COVID-19: Melatonin as a potential adjuvant treatment

Rui Zhang, Xuebin Wang, Leng Ni, Xiao Di, Baitao Ma, Shuai Niu, Changwei Liu, Russel J Reiter, Rui Zhang, Xuebin Wang, Leng Ni, Xiao Di, Baitao Ma, Shuai Niu, Changwei Liu, Russel J Reiter

Abstract

This article summarizes the likely benefits of melatonin in the attenuation of COVID-19 based on its putative pathogenesis. The recent outbreak of COVID-19 has become a pandemic with tens of thousands of infected patients. Based on clinical features, pathology, the pathogenesis of acute respiratory disorder induced by either highly homogenous coronaviruses or other pathogens, the evidence suggests that excessive inflammation, oxidation, and an exaggerated immune response very likely contribute to COVID-19 pathology. This leads to a cytokine storm and subsequent progression to acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) and often death. Melatonin, a well-known anti-inflammatory and anti-oxidative molecule, is protective against ALI/ARDS caused by viral and other pathogens. Melatonin is effective in critical care patients by reducing vessel permeability, anxiety, sedation use, and improving sleeping quality, which might also be beneficial for better clinical outcomes for COVID-19 patients. Notably, melatonin has a high safety profile. There is significant data showing that melatonin limits virus-related diseases and would also likely be beneficial in COVID-19 patients. Additional experiments and clinical studies are required to confirm this speculation.

Keywords: COVID-19; Cytokines; Immunomodulation; Melatonin; Oxidation-reduction; SARS-CoV-2.

Conflict of interest statement

Declaration of competing interest The authors declare that there are no conflicts of interest.

Copyright © 2020. Published by Elsevier Inc.

Figures

Graphical abstract
Graphical abstract
Fig. 1
Fig. 1
Pathogenesis of COVID-19 and potential adjuvant use of melatonin. We postulated that lungs infected by SARS-CoV-2, and a suppressed immune response, elevated inflammation and excessive oxidation stress proceed unabated, this results in the activation of the cytokine storm. ALI/ARDS may ensue, accompanied by a series of complications, the outcomes of which vary according to the severity of the disease. Melatonin may play a role of adjuvant medication in the regulation of immune system, inflammation and oxidation stress, and provide support for patients with ALI/ARDS and related complications. ALI: Acute lung injury; ARDS: Acute respiratory distress syndrome.

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