Therapeutic blockade of inflammation in severe COVID-19 infection with intravenous N-acetylcysteine.
Clin Immunol
; 219: 108544, 2020 10.
Article
in English
| MEDLINE | ID: covidwho-664013
ABSTRACT
Glucose 6-phosphate dehydrogenase (G6PD) deficiency facilitates human coronavirus infection due to glutathione depletion. G6PD deficiency may especially predispose to hemolysis upon coronavirus disease-2019 (COVID-19) infection when employing pro-oxidant therapy. However, glutathione depletion is reversible by N-acetylcysteine (NAC) administration. We describe a severe case of COVID-19 infection in a G6PD-deficient patient treated with hydroxychloroquine who benefited from intravenous (IV) NAC beyond reversal of hemolysis. NAC blocked hemolysis and elevation of liver enzymes, C-reactive protein (CRP), and ferritin and allowed removal from respirator and veno-venous extracorporeal membrane oxygenator and full recovery of the G6PD-deficient patient. NAC was also administered to 9 additional respirator-dependent COVID-19-infected patients without G6PD deficiency. NAC elicited clinical improvement and markedly reduced CRP in all patients and ferritin in 9/10 patients. NAC mechanism of action may involve the blockade of viral infection and the ensuing cytokine storm that warrant follow-up confirmatory studies in the setting of controlled clinical trials.
Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Pneumonia, Viral
/
Acetylcysteine
/
Coronavirus Infections
/
Betacoronavirus
/
Cytokine Release Syndrome
/
Glucosephosphate Dehydrogenase Deficiency
/
Antioxidants
Type of study:
Case report
/
Cohort study
/
Experimental Studies
/
Observational study
/
Prognostic study
Topics:
Long Covid
Limits:
Adult
/
Humans
/
Male
Language:
English
Journal:
Clin Immunol
Journal subject:
Allergy and Immunology
Year:
2020
Document Type:
Article
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