Our latest development project:

Current situation:

SARS-CoV-2 and COVID-19

  • It is known that SARS-CoV-2 is highly reproductive in the upper respiratory tract (URT) [1].
  • Critical cases of SARS-CoV-2 infections will be intubated and mechanically ventilated.
  • Intubation can not prevent further migration of SARS-CoV-2 into the lung [2].
  • Half of non-surviving patients experienced a secondary (nosocomial) bacterial super-infection due to microaspiration [3].
  • Likewise for previous pandemics (e.g. SARS, MERS, H1N1) secondary bacterial pneumonia caused between 30% to 55% of deaths [4].
  • Most of the mechanically ventilated patients will not survive [3].

Hypothesis:

Most COVID-19 patients die from secondary infections
– those need to be prevented!

Efficent reduction of bacteria and SARS-CoV-2 in the upper respiratory tract can help:

  • to stop further migration of SARS-CoV-2 into the lung.
  • to relieve the immune system from a high viral and bacterial burden in addition to standard therapy of ventilated critically ill patients.
  • to prevent super-infections and thus reduce metabolic stress for the patient. Super-infections cause about 50% of deaths in the current SARS-CoV-2 pandemic, which is similar to previous pandemics (e.g. SARS, MERS, H1N1) [4].

Solution:

Application of cold atmospheric plasma to the upper respiratory tract

Inactivation of SARS-CoV-2 and bacteria by cold atmoshperic plasma:

    • It was shown in mutliple publications that cold plasma can inactivate various viruses in-vitro [5].
      Samples are: Adenovirus [6], Bacteriophage, Herpes simplex virus [7], Respiratory syncytial virus, Type A influenza virus, Human parainfluenza virus, Feline calicivirus, Human norovirus [8] and Coronavirus
    • Through a cooperation with the research group von Brunn at the Max-von-Pettenkofer Institute in Munich, first indications that cold atmospheric plasma also inactivates corona viruses in solution were demonstrated.
    • It was shown that cold plasma does not induce adverse reactions in healthy mucosa [9].
    • Cold plasma will reduce the bacterial load of secondary infections.
    • Cold plasma thus can prevent super-infections.

Main product

plasma care®

The plasma care® is a CE approved medical device for the treatment of acute and chronic wounds as well as dermatological disorders by cold atmospheric plasma [10]. The plasma care® efficiently inactivates bacteria including multi-drug resistant organisms (MDRO/MRSA) and viruses [10,11].

Product extension:

plasma intensive care®:

  • The plasma intensive care ® can potentially reduce viral- and bacterial load in upper respiratory tract resulting in a reduction of secondary infections [9].
  • The plasma intensive care® can potentially prevent spreading of SARS-CoV-2 and bacteria into the lung and thus prevent super-infections.
  • The cold plasma is applied trough a thin silicon tube into the mouth. The use of plasma intensive care® is therefore safe fot the user and easy to carry out.
  • A major advantage of the gaseous cold plasma treatment, compared to liquid mouthwash solutions, is the homogenous penetration of all areas in the upper respiratory tract (including the nose). In addition the cold plasma simply evaporates after the treatment.

Preliminary examinations in-vitro

Step 1:

Replica of the upper respiratory tract (URT):

  • The constructed model volume is 105ml and the shape has been approximated to the URT.
  • To determine the concentration of the reactive species within the URT, four different measuring points were implemented.
  • Representative for the reactive species, the ozone concentration is measured.

Step 2:

Two test series with Enterococcus mundtii bacteria on agar were carried out. Thus, the microbial reduction potential of the plasma intensive care® can be be evaluated.

The positions of the agar plates can be seen in the adjacent picture.

Step 3:

In both test series, a log-reduction of approximately 4.5 – 5 (99.999% inactivated bacteria) at P1 (throat) and approximately 4 – 4.5 (99.99% inactivated bacteria) at P2 (subglottis) was detected.

Most of the inactivation was carried out after only 3 minutes.

Literature: 

1) Drosten, Warum Covid-19 ansteckender ist als Sars, Tagesspiegel February 2020 2) BVmed, Beatmungs-assoziierte Infektionen, http://www.krankenhausinfektionen.info/Abgerufen März 2020 3) F. Zhou, et. al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study, The Lancet, March 2020 4) J.L. Gerberding, Antibiotic resistance: the hidden threat lurking behind Covid-19, STAT March 2020 5) M. Weiss, G. Daeschlein, A. Kramer, et. al. Virucide Properties of Cold Atmospheric Plasma for Future Clinical Applications, Journal of Medical Virology 89:952–959 (2017) 6) J.L. Zimmermann, G.E. Morfill, et. al. Effects of cold atmospheric plasmas on adenoviruses in solution, J. Phys. D: Appl. Phys. 44 (2011) 505201 (9pp) 7) G. Isbary, J.L. Zimmermann, G.E. Morfill, et. al. Randomized placebo-controlled clinical trial showed cold atmospheric argon plasma relieved acute pain and accelerated healing in herpes zoster, Clinical Plasma Medicine(2014) 8) B. Ahlfeld, J.L. Zimmermann, G.E. Morfill, et. al. Inactivation of a Foodborne Norovirus Outbreak Strain with Nonthermal Atmospheric Pressure Plasma, mBio 6(1):e02300-14 9) S. Becker, J.L. Zimmermann, G.E. Morfill, et. al.  Effects of cold atmosphericplasma(CAP) on bacteriaand mucosaof the upper aerodigestive tract, Auris Nasus Larynx, Volume 46, Issue 2, April 2019, Pages 294-301 10) C. Roskopf et. al. Plasma Technology: A New Tool in Wound Care, Hospital Report, January 2020 11) J.L. Zimmermann et. al. Antibacterial efficacy of cold atmospheric plasma against Enterococcus faecalis planktonic cultures and biofilms in vitro. PLoS ONE 14(11) 12) V. Boxhammer, J.L. Zimmermann, G.E. Morfill, et. al. Bactericidal action of cold atmospheric plasma in solution, New Journal of Physics, Volume 14, November 2012 13) S. Arndt, J.L. Zimmermann, G.E. Morfill, et. al. Cold Atmospheric Plasma (CAP) Changes Gene Expression of Key Molecules of the Wound Healing Machinery and Improves Wound Healing In Vitro and In Vivo, PLoS ONE 8(11)