A synergistic role of convalescent plasma and mesenchymal stem cells in the treatment of severely ill COVID-19 patients: a clinical case report

Abstract

Acute respiratory distress syndrome virus-2 (SARS-CoV-2) responsible for coronavirus disease 2019 (COVID-19) infection, which causes global public health emergencies, has sped widely for more than 5 months and has the risk of long-term transmission. No effective treatment has been discovered to date. In the cases we report, the patient continued to deteriorate even after administration of antiviral drugs such as lopinavir/ritonavir, interferon-α, and ribavirin, as well as intravenous injection of meropenem, methylprednisolone, and immunoglobulin. So, we infused the patient with convalescent plasma (CP), and the absolute lymphocyte count increased the next day and returned to normal on the fourth day. Followed by intravenous infusion of mesenchymal stem cells (MSCs), bilateral infiltrates were absorbed and the pulmonary function was significantly improved. We note that the intravenous infusion of CP and MSCs for the treatment of severe COVID-19 patients may have synergistic characteristics in inhibiting cytokine storm, promoting the repair of lung injury, and recovering pulmonary function. We hope to provide a reference for the research direction of COVID-19 clinical strategies.

Keywords: COVID-19; Convalescent plasma; Coronavirus disease 2019; Mesenchymal stem cells; SARS-CoV-2.

Fig. 1

From the blood cell count curve, we noticed that there were two peaks of the absolute value of neutrophils (February 7 and February 16) and the low absolute value of lymphocytes before the peak (February 4 and February 15). In the fluctuation of these cell counts, CRP, D-dimer, PaO2, and oxygenation index all fluctuated, although the time did not coincide completely. At the second peak on February 16, IL-6 also increased significantly. It may be related to two cytokine storms. After the second cytokine storm, the absolute value of lymphocytes did not increase significantly after conventional treatment and increased after the application of convalescent plasma co-400 ml on February 20 and 21. After intravenous infusion of MSCs on February 24 and 27 and March 1, the patients could get rid of respiratory support and the symptoms of dyspnea were relieved

Fig. 2

The chest X-ray (A1–A3) of the patient showed that the pulmonary exudative lesions improved after standard treatment and increased before the second cytokine storm. In the patient’s chest CT (B1–B4), we can see the absorption and evolution of pulmonary exudative lesions in patients with COVID-19; comparing February 20 and February 17, the pulmonary exudative lesions have no significant improvement. After the application of convalescent plasma, a small amount of exudative lesions was seen on the chest CT on February 24 (B3). On February 27, after the first application of umbilical cord mesenchymal stem cell therapy, pulmonary exudative lesions improved significantly (B4)