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Therapeutic blockade of inflammation in severe COVID-19 infection with intravenous N-acetylcysteine.
Ibrahim, Homam; Perl, Andras; Smith, Deane; Lewis, Tyler; Kon, Zachary; Goldenberg, Ronald; Yarta, Kinan; Staniloae, Cezar; Williams, Mathew.
  • Ibrahim H; New York University Grossman School of Medicine, NY, New York, United States of America. Electronic address: Homam.ibrahim@NYUlangone.org.
  • Perl A; Upstate Medical University Hospital, Syracuse, New York, United States of America. Electronic address: perla@upstate.edu.
  • Smith D; New York University Grossman School of Medicine, NY, New York, United States of America.
  • Lewis T; New York University Grossman School of Medicine, NY, New York, United States of America.
  • Kon Z; New York University Grossman School of Medicine, NY, New York, United States of America.
  • Goldenberg R; New York University Grossman School of Medicine, NY, New York, United States of America.
  • Yarta K; New York University Grossman School of Medicine, NY, New York, United States of America.
  • Staniloae C; New York University Grossman School of Medicine, NY, New York, United States of America.
  • Williams M; New York University Grossman School of Medicine, NY, New York, United States of America.
Clin Immunol ; 219: 108544, 2020 10.
Artículo en Inglés | 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.
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Texto completo: Disponible Colección: Bases de datos internacionales Base de datos: MEDLINE Asunto principal: Neumonía Viral / Acetilcisteína / Infecciones por Coronavirus / Betacoronavirus / Síndrome de Liberación de Citoquinas / Deficiencia de Glucosafosfato Deshidrogenasa / Antioxidantes Tipo de estudio: Reporte de caso / Estudio de cohorte / Estudio experimental / Estudio observacional / Estudio pronóstico Tópicos: Covid persistente Límite: Adulto / Humanos / Masculino Idioma: Inglés Revista: Clin Immunol Asunto de la revista: Alergia e Inmunología Año: 2020 Tipo del documento: Artículo

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Texto completo: Disponible Colección: Bases de datos internacionales Base de datos: MEDLINE Asunto principal: Neumonía Viral / Acetilcisteína / Infecciones por Coronavirus / Betacoronavirus / Síndrome de Liberación de Citoquinas / Deficiencia de Glucosafosfato Deshidrogenasa / Antioxidantes Tipo de estudio: Reporte de caso / Estudio de cohorte / Estudio experimental / Estudio observacional / Estudio pronóstico Tópicos: Covid persistente Límite: Adulto / Humanos / Masculino Idioma: Inglés Revista: Clin Immunol Asunto de la revista: Alergia e Inmunología Año: 2020 Tipo del documento: Artículo