The first COVID-19 patient has been treated with nebulised (inhaled) surfactant – a substance which makes it easier to breathe – as part of a new clinical trial led by University Hospital Southampton NHS Foundation Trust (UHS) and the University of Southampton (UoS).
The first patient has been recruited to a study aiming to see if extra surfactant, the lung’s natural lubricant, could help prevent COVID-19 progressing and threatening patients’ lives.
Making breathing easier
Lung surfactant is a substance that reduces the work of breathing and prevents the lungs from collapsing. In some respiratory diseases and in patients that require ventilation this substance does not function normally.
Use of surfactant is known to be safe and is already offered in other conditions, such as Neonatal Respiratory Distress Syndrome – where the lungs cannot provide the body with enough oxygen because of surfactant deficiency.
Researchers in the COVSurf study, led by UHS and UoS and funded by the Bill and Melinda Gates Foundation, believe that poor surfactant function may be linked with deterioration in patients with moderate to severe COVID-19.
Treating COVID-19 patients
For the pilot study, researchers aim give up to 12 patients hospitalised with COVID-19 lung surfactant through use of the COVSurf Drug Delivery System, a process that involves a specially designed, ultrasonic nebuliser. This device vibrates rapidly to turn liquid into droplets of the ideal size for inhalation.
Researchers will look at whether this method is feasible, and will begin to assess whether the procedure improves patient outcomes. The dose given to patients will be modified during the study based on how patients’ oxygen levels respond to the treatment as well as sophisticated mass spectrometry measures of surfactant levels available near the bedside within UHS.
“The possibility that early surfactant replacement could help in Covid-19 is compelling. Surfactant is damaged in COVID -19, resulting in surfactant deficiency and acute respiratory distress syndrome,” comments Prof Howard Clark at University College London Hospitals NHS Foundation Trust, who recruited the first patient.
“Surfactant therapy has been very effective in saving the lives of newborn preterm infants who require breathing assistance because of surfactant deficiency. We are looking forward to seeing whether this procedure is feasible, safe and effective in COVID-19 patients,” he adds.
“We know that COVID-19 infects the lungs using receptors on the cells that produce surfactant, likely harming the cells and reducing surfactant function,” commented Prof Mike Grocott, lead for the COVSurf study.
“Nebulised surfactant therapy is an exciting and promising candidate treatment for patients with COVID-19 who are requiring intensive care.”