Tissue Plasminogen Activator (tPA) May Treat Respiratory Failure In COVID-19

For Covid-19 patients in acute respiratory distress, the University of Colorado and MIT have collaborated and proposed a substitute medicinal plan. They hope that this new drug could help to treat patients when ventilators are not available or not helping.

The drug is derived from a protein called tissue plasminogen activator (tPA) that is commonly used to treat stroke and heart attack. 3 hospitals in Colorado and Massachusetts are making plans to check the effectiveness of this drug in severe patients of Covid-19. Data emerging from Italy and china showed that in Covid-19 patients blood clotting disorder is giving rise to respiratory failure.

The detailed findings of this study are available in the “Journal of Trauma and Acute Care Surgery”

Michael Yaffe and  David H. Koch from MIT suggested that if this drug work then it should be scaled up as early as possible because every pharmacy in the hospital has it. Researchers don’t need to make a new drug and are trying to repurpose it.

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In Wuhan, china a large-scale study revealed that 2.3% of Covid-19 patients needed a ventilator and 5% of patients needed intensive care. In the US many public health officials were worried that there may be a shortage of ventilators for severe patients. Many patients in Italy and China died of respiratory failure because ventilators were not available. This indicates that there is a want for additional treatment.

The treatment proposed by the University of Colorado and MIT team is based on past researches. The earlier researches revealed that microthrombi (very small blood clots) often form in the patient’s lungs during acute respiratory distress and reach the air space of the lungs, where gaseous exchange occurs.

A natural protein tPA converts plasminogen to plasmin (an enzyme that dissolves clots) and often given in large amounts to stroke victims and heart attack patients to break down clots leading to stroke or heart attack. Researchers think that tPA may help Covid-19 patients in severe respiratory failure.

1 health trial and animal experiments have shown great benefits of plasminogen activators in treating respiratory failure. In 2001, a human trial was performed and twenty individuals with severe respiratory failure were given plasminogen activating drugs (streptokinase or urokinase). Survival of these patients was not expected because all of them had severe respiratory failure but during treatment, thirty percent of them survived.

Yaffe suggested that till now this is the only human trial to treat respiratory distress using plasminogen activators because ventilators have been doing great and there is no such effect in Covid-19 patients.

MIT and Colorado research group has studied the abnormal bleeding and inflammation in the lungs due to traumatic injuries. Researchers found that inflammation linked tissue damage occurs in these patients and may lead to clot formation.

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Public health officials of New York and Europe revealed that severe Covid-19 patients are hypercoagulate (blood clots causing lung as well as heart and kidney failure). Yaffe found that using this concept should be helpful and it is necessary to know the right dose and route of administration.

Under FDA’s program, researchers will check the effect of tPA in these patients and if it seems to assist in the initial patients then it could be used further.

BARDA will fund the clinical trial and Francis Collins, the NIH director stated that Genentech ( the manufacturer of tPA) has given the drug for trial and if it helps in the initial set of patients then its use will expand further.

The research group decided to deliver the drug directly into the airways as well as intravenously and planned to deliver one dose over a 2 hour period and then an equal dose slowly over twenty hours. Yaffe found that if this drug will work it has great beneficial potential for Covid-19 patients. This study concludes that if tPA will work for coronavirus patients then people might get off ventilators quickly.