COVID-19's hyperinflammation is characterized by the presence of overactivated neutrophils, monocyte-derived alveolar macrophages, and CD4+/CD8+ T cells.
The SARS-Cov2 infection triggers a multisystem inflammatory disorder, knowing as COVID-19, a pandemic disease. This disease is characterized by acute respiratory distress syndrome, cytokine-driven hyperinflammation, and leukocytes count changes. The innate immune response has been linked to COVID-19 immunopathogenesis (e.g., dysfunctional IFN response and myeloid inflammation). In this regard, neutrophils have been highlighted as essential effector cells in the development of COVID-19. This review summarized the significant finds about neutrophils and its effector mechanisms (e.g., neutrophils enzymes and cytokines, neutrophil extracellular traps) in COVID-19 so far.
Keywords: Inflammation, Chemokines, NETs, SARS-CoV2
It is also characterized by an excessive release of hypochlorous acid by myeloperoxidase enzymes via NETosis:
Multi-system involvement and rapid clinical deterioration are hallmarks of coronavirus disease 2019 (COVID-19) related mortality. The unique clinical phenomena in severe COVID-19 can be perplexing, and they include disproportionately severe hypoxemia ...
www.ncbi.nlm.nih.gov
Multi-system involvement and rapid clinical deterioration are hallmarks of coronavirus disease 2019 (COVID-19) related mortality. The unique clinical phenomena in severe COVID-19 can be perplexing, and they include disproportionately severe hypoxemia relative to lung alveolar-parenchymal pathology and rapid clinical deterioration, with poor response to O2 supplementation, despite preserved lung mechanics. Factors such as microvascular injury, thromboembolism, pulmonary hypertension, and alteration in hemoglobin structure and function could play important roles. Overwhelming immune response associated with “cytokine storms” could activate reactive oxygen species (ROS), which may result in consumption of nitric oxide (NO), a critical vasodilation regulator. In other inflammatory infections, activated neutrophils are known to release myeloperoxidase (MPO) in a natural immune response, which contributes to production of hypochlorous acid (HOCl). However, during overwhelming inflammation, HOCl competes with O2 at heme binding sites, decreasing O2 saturation. Moreover, HOCl contributes to several oxidative reactions, including hemoglobin-heme iron oxidation, heme destruction, and subsequent release of free iron, which mediates toxic tissue injury through additional generation of ROS and NO consumption. Connecting these reactions in a multi-hit model can explain generalized tissue damage, vasoconstriction, severe hypoxia, and precipitous clinical deterioration in critically ill COVID-19 patients. Understanding these mechanisms is critical to develop therapeutic strategies to combat COVID-19.
Now, read that abstract again:
However, during overwhelming inflammation, HOCl competes with O2 at heme binding sites, decreasing O2 saturation.
Hypochlorous acid is so reactive, it crowds out oxygen and prevents hemoglobin from accepting it. Sound familiar? What disease do you know of where they intubate people and they still can't get oxygen into their red blood cells?
There is already a substance that could, in all likelihood, treat or prevent the hyper-inflammation of COVID-19. It's called Apocynin, or Acetovanillone. It is one of the main constituents of the Picrorhiza Kurroa root which is found in Ayurvedic medicine, where the ground-up root is known as Kutki powder. However, we also have chemically-isolated, pure Apocynin, as well, which is vastly more potent.
Ischemia and reperfusion (IR) of isolated sheep lungs caused polymorphonuclear leukocyte (PMN) sequestration, pulmonary hypertension secondary to thromboxane (TX), edema, and increased vascular permeability.
1
PMN depletion attenuated this injury, suggesting that PMN-derived O2 radicals were involved.
2
Apocynin (Apo) is a methoxy-substituted catechol that requires activation by myeloperoxidase to inhibit the reduced form of nicotinamide adenine dinucleotide phosphate (NADPH) oxidase and thus prevents O2− production from activated PMN leukocytes. To determine the effect of Apo in IR injury, we subjected 20 sheep lungs to 30 min of ischemia and 180 min of reperfusion with blood. We injected 3 mM, 0.3 mM, 0.03 mM Apo, or diluent (n = 5 each) into the pulmonary artery early in ischemia and the reservoir before reperfusion. Peak pulmonary artery pressure, peak perfusate TXB2 concentration, and the reflection coefficient for albumin were measured (
Table 1) . The ability of Apo to inhibit
in vitro O2− production from zymosan-activated sheep PMN leukocytes was also assessed (n = 3).
