Cytokine Removal and Immunomodulation in COVID-19 Severe Pulmonary Respiratory Infection

Abstract

Coronavirus infection produces a cytokine storm in some patients, developing a moderate to severe clinical condition that is associated to increased mortality mainly because of severe pulmonary involvement. Elevated levels of IL-6 have been found in non-survivor patients. In these patients, clearance of cytokines with extracorporeal therapies, Pulse High- Volume Hemofiltration together with adsorption columns Cytosorb, in short periods of time for 1 to 3 days, could help remove inflammatory cytokines allowing a downregulation of the inflammatory response; and, at the same time, treatment with low dose steroids, could give an opportunity for the host to reach homeostasis, decreasing lung damage and improving survival.

Effect of Rectal Ozone (O3) in Severe COVID-19 Pneumonia: Preliminary Results

“…From an analysis of patients with SARS-CoV-2 new pandemic (Wuhan, China), it was observed that those patients with a higher viral load had a higher hyperinflammatory state, with an elevation of inflammatory cytokines (IL-2, IL-6, IL-7, IL-10, GCSF, INF-γ, TNF-α, MCP-1, and MIP-1). In this series, the patients who died presented high levels of inflammation markers such as ferritin, IL-6, and ESR, suggesting that the severe inflammatory reaction could contribute to the severity and mortality of the disease [18].…”

“…In this scenario of cytokine storm or hyperinflammation and given the high risk of mortality, it is necessary to reduce this severe inflammatory response, either with the use of corticosteroids [6], biological drugs (anti IL-1, anti-IL-6, anti-TNF-α, IFN-β1, JAK inhibitors) [6], human immunoglobulin [6], extracorporeal cytokine clearance therapy [18], or through the use of ozone (due to its "ideal" cytokine-inducing or immunomodulatory effect) [4][5][6][15][16][17]. For this reason, we have opted for ozone therapy in this study as compassionate use, since previous therapies had failed (corticosteroids, anakinra and tocilizumab).…”

“…A postmortem histopathological analysis has established that phase 3 (hyperinflammation or cytokine storm) of COVID-19 infection produces alveolar edema, hyalinosis, and fibrin deposition with infiltration of immune cells at the pulmonary level [18]. The fact that rectal ozone has decreased edema and alveolar infiltrate, verified by radiological tests (Taylor's scale), added to the decrease in inflammation markers (LDH, ferritin, fibrinogen, D-dimer, IL-6, and CRP) and to the improvement in pulmonary oxygenation (O 2 saturation), suggests that ozone is an alternative to consider in the management of severe acute respiratory distress syndrome caused by the SARS-CoV-2 or COVID-19 virus.…”