Rapid Clinical Recovery from Critical COVID-19 Pneumonia with Vasoactive Intestinal Peptide Treatment

INTRODUCTION: RLF-100 (Aviptadil), a synthetic form of human Vasoactive Intestinal Peptide (VIP), is in clinical trials for treatment of critical COVID-19 pneumonia with respiratory failure. VIP was shown to protect the lung against a broad array of injuries by binding to the VPAC(1) receptor of alveolar type II (ATII) cells, the cells that SARS-CoV-2 binds to. The role of RLF-100 in treating lung transplant patients with COVID-19 pneumonia is unknown. CASE REPORT: A 54 year old man with double lung transplant presented with headache, fever and productive cough. COVID-19 infection was confirmed by positive RT-PCR of nasopharyngeal swab. The patient required only supportive care for three days and was discharged home. Two weeks later he presented with worsening dyspnea, fever and severe hypoxemia requiring high flow O2 and ICU admission. Chest CT showed diffuse bilateral consolidations. He had markedly elevated inflammatory markers. He was treated with dexamethasone and tocilizumab without improvement. He was not a candidate for Remdesivir due to chronic kidney disease. Convalescent plasma was not available. Pro-BNP level was normal; echocardiogram showed preserved biventricular function. He received Aviptadil, a total of three doses, per an open label access under an emergency use approved by US FDA. Rapid improvement in oxygenation and radiologic findings were noticed. No adverse effects were recorded. The patient was transferred out of the ICU 24 hours following the third dose and discharged home on room air 15 days later. SUMMARY: We report a case of lung transplant recipient with critical COVID-19 pneumonia treated with RLF-100 chieving rapid clinical and radiologic improvement. This is consistent with that VIP protects ATII cells, ameliorating the inflammation and improving oxygenation in critical COVID-19 pneumonia. A randomized prospective trial is underway to evaluate the efficacy of RLF-100 in reducing mortality and improving oxygenation in patients with critical COVID-19 pneumonia.