Thomas Reppchen introduced Tracey Watson, manager for major gifts for St. Paul’s Foundation. Tracey introduced Dr. Janice Leung, Respirologist at St. Paul’s Hospital and principal investigator at the Centre for Heart Lung Innovation. In 2015 completed post doctoral fellowship at St. Paul’s Hospital. Dr. Leung spoke about their research finding the COVID-19 receptors in the lungs and their work in figuring out which drugs will either destroy or help block the receptor for the COVID-19 molecule.
Dr. Leung, showed us statistics that indicated clearly that older Canadian are more susceptible. As we age the risk goes up significantly. Some conditions that increase risk are obesity, diabetes, hypertension and coronary artery disease. Those with COPD have much worse outcomes with a 3-fold risk of dying or being put on a ventilator.
When we talk about how the virus enters the airways, very early on Berlin scientists figured out it was the ACE2 receptor in the airway cell that the original SARS used. Research focusses on the ACE2 and they found that COVID-19 uses the same receptor. So far an alternate form of entry into the body has not been identified.
Like all things in life its all about balance. This is true of controlling the ACE2 receptors both during infection and post infection.
The research team has been able to use data from bronchoscopies (over 700 are performed every year at St. Pauls). It’s a lot of data. Any patient having one are asked if its okay to take additional research samples during their procedure to be used in the biobank. Over 200 patients have cooperated and another 100 or so have voluntarily signed up for the procedure purely to aid the research.
The samples show that patients with COPD have significantly higher levels of ACE2. Smokers also have higher levels; if a smoker stops smoking the levels do fall back to a never smoked category.
There are central banks of data that are available around the world so scientists can compare data from other areas of the globe to their own. St. Paul’s was able to publish their findings very quickly, indeed they were the first. It has received a lot of attention from numerous news outlets, etc.
There are a lot of questions that still need answering:
- Can we manipulate the expression of aCE-2 in the airway epithelium to prevent or treat COVID-19?
- Do chronic inhaled medications that COPD patients use regularly alter ACE2 levels?
- What is the effect of other inhaled toxins like cannabis, e-cigarettes, and air pollution on ACE2 levels?
We can take the airway cells and grow them in the lab allowing us to test treatments. There is some interest with Losartan. Though more significant results have been found with Dexamethasone. It has been used in the UK, which provided the best results showing lower mortality rates. ACE2 levels were higher. If given as a rescue drug, it may be able to return ACE2 levels back to a balanced level.
Ciclesonide (inhaled steroid) has been used, but unlike Dexamethasone, they have found the opposite effect. It lowered the ACE2 levels. Possibly a combination would work – use Ciclesonide initially and the Dexamethasone as a follow up rescue.
We are working in collaberation with a lab in Taiwan to mimic the conditions of COVID-19. It’s an ongoing project and is possible because of, and with thanks to, all of their supporters who are allowing the continued work and opportunity, including the St. Paul’s Hospital Foundation, Michael Smith Foundation for Health Research, Providence Health Care, The Lung Association, to name a few.
Some links of interest:
- Article, St. Paul’s researcher receives funding to help fight COVID-19, March 25 2020, CLICK HERE
- CBC article, B.C. hospitals taking part in massive WHO COVID-19 treatment study, April 9 2020, CLICK HERE
