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Plasma Exchange to Rescue Patients with Autoantibodies Against Type I Interferons and Life-Threatening COVID-19 Pneumonia
PURPOSE: To report four cases of life-threatening COVID-19 pneumonia in patients with high blood concentrations of neutralizing autoantibodies against type I interferons (IFNs), who were treated with plasma exchange (PE) as a rescue therapy. METHODS: Prospective case series, which included patients,...
Autores principales: | , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer US
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7899072/ https://www.ncbi.nlm.nih.gov/pubmed/33616813 http://dx.doi.org/10.1007/s10875-021-00994-9 |
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author | de Prost, Nicolas Bastard, Paul Arrestier, Romain Fourati, Slim Mahévas, Mathieu Burrel, Sonia Dorgham, Karim Gorochov, Guy Tandjaoui-Lambiotte, Yacine Azzaoui, Iname Fernandes, Ignacio Combes, Alain Casanova, Jean-Laurent Mekontso-Dessap, Armand Luyt, Charles-Edouard |
author_facet | de Prost, Nicolas Bastard, Paul Arrestier, Romain Fourati, Slim Mahévas, Mathieu Burrel, Sonia Dorgham, Karim Gorochov, Guy Tandjaoui-Lambiotte, Yacine Azzaoui, Iname Fernandes, Ignacio Combes, Alain Casanova, Jean-Laurent Mekontso-Dessap, Armand Luyt, Charles-Edouard |
author_sort | de Prost, Nicolas |
collection | PubMed |
description | PURPOSE: To report four cases of life-threatening COVID-19 pneumonia in patients with high blood concentrations of neutralizing autoantibodies against type I interferons (IFNs), who were treated with plasma exchange (PE) as a rescue therapy. METHODS: Prospective case series, which included patients, diagnosed with RT-PCR-confirmed SARS-CoV-2 infection and positive autoantibodies against type I IFNs in two French intensive care units (ICUs) between October 8 and November 14, 2020. Six critically ill COVID-19 patients with no anti-IFN antibodies were used as controls. Anti-IFN autoantibodies and IFN concentrations, together with the levels of anti-SARS-CoV-2 antibodies, were measured sequentially in serum. Viral load was determined in the upper and lower respiratory tract. Patients were followed during hospital stay. RESULTS: Three men and one woman were included. Three of the patients had four PE sessions each, while another had three PE sessions. PE decreased the concentrations of autoantibodies against type I IFN in all four patients, whereas anti-SARS-CoV-2 antibody levels remained stable. Autoantibodies against type I IFN levels were high in tracheal aspirates of one patient and decreased after three PE sessions. By contrast, anti-IFN autoantibodies were not detected in tracheal aspirates from five control patients without detectable anti-IFN autoantibodies in serum. During PE, serum IFN-α levels slightly increased in three out of four patients, and upper respiratory tract viral load decreased in all patients. All patients were alive at day 28 of ICU admission. Two patients eventually died in the ICU, while the two survivors were discharged from the ICU at days 50 and 66. CONCLUSIONS: PE efficiently removes autoantibodies against type I IFNs, including those detected in tracheal aspirates, without affecting anti-SARS-CoV-2 antibody levels, in patients with life-threatening COVID-19 pneumonia. The clinical benefit of PE in patients with autoantibodies against type I IFNs should be tested in a larger study. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10875-021-00994-9. |
format | Online Article Text |
id | pubmed-7899072 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Springer US |
record_format | MEDLINE/PubMed |
