Therapeutic plasma exchange accelerates immune cell recovery in severe COVID-19

• DOI: 10.3389/fimmu.2024.1492672
• Publication Date: 2025-01-17T06:52:44Z
• Authors: Aurelie Guironnet...; Hind Hamzeh-Cognasse; Frederic Berard; Fabrice Cognasse; Jean Christophe R...; Hodane Yonis; Mehdi Mezidi; Olivier Desebbe; Bertrand Delannoy; Sophie Demeret; Clemence Marois; Samir Saheb; Quoc Viet Le; Mathieu Schoeffler; Paul Simon Pugliesi; Sophie Debord; Paul Bastard; Aurélie Cobat; Jean Laurent Casa...; Rémi Pescarmona; Sébastien Viel; Jean François Nic...; Audrey Nosbaum; Marc Vocanson; Olivier Hequet
• Keywords: [SDV.MHEP.ME] Life Sciences [q-bio]/Human health and pathology/Emerging diseases; [SDV]Life Sciences [q-bio]; Immunology; 610; COVID-19; adaptive immunity; RC581-607; immune response; [SDV] Life Sciences [q-bio]; therapeutic plasma exchange; [SDV.IMM.IA] Life Sciences [q-bio]/Immunology/Adaptive immunology; 616; cytokine storm; [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases; anti-type I IFN autoantibodies; [SDV.IMM.IMM] Life Sciences [q-bio]/Immunology/Immunotherapy; Immunologic diseases. Allergy

BackgroundImmunological disturbances (anti-type I IFN auto-antibody production, cytokine storm, lymphopenia, T-cell hyperactivation and exhaustion) are responsible for disease exacerbation during severe COVID-19 infections.MethodsIn this study, we set up a prospective, randomised clinical trial (ClinicalTrials.gov ID: NCT04751643) and performed therapeutic plasma exchange (TPE) in severe COVID-19 patients in order to decrease excess cytokines and auto-antibodies and to assess whether adding TPE to the standard treatment (ST, including corticosteroids plus high-flow rate oxygen) could help restore immune parameters and limit the progression of acute respiratory distress syndrome (ARDS).ResultsAs expected, performing TPE decreased the amount of anti-type I IFN auto-antibodies and improved the elimination or limited the production of certain inflammatory mediators (IL-18, IL-7, CCL2, CCL3, etc.) circulating in the blood of COVID-19 patients, compared to ST controls. Interestingly, while TPE did not influence changes in ARDS parameters throughout the protocol, it proved more effective than ST in reversing lymphopenia, preventing T-cell hyperactivation and reducing T-cell exhaustion, notably in a fraction of TPE patients who had an early favourable respiratory outcome. TPE also restored appropriate numbers of CD4+ and CD8+ T–cell memory populations and increased the number of circulating virus-specific T cells in these patients.ConclusionOur results therefore indicate that the addition of TPE sessions to the standard treatment accelerates immune cell recovery and contributes to the development of appropriate antiviral T-cell responses in some patients with severe COVID-19 disease.