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Photobiomodulation therapy as a high potential treatment modality for COVID-19

Sepideh Soheilifar,1 Homa Fathi,2 and Navid Naghdicorresponding author3 - Lasers Med Sci. 2020 Nov 25 : 1–4. (Publication)
This recent study shows some promise for treating covids damage to the lungs.
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Considering the pathophysiology of COVID-19 and potential positive effects of PBM in balancing the function of the immune system, this treatment modality could be effective in severe COVID-19 cases with ARDS. COVID-19 mortality is mainly because of cytokine storm in severe cases. PBM has the potential to decrease the level of pro-inflammatory cytokines and improve the balance of IL-10. These effects can balance immune response and decrease the impact of cytokine storm. PBM is mainly local and has very limited adverse side effects . Unlike corticosteroids, it does not cause delayed body response to virus elimination, secondary infection, or longer hospitalization period. This hypothesis is mainly based on theoretical data. The authors suggest that researchers should assess the potentials of this treatment method as it might save the lives of severely affected patients.
Intro: OVID-19 is now a worldwide concern, causing an unprecedented pandemic. The infected cases show different symptoms based on the severity of the disease. In asymptomatic and non-severe symptomatic cases, the host immune system can successfully eliminate the virus and its effects. In severe cases, however, immune system impairment causes cytokine release syndrome which eventually leads to acute respiratory distress syndrome (ARDS). In recent years, photobiomodulation (PBM) has shown promising results in reducing acute pulmonary inflammation. Considering the high potential impact of PBM on immune responses, we hypothesized that using PBM could be an effective treatment modality for ARDS management in COVID-19 patients.

Background: In the final days of 2019, China reported the emergence of an unknown pathogen causing pneumonia-like symptoms in the infected cases in Wuhan, Hubei. On January 7, 2020, Chinese Center for Disease Control and Prevention detected the origin as a novel virus from the Coronaviridae family. World Health Organization (WHO) soon confirmed that human to human transmission of the virus has led to a worldwide “pandemic” [1]. The virus was named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing Coronavirus disease 2019 (COVID-19). Coronaviridae is a large family of enveloped, positive-sense, single-stranded RNA virus [2]. Based on the genome structure and phylogenetic relationships, this family is further categorized into four groups; Alphacoronavirus, Betacoronavirus, Gammacoronavirus, and Deltacoronavirus. Alpha and Betacoronaviruses are specific to mammals and cause respiratory diseases in humans, namely Severe Acute Respiratory Syndrome coronavirus (SARS-CoV) and the Middle East Respiratory Syndrome coronavirus (MERS-CoV). Delta and Gammacoronaviruses cause infection in both mammals and birds [3]. Genetic analysis revealed that SARS-CoV-2 is most probably in the Betacoronavirus category [4]. The infected cases show different symptoms based on the severity of the disease. In asymptomatic and non-severe symptomatic cases, the host immune system can successfully eliminate the virus and its effects. In severe cases, however, immune system impairment causes cytokine release syndrome which eventually leads to acute respiratory distress syndrome (ARDS) [5]. One of the treatment strategies is to eliminate inflammatory response in the host. Although some medications such as immunosuppressants have this effect, they cause delayed body response to virus elimination [6]. To address this issue, alternative treatment modalities for inflammation elimination are urgently needed. One such potential treatment is photobiomodulation (PBM), also known as low-level laser therapy (LLLT). PBM is an alternative modality for local management of increased inflammation, which has been used from 50 years ago [7]. It is defined as a low power laser or light-emitting diode (LED) in the range of 1–500 mW utilized to promote tissue regeneration and decrease inflammation and pain. A narrow spectral width light in red or near infra-red range (600–1000 nm) with 1–5000 mW/cm2 power density is used in PBM [8]. PBM can change cellular and molecular metabolism, signaling, inflammation, and chemical messenger release. It has shown promising results in reducing acute pulmonary inflammation, as they have a high potential for the local balance of immune responses [9]. Therefore, the objective of this paper is to hypothesize that using PBM could be an effective treatment modality for ARDS management in COVID-19 patients.

