UCLH first in world to trial inhaled surfactant for Covid-19

UCLH is the first hospital in the world to treat a Covid-19 patient with nebulised (inhaled) surfactant – a substance which makes it easier to breathe – as part of a clinical trial.

Lung surfactant is a substance that reduces the work of breathing and prevents the lungs from collapsing. In some respiratory diseases and in patients that require ventilation their own endogenous surfactant does not function normally.

Researchers in a study at UCL and UCLH, led overall by Prof Mike Grocott at University Hospital Southampton NHS Foundation Trust and funded by the Bill & Melinda Gates Foundation, believe that deficiency in the functioning of surfactant may be linked with deterioration in patients with moderate to severe Covid-19.

The research team – including Prof Howard Clark, who is leading the UCL and UCLH portion of the study – will test whether early replacement of surfactant in patients could prevent disease progression and severity.

The first patient for the study has been recruited at UCLH and they were identified and treated by the Critical Care and Anaesthetic Research Teams, led by consultant Dr David Brealey. There are now two patients on the trial at UCLH.

For the pilot study, researchers will give up to 12 patients hospitalised with Covid-19 lung surfactant through use of the COVSurf Drug Delivery System, specially designed and supplied for the study by Aerogen Pharma as an extension of its AeroFact™ drug development program.  This novel mesh nebuliser device vibrates rapidly to turn liquid into droplets of ideal size for inhalation.

Researchers will look at whether offering surfactant via the COVSurf Drug Delivery System is feasible in Covid-19 patients, and will begin to assess whether the procedure improves patient outcomes. The dose given to patients will be increased gradually during the study – with researchers looking at measures including oxygenation in the body.

Use of surfactant is known to be safe and is already offered in other conditions, such as Neonatal Respiratory Distress Syndrome (RDS) – where the lungs cannot provide the body with enough oxygen because of surfactant deficiency.

Prof Clark said: “The possibility that early surfactant replacement could help in Covid-19 is compelling. Surfactant is damaged in Covid-19, resulting in surfactant deficiency and acute respiratory distress syndrome. Surfactant therapy has been very effective in saving the lives of newborn preterm infants who require breathing assistance because of surfactant deficiency. We are looking forward to seeing whether this procedure is feasible, safe and effective in Covid-19 patients.”