Global Coronavirus Updates, August 15: Explained: What is RLF-100 or Aviptadil, the 1970 drug being explored for Covid-19 treatment

Sat Aug 15 07:45:23 CAT 2020

Explained: What is RLF-100 or Aviptadil, the 1970 drug being explored for
Covid-19 treatment

Preliminary studies have shown that the drug RLF-100 protects alveolar type
II cells that are responsible for oxygen exchange in lungs.

An old drug formulation - RLF-100 - is being probed to treat Covid-19
patients after initial studies have shown that the drug is able to halt
SARS-CoV-2 virus replication in lungs. In Mumbai, doctors have begun
prescribing this drug although it is not available in India.

What does RLF-100 do?

RLF-100, also called Aviptadil, is a formulation of synthetic human
Vasoactive Intestinal Polypeptide (VIP). VIP is released throughout the
body, but remains mostly concentrated in lungs. It is produced by immune
cells and nerve endings and acts as a neurotransmitter. It helps improve
muscle activity and blood flow in gastrointestinal tract.

But it also plays another important function. Studies have shown VIP has
anti-inflammatory and anti-cytokine activity properties. Preliminary studies
have shown this protects alveolar type II cells that are responsible for
oxygen exchange in lungs. Since coronavirus attacks lungs and the alveolar
cells, the drug may be helpful in preventing SARS-CoV-2 onslaught in
alveolar cell and limit damage in lung.

Houston Methodist Hospital was first to report recovery in a 54-year-old man
who developed Covid-19 and became critical. The man had undergone a double
lung transplant and later contracted Covid-19 infection. Doctors
administered RLF-100 under emergency use and the patient could be weaned off
ventilator in four days. "He received three infusions of RLF-100 under an
FDA-approved emergency use IND (Investigational New Drug). Within 24 hours
of the third infusion, substantial improvement in oxygen saturation and
radiographic improvement in characteristic COVID-19 pneumonitis was noted.
He was discharged from intensive care at that point and returned home at 1
week on room air," a multi-author article by doctors stated. This article is
however not yet peer reviewed.

The clinical trial

RLF-100 has been granted "Orphan Drug Designation" by the US Food and Drug
Administration (FDA) for Acute Respiratory Distress Syndrome and chronic
lung diseases, drug maker NeuroRx said. On June 8, NeuroRx and Relief
Therapeutics announced a phase 2/3 clinical trial to treat critical Covid-19
patients. The trial will have 144 participants. The drug will be targeted on
those requiring high flow nasal oxygen, and those on non-invasive or
invasive ventilator support. Doses for three successive days will be given
to patients.

In a press statement earlier this month, CEO of NeuroRx Prof Jonathan Javitt
said, "We are conducting placebo-controlled trials to see whether the
observations made in the case-control and open-label studies will be
confirmed for less ill patients with COVID-19-related respiratory failure.
Our independent Data Monitoring Committee will be conducting an interim
analysis of these data later this month."

RLF-100 is not a new finding. It was discovered in 1970 by Dr Sami Said, a
pulmonary medicine specialist. In 2001, US FDA gave RLF-100 an orphan drug
designation to treat acute respiratory distress syndrome, and in 2006 for
acute lung injury. US FDA also granted investigational new drug (IND)
licenses for human trials of Aviptadil. But it has not shown significant
progress in those trials in treating lung diseases.

There are still no well-designed clinical trials that have found optimistic
findings for RLF-100 and research into its use to treat Covid-19 is in
nascent stages. The manufacturer claims rapid clearance of pneumonia and
improvement in oxygen levels in patients this drug was used on emergency
basis.

In Mumbai, Breach Candy Hospital has prescribed this drug to a critically
ill patient. The drug is currently not available in India. Kin of patient
are trying to procure it from USA, treating doctors said.

Dr Rahul Pandit, intensivist in Fortis hospital, however warned. "There is
very little known. For us to prescribe a drug, we need to wait for
scientific evidence," he said.

Zimbabwe COVID19 Update

Frontline Health Workers follow WHO IPC guidelines as they provide care for
Covid-19 patients   

The first day Princess Zengeya and Vongai Mafunga, where seconded as
COVID-19 front liner care givers, they were extremely frightened about their
safety, recalls Nomazulu Dlodlo, nurse in charge at Thorngrove Hospital in
Bulawayo.

