LLLT may treat or prevent COVID-19 induced endothelial dysfunction

[Diokine]

Low-Level Laser Therapy in Prevention of the Development of Endothelial Dysfunction and Clinical Experience of Treatment and Rehabilitation of COVID-19 Patients

In Russia, low-level laser therapy is a standard procedure that is included in temporary methodological guidelines “Prevention, Diagnosis and Treatment of New Coronavirus Infection (COVID-19),” meaning that this method is officially permitted. There are dozens of COVID-19 centers using low-level laser therapy.

It is known that the thermodynamic triggering of intracellular Ca2+-dependent processes as a result of laser light energy absorption underlies the primary mechanism of the biomodulating effect of low-intensity laser illumination (LILI), followed by further development of secondary responses of the body, restoring (normalizing) the work of almost all systems that regulate and maintain homeostasis: the immune, nervous, circulatory, and hormonal systems [10–12].

The following LILI properties are most interesting in terms of treating and rehabilitating patients with pneumonia: enhanced enzymatic activity in the mitochondrial respiratory chain, lipid peroxidation system, increased RBC hemoglobin-oxygen affinity, increased functional activity of tissue macrophages, and improved functioning of the actin-myosin complex. At the systemic level, these features are manifested by the activation of microcirculation and metabolism, improved regeneration of lung tissue, enhanced muscle support for the respiratory act, and increased local immunity [13].

If we refer specifically to COVID-19, it is mandatory to employ noninvasive (percutaneous) or intravenous laser blood illumination (NLBI or ILBI); additionally, the immunocompetent organs and lesion projections are exposed to laser light [51]. This approach combining systemic and local exposure to LILI has shown itself to be most efficacious in clinical practice [52–54].

Intravenous laser blood illumination has long been a well-established method for correcting endothelial function. Most often, the “classic” version is used: 635 nm wavelength, 2–3 mW illumination power at the fiber output, 10–20 min exposure [55–61], but recently, a combined version of the technique involving laser ultraviolet blood illumination (LUVBI®) has been used increasingly [62–64].
At the initial examination, 90% of the patients presented nonspecific complaints characterizing the presence of hypoxia (asthenization, malaise, and sweating); approximately one-third of the patients had complaints of inspiratory dyspnea, and about 5% complained of a feeling of incomplete inhalation or difficulty in exhaling. According to the physical examinations, chest breathing—which is less physiologically beneficial than other types of breathing—was revealed in the majority of patients; the amplitude of thoracic excursions was decreased, and an auscultatory picture corresponded to the stage of pneumonia resolution.

In addition to breathing exercises, simulator exercises, vibration gymnastics, and aerosol therapy, the rehabilitation scheme for all patients was supplemented with a course of low-level laser therapy (“Matrix” device). The exposure was carried out with a pulsed IR LILI (904 nm wavelength, 100 ns light pulse duration, 15 W pulsed power, 80 Hz frequency, and 1.5 min exposure time per one zone) on the following skin projection areas) focus of inflammation (2–3 zones)(ii)pulmonary hilum(iii)Kronig isthmus(iv)left supraclavicular region (noninvasive laser blood illumination, NLBI) It was recommended to carry out 12–15 procedures per course daily or every other day.

All patients demonstrated good tolerability of the treatment; after the second procedure, there was an improvement in sputum discharge due to an increase in the effectiveness of the cough push and an improvement in overall health. The severity of general hypoxia decreased by the 5th procedure. By the end of the rehabilitation course, a complete regression of complaints was recorded in 90% of the patients. After the completion of the course, it was recommended to continue the autonomous breathing exercises to increase the functional pulmonary reserves and maintain their performance at the highest possible level.

In one case, the course of the disease was assessed as severe, requiring long-term hospitalization with a diagnosis of SARS (+) bilateral pneumonia with type II–III respiratory failure. The course of postdischarge rehabilitation consisted of five daily procedures of combined laser therapy (LASMIK device): intravenous laser blood illumination ILBI-525 + ultraviolet laser blood illumination LUVBI® (525 nm wavelength, green spectrum, 2 mW illumination power, 5 min exposure per one zone + 365-nm wavelength, UV spectrum, 2 mW illumination power, and 5 min exposure per zone on alternate days) and exposure to pulsed IR LILI (904 nm wavelength, 100 ns light pulse duration, 15 W pulsed power, 10–15 W/cm2 power density, 80 Hz frequency, and 1.5 min exposure time per exposed zone) on the following skin projection areas: the inflammation foci in the lung tissue (2–3 zones), the pulmonary hilum, and the left supraclavicular region. After the first procedure, the patient already noted a decrease in fatigue, general weakness, reduced (“now and then”) coughing, relief of sputum discharge, and an improvement in overall health. By the fifth procedure, she noted a significant improvement in overall health and the disappearance of shortness of breath with moderate physical exertion

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In our opinion, the presented brief literature review convincingly demonstrates the possibilities of low-level laser therapy for eliminating EnD. LLLT is a pathogenetically justified treatment method that promotes lung tissue regeneration and mitigates the consequences of the disease. Moreover, there is already a positive experience of applying low-level laser therapy for the comprehensive treatment and rehabilitation of COVID-19 patients [51, 70].

Adjunct low level laser therapy (LLLT) in a morbidly obese patient with severe COVID-19 pneumonia: A case report

Low level laser therapy (LLLT) has significant anti-inflammatory effects and reduces inflammatory cytokines. It is noninvasive and approved for pain management and musculoskeletal injuries. Data from human and experimental animal models of respiratory tract disease suggests that LLLT reduces inflammation and promotes lung healing.
The use of LLLT in the early stage of severe COVID-19 for this patient may have been beneficial and potentially negated the need for ventilator support that was predicted by both Brescia-COVID and SMART-COP scores. Adjunct LLLT in COVID-19 patients may accelerate recovery and reduce the need for ventilator support and ICU admission. This in turn could significantly reduce length of stay, severity of disease, and the clinical burden in our hospitals.

Low level laser therapy as a modality to attenuate cytokine storm at multiple levels, enhance recovery, and reduce the use of ventilators in COVID-19

LLLT combined with conventional medical therapy has the potential to prevent the progression of COVID-19, minimize the length of time needed on a ventilator, enhance the healing process, and shorten recovery time.

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[Peatness]

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