A Concerned Doctor: Is Aviptadil (Vasoactive Intestinal Peptide) the Silver Bullet for COVID-19?
A short August 2020 vlog in which an ICU-minded doctor reviews early COVID-19 trials of aviptadil, a vasoactive intestinal peptide, and a VIP analog, with some basic physiology.
Key moments
Tap a moment to play the video from there.
- 0:00Introducing RLF-100 and VIPThe host introduces RLF-100 (aviptadil) and explains that it is based on vasoactive intestinal peptide, a neuropeptide the body produces.
- 0:26RLF-100 announcement and case reportsThe host describes the announced trial, the ARDS and sepsis background, and a case report of a lung transplant patient who he says left the ventilator in four days.
- 2:07Aviptadil trial designThe host reads the trial listing: multi-center, placebo-controlled, intravenous infusion, with mortality and oxygenation ratio as outcomes.
- 4:24Vanguard trial of PB1046The host covers a VIP analog given as a weekly subcutaneous injection to hospitalized patients, along with the inclusion and exclusion criteria.
- 6:08VIP physiology and blood pressureThe host reviews what VIP does in the body, including vasodilation, and speculates about effects on blood pressure and heart rate in septic shock.
- 7:41Type 2 pneumocytes and surfactantThe host reviews lung cell types and surfactant, then suggests any effect may come from impact on viral replication rather than surfactant.
- 9:42Possible side effectsThe host guesses at side effects such as diarrhea and blood pressure changes, noting he has not read the product insert.
- 10:18Comparison with other COVID therapiesThe host places VIP alongside dexamethasone, remdesivir and convalescent plasma and wonders about use in earlier or milder patients.
- 11:21Prophylaxis and dosing formThe host wonders about prophylaxis for providers and notes a short half-life, which he thinks would favor injection over a pill.
What the video says
This is a short, informal vlog recorded on August 4, 2020. The host, who goes by A Concerned Doctor, reviews a then-new announcement about RLF-100, the aviptadil product from Relief Therapeutics. Aviptadil is a version of vasoactive intestinal peptide (VIP), which the host describes as a neuropeptide the body makes naturally. The host frames it as a possible option for moderate to severe COVID-19, not only mild cases.
Much of the first half is a walk through trial listings. The host says the aviptadil study is a multi-center, placebo-controlled trial using intravenous infusions in patients who have already maxed out standard therapy. It lists mortality and the PaO2 to FiO2 ratio as outcomes, with TNF alpha levels and organ-failure-free days as secondary measures. The host also mentions a case report of a 54 year old double lung transplant recipient who, the host says, came off a ventilator within four days, plus more than 15 other case reports that prompted the larger trials. A second compound, PB1046, is described as a sustained-release human VIP analog from a different sponsor. It is given as a weekly subcutaneous injection in hospitalized patients at risk of deterioration, in the Vanguard trial of over 200 people.
The second half is background. The host reads from general references on VIP's roles, including vasodilation and a possible effect on blood pressure and heart rate, and reviews type 1 and type 2 pneumocytes and surfactant. The host speculates that any benefit would more likely come from affecting viral replication in type 2 pneumocytes than from changing surfactant. Side effects are guessed at, such as diarrhea and blood pressure changes, and the host says the product insert was not checked.
The video ends by placing VIP next to dexamethasone, remdesivir and convalescent plasma, and by wondering aloud about prophylaxis. All of this is early-stage commentary on trials that had not reported results.
On each compound
VIP0:32
The host describes vasoactive intestinal peptide as a naturally produced neuropeptide and covers aviptadil (RLF-100, intravenous) and the analog PB1046 (weekly subcutaneous) in early COVID-19 trials. He speculates it may act on viral replication in lung cells and says its half-life is short.
See how your DNA reads VIPWhat this video doesn’t settle
- The video was recorded when the trials were only recruiting, so it reports no efficacy or safety results for aviptadil or PB1046.
- The lung transplant patient and the other 15 or so cases are anecdotal case reports with no control group.
- The host's ideas about the mechanism, including action on viral replication and effects on blood pressure, are speculation without cited evidence.
Questions this video answers
What is aviptadil (RLF-100)?
The host describes it as a form of vasoactive intestinal peptide, a neuropeptide the body makes, being tested by Relief Therapeutics for COVID-19. In the trial he reviews, it is given by intravenous infusion.
What did the aviptadil COVID-19 trial measure?
According to the host's reading of the listing, the primary outcomes were mortality and the PaO2 to FiO2 ratio. Secondary outcomes were TNF alpha levels and multi-system organ failure free days.
What is PB1046 and the Vanguard trial?
The host describes PB1046 as a sustained-release human VIP analog from a different sponsor. In the Vanguard trial it is given weekly by subcutaneous injection in three doses to hospitalized COVID-19 patients at risk of deterioration.
What side effects of VIP does the video mention?
The host guesses that diarrhea could occur, based on what he recalls about tumors that overproduce VIP, and that blood pressure could change in either direction. He says he has not read the product insert.
How does the host think VIP might work in the lungs?
He suggests it probably does not act directly on surfactant. He thinks it more likely affects the virus's replication inside type 2 pneumocytes, if it works at all.
Video by A Concerned Doctor on YouTube, embedded as published. The summary is written by PeptidesDNA from the video; every claim in it is the speaker’s. Not affiliated with or endorsed by the creator. Not medical advice.
