Oxygen-free radicals and lipid peroxidation in adult respiratory distress syndrome

Bronchoalveolar lavage (BAL) fluid from normal subjects is a potent inhibitor of lipid peroxidation. This antioxidant activity (AOA) of BAL fluid is primarily due to the serum proteins transferrin and ceruloplasmin. In the adult respiratory distress syndrome (ARDS), there is an influx of protein-rich edema fluid into the alveolar space that may increase antioxidant activity and provide protection against further oxidant-mediated lung injury. To test this hypothesis, the AOA of BAL fluid was measured in patients with ARDS (n = 11) and normal subjects (n = 12). When compared with normal subjects, BAL fluid from ARDS patients had a significantly higher concentration of total protein (2,536.8 +/- 408.2 micrograms/ml vs. 77.3 +/- 7.0 micrograms/ml, P less than 0.005). When compared at several volumes, BAL fluid from ARDS patients was a more potent inhibitor of lipid peroxidation than BAL fluid from normals. In addition, when AOA was determined on equal milligram amounts of BAL fluid protein from ARDS patients and normal subjects, ARDS BAL fluid protein had a significantly higher AOA. Consistent with its higher AOA, ARDS BAL fluid contained increased concentrations of both transferrin (77.8 +/- 15.3 micrograms/ml vs. 2.78 +/- 0.3 micrograms/ml, P less than 0.05) and ceruloplasmin (36.5 +/- 5.6 micrograms/ml vs. 0.26 +/- 0.02 micrograms/ml, P less than 0.005) compared with normal subjects. The importance of both ceruloplasmin and transferrin in the enhanced AOA of ARDS BAL fluid was further demonstrated by studies that showed a significant decrement in AOA when the antioxidant functions of these two proteins were selectively blocked.(ABSTRACT TRUNCATED AT 250 WORDS)

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Pathogenetic syndrome management of a patient with COVID-19

Infusion & Chemotherapy ◽

10.32902/2663-0338-2020-3.2-298-299 ◽

2020 ◽

pp. 298-299

Author(s):

E.M. Khodosh

Keyword(s):

Lipid Peroxidation ◽

Acute Respiratory Distress Syndrome ◽

Free Radicals ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Pulmonary Edema ◽

Antioxidant Defense ◽

Distress Syndrome ◽

Nitric Oxide Donor ◽

Antioxidant Effects

Background. In case of coronavirus pneumonia, the virus damages the cells of bronchi and alveoli, as well as triggers a powerful inflammatory response that disrupts the surfactant and prevents the adequate oxygenation. These pathogenetic links lead to the development of acute respiratory distress syndrome, multiorgan hypoxia and disseminated intravascular coagulation syndrome. Objective. To find out the main pathogenetic links that can be affected by coronavirus disease (COVID-19) treatment. Materials and methods. Analysis of literature sources on this topic. Results and discussion. Hypoxia is one of the main backgrounds of coronavirus organ damage in COVID-19. The consequences of hypoxia include the imbalance between aerobic and anaerobic glycolysis, increased lipid peroxidation, acidosis, microcirculation disorders, edema. Pathologically active inflammation is another background. It leads to the damage of pulmonary capillaries, microcirculation disorders and the development of acute respiratory distress syndrome with increased hypoxia. Since the reactive oxygen species are the main inducers of apoptosis and mitochondrial dysfunction, it is necessary to prescribe antioxidant therapy. Edaravone (Ksavron, “Yuria-Pharm”) quickly neutralizes lots of free radicals, inhibits lipid peroxidation and activates the own antioxidant defense. Other components of the pathogenetic therapy of COVID-19 may include Tivortin and Tivorel (“Yuria-Pharm”). L-arginine (Tivortin) is a nitric oxide donor. Its administration has vasodilating, immunostimulating, membrane stabilizing, cytoprotective and antioxidant effects. Tivorel also contains L-carnitine, which inhibits apoptosis, has antioxidant and cardioprotective effects. In case of pneumonia, it is advisable to use Reosorbilact (“Yuria-Pharm”), which prevents pulmonary edema and restores microcirculation. Conclusions. 1. Hypoxia and hyperinflammation are the main elements of the COVID-19 pathogenesis. 2. Edaravone (Ksavron) neutralizes free radicals and activates own antioxidant defense. 3. L-arginine (a component of Tivortin and Tivorel) has vasodilating, immunostimulating, membrane stabilizing, cytoprotective and antioxidant effects. 4. Reosorbilact prevents pulmonary edema and restores microcirculation.

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