1. Pentoxifylline and Oxypurinol: Potential Drugs to Prevent the 'Cytokine Release (Storm) Syndrome' Caused by SARS-CoV-2?
- Author
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Gerardo López-Rodas, Francisco José López-Iranzo, Ana María López-Rodas, and Luis Franco
- Subjects
Pharmacology ,0303 health sciences ,business.industry ,Inflammation ,medicine.disease ,Systemic inflammation ,Pentoxifylline ,Proinflammatory cytokine ,03 medical and health sciences ,chemistry.chemical_compound ,Cytokine release syndrome ,0302 clinical medicine ,chemistry ,030220 oncology & carcinogenesis ,Drug Discovery ,Immunology ,Medicine ,Acute pancreatitis ,Pancreatitis ,medicine.symptom ,Xanthine oxidase ,business ,030304 developmental biology ,medicine.drug - Abstract
Background: COVID-19, caused by SARS-CoV-2, is a potentially lethal, rapidly-expanding pandemic and many efforts are being carried out worldwide to understand and control the disease. COVID-19 patients may display a cytokine release syndrome, which causes severe lung inflammation, leading, in many instances, to death. Objective: This paper is intended to explore the possibilities of controlling the COVID-19-associated hyperinflammation by using licensed drugs with anti-inflammatory effects. Hypothesis: We have previously described that pentoxifylline alone, or in combination with oxypurinol, reduces the systemic inflammation caused by experimentally-induced pancreatitis in rats. Pentoxifylline is an inhibitor of TNF-α production and oxypurinol inhibits xanthine oxidase. TNF-α, in turn, activates other inflammatory genes such as Nos2, Icam or IL-6, which regulate migration and infiltration of neutrophils into the pulmonary interstitial tissue, causing injury to the lung parenchyma. In acute pancreatitis, the anti-inflammatory action of pentoxifylline seems to be mediated by the prevention of the rapid and presumably transient loss of PP2A activity. This may also occur in the hyperinflammatory -cytokine releasing phase- of SARS-CoV-2 infection. Therefore, it may be hypothesized that early treatment of COVID-19 patients with pentoxifylline, alone or in combination with oxypurinol, would prevent the potentially lethal acute respiratory distress syndrome. Conclusion: Pentoxifylline and oxypurinol are licensed drugs used for diseases other than COVID-19 and, therefore, phase I clinical trials would not be necessary for the administration to SARS-CoV-2- infected people. It would be worth investigating their potential effects against the hyperinflammatory response to SARS-CoV-2 infection.
- Published
- 2020
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