More than Expectorant: New Scientific Data on Ambroxol in the Context of the Treatment of Bronchopulmonary Diseases

Plomer, Manuel; Zeeuw, Justus de

doi:10.21767/2471-8505.100096

Cited by 4 publications

(5 citation statements)

References 10 publications

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“…Ambroxol as an adjuvant to pulmonary surfactant intervention is an important proposition here. As described by Plomer and de Zeeuw (2017) , ambroxol is more than just an expectorant and is a potent inducer of surfactant synthesis from alveolar Type 2 cells ( Plomer and de Zeeuw, 2017 ; Depfenhart et al, 2020 ). In addition to this, ambroxol may also assist in the secretion of surfactant lipids by the Type 2 cells ( Post et al, 1983 ).…”

Section: The Hypothesis and The Discussionmentioning

confidence: 99%

Co-aerosolized Pulmonary Surfactant and Ambroxol for COVID-19 ARDS Intervention: What Are We Waiting for?

Kumar

2020

Front. Bioeng. Biotechnol.

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After more than 225 days of the first reports of the novel coronavirus from China, COVID-19 pandemic is still on surge. The search for an effective and efficient therapeutic and pharmaceutical intervention is as important and urgent now as it was on Day 1. Majority of the efforts in this direction are toward finding small molecule interventions via repurposing or redirecting the therapeutic approaches. This hypothesis proposes a physical intervention approach directed toward rescuing the complex lung pathology observed in COVID-19 related acute respiratory distress syndrome (CARDS). The loss of content as well as the synthesis and turnover of the surfactant in ARDS has been termed as a "collateral damage." A synergistic, early stage, cost-effective, pharmaceutically viable, safe, and immediately available solution is hence required. The effectiveness of exogenous surfactant treatment in ARDS has been marred with several limitations as pointed out in various clinical trials and require revised protocols related to surfactant dose and mode of delivery. This hypothesis proposes aerosolized surfactant delivery taking the optimal dosing and coating costs into account along with co-delivery of ambroxol to provide synergistic benefits. Ambroxol is reported to have anti-inflammatory,-oxidant,-viral, and-bacterial activities and has a direct impact on the production and secretion of the surfactant from the alveolar Type 2 cells. If aerosolized, atomized, or nebulized in the form of ambroxol-loaded phospholipid nanovesicles at the early stages of ARDS, depleted surfactant levels may be reinstated and surfactant turnover can be initiated and maintained. The ability to deliver both the components in aerosolized-nebulized form may have a huge impact on alleviating the healthcare burden in low resource settings where the availability of ventilators is limited. In conclusion, the surfactant-ambroxol co-aerosolized intervention approach hypothesized here has implications reaching to clinical and pharmaceutical translation worldwide.

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Section: The Hypothesis and The Discussionmentioning

confidence: 99%

Co-aerosolized Pulmonary Surfactant and Ambroxol for COVID-19 ARDS Intervention: What Are We Waiting for?

Kumar

2020

Front. Bioeng. Biotechnol.

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“…The available data suggests further that ambroxol, a metabolite of bromhexine, is a potent inducer of surfactant synthesis in AT2 cells [33][34][35]. Its lung protective properties have been discussed in infants and severely ill adult patients as well as the potential as an adjuvant in anti-infective therapy [34]. Thus, bromhexine also provides indirect protective effects.…”

Section: Proposed Treatment Strategy Against Covid-19mentioning

confidence: 99%

“…Typically bromide compounds, especially aromatic bromide compounds, show a relatively high binding affinity for serine-containing peptide sequences, proteins and enzymes [30,32] Lucas et al [30] show that this effect is due to a selective inhibition of TMPRSS2 by bromhexine. The available data suggests further that ambroxol, a metabolite of bromhexine, is a potent inducer of surfactant synthesis in AT2 cells [33][34][35]. Its lung protective properties have been discussed in infants and severely ill adult patients as well as the potential as an adjuvant in anti-infective therapy [34].…”

Section: Proposed Treatment Strategy Against Covid-19mentioning

confidence: 99%

A SARS-CoV-2 Prophylactic and Treatment; A Counter Argument Against The Sole Use of Chloroquine

Depfenhart¹

2020

AJBSR

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“…Among several efforts that were directed toward finding an effective treatment for COVID-19, Pradeep Kumar proposed a hypothesis about using surfactant-ambroxol co-aerosolized as a physical therapeutic intervention approach for COVID-19 related ARDS [113]. This hypothesis is based on the function of ambroxol (2-amino-3,5-dibromo-N-[trans-4hydroxycyclohexyl]benzylamine) as a potent stimulant of surfactant production and its assistance of surfactant lipid secretion by alveolar type 2 cells as well as its activities as an anti-inflammatory and antioxidant agent [114][115][116][117]. Moreover, ambroxol alone has been used as an effective and well tolerated treatment for both acute and chronic respiratory diseases in both adults and children [118].…”

Section: Treatment Of Covid-19 With Reducing Surface Tensionmentioning

confidence: 99%

The Role of Pulmonary Surfactant in COVID-19 Understanding

Ettarhouni

Mezoughi

2021

IRJPAC

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Background: In Covid-19 the virus infects the respiratory tract in human. When lung tissue becomes diseased, the walls and lining of the alveoli and capillaries are damaged. At this point lung compliance and ventilation decrease. Pulmonary surfactant that is produced and dispersed into alveolar space, has a significant role in understanding how heavily covid-19 interferes and infects lung cells. The importance of pulmonary surfactant in alveoli is to lower surface tension at air/liquid interface in the lung. This is achieved by reducing the work of breathing and preventing alveolar collapse. The main constituent of pulmonary surfactant is dipalmitoylphosphatidylcholine (DPPC) (C40H80NO8P). It is a phospholipid containing two non polar palmitic acid C16 chains as hydrophobic tails linked to a polar head group of a phosphatidylcholine (also known as lecithin). Rationale of the Review and Objective Method: When DPPC molecules are in contact with a polar solvent, micelles which grow further into bilayers are formed considering their cylindrical structures. This trait makes the whole structure of pulmonary surfactant as amphipathic and surface active molecules. The head group of phosphatidylcholine in the pulmonary surfactant is attracted by polar liquid molecules causing a reduction of the liquid surface tension. Conclusion: This review complements the quoted information analysing them theoretically and integrates recent advances in pulmonary surfactant research with the global pandemic.

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More than Expectorant: New Scientific Data on Ambroxol in the Context of the Treatment of Bronchopulmonary Diseases

Abstract: Background:Ambroxol has been established for decades in the treatment of acute and chronic respiratory diseases. A reassessment of the benefit-risk was conducted recently.

Cited by 4 publications

References 10 publications

Co-aerosolized Pulmonary Surfactant and Ambroxol for COVID-19 ARDS Intervention: What Are We Waiting for?

Co-aerosolized Pulmonary Surfactant and Ambroxol for COVID-19 ARDS Intervention: What Are We Waiting for?

A SARS-CoV-2 Prophylactic and Treatment; A Counter Argument Against The Sole Use of Chloroquine

The Role of Pulmonary Surfactant in COVID-19 Understanding

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