TASK ORDER 16: USE OF INHALED HYALURONAN IN PATIENTS WITH SEVERE COVID-19

COVID-19 is a potentially life-threatening infection by the coronavirus SARS-CoV2, which infects respiratory cells and induces epithelial injury, causing susceptible patients to develop adult respiratory distress syndrome (ARDS). ARDS leads to significant inflammation and accumulation of extracellular matrix (ECM), including hyaluronan (HA), a glycosaminoglycan sugar and abundant component of the lung ECM. HA is a powerful modulator of lung injury, inflammation and repair and is found in the airway lumen overlaying ciliated epithelial cells. Airway HA expression is induced by epithelial injury, including viral infection and recent reports highlight increased HA concentration in COVID-19 affected lungs as well. In cell culture and animal experiments we had found that therapeutic HA inhalation protects against SARS-CoV-2 infection. this study we explored the therapeutic role of HA COVID19-induced lung disease in patients with established moderate disease (admitted to hospital, in need for oxygen therapy). Specifically, we questioned whether inhaled HA may promote recovery from COVID19, since HA has antiviral, anti-inflammatory and pro-lung repair properties and ameliorates lung injury after a number of infectious and toxic exposures. We contracted with the Rome facility and initiated a study of inhaled HA (at least 10 days) or placebo. The outcomes were need for oxygen, and length of hospital stay.