4.6 Editorial Material

NSAIDs and Kelleni's protocol as potential early COVID-19 treatment game changer: could it be the final countdown?

期刊

INFLAMMOPHARMACOLOGY
卷 30, 期 1, 页码 343-348

出版社

SPRINGER BASEL AG
DOI: 10.1007/s10787-021-00896-7

关键词

COVID-19; SARS-CoV-2; NSAIDs; Nitazoxanide; Azithromycin; Kelleni's protocol; Aspirin; Caspases; Apoptosis; Endoplasmic reticulum stress

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The manuscript discusses the immunomodulatory and anti-inflammatory benefits of repurposing generic non-steroidal anti-inflammatory drugs in managing COVID-19 patients. It also highlights the potential role of aspirin and other NSAIDs in preventing SARS-CoV-2 replication and reducing COVID-19-associated complications. Additionally, the paper explores the molecular mechanisms by which NSAIDs may interfere with certain pathological signaling pathways in COVID-19.
We have previously published several papers illustrating numerous immunomodulatory and anti-inflammatory potential benefits when we repurposed safe, generic non-steroidal anti-inflammatory drugs (NSAIDs)/nitazoxanide/azithromycin (Kelleni's protocol), to early manage our COVID-19 pediatric, adult, and pregnant patients. In this manuscript, we discuss some recently published meta-analysis and clinical studies supporting our practice and discuss a molecular study that might be interpreted as an academic proof that our protocol might also prevent SARS-CoV-2 replication. Moreover, after aspirin has been suggested to be independently associated with reduced risk of mechanical ventilation, ICU admission and in-hospital mortality of COVID-19, we claim that the molecular interpretation of the results that led to this suggestion was not scientifically accurate, and we provide our academic interpretation confirming that low-dose aspirin is least likely to improve COVID-19 mortality through anticoagulation as was suggested. Furthermore, we describe other potential benefits related to aspirin-triggered lipoxins and resolvins while illustrating how NSAIDs interfere with COX-1, COX-2, SARS-CoV-2/SARS-CoV-2 ORF protein-dependent activation of caspases and their subsequent mitochondrial dysfunction, endoplasmic reticulum stress, apoptosis and necroptosis which were associated with COVID-19 complications. Similarly, NSAIDs are known caspase inhibitors and thus they might independently inhibit other caspase-related COVID-19-associated downstream pathological signaling mechanisms. Finally, we postulated that CARD-14, a caspase recruitment domain-containing protein, polymorphisms might play a role in the development of severe and critical COVID-19 and confirmed our old call to early adopt NSAIDs, as an integral part of Kelleni's protocol, as of choice in its management aiming to end this pandemic.

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