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Alpha-1 antitrypsin for cystic fibrosis complicated by severe cytokinemic COVID-19.
McElvaney, Oliver J; O'Connor, Eoin; McEvoy, Natalie L; Fraughan, Daniel D; Clarke, Jennifer; McElvaney, Oisín F; Gunaratnam, Cedric; O'Rourke, James; Curley, Gerard F; McElvaney, Noel G.
  • McElvaney OJ; Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland; Beaumont Hospital, Dublin, Ireland. Electronic address: olivermcelvaney@rcsi.ie.
  • O'Connor E; Beaumont Hospital, Dublin, Ireland.
  • McEvoy NL; Department of Anaesthesia and Critical Care Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.
  • Fraughan DD; Beaumont Hospital, Dublin, Ireland.
  • Clarke J; Beaumont Hospital, Dublin, Ireland; Department of Anaesthesia and Critical Care Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.
  • McElvaney OF; Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.
  • Gunaratnam C; Beaumont Hospital, Dublin, Ireland.
  • O'Rourke J; Beaumont Hospital, Dublin, Ireland.
  • Curley GF; Beaumont Hospital, Dublin, Ireland; Department of Anaesthesia and Critical Care Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.
  • McElvaney NG; Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland; Beaumont Hospital, Dublin, Ireland. Electronic address: gmcelvaney@rcsi.ie.
J Cyst Fibros ; 20(1): 31-35, 2021 01.
Article in English | MEDLINE | ID: covidwho-1065291
ABSTRACT

BACKGROUND:

The clinical course of severe COVID-19 in cystic fibrosis (CF) is incompletely understood. We describe the use of alpha-1 antitrypsin (AAT) as a salvage therapy in a critically unwell patient with CF (PWCF) who developed COVID-19 while awaiting lung transplantation.

METHODS:

IV AAT was administered at 120 mg/kg/week for 4 consecutive weeks. Levels of interleukin (IL)-1ß, IL-6, IL-8, and soluble TNF receptor 1 (sTNFR1) were assessed at regular intervals in plasma, with IL-1ß, IL-6, IL-8 and neutrophil elastase (NE) activity measured in airway secretions. Levels were compared to baseline and historic severe exacerbation measurements.

RESULTS:

Systemic and airway inflammatory markers were increased compared to both prior exacerbation and baseline levels, in particular IL-6, IL-1ß and NE activity. Following each AAT dose, rapid decreases in each inflammatory parameter were observed. These were matched by marked clinical and radiographic improvement.

CONCLUSIONS:

The results support further investigation of AAT as a COVID-19 therapeutic, and re-exploration of its use in CF.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Alpha 1-Antitrypsin / Cystic Fibrosis / COVID-19 Type of study: Case report / Diagnostic study / Prognostic study Topics: Long Covid Limits: Adult / Female / Humans Country/Region as subject: Europa Language: English Journal: J Cyst Fibros Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Alpha 1-Antitrypsin / Cystic Fibrosis / COVID-19 Type of study: Case report / Diagnostic study / Prognostic study Topics: Long Covid Limits: Adult / Female / Humans Country/Region as subject: Europa Language: English Journal: J Cyst Fibros Year: 2021 Document Type: Article