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Agresti N, Lalezari JP, Amodeo PP, Mody K, Mosher SF, Seethamraju H, Kelly SA, Pourhassan NZ, Sudduth CD, Bovinet C, ElSharkawi AE, Patterson BK, Stephen R, Sacha JB, Wu HL, Gross SA, Dhody K. Disruption of CCR5 signaling to treat COVID-19-associated cytokine storm: Case series of four critically ill patients treated with leronlimab. J Transl Autoimmun 2021; 4:100083. [PMID: 33521616 PMCID: PMC7823045 DOI: 10.1016/j.jtauto.2021.100083] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 12/25/2020] [Accepted: 12/30/2020] [Indexed: 12/13/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is associated with considerable morbidity and mortality. The number of confirmed cases of infection with SARS-CoV-2, the virus causing COVID-19 continues to escalate with over 70 million confirmed cases and over 1.6 million confirmed deaths. Severe-to-critical COVID-19 is associated with a dysregulated host immune response to the virus, which is thought to lead to pathogenic immune dysregulation and end-organ damage. Presently few effective treatment options are available to treat COVID-19. Leronlimab is a humanized IgG4, kappa monoclonal antibody that blocks C–C chemokine receptor type 5 (CCR5). It has been shown that in patients with severe COVID-19 treatment with leronlimab reduces elevated plasma IL-6 and chemokine ligand 5 (CCL5), and normalized CD4/CD8 ratios. We administered leronlimab to 4 critically ill COVID-19 patients in intensive care. All 4 of these patients improved clinically as measured by vasopressor support, and discontinuation of hemodialysis and mechanical ventilation. Following administration of leronlimab there was a statistically significant decrease in IL-6 observed in patient A (p=0.034) from day 0–7 and patient D (p=0.027) from day 0–14. This corresponds to restoration of the immune function as measured by CD4+/CD8+ T cell ratio. Although two of the patients went on to survive the other two subsequently died of surgical complications after an initial recovery from SARS-CoV-2 infection. Leronlimab is a monoclonal antibody in clinical trials to treat the cytokine storm. Critically ill patients received leronlimab through compassionate use and had remarkable recoveries measured objectively. The CCR5 receptor is important in recruiting inflammatory cells mainly T cells and macrophages. Leronlimab disrupted this signal and may have been responsible for restoration of the immune system, improved survival and decrease in IL-6.
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Key Words
- ACE2, angiotensin-converting enzyme 2
- ALT, alanine aminotransferase
- ARDS, acute respiratory distress syndrome
- AST, aspartate aminotransferase
- Acute respiratory distress syndrome (ARDS)
- BID, bis in die (twice a day)
- CCL2, chemokine C–C motif ligand 2
- CCL3, chemokine C–C motif ligand 3
- CCL4, chemokine C–C motif ligand 4
- CCL5, chemokine C–C motif ligand 5
- CCR1, C–C chemokine receptor type 1
- CCR5, C–C chemokine receptor type 5
- CDC, Centers for Disease Control
- CK, creatine kinase
- COPD, chronic obstructive pulmonary disease
- COVID-19, coronavirus disease 2019
- CRP, C-reactive protein
- CXCL10, chemokine C-X-C motif ligand 10
- CXCL2, chemokine C-X-C motif ligand 2
- Coronavirus disease 2019 (COVID-19)
- DPP4, dipeptidyl peptidase-4
- DVT, deep vein thrombosis
- EDTA, ethylenediaminetetraacetic acid
- FDA, Food and Drug Administration
- Fi02, fraction of inspired oxygen, IgG4
- Hydroxychloroquine, HLH
- Leronlimab (PRO 140)
- Middle East respiratory syndrome coronavirus, MIG
- National Early Warning Score, NK
- RO, receptor occupancy
- RT–PCR, reverse transcriptase polymerase chain reaction
- SARS-CoV, severe acute respiratory syndrome coronavirus
- SARS-CoV-2
- SARS-CoV-2, severe acute respiratory syndrome coronavirus 2
- T-reg RO, regulatory T cells – receptor occupancy
- TGF- α, transforming growth factor alpha
- TNF-α, tumor necrosis factor alpha
- TNF-β, tumor necrosis factor beta
- Tregs, regulatory T cells
- VEGF-A, vascular endothelial growth factor A
- WBC, white blood cell
- WHO, World Health Organization
- eIND, emergency investigational new drug application
- hemophagocytic lymphohistiocytosis, HTN
- hypertension, ICU
- immunoglobulin G4, HCQ
- intensive care unit, IL-1β
- interferon gamma, IL-6
- interferon gamma-inducible protein (IP) 10 or CXCL10, LOA
- interleukin 1 beta, IFN-ƴ
- interleukin 6, IP-10
- letter of authorization, MCP
- macrophage Inflammatory Proteins 1-alpha, MIP-1β
- macrophage Inflammatory Proteins 1-beta, N/A
- macrophage colony stimulating factor, MDC (CCL22)
- macrophage colony-stimulating factor encoded by the CCL22 gene, MERS-CoV
- monocyte chemoattractant protein, M-CSF
- monokine induced by IFN-γ (interferon gamma), MIP-1α
- natural killer, OSA
- not applicable, NEWS2
- obstructive sleep apnea, PDGF-AA
- per os (taken by mouth), RANTES
- platelet-derived growth factor AA, PDGF-AA/BB
- platelet-derived growth factor AA/BB, PEEP
- positive end-expiratory pressure, PNA
- pulmonary nodular amyloidosis, po
- regulated on activation, normal T expressed and secreted (also known as CCL5)
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Affiliation(s)
- Nicholas Agresti
- Southeast Georgia Health System, 2415 Parkwood Drive, Brunswick, GA, 31520, USA
| | | | - Phillip P Amodeo
- Southeast Georgia Health System, 2415 Parkwood Drive, Brunswick, GA, 31520, USA
| | - Kabir Mody
- Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 3222, USA
| | - Steven F Mosher
- Southeast Georgia Health System, 2415 Parkwood Drive, Brunswick, GA, 31520, USA
| | - Harish Seethamraju
- Montefiore Medical Center, Albert Einstein University, 1695A Eastchester Rd, Bronx, NY, 10467, USA
| | - Scott A Kelly
- CytoDyn, 1111 Main Street, Suite 660 Vancouver, WA, 98660, USA
| | | | - C David Sudduth
- Southeast Georgia Health System, 2415 Parkwood Drive, Brunswick, GA, 31520, USA
| | - Christopher Bovinet
- Spine Center of Southeast Georgia, 1111 Glynco Pkwy Ste 300, Brunswick, GA, 31525, USA
| | - Ahmed E ElSharkawi
- Southeast Georgia Health System, 2415 Parkwood Drive, Brunswick, GA, 31520, USA
| | | | - Reejis Stephen
- Southeast Georgia Health System, 2415 Parkwood Drive, Brunswick, GA, 31520, USA
| | - Jonah B Sacha
- Vaccine and Gene Therapy Institute and Oregon National Primate Research Center, Oregon Health and Science University, 505 N.W. 185th Avenue, Beaverton, OR, 97006, USA
| | - Helen L Wu
- Vaccine and Gene Therapy Institute and Oregon National Primate Research Center, Oregon Health and Science University, 505 N.W. 185th Avenue, Beaverton, OR, 97006, USA
| | - Seth A Gross
- NYU Langone Gastroenterology Associates, 240 East 38th Street, 23rd Floor New York, NY, 10016, USA
| | - Kush Dhody
- Amarex Clinical Research, 20201 Century Blvd, Germantown, MD, 20874, USA
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