Abstract
Background The outbreak of Coronavirus Disease 2019 (COVID-19) has been increasing rapidly. This disease causes an increase in proinflammatory cytokine production that leads to cytokine storm or cytokine release syndrome (CRS). Autologous activated platelet-rich plasma (aaPRP) contains various types of growth factors and anti-inflammatory cytokines that may have the potential to suppress CRS. This study of phase I/II trial was aimed to evaluate the safety and efficacy of aaPRP to treat severe COVID-19 patients. Methods A total of 10 severe COVID-19 patients from Koja Regional Public Hospital (Koja RPH) were admitted to the intensive care unit (ICU). All patients received aaPRP administration three times. Primary outcomes involving the duration of hospitalization, oxygen needs, time of recovery, and mortality were observed. Secondary outcomes involving C-reactive protein (CRP), neutrophil, lymphocyte, and lymphocyte-to-CRP (LCR) and neutrophil-lymphocyte ratio (NLR) were analyzed. Results All patients were transferred to the ICU with a median duration of 9 days. All patients received oxygen at enrollment and nine of ten patients recovered from the ICU and transferred to the ward room. There was one patient who passed away in the ICU due to heart failure. The results of secondary outcomes showed that CRP value and lymphocytes counts were significantly decreased while neutrophils, LCR, and NLR were slightly increased after aaPRP administration. Conclusions Our results of the phase I/II trial demonstrated that the use of aaPRP in severe COVID-19 patients was safe and not associated with serious adverse events, which showed that aaPRP was a promising adjunctive therapy for severe COVID-19 patients.
Highlights
In early 2020, the outbreak of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) was confirmed. e disease was named Coronavirus Disease 2019 (COVID-19), causing a pneumonia-associated respiratory syndrome [1]. e virus is known to have originated in Wuhan, China
Lymphopenia, activation and dysfunction of lymphocyte, granulocyte, and monocyte abnormalities, and increased proinflammatory cytokine production are the characteristics of a cytokine storm or cytokine release syndrome (CRS) condition, which is common in severe COVID-19 patients [3]
A total of 10 patients who had the severe COVID-19 condition were transferred to the intensive care unit (ICU), where they received activated platelet-rich plasma (aaPRP) three times. e mean age of patients was 52.1 years, and 40% were male (Table 2)
Summary
In early 2020, the outbreak of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) was confirmed. e disease was named Coronavirus Disease 2019 (COVID-19), causing a pneumonia-associated respiratory syndrome [1]. e virus is known to have originated in Wuhan, China. In early 2020, the outbreak of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) was confirmed. E SARS-CoV-2 virus interferes with the normal immune response, causing the immune system to be compromised; the inflammatory response is not controlled to disease severity [3]. Lymphopenia, activation and dysfunction of lymphocyte, granulocyte, and monocyte abnormalities, and increased proinflammatory cytokine production are the characteristics of a cytokine storm or cytokine release syndrome (CRS) condition, which is common in severe COVID-19 patients [3]. Ere is the exudation of protein-rich pulmonary edema fluid into the air sacs, which in turn causes acute respiratory distress syndrome (ARDS), multiple organ failure, and a large number of deaths in COVID-19 patients [1, 3]. Phase III clinical trials for tocilizumab in COVID-19 patients have not yet been completed to identify the long-term side effects of tocilizumab [8]
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