First-in-Man: Case Report of Selective C-Reactive Protein Apheresis in a Patient with SARS-CoV-2 Infection

• Published in: The American journal of case reports Vol. 21; p. e925020
• Main Authors: Torzewski, Jan, Heigl, Franz, Zimmermann, Oliver, Wagner, Florian, Schumann, Christian, Hettich, Reinhard, Bock, Christopher, Kayser, Stefan, Sheriff, Ahmed
• Format: Journal Article
• Language: English
• Published: United States International Scientific Literature, Inc 14.07.2020
• Subjects: Aged; Betacoronavirus; Blood Component Removal - methods; C-Reactive Protein - metabolism; Coronavirus Infections - blood; Coronavirus Infections - complications; Coronavirus Infections - therapy; COVID-19; Humans; Male; Multiple Organ Failure - blood; Multiple Organ Failure - etiology; Multiple Organ Failure - therapy; Pandemics; Pneumonia, Viral - blood; Pneumonia, Viral - complications; Pneumonia, Viral - therapy; SARS-CoV-2
• ISSN: 1941-5923; 1941-5923
• DOI: 10.12659/AJCR.925020

BACKGROUND C-reactive protein (CRP) plasma levels in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel viral disease, are surprisingly high. Pulmonary inflammation with subsequent fibrosis in SARS-CoV-2 infection is strongly accelerated. Recently, we have developed CRP apheresis to selectively remove CRP from human plasma. CRP may contribute to organ failure and pulmonary fibrosis in SARS-CoV-2 infection by CRP-mediated complement and macrophage activation. CASE REPORT A 72-year-old male patient at high risk was referred with dyspnea and fever. Polymerase chain reaction analysis of throat smear revealed SARS-CoV-2 infection. CRP levels were ~200 mg/L. Two days after admission, CRP apheresis using the selective CRP adsorber (PentraSorb® CRP) was started. CRP apheresis was performed via peripheral venous access on days 2, 3, 4, and 5. Following a 2-day interruption, it was done via central venous access on days 7 and 8. Three days after admission the patient was transferred to the intensive care unit and intubated due to respiratory failure. Plasma CRP levels decreased by ~50% with peripheral (processed blood plasma ≤6000 mL) and by ~75% with central venous access (processed blood plasma ≤8000 mL), respectively. No apheresis-associated side effects were observed. After the 2-day interruption in apheresis, CRP levels rapidly re-increased (>400 mg/L) and the patient developed laboratory signs of multi-organ failure. When CRP apheresis was restarted, CRP levels and creatinine kinases (CK/CK-MB) declined again. Serum creatinine remained constant. Unfortunately, the patient died of respiratory failure on day 9 after admission. CONCLUSIONS This is the first report on CRP apheresis in a SARS-CoV-2 patient. SARS-CoV-2 may cause multi-organ failure in part by inducing an excessive CRP-mediated autoimmune response of the ancient innate immune system.