NZZ Translation
Neue Züricher Zeitung
Nicola von Lutterotti 30.06.2021, 05.30
How a blood cleanse can help against Long Covid
Corona infection strikes at the heart of some patients in the long term and also causes other organ damage. The reason could be reduced microcirculation due to the inflammation. Doctors want to help sufferers with a blood purification procedure.
Similar to dialysis, doctors want to rid the blood of harmful substances in patients with Long Covid.
The fact that Covid-19 can cause the heart to go out of rhythm is one of the findings of the first hour. Depending on the severity of the disease, the proportion of people affected by heart problems can be 50 percent or even higher. Scientists from America now wanted to clarify whether corona infections also increase the risk of potentially fatal heart fibrillation. They focused their attention on people who had been fitted with an implanted defibrillator because of a high risk of such events. This is a device that can detect severe heart palpitations and stop them with a jolt of electricity.
The nearly 15,000 men and women in the study, with an average age of 66, lived in New York, Boston or New Orleans: three metropolises where Sars-CoV-2 hit particularly hard at the beginning of the pandemic. As Selçuk Adabag from the University of Minnesota in Minneapolis and his colleagues write in the "Journal of the American Heart Association", the implanted lifesavers fired much more frequently during this period than in the same calendar weeks of the previous year. The number of shocks delivered to patients increased by one and a half to two times. The study cannot answer whether the increase was due to infections with the new coronavirus. Adabag and his colleagues, however, believe that this is very likely.
No severe infestation of the heart muscle cells
It is still unclear exactly how the new coronavirus affects the heart. Previously vague, the mechanisms involved are, however, becoming increasingly clear. The initial fears that Sars-CoV-2 could attack the heart muscle cells on a large scale and wreak havoc here have not been confirmed. Such a suspicion had been raised by MRI examinations.
However, as scientists led by Zsuzsanna Varga of the University Hospital Zurich and other research groups were then able to show, Sars-CoV-2 usually does not attack the heart muscle, but rather the blood vessels of the circulatory organ. In the heart vessels of patients who had died as a result of Covid-19, the Zurich researchers discovered whole droves of immune cells and, associated with this, pronounced inflammations. Most affected were the small arteries and veins of the microcirculation. These end branches of the blood vessels have the important task of supplying the tissue with energy and nutrients and transporting away the metabolic remnants.
"Ms Varga's findings were an aha experience for me," says German doctor Beate Jaeger from Mühlheim. The laboratory physician has many years of experience with a blood-washing procedure called help-apharesis. "It immediately occurred to me that this therapy could also help patients with long-term complaints after Covid-19." Help apharesis was developed to defat the blood of patients who are at high risk of atherosclerotic-related vascular occlusions such as heart attacks due to excessive blood lipids. The technique has been very successful in this area. For example, it is possible to reduce the occurrence of new heart attacks by almost 90 percent.
"In atherosclerosis - fatty and calcified blood vessels - very similar processes take place as with Covid-19," says Jaeger, explaining her motivation for applying the technique to people with Long Covid. In both diseases, three factors play an important role: vascular inflammation, insufficient tissue perfusion and an increased tendency of the blood to clot. According to Jaeger, help apheresis has a favourable influence on all three factors. This is because it not only frees the blood from excess fats, but also from inflammatory substances and clotting factors.
First experiences with Long Covid patients
In the meantime, the doctor has applied the blood washing technique to 19 men and women with pronounced symptoms after Covid-19, and with exceptional success. Most of those treated had cured the infection at home, but still had not recovered from it months later. All suffered from exertional dyspnoea, equivalent to heart failure, and usually other symptoms as well. These included a rapid pulse, angina pectoris and blood flow-related sensations such as cold hands and blue lips. Many patients also reported that they could hardly concentrate and would often lose the thread of their thoughts in the middle of a sentence.
After one or more aphareses, the symptoms decreased noticeably in almost all patients. Ten of them are said to have been cured, another eight have taken a big step towards recovery, and only one person is said not to have benefited. Not yet published in any medical journal, these results are remarkable. What is particularly striking about the patients' reports is that, in general, the therapy led to a rapid improvement in almost all symptoms, as varied as shortness of breath on exertion, loss of sense of smell, paralysis in the legs, memory lapses, cold hands, reduced oxygen saturation of the blood and exhaustion. This suggests that the manifold complaints are likely to be due to similar disorders.
Is it the microcirculation?
According to the renowned lipid researcher Dietrich Seidel, former director of the Ludwig Maximilian University in Munich, the common denominator could be a deficient blood flow in the microcirculation. "The inflammatory substances and clotting factors that enter the blood in increased quantities during infection and are almost completely filtered out by aphoresis make the blood much more viscous," says the doctor who developed help aphoresis in the 1980s. And this viscosity is much more noticeable in the small arteries and veins than in the large veins. The improvement in blood flow is probably a major reason why so many patients feel so much better after apharesis, says Seidel.
Oliver Weingärtner from the University Hospital in Jena also finds the good results of Help apharesis in Long Covid sufferers credible. "The fact that the microcirculation of these patients is permanently impaired can be seen particularly impressively in the back of the eye," explains the cardiologist and expert on lipometabolic disorders. Due to inflammatory processes, the vessels there are no longer able to expand their diameter and let in more blood when the oxygen demand of the tissue increases. "We see the same thing in patients with atherosclerotically narrowed heart vessels," Weingärtner adds. Atherosclerosis is also associated with vascular inflammation and therefore impairs the ability of the arteries to adjust the blood flow to the demand.
Nevertheless, it remains to be seen whether help apharesis will become established in patients with long covid. One obstacle could be the high costs, which Jaeger is currently financing out of her own pocket and with donations. These costs amount to about 1,300 euros per application. The resistance of experts should not be underestimated, Seidel notes in this context. They often have a negative attitude towards new things. Patients, on the other hand, seem to have recognised the potential of the procedure. In the meantime, the aphthalmology expert is having great difficulty coping with the enormous demand.
Translation by deepl.com