key: cord-0846584-9zf5e4t3
authors: Kayser, Stefan; Kunze, Rudolf; Sheriff, Ahmed
title: Selective C‐reactive protein (CRP) apheresis for Covid‐19 patients suffering from organ damage
date: 2020-06-05
journal: Ther Apher Dial
DOI: 10.1111/1744-9987.13532
sha: 8729b8df929cc6234777e314a35b5bc3ba59c2aa
doc_id: 846584
cord_uid: 9zf5e4t3

nan

. While IL-6 is used as a classical prognostic marker of inflammation, the CRP concentration often correlates with the overall clinical picture and is strongly elevated (>150 mg/L) over several days, especially in severely ill patients with a high risk of death (3) .

With this background, the rapid reduction of extremely high CRP levels in medium and severe courses of Covid-19 could be a rationally comprehensible therapeutic approach (7) . Selective, extracorporeal CRP apheresis lowers the CRP concentration drastically within a few hours, and the repeatable treatment is safe, efficient and selective (4) . Clear evidence has been shown in previous clinical studies, investigating CRP apheresis after myocardial infarction, that CRP depletion reduces systemic inflammation and cardiac tissue damage. The pathomechanism derived from these previous findings (4, 5) is shown schematically in Figure 1 . According to this model, the infection of the epithelial cells leads to the production and release of SARS-CoV-2 and to the activation of proinflammatory cytokines and consequently CRP. This occurs in the sense of a vicious circle, i.e. at the expense of the healthy cell population not only in the lung but also in other ischemic tissues and leads to a continuous decrease in the latter if regeneration cannot take place to the same extent.

Specifically the strong and several days lasting increase of the CRP concentration is striking. Such extremely high CRP levels have never been observed in this magnitude in any other acute or chronic viral infectious disease. The ubiquitous molecular pathomechanism of CRP (complement-mediated) suggests that the tissue-protective effect of CRP apheresis also occurs in tissues other than the heart muscle, e.g. in the lung.

We hypothesize it beneficial for Covid-19 patients to be treated by CRP apheresis especially in the early phase of incipient pulmonary fibrosis. This therapeutic option presents an extremely low risk and expected benefit for patients. Therefore, we propose to acknowledge this treatment and recommend a clinical pilot trial, which can evaluate CRP apheresis in patients suffering from Covid-

This article is protected by copyright. All rights reserved. CoV-2 and to the activation of proinflammatory cytokines, and consquently CRP. This subsequently triggers more inflammation and leads to a vicious circle, finally damaging not only infected cells but also healthy tissue. The model adapts previous findings (4, 5) . SARS Severe acute respiratory syndrome; CoV-2 Coronavirus 2; CRP C-reactive protein.

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