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A 57-Year-Old African American Man with Severe COVID-19 Pneumonia Who Responded to Supportive Photobiomodulation Therapy (PBMT): First Use of PBMT in COVID-19

Scott A. Sigman,A,B,C,D,E,F,1 Soheila Mokmeli,A,B,C,D,E,F,2 Monica Monici,A,3 and Mariana A. Vetrici - Am J Case Rep. 2020; 21: e926779-1–e926779-7. (Publication)
This study shows positive results treat post covid patients with laser therapy.
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Background: Coronavirus disease 2019 (COVID-19) is associated with lung inflammation and cytokine storm. Photobiomodulation therapy (PBMT) is a safe, non-invasive therapy with significant anti-inflammatory effects. Adjunct PBMT has been employed in treating patients with lung conditions. Human studies and experimental models of respiratory disease suggest PBMT reduces inflammation and promotes lung healing. This is the first time supportive PBMT was used in a severe case of COVID-19 pneumonia

Results: This report has presented a patient with severe COVID-19 pneumonia associated with ARDS who was given supportive treatment with PBMT. Based on this case report, as well as clinical experience of PBMT in respiratory tract diseases in humans, we consider PBMT to be a feasible adjunct modality for the treatment of COVID-19. There is published experimental work demonstrating the anti-inflammatory effect of PBMT on lung tissue. We suggest that the use of adjunct PBMT in the early stages of severe ARDS seen in COVID-19 patients can enhance healing and reduce the need for prolonged ventilator support and ICU stay. The urgent current medical situation calls for PMBT pilot studies and clinical trials to evaluate its effect on COVID-19 pneumonia. This patient is part of an ongoing investigational randomized controlled trial.

Conclusions: This case report showed that 4 daily sessions of adjunct PBMT were beneficial in a patient with severe COVID-19 symptoms. The patient’s positive response to treatment was supported by radiological findings, pulmonary severity scores, oxygen requirements, blood and inflammatory markers, and patient questionnaires. On follow-up, his clinical recovery in total was 3 weeks, whereas the median time for COVID-19 is typically 6–8 weeks [30]. The therapeutic effects of PBMT on pneumonia are thought to occur via local and systemic effects that reduce inflammatory cytokines, cellular infiltrates, edema and fibrosis, and increase anti-inflammatory cytokines and processes, and promote healing. Local PBMT affects the entire body when photoproducts are distributed via the vasculature to reach distant targets. Activated photoproducts lead to alleviation of inflammation and immunomodulatory effects, and stimulate wound healing and tissue regeneration [4]. Animal studies illustrate the potency of PBMT. Transcutaneous PBMT in murine models for pulmonary fibrosis and ARDS significantly reduced pro-inflammatory cytokines, inflammatory cells, and collagen fiber deposition in lung parenchyma [14–18]. In contrast, the anti-inflammatory cytokine interleukin-10, serum monocytes, and lung macrophages were significantly increased following PBMT [15,17]. The molecular basis of MLS laser anti-inflammatory effects has been demonstrated in murine and in vitro models [31–33]. In particular, it has been shown to inhibit inflammasome activation, inhibiting ... whose downstream signaling induces the production of interleukin-6, interleukin-8, tumor necrosis factor , and .., which are implicated in ARDS caused by COVID-19 infection [14–18,31–33]. Human trials have shown local and systemic effects of PBMT when applied to quadriceps muscle in patients with chronic obstructive pulmonary disease [10]. Beneficial effects extended beyond improved muscular performance, to statistically significant reductions in dyspnea and fatigue [10]. Our patient also reported subjective feelings of improved respiratory function and strength. Our patient was only placed in the prone position for the duration of laser treatment. Treatments lasted exactly 28 min for each of the 4 days. Physiological evidence and clinical trial data support the use of prone position ventilation in selected patients with moderate-to-severe ARDS. For patients to benefit, the use of long prone positioning sessions of 12 h to 18 h per session are necessary [34,35]. An increase in SpO2 from 94% to 100% occurred within the first 5 min of treatment, and the patient maintained good saturation thereafter. This finding shows the rapid effect of PBMT treatment on oxygen saturation. It is unlikely that prone positioning alone was the reason for improved oxygenation, given the minimal time in that position. A strength of this case report is that we collected patient symptom data before and after treatment. All 4 pulmonary scoring tools and the 3 patient questionnaires demonstrated the benefit of treatment. To the best of our knowledge, this was the first time that PBMT was used as adjunctive treatment for pneumonia in a COVID-19 patient. Irradiation over the posterior projection of the lungs, using the scanning method, has no risk of contamination since the scanning laser does not physically touch the patient. A deficiency of our study is the lack of inflammatory markers and blood tests. Future studies should include measurements before and after treatment of ...., as well as additional inflammatory markers. A limitation of this case report is that this is a single patient and we were unable to carry out any statistical analysis.