It has also been compounded with paeonol to create APPA, which is being investigated as a drug for osteoarthritis:
Neutrophils are key players in the pathophysiological process underlying inflammatory conditions not only by release of tissue-damaging cytotoxic enzymes, reactive oxygen species (ROS) but also by secretion of important immunomodulatory chemokines and cytokines. Here, we report the effects of...
link.springer.com
Neutrophils are key players in the pathophysiological process underlying inflammatory conditions not only by release of tissue-damaging cytotoxic enzymes, reactive oxygen species (ROS) but also by secretion of important immunomodulatory chemokines and cytokines. Here, we report the effects of the novel agent APPA, undergoing formal clinical development for treatment of osteoarthritis, and its constituent components, apocynin (AP) and paeonol (PA) on a number of neutrophil functions, including effects on TNFα- expression and signalling. Neutrophils were treated with APPA (10–1000 µg/mL) prior to the measurement of cell functions, including ROS production, chemotaxis, apoptosis and surface receptor expression. Expression levels of several key genes and proteins were measured after incubation with APPA and the chromatin re-modelling agent, R848. APPA did not significantly affect phagocytosis, bacterial killing or expression of surface receptors, while chemotactic migration was affected only at the highest concentrations. However, APPA down-regulated neutrophil degranulation and ROS levels, and decreased the formation of neutrophil extracellular traps. APPA also decreased cytokine-stimulated gene expression, inhibiting both TNFα- and GM-CSF-induced cell signalling. APPA was as effective as infliximab in down-regulating chemokine and IL-6 expression following incubation with R848. Whilst APPA does not interfere with neutrophil host defence against infections, it does inhibit neutrophil degranulation, and cytokine-driven signalling pathways (e.g. autocrine signalling and NF-κB activation), processes that are associated with inflammation. These observations may explain the mechanisms by which APPA exerts anti-inflammatory effects and suggests a potential therapeutic role in inflammatory diseases in which neutrophils and TNFα signalling are important in pathology, such as rheumatoid arthritis.
COVID-19 activates many of the same inflammatory pathways as arthritis, except instead of being in the joints, it's in the lining of blood vessels and small capillaries in the lungs:
This Perspective article explores similarities in the inflammatory processes underlying coronavirus disease 2019 (COVID-19) and rheumatoid arthritis, including the role of pro-inflammatory cytokines and the potential of anti-cytokine therapies to treat COVID-19, as well as the effect of the...
www.nature.com
Coronavirus disease 2019 (COVID-19) is an infectious disease, caused by severe acute respiratory syndrome coronavirus 2, which predominantly affects the lungs and, under certain circumstances, leads to an excessive or uncontrolled immune activation and cytokine response in alveolar structures. The pattern of pro-inflammatory cytokines induced in COVID-19 has similarities to those targeted in the treatment of rheumatoid arthritis. Several clinical studies are underway that test the effects of inhibiting IL-6, IL-1β or TNF or targeting cytokine signalling via Janus kinase inhibition in the treatment of COVID-19. Despite these similarities, COVID-19 and other zoonotic coronavirus-mediated diseases do not induce clinical arthritis, suggesting that a local inflammatory niche develops in alveolar structures and drives the disease process. COVID-19 constitutes a challenge for patients with inflammatory arthritis for several reasons, in particular, the safety of immune interventions during the pandemic. Preliminary data, however, do not suggest that patients with inflammatory arthritis are at increased risk of COVID-19.
Apocynin can defang neutrophils by having a potent antioxidant effect, reducing ROS formation, NETosis and release of myeloperoxidase enzymes into the extracellular space, et cetera. It also reduces the production of certain key inflammatory cytokines that have been noted to be elevated in COVID-19.
COVID-19 hyperinflammation can and should be treated with antioxidants, including plant-derived antioxidants. Look at what the current critical care protocol is:
The MATH+ Hospital Treatment Protocol for Covid-19 is a physiologic-based combination treatment regimen created by leaders in critical care medicine.
covid19criticalcare.com
METHYLPREDNISOLONE, ASCORBIC ACID, THIAMINE, HEPARIN, IVERMECTIN, Fluvoxamine, Cyproheptadine, Anti-Androgen Therapy, Vitamin D, Atorvastatin, Melatonin, Zinc, Famotidine, Therapeutic Plasma Exchange
Ascorbic Acid is, of course, Vitamin C. They're promoting high-dose Vitamin C, Vitamin D, Melatonin, and Famotidine, and those are all antioxidants. Vitamin C shields lipids from oxidation by donating electrons to radicals. Vitamin D activates calcium pumps to decalcify cells and drive down ROS production, among many other things. Melatonin scavenges peroxynitrite. Famotidine and the other related H2 blockers, Cimetidine and Ranitidine, are scavengers of hydroxyl radicals and have a potent antioxidant effect separate from their use as H2-blocking antacid drugs.
They're basically admitting that antioxidants have a central place in COVID-19 critical care, as adjunct therapies alongside steroids, antivirals, blood thinners, NSAIDs, etc.