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calendar   Thursday - April 09, 2020

Jumpin Jack Flash, It’s A Gas

Nitric Oxide Showing Promise As COVID-19 Treatment

Nitric oxide, not nitrous oxide (laughing gas). It helps relax the lungs so people can breath better. It’s been used to help premature “blue babies” to get their lungs working. Like so many other treatments being tested, it also has anti-viral properties. Every cell in your body makes it, but breathing some a couple times a day might really help, both as a cure and as a preventative.

Boston Massachussets:

A drug known to relax blood vessels could help coronavirus patients with severely damaged lungs and will be tested at Massachusetts General Hospital

The Boston hospital will be the first in the nation to rigorously test nitric oxide in coronavirus patients.

“It’s a pretty remarkable drug,” said Dr. Lorenzo Berra, the critical-care specialist at Massachusetts General who is overseeing the new, international trial. “It has a risk profile that is minimal.”

The study administers inhaled nitric oxide to patients with mild to moderate cases of the coronavirus. The gas is delivered through a CPAP breathing machine for 20-30 minutes twice a day.

“We have tremendous confidence this therapy will alter the devastating effects of COVID-19 but we must test it. If results show promise, and since this gas is already FDA-approved, widespread use could begin immediately,” said Dr. Keith Scott, principal investigator of the Louisiana component of the trial.

The trial will also test if the treatment could cut down on the number of patients who need a ventilator to breathe, as they are currently in short supply across the nation.

A proposed second trial that is being reviewed would enroll health care workers who are routinely exposed to coronavirus patients. Under that potential study, staff would inhale a high dose of the drug for 10 to 15 minutes at the start and end of every shift.

link to similar news article at LA Daily News



Birmingham Alabama:

The University of Alabama at Birmingham has been selected to begin enrolling patients in an international study assessing the use of inhaled nitric oxide to improve outcomes for COVID-19 patients with severely damaged lungs.

Acute respiratory distress syndrome, a severe form of lung failure, is the leading cause of death in COVID-19. Nitric oxide has been used for the treatment of failing lungs, but it was also found to have antiviral properties against coronaviruses, according to UAB officials.

The antiviral effect of nitric oxide was tested and demonstrated during the 2002-2003 SARS pandemic, which was caused by a similar coronavirus called the SARS-CoV virus.

“This trial will allow the sickest COVID-19 patients at UAB access to a rescue therapy that may have antiviral benefits in addition to improving the status of lungs,” said Dr. Vibhu Parcha, a research fellow with UAB’s Division of Cardiovascular Disease.

Dr. Pankaj Arora, assistant professor in the division, is spearheading UAB’s efforts in providing this treatment option to eligible COVID-19 patients.

“In humans, nitric oxide is generated within the blood vessels and regulates blood pressure, and prevents formation of clots and also destroys potential toxins,” Arora said.



Shreveport, Louisiana:

Critical care and emergency medicine faculty at the LSU Health Shreveport Department of Medicine join the Department of Anesthesia at Massachusetts General Hospital (MGH) and the Division of Cardiology in the Department of Medicine at University of Alabama-Birmingham (UAB) as being among the first centers in the U.S. to enroll patients in an international study testing using inhaled nitric oxide to improve outcomes for COVID-19 patients with severely damaged lungs; using gas to effectively “kill” corona virus in the lungs and improve delivery of oxygen to injured tissues.

“Inhaled nitric oxide had previously been suggested to decrease original SARS-CoV infectivity over a decade ago, but its effect on SARS-CoV2 [ aka COVID-19 ] remains unknown.  Moreover, research from LSU Health Shreveport has shown that nitric oxide is a strong protector against tissue hypoxia, which occurs during severe Covid-1 infection”, said Dr. Chris Kevil, Vice Chancellor for Research at LSU Health Shreveport.

...

Nitric oxide has already been a miracle drug for newborns starved of oxygen by a heart defect due to the gas’s ability to relax blood vessels, which ultimately led to the resolution of erectile dysfunction as targeted by the drug Viagra.

In 1992, the journal Science named nitric oxide “molecule of the year.” In addition, in 1998, UCLA pharmacologist Louis J. Ignarro shared a Nobel Prize in medicine for uncovering nitric oxide’s role as a “signaling molecule in the cardiovascular system.”



Italy:

In Italy during the COVID-19 outbreak the gas was used under less controlled study conditions; however the treatment appeared to dramatically boost oxygen levels in the blood of COVID-19 patients, said Dr. Lorenzo Berra, the critical-care specialist at Massachusetts General Hospital who is leading the new trial. However, it will take more rigorous testing to clarify how much nitric oxide helps, he said.

...

When inflammation, emphysema or a disease like cystic fibrosis attacks the lungs, the large blood vessels and tiny capillaries that deliver oxygen constrict. Inhaled nitric oxide also relaxes those vessels, increasing the transfer of oxygen to the blood and easing the heart’s workload.



Extra info:

As scientists race to find specific treatments for COVID-19, the colorless gas nitric oxide has emerged as a candidate.

Nitric oxide works as a signalling molecule in the cardiovascular, nervous and immune systems of animals, and is mostly produced in the inner layer of blood vessels called the endothelium. The compound relaxes muscle cells, which in turn prompts blood vessel walls to widen, boosting blood flow and decreasing blood pressure.

As such, physicians have used it for a range of conditions, and it was first approved for use by the U.S. Food and Drug Administration in 1999.

Warren Zapol, emeritus anesthetist-in-chief at Massachusetts General Hospital and a professor at Harvard Medical School, told Gizmodo nitric oxide is used to treat babies born blue, as well as adults with cardiac surgery, and patients with what is known as acute respiratory distress syndrome, where the oxygen supply to lungs are cut off by bodily fluids. “About a half-million Americans have breathed in NO [nitric oxide],” Zapol told the outlet.

~~~~

One very nice thing about the nitric oxide approach is that it can be delivered through a nasal cannula, or a CPAP or BiPaP machine and face mask. It does not have to be given via a ventilator. And the ventilators themselves may be doing more harm than good. Patients on them have an 80% fatality rate in NYC, and low surviveability rates elsewhere. With many other diseases, patients are only on the ventilators for a day or two, but with COVID-19 many are hooked up for two weeks. Ventilators are a rough treatment, and extended use may do more harm than good.

Generally speaking, 40% to 50% of patients with severe respiratory distress die while on ventilators, experts say. But 80% or more of coronavirus patients placed on the machines in New York City have died, state and city officials say.

Higher-than-normal death rates also have been reported elsewhere in the U.S., said Dr. Albert Rizzo, the American Lung Association’s chief medical officer.

Similar reports have emerged from China and the United Kingdom. One U.K. report put the figure at 66%. A very small study in Wuhan, the Chinese city where the disease first emerged, said 86% died.

The reason is not clear. It may have to do with what kind of shape the patients were in before they were infected. Or it could be related to how sick they had become by the time they were put on the machines, some experts said.

But some health professionals have wondered whether ventilators might actually make matters worse in certain patients, perhaps by igniting or worsening a harmful immune system reaction.

That’s speculation. But experts do say ventilators can be damaging to a patient over time, as high-pressure oxygen is forced into the tiny air sacs in a patient’s lungs.

“We know that mechanical ventilation is not benign,” said Dr. Eddy Fan, an expert on respiratory treatment at Toronto General Hospital. “One of the most important findings in the last few decades is that medical ventilation can worsen lung injury — so we have to be careful how we use it.”


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Posted by Drew458   United States  on 04/09/2020 at 11:19 AM   
Filed Under: • Health-Medicinepandemic and epidemic diseases •  
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