Intravenous vitamin C for reduction of cytokines storm in acute respiratory distress syndrome – PMC

1. Introduction

The recent outbreak of Covid19 has required urgent treatments for numerous patients. The Covid19 originated in Wuhan, China has spread to other continents and has caused significant harm to the public. Fig. 1 represents a transmission electron microscope image of Covid19 along with a 3D structure of coronavirus. No suitable vaccines or antiviral drugs exist against Covid19. At the time of writing (15 March 2020), Coronavirus cases were already 173,085 (+19 % over the last 24 h, +5% the day before), with 6664 deaths (+23 % over the last 24 h, +6% the day before) vs. 77,784 recovered (+6% over the last 24 h), with some improvements in China. However, the condition is deteriorating in Western Europe, especially Italy. No cure for Covid19 is known at this time. In addition to administering oxygen, current treatments recommended by the World Health Organization (WHO) for the serious, critical cases of Covid19 include Remdesivir, Kaletra, and Kaletra plus Interferon (France24, “Conquering the coronavirus: the most pressing goal for these researchers in Paris”, Remdesivir is an antiviral nucleotide developed as a treatment for the Ebola virus and Marburg virus infections. Kaletra is a combination of Lopinavir and Ritonavir (LPV/r). This is also used as antiviral nucleotide analogs developed for the treatment of HIV/AIDS. The third option is a combination of Kaletra with Interferon. Interferons are signaling proteins (cytokines) that infected cells produce and release in response to viruses. Interferons activate other cells of the immune system so that a stronger immune system response can be achieved. Interferon alphas are specifically recommended for viral infections and some cancers. The efficacy of these processes for Covid19 is controversial. Therefore, alternative approaches are urgently needed.

In China, the death rate was peaked at 3% a few weeks ago but is now declined to 0.7 %. Good results are obtained using Interferon Alpha 2B (IFNrec) without any combination with Kaletra. The use of Intravenous (IV) Vitamin C (Vit-C) has shown promise in this area in China. The IV Vit-C (or Ascorbic acid) protocols are mentioned in, for Covid19 and other pathologies. Shanghai now utilizes IV Vit-C in the treatment for Covid-19. Many physicians in China have identified promising results using IV Vit-C against Covid19. Thus, there is a need to urgently review the uses of IV Vit-C, pre- and post-infection, and during different stages of the infection. IV Vit-C is helping to develop a stronger immune system response, reducing the cytokines storm, or increasing antiviral activities through other unknown mechanisms.

Perhaps, the reduction of the cytokines storm in the late stages of the Covid19 infection is the most significant application of IV Vit-C. Covid19 pneumonia is a complex medical disorder with high morbidity and mortality rate. This causes severe lung injury that results in Acute Respiratory Distress Syndrome (ARDS), a life-threatening lung disorder. This process prevents the necessary oxygen to enter into the lungs and ultimately causes death. Coronaviruses increase oxidative stress that promotes cellular malfunction and ultimately results in organ failure. It is believed that pulmonary failure (ARDS) is the principal cause of Covid19′s action on humans. This helps to increase oxidative stress considerably because of the generation of free radicals and cytokines. This process finally leads to serious cellular injury, organ failure and death. The administration of anti-oxidizing agents along with proven conventional supportive therapies is believed to have an important role in controlling these medical situations. Appropriate vaccines and antiviral drugs for the Covid19 epidemic are not available. IV Vitamin C and other antioxidants are extremely good agents for ARDS. These can be applied clinically. Importantly, high dose IV Vit-C is safe and effective. In this paper, we review the use of high-dose Vit-C as an efficient method of treatment for patients with cancers and infections.

The antiviral properties of Vit-C help to reduce symptoms and mortality in children and adults [[1], [2], [3], [4]]. The antiviral activities of ascorbic acid was known and it was published almost 80 years ago [[5], [6], [7], [8], [9]] when scientists were involved in work on poliomyelitis. Moreover, the use of ascorbic acid as a medicinally crucial agent against various diseases was also well established [[10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21]]. Applications of Vit-C are found in poliomyelitis [[22], [23], [24], [25], [26]]. Many other uses of Vit-C include hepatitis, herpes, chickenpox and measles, infectious mononucleosis, trichinosis, urethritis, Antabuse, arthritis, and cancer. Vit-C is also helpful for the treatment of elevated cholesterol and arteriosclerosis, [[27], [28], [29], [30], [31], [32]], corneal ulcers, glaucoma, burns, heatstroke, sunburn, slipped disc, toxins, and heavy metal poisonings [[33], [34], [35]]. The appropriate clinically effective vaccines and specific antivirals may serve effectively if they are available. Considering the current situation, the use of Vit-C as an antiviral agent should also be considered. Notably, Vit-C can be used alone or in combination with other available medicines to exert positive synergistic effects. Here we review the principal mechanism of actions of IV Vit-C that helps to make the immune system stronger, reduces the cytokines storm and inhibits oxidative processes. Under the first criteria, literature knowledge on cancer treatment will be reviewed first. Then, the antiviral properties will be reviewed, with focusing on the reduction of the oxidative pathways typical of the Covid19 ARDS.

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