|LETTER TO THE EDITOR
|Year : 2020 | Volume
| Issue : 3 | Page : 150-151
Dapsone old drug can be useful in management of COVID-19
Naguib El Farnawany
Department of Dermatology and Venereology, Kafr El Sheikh General Hospital, Kafr El Sheikh, Egypt; Dermatology Registrar, Al Hayat Hospital, Jeddah, Saudi Arabia
|Date of Submission||09-Apr-2020|
|Date of Decision||12-Apr-2020|
|Date of Acceptance||05-Jun-2020|
|Date of Web Publication||15-Jul-2020|
Dr. Naguib El Farnawany
Department of Dermatology and Venereology, Kafr El Sheikh General Hospital, Kafr El Sheikh 31155
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
El Farnawany N. Dapsone old drug can be useful in management of COVID-19. APIK J Int Med 2020;8:150-1
COVID-19 has become a pandemic with tens of thousands of infected patients. Based on clinical features, pathology, the pathogenesis of acute respiratory disorder induced by either highly homogeneous coronaviruses or other pathogens, the evidence suggests that excessive inflammation, oxidation, and an exaggerated immune response very likely contribute to COVID-19 pathology. This leads to a cytokine storm and subsequent progression to acute lung injury/acute respiratory distress syndrome and often death.
Cytokine storm, also known as high cytokine disease, is the systemic expression of a healthy and vigorous immune system resulting in the release of >150 inflammatory mediators such as tumor necrosis factor-alpha (TNF-α), interleukin-1 (IL-1), IL-6, IL-12, interferon (IFN)-α, IFN-β, IFN-γ, monocyte chemoattractant protein-1, and IL-8. Both pro-inflammatory cytokines and anti-inflammatory cytokines are elevated in the serum.
Over-production of reactive oxygen species, most frequently due to excessive stimulation of either reduced nicotinamide adenine dinucleotide phosphate by cytokines or the mitochondrial electron transport chain and xanthine oxidase, results in oxidative stress. Oxidative stress is a deleterious process that leads to lung damage and consequently, to various disease states.
Another researches about COVID 19 added that there is high neutrophils with low lymphocytes that leading to high neutrophils/lymphocytes ratio, which is an indicator for bad prognosis and severe lung damage may happen with increase need for mechanical ventilation.
Dapsone has been shown to have anti-inflammatory effects in addition to antibiotic activity, and two functional mechanisms have been suggested so far. The first is to modulate the production of inflammatory cytokines. Dapsone inhibits the secretion of interleukin-8 from lipopolysaccharide-stimulated human bronchial epithelial cells and the production of TNF-α from activated mononuclear cells.
The second mechanism suggested for the anti-inflammatory effect of dapsone is to inhibit myeloperoxidase (MPO) in neutrophils. MPO in neutrophils produces hypohalous acids involved in the microbicidal activity of neutrophils. A previous study demonstrated that dapsone affected the function of neutrophils by blocking MPO in azurophilic granules; as a result, dapsone reduced the accumulation of hypohalous acid, a causative agent for tissue damage.
In practice, some investigators have reported that dapsone inhibits not only IL-8-induced chemotaxis but also direct IL-8 release and that this inhibition follows a dose-dependent effect. Another study previously showed that chemotaxis to IL-8 decreased by 24% in the presence of 100 μg/ml dapsone, while this decrease was even more pronounced (increased to 61%) in the presence of 300 μg/ml dapsone (P < 0.05).
Hence, it can be a good option as anti-inflammatory, immuno modulator for reducing serious effects of immune dysregulation that happened by COVID 19 as add on to other medications or alone. This observation needs clinical studies to prove its efficacy.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Park HS, Kim SR, Lee YC. Impact of oxidative stress on lung diseases. Respirology 2009;14:27-38.
Abe M, Shimizu A, Yokoyama Y, Takeuchi Y, Ishikawa O. A possible inhibitory action of diaminodiphenyl sulfone on tumour necrosis factor-α production from activated mononuclear cells on cutaneous lupus erythematosus. Clin Exp Dermatol 2008;33:759-63.
Kettle AJ, Winterbourn CC. Mechanism of inhibition of myeloperoxidase by anti-inflammatory drugs. Biochem Pharmacol 1991;41:1485-92.
Booth SA, Moody CE, Dahl MV, Herron MJ, Nelson RD. Dapsone suppresses integrin-mediated neutrophil adherence function. J Invest Dermatol 1992;98:135-140.