In many diseases C-reactive protein (CRP) plays a dangerous double role: it is not only a biomarker of inflammation but also contributes to the excessive immune reaction and thus can permanently damage healthy tissue. While CRP and it functions have been known for several decades, during the corona pandemic the protein has taken centre stage since many Covid patients, particularly those with a severe course of infection, showed elevated CRP levels in the blood.
A team of physicians at the dialysis centre Diamedikum in Potsdam, Germany, have for the first time successfully treated a Covid-19 patient with a specific blood separation procedure to decrease CRP levels. CRP apheresis was crucial in improving the critical condition of the 53-year-old patient and most likely to avoid intensive care. “From our point of view this ‘experiment’ was very successful,” says Dr Jens Ringel, physician-in-charge and head of the dialysis centre, at a press conference.
New application for an established therapy
It is not the corona virus that damages the lung but the inflammation. CRP is the core problem of the Covid infectionAhmed Sheriff
Originally, CRP apheresis was developed by Pentracor to treat stroke and myocardial infarction patients. Already a year ago, the Pentracor team recognized the relevance for Covid-19 as Dr Sheriff, managing director of Pentracor, points out: “We understood pretty soon why the lung is seriously damaged in the course of the infection: the main task of CRP is to dispose of dying cells. In the course of the disease water clogs the alveoli and thus the lung cells don’t have sufficient oxygen to regenerate. CRP eliminates cells that in fact are healthy, thus triggering a dangerous overreaction. In other words: It is not the corona virus that damages the lung but the inflammation. CRP is the core problem of the Covid infection.”
The case of the 53-year-old patient, a Pentracor employee, seems to support this theory. Prior to the infection he was in good physical shape, his type II diabetes being well controlled with medication. At first, he suffered from general fatigue, but then his health deteriorated within days. He had fever (up to 40 °C) and chills, lung function was severely compromised and he lost 10 percent of his body weight. Due to lack of oxygen and dehydration his blood had turned almost black. In view of the symptoms, the patient, Dr Sheriff and Dr Ringel decided to try experimental apheresis.
Significant improvement after four sessions
CRP apheresis is a double filtration procedure, Dr Ringel explains: “In a first step the blood plasma centrifugation separates blood plasma from the solid constituents of the blood. The plasma is then filtered to remove CRP.” Since the method is well established no new equipment had to be purchased for the treatment. Moreover, the staff was familiar with the procedure and did not require additional training.
Dr Ringel: “In the first blood test, the patient‘s CRP level was 20mg/l which is twenty times the normal value. It even increased to 133mg/l, which is a sure sign of a serious disease. With CRP apheresis we were able to reduce the level to less than 20mg/l in four sessions. At the same time the overall health status of the patient improved markedly. A few days after the treatment, the patient’s CRP level was back to normal and the pulmonary changes had disappeared.
Potential for other patients
After this successful therapy, Dr Sheriff considers CRP apheresis, which he invented, a valuable option for patients with severe Covid-19: “Ideally, the procedure is applied in the early stages of the disease in order to prevent the protein from causing damages in the cells. As soon as a rapid increase in the CRP level is detected, the physicians’ alarm bells should go off.”