The role of NO in COVID-19 and potential therapeutic strategies

Wanyi Fang, Jingrui Jiang, Lei Su, Tong Shu, Huan Liu, Shenghan Lai, Reza A Ghiladi, Jun Wang, Wanyi Fang, Jingrui Jiang, Lei Su, Tong Shu, Huan Liu, Shenghan Lai, Reza A Ghiladi, Jun Wang

Abstract

Nitric oxide (NO) is a free radical playing an important pathophysiological role in cardiovascular and immune systems. Recent studies reported that NO levels were significantly lower in patients with COVID-19, which was suggested to be closely related to vascular dysfunction and immune inflammation among them. In this review, we examine the potential role of NO during SARS-CoV-2 infection from the perspective of the unique physical, chemical and biological properties and potential mechanisms of NO in COVID-19, as well as possible therapeutic strategies using inhaled NO. We also discuss the limits of NO treatment, and the future application of this approach in prevention and therapy of COVID-19.

Keywords: Anti-inflammation; Anti-viral; COVID-19; Nitric oxide; Vasodilation.

Copyright © 2020 Elsevier Inc. All rights reserved.

Figures

Graphical abstract
Graphical abstract
Fig. 1
Fig. 1
Regulation of NO level and bioavailability via four potential pathways in COVID-19 etiology.
Fig. 2
Fig. 2
General biochemical features of NO.
Fig. 3
Fig. 3
Six pathways of NO to function in the lungs. (I) NO plays the role of a vasodilator, including selective pulmonary vasodilator effects, bronchodilator effects, increased blood flow to the alveoli and anti-thrombotic effects. (II) NO plays the role of an immune regulator, including anti-inflammatory effects and microbiocidal effects (reference 33, reprinted with permission of the American Thoracic Society. Copyright © 2020 American Thoracic Society. Cite: Roger A. Alvarez, Lorenzo Berra, and Mark T. Gladwin. 2020, Home Nitric Oxide Therapy for COVID-19, Am J Respir Crit Care Med, 202, 16–20. The American Journal of Respiratory and Critical Care Medicine is an official journal of the American Thoracic Society).

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