Anti-complement C5 therapy with eculizumab in three cases of critical COVID-19 Journal Article
| Authors: | Laurence, J.; Mulvey, J. J.; Seshadri, M.; Racanelli, A.; Harp, J.; Schenck, E. J.; Zappetti, D.; Horn, E. M.; Magro, C. M. |
| Article Title: | Anti-complement C5 therapy with eculizumab in three cases of critical COVID-19 |
| Abstract: | Respiratory failure and acute kidney injury (AKI) are associated with high mortality in SARS-CoV-2-associated Coronavirus disease 2019 (COVID-19). These manifestations are linked to a hypercoaguable, pro-inflammatory state with persistent, systemic complement activation. Three critical COVID-19 patients recalcitrant to multiple interventions had skin biopsies documenting deposition of the terminal complement component C5b-9, the lectin complement pathway enzyme MASP2, and C4d in microvascular endothelium. Administration of anti-C5 monoclonal antibody eculizumab led to a marked decline in D-dimers and neutrophil counts in all three cases, and normalization of liver functions and creatinine in two. One patient with severe heart failure and AKI had a complete remission. The other two individuals had partial remissions, one with resolution of his AKI but ultimately succumbing to respiratory failure, and another with a significant decline in FiO2 requirements, but persistent renal failure. In conclusion, anti-complement therapy may be beneficial in at least some patients with critical COVID-19. © 2020 Elsevier Inc. |
| Keywords: | immunohistochemistry; adult; clinical article; human tissue; case report; diarrhea; drug withdrawal; liver function; c reactive protein; reverse transcription polymerase chain reaction; neutrophil count; skin biopsy; myalgia; creatinine; anticoagulant therapy; creatinine blood level; kidney failure; continuous infusion; chill; coughing; dyspnea; fever; aspartate aminotransferase; acute kidney failure; immunotherapy; laboratory test; heart failure; prophylaxis; interleukin 6; heparin; remission; sepsis; hospital admission; hospital discharge; rehabilitation center; creatine kinase; hydroxychloroquine; lactate dehydrogenase; thorax radiography; headache; migraine; heart left ventricle ejection fraction; hypoxemia; hemodialysis; electrocardiogram; lactate dehydrogenase blood level; troponin i; candida albicans; enoxaparin; platelet count; hypertensive factor; artificial ventilation; creatine kinase blood level; respiratory failure; d dimer; complement; fibrin; critically ill patient; deterioration; eculizumab; coronavirus; tocilizumab; cardiogenic shock; complement membrane attack complex; complement activation; lung abscess; human; male; female; priority journal; article; anterior myocardial infarction; complement component c4d; body rash; pseudomonas infection; ventilator weaning; obese patient; severe acute respiratory syndrome coronavirus 2; coronavirus disease 2019; covid-19; lectin pathway; masp2; mannose binding lectin 2; remdesivir; complement lectin pathway |
| Journal Title: | Clinical Immunology |
| Volume: | 219 |
| ISSN: | 1521-6616 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2020-10-01 |
| Start Page: | 108555 |
| Language: | English |
| DOI: | 10.1016/j.clim.2020.108555 |
| PUBMED: | 32771488 |
| PROVIDER: | scopus |
| PMCID: | PMC7410014 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 September 2020 -- Source: Scopus |
