Raymond Benza, MD, The Ohio State University Medical Center, talks about a new way to deliver drugs to COVID patients.
It’s certainly been a challenging year for everyone, and certainly for you and your colleagues in the medical profession. Specifically, we’ve heard a lot more about ventilators and mechanical ventilation this past year than I think most of us ever wanted to hear. Specifically, what are you and your colleagues looking at in terms of improving patient care?
BENZA: Yeah. You know, the interesting thing about crises is they help to spark innovation. And when crises affect the population’s health, physicians’ innovative abilities really come forward. And trying to understand the problem and then learning ways to mitigate the problems or the things that we do in our everyday activities and practices. So the COVID pandemic has proven to be a dramatic challenge for us as a medical field. The amount of pain and suffering that we’ve experienced this year has been unprecedented, not only for a health care professional like myself, but the people who are actually suffering from the disease. And as you know, COVID-19 has a predilection for the lung, although it is a systemic disease – it affects almost every organ in the body – but it’s most lethal effects are in the chest and in the heart and in the lungs. And it creates an inflammatory process in the lung that often leads to mechanical ventilation, which, again, everyone has become so familiar with these days – not only with the shortage of ventilators that we experienced in the very beginning of the pandemic, but then having to learn how to use ventilators in a totally different way that were designed to help this particular type of patient and this particular type of disease. So not only did we use more ventilators, we used them in different ways and we tried to find innovative products to deliver through them to the affected organ, which is the lung. And that’s where the study that we’re doing here at Ohio State comes into. As a pulmonary vascular disease specialist, I treat diseases that affect the blood vessels of the lungs. Pulmonary hypertension is the medical name for that. And this is a disease that primarily afflicts young women of childbearing age, and it’s a very lethal disease. The disease causes the attrition or loss of the blood vessels that actually deliver blood to the lungs that allows the lungs to put oxygen into the blood. So if you don’t have these blood vessels, you can’t deliver oxygen well to the body. And as we were learning more and more about what it did to the lungs, we recognized that COVID did the same thing that pulmonary hypertension does to the blood vessels of the lungs. It causes a drop out of these pulmonary vessels so that the conduits through which the body delivers blood to the lungs to get oxygen in were disappearing. And we noticed this was the unique physiology of the COVID-19-infected patient. So being a pulmonary vascular disease specialist, we thought, well, you know what? We have medicines that we use now to heal those blood vessels, maybe it would be a good idea to try to implement this in someone afflicted with COVID-19 to try to heal these vessels to improve oxygen exchange. And that’s where the study really evolved from. Aerogen, which is the company that manufactures the pieces that we can fit to a ventilator that allowed us to deliver these medications to the ventilated patient with COVID-19, was really the breakthrough that we needed to deliver this drug because it involves an even distribution of this drug which is called Epoprostenol to the affected areas of the blood vessels. And Epoprostenol is a drug that’s been around for a long time. It’s really one of the cornerstones of therapy for pulmonary hypertension. And Epoprostenol does all the good things that you want to do to a blood vessel. It makes the blood vessel reactive again, it helps heal the lining of the blood vessels, and it restores the intelligence to the blood vessel that we need for it to regulate the flow of blood to the lungs. And so now we had a good drug and now we had a delivery system that we can use that can aerosolize that drug and deliver it to patients who are ventilated with COVID-19. And that’s what we’re exploring now is whether this therapy delivered through this novel system allows the lungs to heal more rapidly to allow people shorter times on the ventilators, to improve their oxygenation, and also to facilitate their rehab after they’re done with the main portion of their disease.
For our viewers, can you walk me through what you and your colleagues would physically have to do or have to watch while these patients are on a ventilator? Is it an addition, this system, to the ventilator?
BENZA: So, this is a nifty but compact therapy system. It looks like a screen that has delivery tubes hooked up to it. And the screen is actually a computerized motor, in essence, that allows you to deliver a specific amount of the drug with ventilation. And so, it kind of hooks up to the ventilator and works in tandem with the ventilator.
And how much of this drug is delivered into a patient system and over what period of time?
BENZA: So this is the neat thing about the drug and also the delivery device is that I can titrate the amount of drug that I deliver. So if I don’t see the effect at a certain level, I can crank the dosage up and see if that results in an improvement. And then I can also wean it as the patients get better.
Where are you in this trial?
BENZA: We’ve used this now on a half a dozen patients or so. And we have noted some improvements in their oxygenation. We have survivors now that are off the ventilators who have benefited from this therapy. So we’re keeping our fingers crossed that this could be part of our new armamentarium for these people and then, you know, even explore earlier uses of this combination of inhale therapy earlier, even perhaps before people need ventilators, to try to prevent them from being on ventilators altogether.
How long is the trial and how many patients do you have enrolled?
BENZA: So we want to we want enrolls up to a dozen to 20 patients. We’re doing this in accordance with the FDA guidelines. And what we’re doing is we’re treating people for 10 days with this drug and we’re monitoring their length of time they’re on the ventilator, how their oxygenation and gas exchange improves while they’re receiving the drug, and also, very importantly, the – seeing if we can reduce the need to go even beyond the ventilator because, as you know, in some people, even the ventilator’s not enough and we have to result to even more aggressive means to oxygenate the body using extracorporeal membrane oxygenation, which is a whole nother technique that we do here at OSU to provide advanced life support to people suffering from very severe respiratory and cardiac diseases. So we want to see if we can prevent that progression to that new technology.
What is the benefit, doctor, of having one more tool? Some people have said, ‘oh, we’re at the end of COVID.’ I’m playing devil’s advocate, but what is the benefit to this?
BENZA: Well, we’re at the end of this COVID. I mean, as you know, there are many different variants that are developed because we didn’t mitigate the problem quick enough. And these new variants – some of them were much more contagious. And so I don’t think we’ve seen the end of this yet. I do believe we are on the tail, but we need to be very cautious and we need to keep ever-vigilant and observant to make sure that this virus doesn’t come back and affect us in a different way with some of these new variants. In addition, you know, this is not the first coronavirus that we know has caused diseases. We’ve had SARS and other forms of the same sort of virus, and there’s no telling if a new type of coronavirus will come out and pose a problem. And so knowing how to mitigate this virus teaches us what we need to do for the next one when it comes around.
So lessons learned?
BENZA: That’s right. Never, never avoid history.
Interview conducted by Ivanhoe Broadcast News.
END OF INTERVIEW
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