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Treatment of COVID-19 With Conestat Alfa, a Regulator of the Complement, Contact Activation and Kallikrein-Kinin System

Urwyler, Pascal ; Moser, Stephan ; Charitos, Panteleimon ; Heijnen, Ingmar A F M ; Rudin, Melanie ; Sommer, Gregor ; Giannetti, Bruno M ; Bassetti, Stefano ; Sendi, Parham ; Trendelenburg, Marten ; Osthoff, Michael

Frontiers in immunology, 2020-08, Vol.11, p.2072-2072 [Periódico revisado por pares]

Switzerland: Frontiers Media S.A

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Título:
Treatment of COVID-19 With Conestat Alfa, a Regulator of the Complement, Contact Activation and Kallikrein-Kinin System
Autor: Urwyler, Pascal ; Moser, Stephan ; Charitos, Panteleimon ; Heijnen, Ingmar A F M ; Rudin, Melanie ; Sommer, Gregor ; Giannetti, Bruno M ; Bassetti, Stefano ; Sendi, Parham ; Trendelenburg, Marten ; Osthoff, Michael
Assuntos: Aged ; Aged, 80 and over ; Betacoronavirus - drug effects ; C1 esterase inhibitor ; Complement C1 - antagonists & inhibitors ; Complement C1 Inhibitor Protein - analysis ; Complement C1 Inhibitor Protein - therapeutic use ; complement system ; Coronavirus Infections - drug therapy ; COVID-19 ; Cytokine Release Syndrome - drug therapy ; Factor XIa - antagonists & inhibitors ; Female ; Humans ; Immunology ; inflammation ; kallikrein-kinin system ; Kallikrein-Kinin System - drug effects ; Kallikreins - antagonists & inhibitors ; Male ; Middle Aged ; Pandemics ; Pneumonia, Viral - drug therapy ; Recombinant Proteins - therapeutic use ; SARS-CoV-2 ; Viral Load - drug effects
É parte de: Frontiers in immunology, 2020-08, Vol.11, p.2072-2072
Notas: ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
Edited by: Marcin Okrój, Intercollegiate Faculty of Biotechnology of University of Gdaǹsk and Medical University of Gdaǹsk, Poland
Reviewed by: Timothy M. Thomson, Consejo Superior de Investigaciones Científicas (CSIC), Spain; Zoltan Prohaszka, Semmelweis University, Hungary
ORCID: Michael Osthoff orcid.org/0000-0001-5439-957X
This article was submitted to Molecular Innate Immunity, a section of the journal Frontiers in Immunology
These authors have contributed equally to this work
Descrição: A dysregulated immune response with hyperinflammation is observed in patients with severe coronavirus disease 2019 (COVID-19). The aim of the present study was to assess the safety and potential benefits of human recombinant C1 esterase inhibitor (conestat alfa), a complement, contact activation and kallikrein-kinin system regulator, in severe COVID-19. Patients with evidence of progressive disease after 24 h including an oxygen saturation <93% at rest in ambient air were included at the University Hospital Basel, Switzerland in April 2020. Conestat alfa was administered by intravenous injections of 8400 IU followed by 3 additional doses of 4200 IU in 12-h intervals. Five patients (age range, 53-85 years; one woman) with severe COVID-19 pneumonia (11-39% lung involvement on computed tomography scan of the chest) were treated a median of 1 day (range 1-7 days) after admission. Treatment was well-tolerated. Immediate defervescence occurred, and inflammatory markers and oxygen supplementation decreased or stabilized in 4 patients (e.g., median C-reactive protein 203 (range 31-235) mg/L before vs. 32 (12-72) mg/L on day 5). Only one patient required mechanical ventilation. All patients recovered. C1INH concentrations were elevated before conestat alfa treatment. Levels of complement activation products declined after treatment. Viral loads in nasopharyngeal swabs declined in 4 patients. In this uncontrolled case series, targeting multiple inflammatory cascades by conestat alfa was safe and associated with clinical improvements in the majority of severe COVID-19 patients. Controlled clinical trials are needed to assess its safety and efficacy in preventing disease progression.
Editor: Switzerland: Frontiers Media S.A
Idioma: Inglês

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Treatment of COVID-19 With Conestat Alfa, a Regulator of the Complement, Contact Activation and Kallikrein-Kinin System

Urwyler, Pascal ; Moser, Stephan ; Charitos, Panteleimon ; Heijnen, Ingmar A F M ; Rudin, Melanie ; Sommer, Gregor ; Giannetti, Bruno M ; Bassetti, Stefano ; Sendi, Parham ; Trendelenburg, Marten ; Osthoff, Michael

Switzerland: Frontiers Media S.A

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