Patients with COVID-19 are reported to present with fever, dry cough, myalgia, fatigue, and diarrhea, etc. In some cases, the severe progression of the disease results in debilitating conditions such as acute respiratory distress syndrome (ARDS), respiratory failure, heart failure, sepsis, and sudden cardiac arrest within a few days.1,2Studies have reported the findings of pathogenic examination of lung specimens from mild COVID-19 patients (who were retrospectively found to have COVID-19 at the time of lung cancer surgery) such as edema, proteinaceous exudate with globules, patchy inflammatory cellular infiltration and moderate formation of hyaline membranes.3 In a postmortem assessment of a COVID-19 patient with severe ARDS, specimens of infected lungs demonstrated bilateral diffuse alveolar damage with edema, pneumocyte desquamation and hyaline membrane formation.1 Based on the genetic homology and pathologic features of the infected lung, it is inferred that cytokine storm also prevails in patients with COVID-19. This has led to the rationale for the use of melatonin in COVID-19 patients.
Melatonin is a bioactive molecule with an array of health-promoting properties; melatonin has been successfully used to treat sleep disorders, delirium, atherosclerosis, respiratory disease and viral infections.4 Previous research has documented the positive effects of melatonin in alleviating acute respiratory stress induced by virus, bacteria, radiation, etc.
Melatonin is not viricidal, meaning the ability to kill viruses, but it has indirect anti-viral actions4 due to its anti-inflammation, anti-oxidation and immune enhancing features.5-8 There are situations in which melatonin suppresses the features of viral infections. In previous respiratory syncytial virus models, melatonin caused down-regulation of acute lung oxidative injury, pro-inflammatory cytokine release and inflammatory cell recruitment. These findings, along with those recently summarized by Reiter et al.4, support a rationale for melatonin use in viral diseases. Also, the features such as melatonin’s anti-inflammation, anti-oxidation and immune enhancing actions support its potential attenuation of COVID-19 infection.9
Source
1 Chen N, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet (London, England) 2020;395:497–506. doi: 10.1016/S0140-6736(20)30183-5.
2 Tian S, et al. Pulmonary Pathology of Early Phase SARSCoV-2 Pneumonia.
3 Xu Z, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir. Med. 2020 doi: 10.1016/S2213-2600(20)30076-X.
4 Reiter RJ, et al. Treatment of Ebola and other infectious diseases: melatonin “goes viral”. Melatonin Res. 2020;3:43–57. doi: 10.32794/mr11250047.
5 Junaid A, et al. Ebola hemorrhagic shock syndrome-on-a-chip. IScience. 2020;23 doi: 10.1016/j.isci.2019.100765.
6 Boga JA, et al. Beneficial actions of melatonin in the management of viral infections: a new use for this “molecular handyman”? Rev. Med. Virol. 2012;22:323–338. doi: 10.1002/rmv.1714.
7 Anderson G, et al. Ebola virus: melatonin as a readily available treatment option. J. Med. Virol. 2015;87:537–543. doi: 10.1002/jmv.24130.
8 Reiter RJ, et al. Melatonin in mitochondria: mitigating clear and present dangers. Physiology (Bethesda) 2020;35:86–95. doi: 10.1152/physiol.00034.2019.
9 Zhang R et al. COVID-19: Melatonin as a potential adjuvant treatment. Life Sci. 2020;250: 117583. doi: 10.1016/j.lfs.2020.117583
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