A breath of salvation

COVID-19 is offered to be treated with cellular inhalations

New technique will reduce inflammation in severe forms of pneumonia, scientists say

Maria Nedyuk, Izvestia

Scientists from China have proposed to treat a severe form of coronavirus pneumonia using cellular technologies. They plan to use exosomes, stem cell isolation products, as an active component. Experimental studies have shown that their use significantly reduces lung inflammation. This technique is safer than injecting the patient with stem cells themselves, since there is no risk of mutations and cancer development. Another advantage of such therapy is the possibility of storing drugs for several weeks or even months, which ensures their safe transportation and delayed use. Russian experts believe that the technique looks promising.

Magic Bubbles

Despite the fact that effective methods of treating patients with severe coronavirus infection have already been developed, many people, especially elderly and in poor health, are still at high risk of death from pneumonia. Therefore, it is extremely necessary to find a safe and effective therapeutic approach to patients with COVID-19 complicated by acute respiratory failure. In this regard, many research teams are turning their attention to the prospect of using human stem cells.

Scientists from the Shanghai Clinical Center for Public Health and Jinintan Hospital in Wuhan plan to launch a pilot clinical study of inhalation with stem cell waste products. We are talking about exosomes – bubble-like small particles that secrete all types of cells into the surrounding fluids. They are needed for the intercellular transfer of various proteins or microRNAs. Such exosomes are also isolated by mesenchymal stem cells, which are proposed to be used in the treatment of severe coronavirus pneumonia.

"Experimental studies have shown that their use significantly reduces lung inflammation and pathological disorders resulting from various types of lung damage," the text of the description of the clinical study says. At the same time, scientists note that intravenous administration of living stem cells (not exosomes), which is also being studied by various research teams, may carry risks of mutations and the development of oncological diseases. What is not observed in the treatment of cells sprayed in an aerosol.

Another advantage of the proposed technique is the possibility of storing such drugs for several weeks and months, which ensures their safe transportation and delayed therapeutic use. As stated in the document, it is planned to recruit 30 participants for the first stage. It is assumed that five inhalation procedures will be carried out for each.

A promising idea

Mesenchymal stem cells (MSCs) interact with the innate immune system and can have both anti-inflammatory and pro-inflammatory activity. The type of activity is determined by the source of MSCs, surface markers, and the profile of secreted cytokines (proteins secreted by immune cells. – Izvestia) and other factors, the acting director of the Institute of Biomedical Systems and Biotechnologies of Peter the Great St. Petersburg Polytechnic University (the university is a participant in the project to increase the competitiveness of education "5-100") Andrey Vasin told the newspaper.

– Since it is believed that acute respiratory distress syndrome (ARDS) in COVID-19 is the result of an imbalance of cytokines and other molecules involved in the implementation of inflammatory reactions, the use of approaches to mitigate these reactions seems reasonable. A number of studies were conducted that suggested the effectiveness of MSCs for the treatment of ARDS," explained Andrey Vasin. – Since some of the functions are realized due to the molecules secreted by these cells, it was proposed to use not them, but exosomes containing these molecules.

Scientists have shown that in some cases the use of exosomes gave the same results as the use of MSCs. Therefore, it is not necessary to inject the stem cells themselves to the patient. This is exactly the approach that Chinese researchers decided to use in this clinical study, noted Andrey Vasin. And the very possibility of aerosol administration of the drug potentially has a number of advantages in terms of the safety profile and the direction of delivery to the site of pathology.

In general, since the beginning of this year, about two dozen studies have been organized around the world using cellular products, Alexey Lyundup, executive director of the Association of Manufacturers of BMCP (Biomedical Cell Products), told Izvestia. Moreover, the sources of cells can be different.

– In the technique proposed by Chinese specialists, it is supposed to use exosomes of MSCs of adipose tissue, – the expert emphasized. – Research continues, the idea itself is promising.

According to the specialist, such exosomes from MSCs contain cytokines and growth factors (natural compounds capable of stimulating the production of living cells), signaling lipids (substances that transmit signals inside the cell) and other substances necessary to relieve inflammation. However, it is worth waiting for evidence of the safety and effectiveness of their use in preclinical studies. And only then proceed to the clinical trials announced by Chinese scientists.

– We have sufficient grounds to believe that mesenchymal stem cells (as well as exosomes with similar properties. – "Izvestia") extinguish the cytokine storm, – said the deputy head of the laboratory for the analysis of indicators of public health and digitalization of healthcare at MIPT Stanislav Otstanov. – I assess the methodology proposed in China as promising, but clinical trials will just tell about the effectiveness and safety. In theory, cell therapy should also help in the regeneration of damaged lung areas, but there is still little special information in official sources on this issue. But the decrease in the immune response is confirmed.

Experts emphasize that, in general, the available data on the use of exosomes in patients with COVID-19 look interesting and such an approach may be promising. However, there are still unanswered questions related to the dose of such drugs, the route and frequency of administration, groups of recipients, interaction with other methods of treatment, and so on. Therefore, research in this direction should be continued.

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