Peking Union Medical College Hospital (PUMCH) investigators are exploring the use of immunoglobulin and low-molecular-weight heparin (LMWH) to prevent COVID-19 patents from slipping into critical condition. After a 30-patient study in Wuhan, professor Li Taisheng, director of the Infectious Disease Department at PUMCH, reported that this approach could effectively stop patients from developing critical complications including multiple organ dysfunction and respiratory failure. The takeaway: a high dose of immunoglobulin can potentially stop the inflammatory force and help improve humoral immunity.
What follows is a brief breakdown of this update out of China.
Principal Investigator Li’s Premise
As he explained during an online lecture last month, “During a severe viral infection, a high dose of immunoglobulin can shut down the inflammatory cascade, and help improve humoral immunity. Li and team arrived at this point based on their ongoing analysis into the differences of COVID-19 and severe acute respiratory syndrome (ARDS).
The PUMCH team designed a randomized clinical trial using a high dose of immunoglobulin among critically ill COVID-19 patients in Wuhan. As reported in ChinaNews, the results appeared effective with a particular emphasis on those who developed symptoms within two weeks.
The study team sought to identify and track biomarkers associated with the turning of COVID-19 patients from mild to critical—as “Professor Li commented “These include a significantly elevated level of C-reactive protein, ferritin, as well as interleukin-6 in some cases. Meanwhile the increase of these inflammatory proteins often comes with continuous decrease of lymphocyte.” Professor Li emphasizes that advanced age and other co-morbidities such as diabetes, hypertension and tumors increase risk.
Three Stage Hypothesis to COVID-19 Severity
Li and the team from PUMCH articulated a hypothesis as to COVID-19 complications involving three major stages including: 1) viremia, 2) acute, and 3) critical.
In the first “viremia” stage, which lasts for several days, most patients develop only mild symptoms. If patients can recover via their own immune system that is what in fact occurs. Otherwise the patient then moves to the next “acute” stage after one week. Things turn for the bad in this second stage as patients experience a loss of B-cells and T-cells (lymphocytes). At this point Li cautions “we can only provide passive treatment for them, such as providing oxygen supplies and ventilators, so the fatality rate is rather high at this stage.” For these patients now at high risk of moving into the “critical” stage Li and team hypothesize applying “a high dose of immunoglobulin and LMWH to patients at high risk of turning critical within two weeks of them starting to show COVID-19 symptoms.”
If patients turn to critical Li notes that plasma therapy should be considered as potentially the most effective treatment known today.
Peking University Medical College
Peking University Medical College was first established in 1902 as the Medical branch of the Imperial College it was the first of its kind in China to teach western medicine and train medical doctors following the British medical education system. By 1923, it adopted the name Beijing Medical University. It merged with Peking University in 2000. Today, this university is a world class medical research and educations, shoulder the responsibility of advising the Chinese government on pivotal health care and medical education.
Li Taisheng, director of the Infectious Disease Department, Peking University Medical College