My two cents.
There is no evidence that subcutaneous drugs are less effective in comatose patients, eg, insulin, etc. Good theory though!
I think the simple reason for the lack of effectiveness of the PhaseBio version of VIP for lung disease is because its linkage with ELP fusion protein makes it selectively active at VPAC2, whereas VIP by itself is active at both VPAC1 and VPAC2 receptors. The linkage with ELP fusion protein changes its activity, even though it also VIP.
From Wikipedia:
VPAC1 is expressed in the brain (cerebral cortex, hippocampus, amygdala), lung, prostate, peripheral blood leukocytes, liver, small intestine, heart, spleen, placenta, kidney, thymus and testis.
VAPC2 is expressed in the uterus, prostate, smooth muscle of the gastrointestinal tract, seminal vesicles and skin, blood vessels and thymus. VVAPC2 is also expressed in the cerebellum
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