blood can potentially mitigate or reverse cytokine storm related complications of COVID-19. Here, we presented series of COVID-19 patients, who were treated with HP (HA 380 cartridge, Jafron Biomedocal Co, China). The medical records were evaluated retrospectively to determine the effect of HP on patients’ clinical outcome. Our results showed that HP improvee PO2 and O2 saturation in patients with severe COVID-19. After the last courses of HP, 5 out of 6 patients were extubated and transferred to the general ward with an acceptable medical condition. The following case series demonstrate the promising role of HP in controlling the consequential effect of cytokine storm following a COVID-19 infection, which could facilitate patient survival.

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Cystic Fibrosis Transmembrane Conductance Regulator Gene Abnormalities in Patients with Asthma and Recurrent Neutrophilic Bronchitis

Canadian Respiratory Journal ◽

10.1155/2012/546702 ◽

2012 ◽

Vol 19 (1) ◽

pp. 46-48 ◽

Cited By ~ 7

Author(s):

Jodi Goodwin ◽

Naomi Spitale ◽

Asma Yaghi ◽

Myrna Dolovich ◽

Parameswaran Nair

Keyword(s):

Cystic Fibrosis ◽

Therapeutic Option ◽

Case Series ◽

Gene Mutations ◽

Transmembrane Conductance Regulator ◽

Regulator Gene ◽

Transmembrane Conductance ◽

Related Disease ◽

Cystic Fibrosis Transmembrane

The present case series describes four patients with asthma, airway hyper-responsiveness and neutrophilic bronchitis who harboured abnormal cystic fibrosis transmembrance conductance regulator (CFTR) gene mutations. It serves both to alert clinicians to consider CFTR-related disease in both young and elderly patients with persistent neutrophilic bronchitis, and to highlight the potential utility of future genetic testing for CFTR abnormalities in patients with asthma and recurrent bronchitis or pansinusitis, and the role of nebulized hypertonic saline as a therapeutic option in these patients.

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