New way to prevent immune inflammatory overreaction, a big cause of COVID-19 death

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Cytokine storms created by COVID-19 are causing major organ destruction and death.

In a new study, researchers found that replacing the usual filter in a kidney dialysis machine with a filter known to trap these tiny proteins may help avoid the devastation.

The research was conducted by a team at Augusta University.

Cytokines are supposed to destroy the virus, but there is such a high level of cytokines that they are actually destroying organs.

The researchers were already working with patients with COVID-19 who, like many critically ill patients, needed dialysis because their kidneys were failing.

These experts wondered if dialysis could also be used much earlier in the disease course to cleanse the blood of excessive, destructive cytokines and stop the damage to the kidneys and other organs.

They found the Oxiris filter set, used for more than a decade in Europe and Asia, works like a sponge to capture and absorb cytokines along with toxins released by bacteria called endotoxins which also induce cytokines, as well as toxins typically filtered by the kidneys called uremic toxins.

Like standard kidney dialysis filters, these also filter excess fluid and contain the blood thinner heparin, which can reduce clots, another concern with this novel viral infection, in which strokes also are being reported even in young people.

Its use in Europe and Asia includes treating sepsis, another overwhelming and typically bacterial infection that also produces a cytokine storm.

Beginning last week at AU Health System, when patients show signs of significant respiratory problems and are headed to intensive care, the researchers are using this blood filter for up to 72 hours, the outside limit for the life of a filter.

They are assessing cytokine levels before the new therapy, then at 24 and 48 hours to look at trends and assess how the patients are doing clinically.

The nephrologists expect to see cytokine levels fall and the clinical status improves.

While they are not yet conducting a clinical trial, they are collecting this kind of data on patients as well as comparative data on similar patients, who were treated before the availability of the filter, and have begun steps to enable a traditional, clinical trial for their treatment of the novel virus.

The team says if they can come in early in the disease process, patients will not do so poorly, they will not have so much organ dysfunction, they will probably have less clotting, less ARDS, and less kidney failure.

ARDS, or adult respiratory distress syndrome, is a leading cause of death from COVID-19, in which cytokines, as well as the virus, attack the lungs, and a clear indicator that more trouble is ahead.

The researchers believe that with this new approach, you basically are not waiting for all these disasters to happen.

If they can cut down the cytokine storm, patients can avoid all those things, which should mean a shorter, less traumatic—and deadly—disease course.

The team is optimistic as well about the safety of the procedure, which requires ultrasound-guided temporary placement of a catheter into an internal jugular vein.

The jugular vein is now the preferred placement site for kidney dialysis as well, and the potential acute risks are essentially the same as those for kidney dialysis, including bleeding, infection and collapsed lung, or pneumothorax.

A documented allergy to heparin is the only absolute contraindication for using the new therapy.

One leader of the study is Dr. Azeem Mohammed, a nephrologist at the Medical College of Georgia and Augusta University Health System.

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