Led by Dr. Nicole Ezer, a team of RI-MUHC researchers have initiated a clinical trial of ciclesonide to possibly prevent mild cases of COVID-19 from worsening.
Ciclesonide is an inhaled and nasal steroid drug currently used for asthma and nasal rhinitis. Laboratory studies have already shown that treatment with ciclesonide can decrease viral replication of SARS-Cov2, the virus responsible for the disease. This placebo-controlled randomized trial will confirm if the administration of inhaled and nasal ciclesonide can reduce the severity of respiratory symptoms among mild cases of COVID-19 and potentially avoid the need for hospitalization and oxygen.
Diagnosed with COVID? Contain COVID at the source. Protect your lungs! Register for a clinical trial of inhaled ciclesonide:
“We know the COVID-19 virus starts by multiplying in the nose and progresses downwards to the lower parts of the airways and lungs. We hope that targeting the site of viral replication with inhaled and nasal ciclesonide will reduce early viral replication and decrease severity of COVID-19 illness,”– Nicole Ezer
In a new cost-analysis study, researchers recommend widespread SARS-CoV-2 testing of priority groups, including healthcare workers, school students and staff, and essential services employees. The study was led by Dr. Jonathon Campbell, postdoctoral Fellow and Dr. Dick Menzies, senior scientist in the Translational Research in Respiratory Diseases Program at the RI-MUHC.
“We believe that a strategy of actively testing large population groups who are at increased risk of acquiring SARS-CoV-2 is feasible and affordable in Canada. This testing approach should be an integral component of a broad strategy to allow all Canadians to return safely to work and school,”
The benefit of widespread testing would be detection and isolation of asymptomatic people infected with SARS-CoV-2. This could prevent community transmission, which otherwise could result in a second wave, and a second shutdown.
About the publication
Active testing of groups at increased risk of acquiring SARS-CoV-2 in Canada: costs and human resource needs. Campbell JR, Uppal A, Oxlade O, Fregonese F, Bastos ML, Lan Z, Law S, Oh CE, Russell WA, Sulis G, Winters N, Yanes-Lane M, Brisson M, Laszlo S, Evans TG, Menzies D. CMAJ. 2020 Sep 9:cmaj.201128.
There is much to be learned still as to why some people with COVID-19 are asymptomatic while others develop symptoms, sometimes severe. The prevailing theory is that their immune systems fight off the virus so efficiently that they never get sick. But some scientists are confident that the immune system’s aggressive response, the churning out of antibodies and other molecules to eliminate an infection, is only part of the story.
Our knowledge of how our immune system fights off a virus is constantly evolving and involves both disease tolerance and resistance. The phenomenon of disease tolerance, which is an inherent component of immunity, is defined as the ability of a host to limit the impact of pathogens. In other words, it is the mechanism that limits tissue damage independent of changes to pathogen burden. This is different from disease resistance, in which the host is able to prevent infection or reduce the number of pathogens. Disease tolerance is well-known in plants but has only been documented in animals within the last 15 years. Disease tolerance may at least partially explain why some infected people have mild symptoms or none at all.
Dr. Irah King sheds some light about disease tolerance in light of the recent COVID-19 pandemic. Read the full article here:
Drs. Irah King and Maziar Divangahi have also co-authored an editorial on the subject in Frontiers in Immunology:
Editorial: Evolving Mechanisms of Disease Tolerance. King IL, Divangahi M. Front Immunol. 2019 Dec 20;10:2974.
In this editorial, Divangahi and King discuss the history of disease tolerance. The concept of disease tolerance was first introduced following observations in plants in the late 19th century. It was only more than a century later that similar observations were seen in animals following infection. This then opened up a whole new field of immunology that started to tease out the cellular and molecular mechanisms of this concept.
A deeper understanding of disease tolerance could lead to “a new golden age of infectious disease research and discovery,” Irah King and Maziar Divangahi
A series of reviews are featured in this issue that detail how this defense strategy is conserved from plants to humans against diverse forms of infection. Reviews by Meakins members are prominently featured, including:
- Beyond Killing Mycobacterium tuberculosis: Disease Tolerance. Divangahi M, Khan N, Kaufmann E. Front Immunol. 2018 Dec 19;9:2976.
- Resistance and Tolerance to Cryptococcal Infection: An Intricate Balance That Controls the Development of Disease. Shourian M, Qureshi ST. Front Immunol. 2019 Jan 29;10:66.
- Pseudomonas aeruginosa in Chronic Lung Infections: How to Adapt Within the Host? Faure E, Kwong K, Nguyen D. Front Immunol. 2018 Oct 22;9:2416.
- Alveolar Macrophages in the Resolution of Inflammation, Tissue Repair, and Tolerance to Infection. Allard B, Panariti A, Martin JG. Front Immunol. 2018 Jul 31;9:1777.
- Host–Parasite Interactions Promote Disease Tolerance to Intestinal Helminth Infection. King IL, Li Y. Front Immunol. 2018 Sep 20;9:2128.
Dr. Jean Bourbeau is leading a new Phase III clinical trial using dapson to target lung inflammation caused by COVID-19.
Dapsone is a decades-old safe and affordable oral antibacterial that has well-recognized anti-inflammatory and immuno-modulatory properties used against malaria, lupus, HIV and many other inflammatory infections. Repurposing drugs could be a quick, safe and cost-effective way to develop new COVID-19 therapies. Dapsone works on the adherence of immune cells called neutrophils to prevent the release of cytokines. Cytokines are proteins produced by white blood cells that help coordinate the body’s immune response.
