Potential Use of Cellular Stromal Vascular Fraction In Post-COVID-19 Pulmonary Injury and Adult Respiratory Distress Syndrome

Robert W Alexander

doi:10.15520/jcmro.v3i05.296

Abstract

A coronavirus (nCoV-2) has caused a worldwide pandemic, beginning in Wuhan, China. Patient’s acquiring viral infection (COVID-19) which is often featured by elevation of temperature (>100.3 F°), cough, severe fatigue, and a variety of symptoms mimicking the flu and pneumonias. This gradually may extend to a progressive and serious respiratory failure with associated ARDS-like status and severe pneumonias with residual scarring of the interstitial areas of the lung alveoli, resulting in acute life-threatening, and permanent compromised gas exchange. Those that survive with controlled ventilation (low tidal volumes), medical induced coma, and prone positioning, are often left with reduction in pulmonary function abilities. This paper reviews some pertinent knowledge and advances in understanding of the pulmonary injuries and long-term damage of the COVID-19 patients, and reports a study to ameliorate such damage with use of cSVF for those who successfully recover. There now exists technology to perform sophisticated analytics (Functional Respiratory Imaging, FRI) developed by Fluidda (Belgium, EU) which provides great detail and information, including the ability to help triage the infected patients early to help assist in prediction of ventilation and ICU needs. In addition, author’s experience with use in Chronic Obstructive Pulmonary Disease (COPD) and Fibrotic Lung Diseases, the ability to evaluate effectiveness of use of cellular Stromal Vascular Fraction (cSVF) following intravascular deployment of isolated and concentrated cSVF. The hypothesis is that reduction of the widespread pulmonary inflammatory and immune responses which destroy much of the gas exchange abilities in the acute and residual damage which appears to create a long-term problem in the surviving patient population. Fluidda imaging analytics, coupled with standard pulmonary function studies, are effective at predictive studies which may prove of great help in anticipating which patient group is at most risk in the earlier infections to require ICU and potential ventilation needs. Use of Stromal Vascular Fraction Cells (cSVF) are known to help mitigate damage from severe inflammatory disorders, provide immunomodulation, and promote repair and regenerative effects. The ease of access, simple ability to obtain significant numbers of viable cell elements, and the deployment via intravascular route has proven safe and efficacious in other forms of lung disease, including fibrotic lung disorders. This paper reviews many of the current issues facing the severely infected Post-COVID-19 patient’s lung compromise, and a therapeutic option which clearly shows promise to reverse some residual damage of the lung and gas exchange functions.

Highlights

COVID-19 is a novel Coronavirus strain (SARS-CoV-2) that was first discovered in Wuhan, China in 2019
This is of interest, as it suggests an unexpected vasoconstriction compared to the vasodilation noted the the non-COVID-9 acute respiratory distress syndrome (ARDS) patients. This is core evidence as to why careful use of tidal volumes and positive end expiratory pressure (PEEP) controls to avoid Ventilator-Induced Lung Injury (VILA) in these patients is important. This raises the question that use of inhaled Nitrous Oxide may be of some value to alleviate the vasoconstrictive tendencies in COVID-19 ARDS earlier in cases may avoid the precipitous fall into hypoxia and require intubation
The ability to utilize the functional respiratory imaging (FRI) testing, including use of inert gas elimination evaluation, both in prediction and in reducing the residual lung damage resulting from the ongoing viral challenges and in the future

Summary

INTRODUCTION

COVID-19 is a novel Coronavirus strain (SARS-CoV-2) that was first discovered in Wuhan, China in 2019. It is believed that COVID-19 group often initially report no major difficulty in their effort to breathe relatively with lowering O2 saturations, some degree of confusion and signs of low oxygenation are encountered It appears that a significant feature in COVID-19 related ARDS involves vascular dilation and pulmonary edema often mimicking findings of high altitude pulmonary edema patients (HAPE), often showing interstitial and alveolar fluid accumulation with accompanying mental confusion. It may explain why patients requiring hospitalization may be somewhat improved on O2 supplement via non-invasive modalities (including need for high flow or BIPAP use) at time of presentation to the Hospital.

MATERIALS AND METHODS

DISCUSSION