Treatment of Acute Respiratory Distress Syndrome with Vasoactive Intestinal Peptide

Abstract

Purpose: To assess the clinical safety and possible effectiveness of Vasoactive Intestinal Peptide in the treatment of Acute Respiratory Distress Syndrome (ARDS) related to sepsis. Methods: Under FDA Investigational New Drug clearance, 8 patients with ARDS related to sepsis were treated with 50 pmole/kg/hr – 100 pmole/kg/hr of Vasoactive Intestinal Peptide by intravenous infusion for 12 hours. All patients were on mechanical ventilation and full telemetery. Results: No drug-related serious adverse events were seen. Hypotension was seen in association with two infusions and diarrhea in association with one, but did not necessitate cessation of therapy. Bigeminy was seen in association with one infusion without sequelae. Seven of eight patients demonstrated a successful course during intensive care and were successfully removed from mechanical ventilation and discharged from intensive care. The eighth patient succumbed to purulent secretions in the lungs. Of those who were discharged from the ICU, six demonstrated successful 30 day survival. The seventh died from a cerebral infract at day 30, deemed unrelated to treatment with VIP. Serum levels of Tumor Necrosis Factor α were obtained in 6 patients at baseline and 24 hours and were seen to decrease with treatment in five patients. Conclusions: Initial clinical results of treatment with VIP in patients with ARDS demonstrated a safety profile consistent with previous studies in normal volunteers. The successful clinical course seen in 7 of 8 patients in the setting of an expected 50% survival may suggest that VIP shows promise in the treatment of other infectious conditions that damage the pulmonary epithelium, particularly COVID-19.

Acute respiratory distress syndrome: potential of therapeutic interventions effective in treating progression from COVID-19 to treat progression from other illnesses—a systematic review

“…The peptide is speculated to protect alveolar type II cells from inflammatory damage, preserve surfactant production and have immunomodulatory effects, such as inhibiting nuclear factor-kappa B signalling. These effects reduce production of TNF-α, interleukins and other proinflammatory cytokines, averting the cytokine storm in CARDS; these actions may also reduce or alleviate inflammation in ARDS 10 43 46…”

“…Cytokine storms, which are also observed in ARDS, are considered to be the main cause of CARDS45 and are linked to its progression with cytokine-neutralising agents, including interleukin-6 (IL-6) and IL-6 receptor inhibitors being used to clinical benefit 38 40. CARDS is more likely to require longer MV durations30 32 33 and potentially a higher VILI frequency,43 46 since prolonged MV is associated with persistently raised immune cells 30. Furthermore, CARDS has a higher incidence of intravascular thrombosis and other thromboembolic manifestations,31 39 which may be due to coagulation dysfunction 39.…”

Rapid Recovery from Critical COVID-19 Respiratory Failure after treatment with VIP

“…In 2005, 8 patients with sepsis-related Acute Respiratory Distress Syndrome were treated with the same intravenous VIP protocol. 12 All 8 patients demonstrated clinical improvement, 7 were discharged from intensive care and life support was terminated in the 8 th for neurologic, rather than pulmonary reasons. Although the case series was not reported until recently because of the retirement and subsequent demise of the senior author, the clinical care was managed and results recorded by one of our authorship (JGY).…”

Rapid Recovery in Six Patients with COVID-19 Respiratory Failure after Treatment with Vasoactive Intestinal Peptide

“…In the 2005 time frame, 8 patients with sepsis-related Acute Respiratory Distress Syndrome were treated with the same intravenous protocol. 12 All 8 patients demonstrated clinical improvement, 7 were discharged from intensive care and life support was terminated in the 8 th for neurologic, rather than pulmonary reasons. Although the case series was not reported until recently because of the retirement and subsequent demise of the senior author, the clinical care was managed and results recorded by one of our authorship (JGY).…”