spelling | pubmed-78990722021-02-23 Plasma Exchange to Rescue Patients with Autoantibodies Against Type I Interferons and Life-Threatening COVID-19 Pneumonia de Prost, Nicolas Bastard, Paul Arrestier, Romain Fourati, Slim Mahévas, Mathieu Burrel, Sonia Dorgham, Karim Gorochov, Guy Tandjaoui-Lambiotte, Yacine Azzaoui, Iname Fernandes, Ignacio Combes, Alain Casanova, Jean-Laurent Mekontso-Dessap, Armand Luyt, Charles-Edouard J Clin Immunol Original Article PURPOSE: To report four cases of life-threatening COVID-19 pneumonia in patients with high blood concentrations of neutralizing autoantibodies against type I interferons (IFNs), who were treated with plasma exchange (PE) as a rescue therapy. METHODS: Prospective case series, which included patients, diagnosed with RT-PCR-confirmed SARS-CoV-2 infection and positive autoantibodies against type I IFNs in two French intensive care units (ICUs) between October 8 and November 14, 2020. Six critically ill COVID-19 patients with no anti-IFN antibodies were used as controls. Anti-IFN autoantibodies and IFN concentrations, together with the levels of anti-SARS-CoV-2 antibodies, were measured sequentially in serum. Viral load was determined in the upper and lower respiratory tract. Patients were followed during hospital stay. RESULTS: Three men and one woman were included. Three of the patients had four PE sessions each, while another had three PE sessions. PE decreased the concentrations of autoantibodies against type I IFN in all four patients, whereas anti-SARS-CoV-2 antibody levels remained stable. Autoantibodies against type I IFN levels were high in tracheal aspirates of one patient and decreased after three PE sessions. By contrast, anti-IFN autoantibodies were not detected in tracheal aspirates from five control patients without detectable anti-IFN autoantibodies in serum. During PE, serum IFN-α levels slightly increased in three out of four patients, and upper respiratory tract viral load decreased in all patients. All patients were alive at day 28 of ICU admission. Two patients eventually died in the ICU, while the two survivors were discharged from the ICU at days 50 and 66. CONCLUSIONS: PE efficiently removes autoantibodies against type I IFNs, including those detected in tracheal aspirates, without affecting anti-SARS-CoV-2 antibody levels, in patients with life-threatening COVID-19 pneumonia. The clinical benefit of PE in patients with autoantibodies against type I IFNs should be tested in a larger study. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10875-021-00994-9. Springer US 2021-02-22 2021 /pmc/articles/PMC7899072/ /pubmed/33616813 http://dx.doi.org/10.1007/s10875-021-00994-9 Text en © The Author(s), under exclusive licence to Springer Science+Business Media, LLC part of Springer Nature 2021 This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic. |
spellingShingle | Original Article de Prost, Nicolas Bastard, Paul Arrestier, Romain Fourati, Slim Mahévas, Mathieu Burrel, Sonia Dorgham, Karim Gorochov, Guy Tandjaoui-Lambiotte, Yacine Azzaoui, Iname Fernandes, Ignacio Combes, Alain Casanova, Jean-Laurent Mekontso-Dessap, Armand Luyt, Charles-Edouard Plasma Exchange to Rescue Patients with Autoantibodies Against Type I Interferons and Life-Threatening COVID-19 Pneumonia |
title | Plasma Exchange to Rescue Patients with Autoantibodies Against Type I Interferons and Life-Threatening COVID-19 Pneumonia |
title_full | Plasma Exchange to Rescue Patients with Autoantibodies Against Type I Interferons and Life-Threatening COVID-19 Pneumonia |
title_fullStr | Plasma Exchange to Rescue Patients with Autoantibodies Against Type I Interferons and Life-Threatening COVID-19 Pneumonia |
title_full_unstemmed | Plasma Exchange to Rescue Patients with Autoantibodies Against Type I Interferons and Life-Threatening COVID-19 Pneumonia |
title_short | Plasma Exchange to Rescue Patients with Autoantibodies Against Type I Interferons and Life-Threatening COVID-19 Pneumonia |
title_sort | plasma exchange to rescue patients with autoantibodies against type i interferons and life-threatening covid-19 pneumonia |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7899072/ https://www.ncbi.nlm.nih.gov/pubmed/33616813 http://dx.doi.org/10.1007/s10875-021-00994-9 |
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