“By administering the drug as soon as symptoms start, we hope to attenuate the lung inflammation that is the most frequent cause of worsening symptoms and complications requiring hospitalization.”Dr. Jean Bourbeau
Read the full news release here: Old drug, new therapy: RI-MUHC-sponsored phase III clinical trial ready to test repurposed dapsone to tone down lung inflammation caused by COVID-19.
Dr. Jean Bourbeau in the News:
Dr. Jean Bourbeau is an Associate Member of the Meakins-Christie Laboratories, member of the RECRU, member of the Translational Research in Respiratory Diseases Program and director of the Centre for Innovative Medicine at the Research Institute of the MUHC.
Dr. Peter Goldberg is a COVID-19 Innovation Grant recipient for the Code Life Ventilator Challenge. The pandemic has exposed the critical shortage of ventilators in a number of health care settings. Ventilators are expensive — low-cost models range between $5,000-$10,000 — and are unavailable in many care settings. Dr. Peter Goldberg and his team launched the SubK Sprint to build a clinical-grade ventilator that can be produced cheaply and easily, anywhere in the world.
Read more about the award: Code Life Ventilator Challenge – Made For All, McGill University.
About the Joule COVID-19 Innovation grant program: https://joulecma.ca/innovate/covid-grants.
Dr. Peter Goldberg is a member of the Meakins-Christie Laboratories, Associate Member of the RI-MUHC RESP program, leader of the SubK Sprint, and is the Director of the Department of Critical Care Medicine at the McGill University Health Centre.
Dr. Peter Goldberg of the Meakins-Christie Laboratories, Director of Critical Care Medicine at the MUHC and member of the RESP Program at the RI-MUHC, interviewed by La Presse about COVID-19 recovery post-ICU. Specifically, Dr. Goldberg discusses the experiences of himself and his team caring for patients like Paul Mayrand. Mr. Mayrand was the first COVID-19 patient to be admitted to the ICU in mid-March 2020.
Dr. Goldberg explains how patients like Mr. Mayrand, who survive days or even months in the ICU, experience severe and enduring side effects from the powerful medications they required. Recovery includes a long period of rehabilitation as patients re-learn how to eat, speak, move and to perform other basic tasks. As well, permanent damage is done to major organs, not to mention the psychological effects of enduring such a traumatic experience.
Learn more about Dr. Goldberg’s work in the ICU during the COVID pandemic, and the experiences of other COVID patients, in the August 3, 2020 edition of La Presse here.
How is COVID-19 experiencing on the ground?
Listen to the CJAD radio interview with Dr. Peter Goldberg, Director of MUHC Intensive Care
In his opinion piece appearing in the July 13, 2020 edition of The Gazette, Dr. Maziar Divangahi of the Meakins-Christie Laboratories addresses the question: “How can we eliminate this virus?” Dr. Divangahi speaks to the growth of the knowledge base about this virus to date and some of the many remaining questions to be answered.
The complete article can be read by clicking here.
Thanks to the initiative of Adamo Donovan, PhD student with Dr. Benjamin Smith, the staff of the MUHC Royal Victoria Hospital ICU Department are now sharing their identity with colleagues and patients despite their PPE. With a photo of their face pinned to the outside of their PPE, staff are now able to clearly identify each other beyond their eye color. Here is an excerpt from the CBC article of July 4, 2020: Faces hidden due to PPE, Royal Victoria ICU nurses don portraits of themselves:
“The nurses of the MUHC’s Royal Victoria Hospital intensive-care unit are now wearing pictures of themselves so that patients and colleagues can recognize them through their face masks, shields and hospital gowns. They took inspiration from American artist Mary Beth Heffernan, who during the 2014 Ebola outbreak in Liberia spearheaded the PPE Portrait Project there. The driving force behind the McGill University Health Centre initiative was Adamo Donovan, a PhD student and the co-founder of the ICU Bridge Program, which helps university students volunteer in intensive care.”
To read the article and watch the associated video, click here.
Dr. Nicole Ezer, Dr. James Martin, Dr. Andrea Benedetti and Dr. Ben Smith, all members of the RI-MUHC’s RESP Program, have recently announced their new COVID-19 study. This study is designed to test the efficacy of ciclesonide, a steroid currently on the market, to inhibit the spread of the COVID virus in its early stages. This new trial builds on the knowledge gained from a recent study using dexamethasone on advanced cases of COVID-19.
This new study, called Contain COVID-19, which will soon be in the recruiting stage, is aimed at decreasing the severity of shortness of breath among patients who have not yet been hospitalized. Dr. Ezer states in her recent interview with Mathieu Perreault of La Presse:
« Nous espérons que ça va diminuer la gêne respiratoire et éviter l’hospitalisation en stoppant la réplication virale et en diminuant la progression de l’inflammation dans les voies respiratoires inférieures. »
Eligible participants of the study will receive the medication (or placebo) in inhaler and nasal spray form at their residence, to be used for a period of 14 days. Ciclesonide was approved by Health Canada in 2008, and side effects are fairly uncommon, mild and cease when the medication is stopped.
Dr. Ezer’s interview with Mathieu Perreault of La Presse can be read here.
Detailed information on the clinical trial as well as registration information, can be found here.
Dr. Jean Bourbeau received funding from the CIHR COVID-19 May 2020 Rapid Research Funding Opportunity. Title of grant: COVID-19 and COPD: Important knowledge gaps in subclinical pulmonary disease in the Canadian population.
Dr. Jean Bourbeau is an Associate Member of the Meakins-Christie Laboratories, Member of the RECRU, and Scientist at the RI-MUHC RESP Program. His research focuses primarily on chronic obstructive pulmonary disease (COPD) and secondarily on disease management, self-management, pulmonary rehabilitation and cardiorespiratory exercise physiology.