With the increased infection rate of COVID-19 frontline workers in Bulawayo,
Princess and Vongai were not sure if they could conduct their duties without
exposing themselves to the virus.

A week into their duties as primary care givers of COVID-19 positive
patients in isolation with moderate symptoms such as dry coughs, Princess
and Vongai received a three-day comprehensive training for front line
workers.

The exercise focused on issues such as use of Personal Protective Equipment
(PPE); management of waste produced during the care of patients; hand and
respiratory hygiene. Including contact and droplet precautions as stipulated
by WHO's Infectious Prevention Control (IPC) guidelines for health care
workers when providing care for COVID-19 patients.

Although Princess and Vongai were scared at first, receiving training was
extremely empowering to them. It provided them with a practical lesson on
donning and doffing amongst many things. Describing her initial experience
as a COVID-l9 frontline worker, Princess says she was extremely anxious.

"I won't lie l was extremely nervous. l was just seconded here without any
knowledge or training on caring for COVID-19 patients," says Princess.

Because of the training, she learnt that donning is the process of putting
on PPE while doffing is the procedure of removing it. Learning about the
best IPC measures for Princess was extremely important.

"Now I know how to handle a patient with COVID-19 and how to protect myself.
I am also aware of WHO donning and doffing guidelines which l follow
everyday as l look after the COVID-19 patients," explains Princess.

The two COVID-19 frontline workers say they both learnt of the proper use of
appropriate PPE such as medical mask, eye protection (googles) or facial
protection (face shield) to avoid contamination, clean, nonsterile,
long-sleeved gown, and medical gloves. The frontline workers were also
educated on the hand hygiene they should follow before putting on and after
removing PPE.

Princess further narrates the kind of care she provides to the patients in
the isolation room.

"The patients' l look after are brave and inspire me.  They communicate
well, and tell me how they feel. l regularly check-up on them after a few
hours. I am always there when they need me and just offer them with
emotional support as well. I assist some of them with bathing, feed them as
well as clean their rooms," Princess reveals.

Despite the growing myth and stigma within their community of health care
workers spreading COVID-19 in Bulawayo, Vongai has remained resolute.

"People run away from us all the time even public transport drivers leave us
behind because of fear of being infected," notes Vongai.

Princess and Vongai started working at Margret Hospital at the same time.
They both had similar fears on what to do when providing care to COVID-19
patients.  By the time of writing, Thorngrove Hospital had admitted 23
COVID-19 patients.

Princess and Vongai are currently looking after one patient and are
practicing what they have learned.

"Doffing is a critical part because that is when l am contaminated.
Therefore, following the right IPC measures as recommended by WHO is
extremely important in protecting myself and those around me," says Vongai.

Thus, the exercise taught Princess and Vongai how the correct use of PPE
reduces exposure to COVID-19.

The training also taught Vongai of the critical elements- which an isolation
room or ward should have. As well as the symptoms to look out for when
caring for patients with moderate symptoms. Moreover, the exercise showed
her what to do if their conditions become critical.

"For instance, l learnt that l should always observe patients all the time
and check if they can breathe normally," adds Vongai.

The Ministry of Health and Child Care (MoHCC) facilitated the training at
Montgomery Gardens with all new front liners care givers at Thorngrove
Hospital. The material used during the training was steered by WHO IPC
guidelines. Thanks to the generous funding from Department for International
Development (DFID). WHO has been able to offer technical support to MoHCC in
translating national guidance on IPC into practices by frontline health
workers through training, mentoring and supportive supervision.

Thorngrove Hospital was one of the health facilities WHO visited during
their two weeks support visit to the City of Bulawayo's COVID-19 response.
WHO also visited Ekusileni Medical Centre and Mpilo Hospital.

WHO's visit was necessitated by the drastic increase in COVID-19 cases in
Bulawayo.  Bulawayo has the second highest number of Covid-19 positive cases
standing at 1161 as of August 14 2020.

Throughout the visit, WHO took time to identify areas they will support to
strengthen Bulawayo's COVID-19 response efforts further.  Moreover, WHO
continues to work very closely with technical partners supporting the
COVID-19 response pillars in Zimbabwe including NGOs, professional
associations and other UN agencies.

Tatenda Chimbwanda is a communications officer at WHO Zimbabwe Country
office

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