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​ Apherese: effective treatment for Long-COVID?
Author: Media & Communication, Faculty of Science
Published: 09/11/2021

A team of researchers from Stellenbosch University's (SU) Department of Physiological Sciences are on their way to Mülheim in Germany to collaborate with and receive training from Dr Beate Jaeger, a medical doctor pioneering the use of apheresis in the treatment of individuals with Long-COVID.

This is part of an international research and collaboration effort focused on the treatment of Long-COVID. In South Africa alone, the prevalence of persistent COVID symptoms lasting longer than 90 days is estimated to affect at least 45% of the 2.7 million South Africans who have survived the SARS-Cov-2 infection. This means that over 1.2 million South Africans may require further medical support for this very poorly understood condition.

Prof Pretorius, head of SU's Department of Physiological Sciences, says the social and economic burden of this condition will be staggering if effective treatments are not developed: “We will work with Dr Jaeger to assess the efficacy and feasibility of H.E.L.P. apheresis in treating individuals with Long-COVID, and elucidate further avenues of investigation in COVID coagulopathy."

Apheresis essentially means a separation of plasma from blood cells in order to remove pathogenic substances from the blood in the treatment of chronic metabolic diseases. H.E.L.P. apheresis, where H.E.L.P. stands for Heparin-induced Extracorporeal Lipoprotein/fibrinogen Precipitation, consists of four steps: plasma separation, precipitation with subsequent filtration, heparin adsorption and ultrafiltration.

Dr Jaeger has been working with H.E.L.P. apheresis since 1985, treating patients with metabolic disease, in collaboration with the inventor of the machine. She is currently using the B Braun H.E.L.P. apheresis machine in the treatment of individuals suffering from Long-COVID to filter out micro clots, clotting factors, cholesterol, fibrinogen, cytokines, the COVID spike protein and autoantibodies.

It was however only after Prof Pretorius found evidence of an overload of insoluble inflammatory micro clots circulating in the blood of individuals suffering from Long-COVID, that apheresis as a potential treatment option started to make sense. This phenomenon has previously gone unnoticed, as normal coagulation tests do not give a true reflection of the hypercoagulable state in acute COVID-patients. Typical laboratory pathology tests are also usually done on plasma only, without cellular material such as the platelets.

Prof Pretorius says the collaboration will be invaluable in terms of evaluating the technology and establishing a treatment protocol for the treatment of Long-COVID. Based on this ongoing research effort, she and Dr Chantelle Venter, with the assistance of Dr Jaco Laubscher, has developed a micro clot and platelet grading system that will aid in the interpretation of results and the more personalised treatment of individuals suffering from Long-COVID.

Accompanying her to Germany is Dr Chantelle Venter, a technical officer and head of the blood lab in SU's Department of Physiological Sciences, as well as Esté Burger and Simoné Turner, both who completed their postgraduate studies at SU in 2020. They are currently employees of the SU start-up company, BioCODE Technologies.

In South Africa, Prof Pretorius is working closely with Dr Maré Vlok, a senior proteonomics analyst at SU's Central Analytical Facilities, as well as Dr Jaco Laubscher and Dr Johan Lourens, both internists at Mediclinic in Stellenbosch. They are studying coagulation and platelet defects in acute and Long-COVID patients.

The other collaborators are:

  • Prof Patrick Moriarty from the Department of Internal Medicine at the University of Kansas Medical Center and director of Clinical Pharmacology and the Atherosclerosis/Lipid Apheresis Center;
  • Dr Ilene Ruhoy, a neurologist and medical director for the EDS/Chiari Center at the Mount Sinai South Nassau Hospital;
  • Dr David Lee, an emergency physician and geospatial epidemiologist at the New York University Grossman School of Medicine;
  • Dr Amy Proal, a microbiologist at the PolyBio Research Foundation;
  • Dr Susan Levine, clinician at the Center for Enervating Neuro-Immune Disease at Cornell University;
  • Dr Asad Khan, a respiratory consultant from Manchester University Hospitals;
  • Dr Anna Brooks, a cellular immunologist and director at the University of Auckland;
  • Dr David Putrino, director of Rehabilitation Innovation for the Mount Sinai Health System and an assistant professor of rehabilitation medicine at the Icahn School of Medicine at Mount Sinai; and
  • Dr Anne Maitland, assistant professor at the Icahn School of Medicine at Mount Sinai and medical director of Comprehensive Allergy and Asthma Care.

The collaboration is administrated by Anne McCloskey, a former long-COVID patient of Dr Jaeger and advocate for finding a treatment that works.

On the photo above, from left to right, Simoné Turner and Esté Burger from Biocode, and Prof Resia Pretorius and Dr Chantelle Venter from the Department of Physiological Sciences at Stellenbosch University. Photo: Anton Jordaan

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Prof. Resia Pretorius

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