Base upon the WSJ article on Friday, research presented by Randy Cron, MD, UAB, that the proliferation of macrophages and cytokine levels are causing escalation of the mortality associated with Covid-19 I am offering up a possible solution to slow the mortality rate:
Based upon your analysis of the problem leading to mortality with patients infected with the Covid-19 virus , the proliferation of macrophages then subsequently leading to overwhelming production of Cytokines, I believe that I could share with you possible therapeutic interventions that would slow or resolve at least that portion of the issue that causes rapid decline in the patients status leading to mortality.
As you know the inflammatory cascade ( previously described in AHA journal and NLA journals in the early 2000's) is caused by the stimulation of both PPAR-alpha and PPAR-gamma in the body.
PPAR alpha stimulation leads to enhanced production of macrophages and then the macrophages then produce elevations in Cytokines which can also be attributed to elevated production of Free Fatty Acids/Triglycerides. PPAR-gamma stimulation can lead to an increase in c-IMT.
Two medications can inhibit these proliferation events that , as you suggest can cause cardiovascular collapse.
To block the PPAR alpha , the medication Fenofibrate( Tricor, Trilipix-Abbott) is used. This is available in multiple strengths ranging from 48 mg to 160 mg , dosage of one tablet daily. It is available in both immediate release or sustained release product. The drug was designed to both lower triglycerides and elevate HDL.
To block the PPAR gamma response, the medication known as Pioglitazone ( Actos-Takeda), comes from the class of the thiazolidinedione-type , or sometimes referred to as TZD's. This medication will lower c-IMT. It is dosed safely in 15-30 mg tablets as an immediate release product. It is however contra indicated for use in patients with CHF.
The medication has the indication for insulin resistance in diabetes patients, as an oral anti-diabetic treatment.
I would suspect that if patients upon admission were given a lipid panel, I would estimate that you would see elevations in the triglyceride levels and if post mortem's were performed looking at c-IMT, you would observe an abnormal level of thickening in the carotid intima media.
Allen Nichol, Pharm.D., FAPhA
COO/VP Clinical Operations CeutiCare Inc.
2014 APhA Daniel B. Smith Award Recipient
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