What is the role of supplementation with ascorbic acid, zinc, vitamin D, or <i>N</i>-acetylcysteine for prevention or treatment of COVID-19?

Bauer, Seth; Kapoor, Aanchal; Rath, Mary; Thomas, Shirley

doi:10.3949/ccjm.87a.ccc046

Cited by 60 publications

(49 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…NAC is approved by FDA under various formulations and is popular as a health supplement, this molecule having been proposed as a nutraceutical that might aid the control of RNA viruses including influenza and coronavirus. [64][65][66] Almost 60 years of experience in the prophylaxis and therapy of a variety of clinical conditions have established the safety of this drug, even at very high doses and for long-term treatments. Drug repurposing is the fastest strategy toward an effective and accessible treatment against COVID-19 before a vaccine is available, 67 and molecules working via multiple mechanisms of action, such as NAC, are more likely to be effective as compared with drugs having a single target.…”

Section: Discussionmentioning

confidence: 99%

Rationale for the use of N ‐acetylcysteine in both prevention and adjuvant therapy of COVID‐19

Balansky²,

2020

View full text Add to dashboard Cite

COVID‐19 may cause pneumonia, acute respiratory distress syndrome, cardiovascular alterations, and multiple organ failure, which have been ascribed to a cytokine storm, a systemic inflammatory response, and an attack by the immune system. Moreover, an oxidative stress imbalance has been demonstrated to occur in COVID‐19 patients. N‐ Acetyl‐L‐cysteine (NAC) is a precursor of reduced glutathione (GSH). Due to its tolerability, this pleiotropic drug has been proposed not only as a mucolytic agent, but also as a preventive/therapeutic agent in a variety of disorders involving GSH depletion and oxidative stress. At very high doses, NAC is also used as an antidote against paracetamol intoxication. Thiols block the angiotensin‐converting enzyme 2 thereby hampering penetration of SARS‐CoV‐2 into cells. Based on a broad range of antioxidant and anti‐inflammatory mechanisms, which are herein reviewed, the oral administration of NAC is likely to attenuate the risk of developing COVID‐19, as it was previously demonstrated for influenza and influenza‐like illnesses. Moreover, high‐dose intravenous NAC may be expected to play an adjuvant role in the treatment of severe COVID‐19 cases and in the control of its lethal complications, also including pulmonary and cardiovascular adverse events.

show abstract

Section: Discussionmentioning

confidence: 99%

Rationale for the use of N ‐acetylcysteine in both prevention and adjuvant therapy of COVID‐19

Balansky²,

2020

View full text Add to dashboard Cite

show abstract

“…NF-κB is a redox-sensitive transcription factor, which gets activated by oxidative stress (Das 2020 ). Blocking this pathway with antioxidants such as Vitamin A, Vitamin C, Glutathione, Vitamin E, Zinc and many others could have both prophylactic protection and also prevent progression of illness (Nwose and Bwititi 2020 ; Bauer et al 2020 ).…”

Section: Introductionmentioning

confidence: 99%

The Role and Therapeutic Potential of NF-kappa-B Pathway in Severe COVID-19 Patients

et al. 2020

View full text Add to dashboard Cite

Coronavirus disease 2019 (COVID-19) pandemic has affected health care systems worldwide. Severe presentations of COVID-19 such as severe pneumonia and acute respiratory distress syndrome (ARDS) have been associated with the post-viral activation and release of cytokine/chemokines which leads to a “cytokine storm” causing inflammatory response and destruction, mainly affecting the lungs. COVID-19 activation of transcription factor, NF-kappa B (NF-κB) in various cells such as macrophages of lung, liver, kidney, central nervous system, gastrointestinal system and cardiovascular system leads to production of IL-1, IL-2, IL-6, IL-12, TNF-α, LT-α, LT-β, GM-CSF, and various chemokines. The sensitised NF-κB in elderly and in patients with metabolic syndrome makes this set of population susceptible to COVID-19 and their worse complications, including higher mortality. Immunomodulation at the level of NF-κB activation and inhibitors of NF-κB (IκB) degradation along with TNF-α inhibition will potentially result in a reduction in the cytokine storm and alleviate the severity of COVID-19. Inhibition of NF-κB pathway has a potential therapeutic role in alleviating the severe form of COVID-19.

show abstract

“…It is noticed that serum and leukocyte levels of vitamin C is depleted during the acute stage of the infection [ 3 , 4 ]. Previous clinical trials found that supplementation with high dose of vitamin C decreased the severity and duration of respiratory viral infections [ 5 ]. Based on these findings, vitamin C might be used in management of COVID-19 as it might improve the immunological response against the novel coronavirus (SARS-CoV-2).…”

Section: Introductionmentioning

confidence: 99%

“…The pathological damage induced by SARS-CoV-2 infection is partially due to the direct viral virulence effect, but the main part is caused by massive host immune response and oxidative stress secondary to release of free radicals [ 5 ]. SARS-CoV-2 infection induces excessive release of proinflammatory cytokines, leading to cytokines storm, and increases production of reactive oxygen species which both cause significant lung damage which leads to subsequent development of adult respiratory distress syndrome (ARDS) [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Overview of the possible role of vitamin C in management of COVID-19

2020

View full text Add to dashboard Cite

The mainstay of management of coronavirus disease 2019 (COVID-19) is mainly supportive as to date there is no effective antiviral treatment, apart from remdesivir which has been approved by Food and Drug administration (FDA) for treatment of COVID-19, or vaccine. Supplementation with micronutrients, such as vitamins and minerals, has gained an increasing interest as part of the supportive management of COVID-19. Vitamin C levels in serum and leukocytes are depleted during the acute stage of infection owing to increased metabolic demands. High-dose vitamin C supplement helps to normalise both serum and leukocytes vitamin C levels. Vitamin C has multiple pharmacological characteristics, antiviral, anti-oxidant, anti-inflammatory and immunomodulatory effects, which make it a potential therapeutic option in management of COVID-19. The use of high dose of intravenous vitamin C for management of COVID-19 in China and the United Stated has shown promising results. There were no reported adverse reactions with the short-term use of high dose of vitamin C. Given the fact that vitamin C is cheap, available and safe drug with beneficial effects in management of viral infections and critically ill patients reported in previous clinical trials, it is sensible to add it to COVID-19 management protocol particularly if the current ongoing clinical trials testing the effect of vitamin C in management of COVID-19 show positive results.

show abstract

What is the role of supplementation with ascorbic acid, zinc, vitamin D, or N-acetylcysteine for prevention or treatment of COVID-19?

Cited by 60 publications

References 10 publications

Rationale for the use of N ‐acetylcysteine in both prevention and adjuvant therapy of COVID‐19

Rationale for the use of N ‐acetylcysteine in both prevention and adjuvant therapy of COVID‐19

The Role and Therapeutic Potential of NF-kappa-B Pathway in Severe COVID-19 Patients

Overview of the possible role of vitamin C in management of COVID-19

Contact Info

Product

Resources

About