Is Inhaled Furosemide A Potential Therapeutic For COVID-19?

Abstract

The potentially lethal COVID-19 infection caused by the novel Severe Acute Respiratory Disease Coronavirus-2 (SARS-CoV-2) has evolved into a global crisis. There are two major processes that lead to the morbidity and mortality of this disease: initially the viral infection, followed by a host inflammatory response that frequently results in excessive secretion of inflammatory cytokines (e.g. IL-6, IL-8, IL-10, TNFα), developing into a self-targeting toxic "cytokine storm" in which the lungs fill with inflammatory secretions causing critical pulmonary tissue damage. Even though the search for a vaccine and anti-viral agents has already been initiated, the de novo development of a safe, COVID-19 specific solution may take years; regrettably, the need for a therapeutic that is available immediately is growing daily. Therefore, repurposing an already approved drug offers a promising approach to address this urgent need. A truly effective therapeutic, however, should be available not only for the single individual in a developed country, but also for the many people in developing countries. As presented in this review, inhaled furosemide, a small molecule capable of inhibiting IL-6, IL-8 and TNFα within the lung, may be an agent capable of treating the COVID-19 cytokine storm in both resource-rich and developing countries. Furosemide is a "repurpose-able" small molecule therapeutic, that is safe, easily synthesized, handled and stored, and is available in reasonable quantities worldwide.

A Narrative Review of SARS-CoV-2 Pathogenesis, Transmission, and Clinical Manifestations

“…One study suggests that the immune system may act differently in 2 phases. During the first phase, the immune defense system tries to fight the virus, and it needs to be boosted; however, the immunological response could result in a phenomenon known as cytokine storm syndrome in the second phase that needs to be inhibited as this syndrome may lead to pulmonary damage and even death [67,68]. COVID-19 cases are also susceptible to thrombosis and thromboembolic events with the release of inflammatory cytokines throughout the body [69].…”