key: cord-0769517-hsa14a58
authors: Jahandideh, Dariush; Taheri, Andisheh
title: Old Medication for a Novel Disease?
date: 2020-05-11
journal: Med Hypotheses
DOI: 10.1016/j.mehy.2020.109830
sha: 3fd4abe73c9451617e1c62bd99e65e80a4d84cf8
doc_id: 769517
cord_uid: hsa14a58

nan

of severe pulmonary inflammation. The purpose of this letter is to propose that aldosterone antagonists might improve the outcome of ARDS.

It has been proved by multiple studies on cell lines, animal model, and also human subjects that aldosterone induces collagen synthesis in different tissues (1, 2), and that aldosterone antagonists (e.g. spironolactone) can inhibit collagen synthesis in different tissues including heart, muscle, kidney, and lung (3) (4) (5) . There has been a few studies done on ARDS and it has been shown that spironolactone improves the outcome in this condition as well (6) .

Studies have shown that expression of ACE2 might facilitate infection by SARS-CoV-2, but it was demonstrated that aldosterone antagonists (which increase expression of ACE2) can protect against ARDS in animal models (7) .

Based on the previous evidence and also pathophysiology of ARDS it seems reasonable to consider spironolcatone for improvement of ARDS outcome if started early in the course of the disease. Now that we have a surge in ARDS cases caused by COVID-19 and since there is not effective treatment or vaccine available yet, we need to decrease mortality and morbidity it seems that early initiation of aldosterone antagonist early in the course of COVID-19 might improve the outcome by decreasing fibrosis in lung tissue.

Aldosterone stimulates collagen gene expression and synthesis via activation of ERK1/2 in rat renal fibroblasts

The mineralocorticoid receptor promotes fibrotic remodeling in atrial fibrillation

Limitation of excessive extracellular matrix turnover may contribute to survival benefit of spironolactone therapy in patients with congestive heart failure: insights from the Randomized Aldactone Evaluation Study (RALES)

Antifibrotic effects of aldosterone receptor blocker (spironolactone) in patients with chronic kidney disease. Renal failure

Potential spironolactone effects on collagen metabolism biomarkers in patients with uncontrolled blood pressure

The efficacy of spironolactone and surfactant treatment on HMGB1, CRP, IL-1b and TNF-a levels in acute lung injury

Angiotensin-converting enzyme 2 prevents lipopolysaccharide-induced rat acute lung injury via suppressing the ERK1/2 and NF-κB signaling pathways. Sci Rep