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From nicotine to the cholinergic anti-inflammatory reflex - Can nicotine alleviate the dysregulated inflammation in COVID-19?
Gauthier, Alex G; Lin, Mosi; Wu, Jiaqi; Kennedy, Thomas P; Daley, Lee-Anne; Ashby, Charles R; Mantell, Lin L.
  • Gauthier AG; Department of Pharmaceutical Sciences, St. John's University, Queens, NY, USA.
  • Lin M; Department of Pharmaceutical Sciences, St. John's University, Queens, NY, USA.
  • Wu J; Department of Pharmaceutical Sciences, St. John's University, Queens, NY, USA.
  • Kennedy TP; School of Medicine, Tulane University, New Orleans, LA, USA.
  • Daley LA; Department of Pharmaceutical Sciences, St. John's University, Queens, NY, USA.
  • Ashby CR; Department of Pharmaceutical Sciences, St. John's University, Queens, NY, USA.
  • Mantell LL; Department of Pharmaceutical Sciences, St. John's University, Queens, NY, USA.
J Immunotoxicol ; 18(1): 23-29, 2021 12.
Article in English | MEDLINE | ID: covidwho-1593522
ABSTRACT
The coronavirus SARS-CoV-2 of 2019 (COVID-19) causes a pandemic that has been diagnosed in more than 70 million people worldwide. Mild-to-moderate COVID-19 symptoms include coughing, fever, myalgia, shortness of breath, and acute inflammatory lung injury (ALI). In contrast, acute respiratory distress syndrome (ARDS) and respiratory failure occur in patients diagnosed with severe COVID-19. ARDS is mediated, at least in part, by a dysregulated inflammatory response due to excessive levels of circulating cytokines, a condition known as the "cytokine-storm syndrome." Currently, there are FDA-approved therapies that attenuate the dysregulated inflammation that occurs in COVID-19 patients, such as dexamethasone or other corticosteroids and IL-6 inhibitors, including sarilumab, tocilizumab, and siltuximab. However, the efficacy of these treatments have been shown to be inconsistent. Compounds that activate the vagus nerve-mediated cholinergic anti-inflammatory reflex, such as the α7 nicotinic acetylcholine receptor agonist, GTS-21, attenuate ARDS/inflammatory lung injury by decreasing the extracellular levels of high mobility group box-1 (HMGB1) in the airways and the circulation. It is possible that HMGB1 may be an important mediator of the "cytokine-storm syndrome." Notably, high plasma levels of HMGB1 have been reported in patients diagnosed with severe COVID-19, and there is a significant negative correlation between HMGB1 plasma levels and clinical outcomes. Nicotine can activate the cholinergic anti-inflammatory reflex, which attenuates the up-regulation and the excessive release of pro-inflammatory cytokines/chemokines. Therefore, we hypothesize that low molecular weight compounds that activate the cholinergic anti-inflammatory reflex, such as nicotine or GTS-21, may represent a potential therapeutic approach to attenuate the dysregulated inflammatory responses in patients with severe COVID-19.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pyridines / Tobacco Use Disorder / Benzylidene Compounds / Cholinergic Agents / SARS-CoV-2 / COVID-19 Drug Treatment / Inflammation / Nicotine Type of study: Prognostic study Limits: Humans Language: English Journal: J Immunotoxicol Journal subject: Allergy and Immunology / Toxicology Year: 2021 Document Type: Article Affiliation country: 1547691x.2021.1875085

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pyridines / Tobacco Use Disorder / Benzylidene Compounds / Cholinergic Agents / SARS-CoV-2 / COVID-19 Drug Treatment / Inflammation / Nicotine Type of study: Prognostic study Limits: Humans Language: English Journal: J Immunotoxicol Journal subject: Allergy and Immunology / Toxicology Year: 2021 Document Type: Article Affiliation country: 1547691x.2021.1875085