COVID-19-The Potential Beneficial Therapeutic Effects of Spironolactone during SARS-CoV-2 Infection.
COVID-19-The Potential Beneficial Therapeutic Effects of Spironolactone during SARS-CoV-2 Infection.
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DOI：
10.3390/ph14010071
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发表时间：
2021-01-17
期刊：
影响因子：
--
通讯作者：
Parczewski M
中科院分区：
文献类型：
--
作者：
Kotfis K;Lechowicz K;Drożdżal S;Niedźwiedzka-Rystwej P;Wojdacz TK;Grywalska E;Biernawska J;Wiśniewska M;Parczewski M
2020年3月，由SARS-CoV-2引起的2019冠状病毒病（COVID-19）被世界卫生组织宣布为全球大流行。该病的临床病程不可预测，但可能导致严重急性呼吸道感染（SARI）和肺炎，导致急性呼吸窘迫综合征（ARDS）。研究表明，肺纤维化可能是COVID-19的主要长期并发症之一。在动物模型中，使用螺内酯被证明是预防肺纤维化的重要药物。通过作为矿物皮质激素受体（MR）拮抗剂和雄激素抑制剂的双重作用，螺内酯可以对COVID-19感染提供显着益处。螺内酯在减少肺水肿方面的主要作用也可能对COVID-19 ARDS有益。螺内酯是一种众所周知、广泛使用且安全的抗高血压和抗雄激素药物。它通过拮抗矿皮质激素受体（MRs）具有保钾利尿作用。螺内酯和canrenate钾发挥联合多效作用，可能通过抗雄激素、MR阻断、抗纤维化和抗高炎症作用为COVID-19肺炎患者提供治疗益处。有研究认为，螺内酯可预防COVID-19感染的急性肺损伤，其多效性包括有利的肾素-血管紧张素-醛固酮系统（RAAS）和ACE2表达，降低跨膜丝氨酸蛋白酶2 （TMPRSS2）活性和抗雄激素作用，因此可能被证明对重症肺炎高危患者具有额外的保护作用。未来的前瞻性临床试验有必要评估其治疗潜力。
In March 2020, coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 was declared a global pandemic by the World Health Organization (WHO). The clinical course of the disease is unpredictable but may lead to severe acute respiratory infection (SARI) and pneumonia leading to acute respiratory distress syndrome (ARDS). It has been shown that pulmonary fibrosis may be one of the major long-term complications of COVID-19. In animal models, the use of spironolactone was proven to be an important drug in the prevention of pulmonary fibrosis. Through its dual action as a mineralocorticoid receptor (MR) antagonist and an androgenic inhibitor, spironolactone can provide significant benefits concerning COVID-19 infection. The primary effect of spironolactone in reducing pulmonary edema may also be beneficial in COVID-19 ARDS. Spironolactone is a well-known, widely used and safe anti-hypertensive and antiandrogenic medication. It has potassium-sparing diuretic action by antagonizing mineralocorticoid receptors (MRs). Spironolactone and potassium canrenoate, exerting combined pleiotropic action, may provide a therapeutic benefit to patients with COVID-19 pneumonia through antiandrogen, MR blocking, antifibrotic and anti-hyperinflammatory action. It has been proposed that spironolactone may prevent acute lung injury in COVID-19 infection due to its pleiotropic effects with favorable renin–angiotensin–aldosterone system (RAAS) and ACE2 expression, reduction in transmembrane serine protease 2 (TMPRSS2) activity and antiandrogenic action, and therefore it may prove to act as additional protection for patients at highest risk of severe pneumonia. Future prospective clinical trials are warranted to evaluate its therapeutic potential.
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作者：
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