Failure of trpc6 inhibition to prevent COVID-19 deterioration: More questions than answers

The COVID-19 pandemic, estimated to have caused at least 6.8 million deaths worldwide, highlighted the dearth of effective pharmacotherapy for acute respiratory distress syndrome (ARDS). The pandemic also served as a tremendous catalyst for ARDS clinical trials. Faced with an overwhelming number of critically hypoxaemic patients and limited intensive care resources, biopharmaceutical communities rapidly accelerated testing of candidate drugs and the world witnessed an explosion of clinical trials for a syndrome previously with ‘orphan’ status. Whereas some trials concentrated on pathogen-specific aspects of the virus, others focused on ARDS pathogenesis. Flooded alveoli are a hallmark of ARDS and there has long been interest in agents that might decrease alveolocapillary permeability. In this issue of Thorax, Ware et al share the results of their randomised control trial investigating a novel antipermeability treatment option for COVID-19. Although the trial failed to meet its primary endpoints, important lessons emerge.

Elizabeth Levy, Nuala J Meyer