Prospects of plasmapheresis for patients with severe COVID-19

Ineffectiveness of therapeutic plasma exchange as a last resort in severe COVID-19 cases: Experience from a tertiary intensive care unit

AIM

Several studies have suggested that cytokine release syndrome (CRS) can be controlled by therapeutic plasma exchange (TPE) treatment. In this study, it was aimed to evaluate the efficacy of TPE treatment in patients who developed life-threatening respiratory failure syndrome (SARS) due to COVID-19 infection.

METHODS

In this retrospective, case-control study, patients, who developed SARS, were infected with the COVID-19 virus, and required intensive care unit (ICU) admission were included. Patients included in the study were divided into groups according to whether TPE experience or not and if so, how many sessions were applied. Mortality rates of patients in the ICU and 30-day mortality ratios were evaluated.

RESULTS

A total of 110 patients, 71.8% of whom were male, with a mean age of 59.7 ± 13.3 years, were included in our study. It was observed that 70% of the patients died within a month and 80% of them died during the ICU follow-up period. The 30-day mortality rates of patients who underwent TPE at least once and those who never underwent TPE were 72.2% and 67.9%, respectively (p: 0.617). CRP, D-dimer, fibrinogen and platelet levels showed to have a decreasing trend after plasmapheresis and fluctuated thereafter. It was observed that procalcitonin and IL-6 levels were increased in the group that underwent plasmapheresis but decreased in those who did not receive plasmapheresis.

CONCLUSION

Patients severely infected with SARS-CoV-2 showed fluctuations in inflammatory parameters despite TPE treatment; CRS was not suppressed by TPE; and this treatment did not confer survival benefit in this patient group.

COVID-19 IgG antibodies detection based on CNN-BiLSTM algorithm combined with fiber-optic dataset

The urgent need for efficient and accurate automated screening tools for COVID-19 detection has led to research efforts exploring various approaches. In this study, we present pioneering research on COVID-19 detection using a hybrid model that combines convolutional neural networks (CNN) with a bi-directional long short-term memory (Bi-LSTM) network, in conjunction with fiber optic data for SARS-CoV-2 Immunoglobulin G (IgG) antibodies. Our research introduces a comprehensive data preprocessing pipeline and evaluates the performance of four different deep learning (DL) algorithms: CNN, CNN-RNN, BiLSTM, and CNN-BiLSTM, in classifying samples as positive or negative for the COVID-19 virus. Among these, the CNN-BiLSTM classifier demonstrated superior performance on the training datasets, achieving an accuracy of 89 %, a recall of 88 %, a precision of 90 %, an F1-score of 89 %, a specificity of 90 %, a geometric mean (G-mean) of 89 %, and a receiver operating characteristic (ROC) of 96 %. In addition, the achieved classification results were compared with those reported in the literature. The findings indicate that the proposed model has promising potential for classifying COVID-19 and could serve as a valuable tool for healthcare professionals. The use of IgG antibodies to detect the virus enhances the specificity and accuracy of the diagnostic tool.

Development of Fluorescence-Based Assays for Key Viral Proteins in the SARS-CoV-2 Infection Process and Lifecycle

Since the appearance of SARS-CoV-2 in 2019, the ensuing COVID-19 (Corona Virus Disease 2019) pandemic has posed a significant threat to the global public health system, human health, life, and economic well-being. Researchers worldwide have devoted considerable efforts to curb its spread and development. The latest studies have identified five viral proteins, spike protein (Spike), viral main protease (3CLpro), papain-like protease (PLpro), RNA-dependent RNA polymerase (RdRp), and viral helicase (Helicase), which play crucial roles in the invasion of SARS-CoV-2 into the human body and its lifecycle. The development of novel anti-SARS-CoV-2 drugs targeting these five viral proteins holds immense promise. Therefore, the development of efficient, high-throughput screening methodologies specifically designed for these viral proteins is of utmost importance. Currently, a plethora of screening techniques exists, with fluorescence-based assays emerging as predominant contenders. In this review, we elucidate the foundational principles and methodologies underpinning fluorescence-based screening approaches directed at these pivotal viral targets, hoping to guide researchers in the judicious selection and refinement of screening strategies, thereby facilitating the discovery and development of lead compounds for anti-SARS-CoV-2 pharmaceuticals.

Recent Advances of Representative Optical Biosensors for Rapid and Sensitive Diagnostics of SARS-CoV-2

The outbreak of Corona Virus Disease 2019 (COVID-19) has again emphasized the significance of developing rapid and highly sensitive testing tools for quickly identifying infected patients. Although the current reverse transcription polymerase chain reaction (RT-PCR) diagnostic techniques can satisfy the required sensitivity and specificity, the inherent disadvantages with time-consuming, sophisticated equipment and professional operators limit its application scopes. Compared with traditional detection techniques, optical biosensors based on nanomaterials/nanostructures have received much interest in the detection of SARS-CoV-2 due to the high sensitivity, high accuracy, and fast response. In this review, the research progress on optical biosensors in SARS-CoV-2 diagnosis, including fluorescence biosensors, colorimetric biosensors, Surface Enhancement Raman Scattering (SERS) biosensors, and Surface Plasmon Resonance (SPR) biosensors, was comprehensively summarized. Further, promising strategies to improve optical biosensors are also explained. Optical biosensors can not only realize the rapid detection of SARS-CoV-2 but also be applied to judge the infectiousness of the virus and guide the choice of SARS-CoV-2 vaccines, showing enormous potential to become point-of-care detection tools for the timely control of the pandemic.

