Mucolytic and Antioxidant Properties of Carbocysteine as a Strategy in COVID-19 Therapy

Abstract

SARS-CoV-2 infection leads to a heterogenous spectrum of clinical conditions ranging from self-limiting upper airway infection to severe respiratory failure. Carbocysteine is a thioether mucolytic with antioxidant and anti-inflammatory activities. Carbocysteine has been shown to have anti-viral effects on human rhinovirus, RSV and the influenza virus as well as interfering with upper airway ciliary motility, the first site of SARS-CoV-2 infection, leading to more effective mucus clearance and potential containment of viral spread towards the lower airway. Positive effects, in terms of limiting superimposed bacterial infection and reducing oxidative stress, have also been documented in COPD patients. Accordingly, Carbocysteine should also be considered in both post-exposure prophylaxis and early-phase treatment of COVID-19 in combination with other agents (monoclonal antibodies, antivirals, non-steroidal anti-inflammatory agents, and inhaled corticosteroids). In this review, we explored the pharmacokinetic and pharmacodynamic aspects of Carbocysteine to delineate its potential therapeutic impact in patients with COVID-19.

Carbocysteine as Adjuvant Therapy in Acute Respiratory Tract Infections in Patients without Underlying Chronic Conditions: Systematic Review and Meta-Analysis

“…When respiratory viruses infect the upper airway, they often disrupt normal ciliary function, hindering this natural defense mechanism. Carbocysteine, as a mucolytic agent, helps in restoring ciliary efficiency by modifying the rheological properties of mucus, making it less viscous and easier to clear [10]. This enhancement of ciliary function leads to more effective mucus clearance, crucial for eliminating trapped viruses and other pathogens from the respiratory tract.…”

“…This enhancement of ciliary function leads to more effective mucus clearance, crucial for eliminating trapped viruses and other pathogens from the respiratory tract. Consequently, carbocysteine's effect on mucus clearance may help limit the viral spread to the lower airways [10].…”

“…Carbocysteine's significance has risen notably during the SARS-CoV-2 pandemic, largely due to the infection's tendency to provoke excessive mucus production, thicken mucus, and trigger substantial inflammation. Its mechanism of action, which disrupts the ciliary movement in the upper airways-the initial site of SARS-CoV-2 infection-enhances mucus clearance and may prevent the virus from progressing to the lower respiratory tract [10]. Additionally, carbocysteine's capacity to reduce the risk of secondary bacterial infections and alleviate oxidative stress is particularly beneficial in managing patients with chronic obstructive pulmonary disease (COPD).…”

Role of airway epithelium in viral respiratory infections: Can carbocysteine prevent or mitigate them?

“…Moreover, by increasing anti‐oxidant defences, carbocysteine may play a role in the treatment of Long COVID. Although these pieces of evidence and a recent review support a positive role for carbocysteine in COVID‐19 management, no specific study has proven its efficacy [77].…”

Strategies Tackling Viral Replication and Inflammatory Pathways as Early Pharmacological Treatment for SARS-CoV-2 Infection: Any Potential Role for Ketoprofen Lysine Salt?

“…These cytokines represent the first line of host defense and subsequently induce adaptive immune responses [12]. The upregulation of the NF-κB signaling pathway leads to cytokine storm and hyperinflammation, with a greater risk of severe COVID-19 disease [13,14]. Regarding adaptive immune response, T lymphocytes attempt to eliminate virus by killing infected cells and secrete cytokines to amplify T lymphocytes immune response [15].…”