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Home Search Introduction

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Welcome to the research tool. This tool is a searchable collection of technical publications, books, videos and other resources about the use of lasers for photobiomodulation. This tool includes almost the entire U.S. library of medicine research papers on LLLT, videos from Youtube associated with therapy lasers and the tables of contents from laser therapy books. This allows users to search for a keyword or condition and see resources about using lasers to treat that condition. All the resources include links to the original source so we are not making any statement about the use of lasers for treating non-FDA cleared application, we are simple summarizing what others have said.  Where every possible, we have included a link to the orginal publication.

Here are some of our favorite queries:

This tool uses a broad match query so:

  • It does not correct spelling and searches only cold laser related subjects so do not use LLLT, cold or laser in the search bar
  • It works better with shorter search terms or even parts of search terms
  • It searches all the available fields so you can enter a body part, author, condition or laser brand.
  • Where ever possible, the detailed section about the resource will link to the sources.
  • This system is only for photobiomodulation or cold laser therapy research (including LLLT, laser acupuncture and high power laser therapy) only. It does NOT include photodynamic laser therapy (where the laser is used to react with a pharmaceutical), hot surgery lasers or cosmetic lasers. It does include some resources on weight loss and smoking cessation.

The results of the search are sorted based on 3 quality factors on a scale of 1 to 10 with 10 being the best score. Originally all the resources were given a 5-5-5 until they could be individually evaluated. These scores are purely opinion and are only used to simplify the rank of the results from more valuable to least valuable. This should not be considered a critique of any work. This system was created to help researchers (including ourselves) find the most usable resources for any cold laser therapy research. The resources are assigned values based on the following 3 factors:

  • Efficacy: The resource (especially research papers) should show a significant improvement in the condition being treated. Resources that show better results are given a higher quality score.
  • Detail: The source must give enough information that the results can be duplicated. If a resource lacks too many details that it cannot be recreated, it is given a lower detail score.
  • Lack of Bias: Many resources are created to try and show that one device is superior to its competition. Many manufacturers have staff that crank out biased papers on a regular basis on the hope that this will make their product look superior. If the author of the resource is paid by a manufacturer of the resource appears to be biased towards one device and not one technology, the resource has much less value.

Over the past few years of working with research, we found that a majority of the published resources are lacking in one of these three ranking factors.
The original goal of this research tool was to tie published resources to the protocols in the library. This connection allows users to trace each protocol back to a list of resources so the protocol can be researched and improved.

General Comments

When many of the first research papers were published, the most power laser available for therapy were less than 100mW and many systems had to be pulsed to keep the laser from burning out too quickly. Today, system are available that will deliver up to 60,000mW of continuous output. Because of these power limitation, many early studies were limited to extremely low dosages by today’s standards. It takes a 50mW system 17 minutes to deliver 50 joules at the surface of the skin. If this was spread over a large area of damage or was treating a deeper problem, the actual dosages were much less than 1J/cm2.  Today, we know that these dosages typically produce very little or no results.
About 80% of the resources in this database are in the near infrared wavelength. There is also some interest in the red wavelength (600 to 660nm) . Other wavelengths like blue, purple, and green have very little scientific research behind them and have not gotten much traction in the core therapy market with the exception of some fringe consumer products.
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