On Therapeutic Plasma Exchange Against Severe COVID-19-Associated Pneumonia: An Observational Clinical Study

Background

There is a risk of novel mutations of SARS-CoV-2 that may render COVID-19 resistant to most of the therapies, including antiviral drugs and vaccines. The evidence around the application of therapeutic plasma exchange (TPE) for the management of critically ill patients with COVID-19 is still provisional, and further investigations are needed to confirm its eventual beneficial effects.

Aims

To assess the effect of TPE on the risk of mortality in patients with COVID-19-associated pneumonia, using three statistical procedures to rule out any threats to validity.

Methods

We therefore carried out a single-centered retrospective observational non-placebo-controlled trial enrolling 73 inpatients from Baqiyatallah Hospital in Tehran (Iran) with the diagnosis of COVID-19-associated pneumonia confirmed by real-time polymerase chain reaction (RT-qPCR) on nasopharyngeal swabs and high-resolution computerized tomography chest scan. These patients were broken down into two groups: Group 1 (30 patients) receiving standard care (corticosteroids, ceftriaxone, azithromycin, pantoprazole, hydroxychloroquine, lopinavir/ritonavir), and Group 2 (43 patients) receiving the above regimen plus TPE (replacing 2 l of patients' plasma by a solution, 50% of normal plasma, and 50% of albumin at 5%) administered according to various time schedules. The follow-up time was 30 days and all-cause mortality was the endpoint.

Results

Deaths were 6 (14%) in Group 2 and 14 (47%) in Group 1. However, different harmful risk factors prevailed among patients not receiving TPE rather than being equally split between the intervention and control group. We used an algorithm of structural equation modeling (of STATA) to summarize a large pool of potential confounders into a single score (called with the descriptive name “severity”). Disease severity was lower (Wilkinson rank-sum test p < 0.001) among patients with COVID-19 undergoing TPE (median: −2.82; range: −5.18; 7.96) as compared to those not receiving TPE (median: −1.35; range: −3.89; 8.84), confirming that treatment assignment involved a selection bias of patients according to the severity of COVID-19 at hospital admission. The adjustment for confounding was carried out using severity as the covariate in Cox regression models. The univariate hazard ratio (HR) of 0.68 (95%CI: 0.26; 1.80; p = 0.441) for TPE turned to 1.19 (95%CI: 0.43; 3.29; p = 0.741) after adjusting for severity.

Conclusions

In this study sample, the lower mortality observed among patients receiving TPE was due to a lower severity of COVID-19 rather than the TPE effects.

The use of therapeutic plasmapheresis in preventive and sports medicine

Maintenance of active longevity, preservation of physical activity, and prevention of decreased mobility associated with injury or age of patients are among the most urgent tasks for modern healthcare. The suppression of pathological processes and activation of defense systems at the cellular and organismal levels are the main routes for solving these problems. Several initial anti-aging therapy approaches are detoxification, rheocorrection, and immunocorrection. In these areas, methods of extracorporeal hemocorrection, in particular, therapeutic plasmapheresis, are effective. This study aimed to evaluate the effectiveness of hardware plasmapheresis with albumin compensation by assessing the dynamics of circulating age-related biomarker levels in randomly selected patients. Twenty human subjects of both sexes aged 40–55 years with an increase in one or more aging-related biomarkers participated in this study. The patients were randomly divided into two groups with ten people each. Patients from Group 1 underwent therapeutic plasmapheresis with albumin replacement (four procedures with a 2-day interval). Patients from Group 2 were offered plasmapheresis treatment with saline replacement. The levels of aging-related biomarkers were determined in the blood of patients before and 30 days after starting treatment. Preliminary data showed that plasmapheresis with albumin replacement in randomly selected male and female patients was accompanied by normalization of the selected aging biomarkers. Thirty days after the start of the plasmapheresis treatment, a decrease in both biological and phenotypic age was determined. Further studies are needed to investigate the effects of nutritional factors on aging biomarkers with and without plasmapheresis treatment. Based on the obtained results, recommendations will be made on the use of plasmapheresis in preventive and sports medicine. The use of this method will help reduce the biological age of patients and, as a result, reduce the risks of developing age-related diseases and disabilities and contribute to prolonging life and improving its quality.

Therapeutic plasma exchange in patients with COVID-19 pneumonia in intensive care unit: Cases series

Introduction

COVID 19 pneumonia can lead to an inappropriate inflammatory response, and can be complicated by acute respiratory distress syndrome, multivisceral failure with a high mortality rate.

Objective

To observe the effect of therapeutic plasma exchange on the excessive inflammatory response.

Materials and methods

In this study, we included 7 confirmed cases of COVID-19 in the intensive care unit (ICU) department of the university hospital of Oujda. COVID-19 cases were confirmed by RT PCR (reverse transcription-polymerase chain) and CT (computerized tomography) imaging according to WHO guidelines. Therapeutic plasma exchange was performed decrease cytokine storm-induced ARDS (Acute respiratory distress syndrome). Inflammation marker assays were performed before and after therapeutic plasma exchange to assess its efficacy.

Results

Levels of inflammatory cytokines (IL-6) and acute phase response proteins, including ferritin and CRP, were elevated before therapeutic plasma exchange.After therapeutic plasma exchange, levels of acute phase reactants, inflammatory mediators, were significantly reduced (p < 0.05).

Conclusion

Our data suggest that therapeutic plasma exchange reduces the inflammatory response in patients with severe COVID-19 not undergoing mechanical ventilation. Further studies are needed to explore the efficacy of therapeutic plasma exchange in patients with COVID-19.