Experimental hormone therapy may aid in COVID-19 recovery
DULUTH, Minn. — Every time the phone rang, it seemed to Kristine Smoley like more bad news about her husband, who contracted COVID-19 and was in a hospital intensive care unit on a ventilator because he couldn’t breathe on his own.
Smoley was prepared for the worst when a nurse from Duluth’s Essentia Health called with hope — albeit with risks and no solid evidence it would save her husband.
“They asked if I wanted to consider signing off on an experimental treatment for him,” Smoley said. “A treatment that had never been done before.”
Essentia’s Dr. Tim Rich and the University of Minnesota Medical School’s Dr. David Ingbar had studied for years whether a common thyroid hormone could be repurposed for the treatment of acute respiratory distress syndrome (ARDS), an often fatal type of lung failure. The doctors received federal approval late last year to test the therapy, so when COVID-19 caused a sudden surge in ARDS, they were ready for their first patient — Smoley’s husband, Bob Schlicht.
“It was scary,” Smoley said. “But I don’t know that I really had an option, because the other option wasn’t good.”
The turnaround that followed was so remarkable that Rich and Ingbar have advanced their research — unique for a regional medical provider in a world of urban and academic COVID-19 studies — to a phase 2 U.S. Food and Drug Administration study. The doctors have optimism about the impact their treatment could have amid the pandemic.
“There has been a lot of highly technical science to understand this biology, but the elegance now is in its simplicity,” said Rich, a pulmonologist. “This is not a designer drug. This is something we know the lung needs and uses.”
So far, only the antiviral remdesivir has received full FDA approval as a COVID19 therapy for hospitalized patients, while treatments such as plasma infusions remain experimental and available only under emergency authorization.
Rich and Ingbar made a key discovery during the H1N1 pandemic of 2009, when families of those who died from influenza-related ARDS permitted autopsies. Rich found the victims’ lungs lacked T3, a thyroid hormone that would normally be detectable.
Ingbar said T3 reduces inflammation and coaxes epithelial cells in the lungs to absorb fluids — which is vital for patients with ARDS.
“A part of this acute lung injury with ARDS is the lungs get leaky, and they tend to fill with fluid,” Ingbar said. “That makes it really hard to get oxygen in or carbon dioxide out.”
Schlicht, 68, was Itasca County’s first known positive case of COVID-19.
A few weeks later, Mary Ellen Evangelista found herself urging her brother, Tim White, to call an ambulance after he spent a week getting sicker at home.
White is a corrections officer at the Moose Lake prison, where inmates and workers tested positive for COVID-19 in early April. He was placed on a ventilator in Duluth late that night because the virus led to ARDS.
Doctors told Evengelista that her 51-year-old brother might not survive and asked to try the thyroid hormone.
“And every day, I just had a little more glimmer of hope,” she said.
White spent more than a month in the Duluth hospital but has been back home since spring and is working to gain enough strength to return to work. Chest Xrays for months have shown healthy lungs.
“This is really a much faster recovery than we see with typical ARDS,” said Ingbar, noting that many survivors have lung scarring that can cause breathing problems for years and the need for supplemental oxygen.