Therapeutic plasma exchange accelerates immune cell recovery in severe COVID-19

Therapeutic plasma exchange accelerates immune cell recovery in severe COVID-19

BackgroundImmunological disturbances (anti-type I IFN auto-antibody production, cytokine storm, lymphopenia, T-cell hyperactivation and exhaustion) are responsible for disease exacerbation during severe COVID-19 infections.MethodsIn this study, we set up a prospective, randomised clinical trial (Cli...

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Main Authors: Aurelie Guironnet-Paquet, Hind Hamzeh-Cognasse, Frederic Berard, Fabrice Cognasse, Jean Christophe Richard, Hodane Yonis, Mehdi Mezidi, Olivier Desebbe, Bertrand Delannoy, Sophie Demeret, Clemence Marois, Samir Saheb, Quoc Viet Le, Mathieu Schoeffler, Paul Simon Pugliesi, Sophie Debord, Paul Bastard, Aurélie Cobat, Jean Laurent Casanova, Rémi Pescarmona, Sébastien Viel, Jean François Nicolas, Audrey Nosbaum, Marc Vocanson, Olivier Hequet
Format: Article
Language:English
Published: Frontiers Media S.A. 2025-01-01
Series:Frontiers in Immunology
Subjects:
COVID-19
therapeutic plasma exchange
immune response
anti-type I IFN autoantibodies
cytokine storm
adaptive immunity
Online Access:https://www.frontiersin.org/articles/10.3389/fimmu.2024.1492672/full
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Summary:BackgroundImmunological disturbances (anti-type I IFN auto-antibody production, cytokine storm, lymphopenia, T-cell hyperactivation and exhaustion) are responsible for disease exacerbation during severe COVID-19 infections.MethodsIn this study, we set up a prospective, randomised clinical trial (ClinicalTrials.gov ID: NCT04751643) and performed therapeutic plasma exchange (TPE) in severe COVID-19 patients in order to decrease excess cytokines and auto-antibodies and to assess whether adding TPE to the standard treatment (ST, including corticosteroids plus high-flow rate oxygen) could help restore immune parameters and limit the progression of acute respiratory distress syndrome (ARDS).ResultsAs expected, performing TPE decreased the amount of anti-type I IFN auto-antibodies and improved the elimination or limited the production of certain inflammatory mediators (IL-18, IL-7, CCL2, CCL3, etc.) circulating in the blood of COVID-19 patients, compared to ST controls. Interestingly, while TPE did not influence changes in ARDS parameters throughout the protocol, it proved more effective than ST in reversing lymphopenia, preventing T-cell hyperactivation and reducing T-cell exhaustion, notably in a fraction of TPE patients who had an early favourable respiratory outcome. TPE also restored appropriate numbers of CD4+ and CD8+ T–cell memory populations and increased the number of circulating virus-specific T cells in these patients.ConclusionOur results therefore indicate that the addition of TPE sessions to the standard treatment accelerates immune cell recovery and contributes to the development of appropriate antiviral T-cell responses in some patients with severe COVID-19 disease.
ISSN:1664-3224

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