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EVA Technology
In critically ill patients with respiratory failure, mechanical ventilation and extracorporeal membrane oxygenation are used as standard treatments to provide vital oxygenation. However, in general, their use requires advanced medical resources and highly invasive procedures, potentially making the some of the patients contraindicated. Thus, developing another supportive oxygenation approach is urgently needed to help countless patients under respiratory distressed conditions, now much more become evident due to recent coronavirus pandemic.
Some aquatic organisms acquire accessory modes of respiration that do not involve the gills or skins. Loaches and catfish, for instance, use their gut to maintain systemic oxygenation under hypoxic conditions. In particular, the loach develops a lung-ventilation-independent intestinal breathing system that works in hindgut area when extremely become hypoxic. While exciting progress has been made in the biology of aquatic organisms, virtually no scientific attempts have been made to translate such mechanisms of intestinal respiration in mammals. Thus, we explored intestinal respiration in mammals and examined the feasibility of supplying oxygen to the blood via the gut.
Though complete mechanisms remain unclear, some key enabling conditions for intestinal respiration involve: 1. abundant capillaries ; 2. thin epithelium; and 3. anatomical proximity to areas of air uptake. Meanwhile, when we analyzed the distal rectum corresponding to the hindgut, there are considerable similarities in the distal end of the rectum, leading us to pursue the oxygen delivery approach via intra-rectal route in mice. Excitingly, our team developed two methods, termed EVA technology, to deliver oxygen to the bloodstream via rectal access to the intestines. One was a gas ventilation system, the other involved highly oxygenated liquid perfluorochemicals. Both EVA approaches showed promise in tests involving rodent and porcine models.
The gas ventilation system helped 75% of mice survive 50 minutes of normally lethal low-oxygen conditions, while no mice survived more than 11 minutes without assistance. The intestinal liquid ventilation system–considered to be the most likely approach for potential use in humans–showed that rodents could walk farther in sub-lethal 10% oxygen conditions, and that more oxygen reached their hearts compared to those not receiving the liquid. The intestinal liquid ventilation also worked effectively in pig models accompanied by a reversed skin pallor and coldness without producing obvious side effects. The improvement of arterial blood oxygenation demonstrated in our study using mice and pigs would be effective in the treatment of patients with severe respiratory failure when applied to humans.