Scientists from the Sarov Physical-Technical Institute (SarPTI) — a branch of MEPhI— and the Russian Federal Nuclear Center — All-Russian Scientific Research Institute of Experimental Physics have developed a unique apparatus for producing nitric oxide, which is now successfully tested for the treatment of patients with COVID-19 coronavirus. The head of the team, corresponding member of the Russian Academy of Sciences Viktor Selemir told us about the apparatus.

— Viktor Dmitrievich, who was involved in the development of the Tianox apparatus?

— This apparatus was created by RFNC-VNIIEF employees. They are part-time teachers of the Sarov Physics and Technology Institute, MEPhI. Among the authors is one of the leading Russian experts in gas discharge physics, professor, head of the SarFTI department Vladimir Karelin, VNIIEF chief specialist Sergey Buranov and VNIIEF leading researcher Alexander Shirshin. 

— What preceded the creation of the device?

— Anatoly Vanin, the head of the laboratory of the Institute of Chemical Physics of the Russian Academy of Sciences named after N.N. Semenov, discovered the effect of nitrogen monoxide NO on the human body in 1965 and studied the role of this molecule in the regulation of processes occurring in it. In 1992, the molecule of nitrogen monoxide has named the molecule of the year in the journal Science. In the late 90s, a group of three American biophysicists received the Nobel Prize for their discovery of nitrogen monoxide. 

At the same time, physicians in the United States and Russia began to use nitrogen monoxide in clinical practice as an effective tool to combat thrombosis and to reduce pressure in the pulmonary circulation.

Nitrogen monoxide was produced by decomposing ammonia, filled with cylinders, and transported to nearby medical institutions. Unfortunately, transporting this substance over long distances is not possible. It oxidizes to NO2, which in the human body can react with water and form nitric acid, which is not good for health.

We can say that in Russia was  “metropolitan medicine”: the plant that produces nitrogen monoxide is located in the Moscow Region, and it served the needs of only Moscow patients.

So, the inevitable task was to learn how to quickly make and deliver fresh gas to the patients.

— Why are physicists from the nuclear center connected to the solution of this problem?

— One of the pioneers in the use of nitrogen monoxide in Russia is the world-famous pulmonologist, academician of the Russian Academy of Sciences Alexander Grigorievich Chuchalin. Under his leadership, the first lung transplant operation was performed in our country. He called on scientists and engineers to create an apparatus that would generate nitrogen monoxide directly at the patient’s bed.

Alexander’s letters came to us. Having passed the stage of denying that such a device cannot be made and this is a task for chemists, finally, we set to work. We put electrophysical methods into the basis of the apparatus for producing nitrogen monoxide.

We studied the book of the classics of the Soviet atomic project Jacob Zeldovich and David Frank-Kamenetsky "Nitrogen burning in an oxygen atmosphere." There were considered chain reactions that occur during combustion. An equilibrium plasma is obtained where nitrogen monoxide with impurities are generated. Impurities are nitrogen dioxide NO2 and ozone, which are not suitable for breathing. Our task was to get rid of impurities.

Finally, our staff realized that it was possible to use a non-equilibrium plasma. They calculated kinetics, found ways to generate plasma with very high electron temperatures and almost cold ions. As a result, we were able to obtain pure nitrogen monoxide, which can be used for medical purposes.

— The apparatus was made after that, wasn’t it?

— Yes, its final appearance was determined in 2017. After that, there was a lot of work on preclinical and clinical trials. At the moment, we have all the documentation; an experimental batch of devices has been released. The necessary technical tests were carried out. They showed the safety of this device and the possibility of using it in medical institutions.

Roszdravnadzor and the Ministry of Health of Russia allowed conducting clinical trials with human participation. Such trials with adult patients and infants were completed under the guidance of Dr. Andrei Bautin at the Almazov Research Medical Center in St. Petersburg.

Soon, we hope to receive a registration certificate from Roszdravnadzor, which will allow us to manufacture and sell our device, and allow physicians to buy and use it in medical practice.

— What diseases will be treated using the Tianox apparatus?

— The main use of the device is to help cardiac patients. Pressure in the pulmonary circulation often rises because of cardiovascular problems. The only acceptable way to reduce this pressure is through nitric oxide inhalation. If the patient's pressure drops to certain values, it can already be operated on.

In general, patients with cardiovascular diseases, the pressure of which exceeds the level necessary for surgery, is 25% in the world. Previously, such people outside the capital’s clinics equipped with nitric oxide tanks did not have surgery. So, cardiologists from Vladivostok to Kaliningrad will be able to use our device. We have made the section of high-tech medicine more accessible for patients in any region of Russia.

— How did the Tianox apparatus prove it in treating patients with coronavirus infection?

— Doctors put forward various hypotheses about what is happening in the body of a patient with coronavirus. In particular, patients with pneumonia, which develops under the influence of coronavirus, have thrombosis of small vessels in the lungs. Nitrogen monoxide allows them to uncork, and it helps patients. We hope that the device will find its application in the treatment of coronavirus infection.

Research on this topic is being conducted at N.V. Sklifosovsky Scientific Research Institute of First Aid, in the Volga district medical center FMBA, in the center named after Almazov. Time will show how effective this treatment method is.

— Who will manufacture the apparatus?

— Our team received an order from Rosatom — 50 devices by the end of June this year. It is not so much, but it will help to establish mass production.

— One device provides only one patient per unit of time, doesn't it?

— The treatment protocols have not been approved yet, but there are options: in the early stages of the disease it is enough for the patient to breathe nitric oxide for a short time. In this case, one device will provide a lot of patients. But severe patients have to be connected both to this device and artificial pulmonary ventilation. The apparatus is used in this way in cardiovascular clinics. Of course, we would like to help as many people as possible.

Source: RIA Novosti

Photo: press-service of the RFNC-VNIIEF