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In these challenging times of the pandemic, as coronavirus disease 2019 (COVID-19) has taken over the planet,
its complications such as acute respiratory distress syndrome (ARDS) have the potential to wipe out a large portion of our
population. Whereas a serious lack of ventilators, vaccine being months away makes the condition even worse. That's why
promising drug therapy is required. One of them was suggested in this article. It is the angiotensin-converting enzyme-2
(ACE-2) to which the COVID-19 virus binds and upon downregulation of which the pulmonary permeability increases and
results in the filling of alveoli by proteinaceous fluids, which finally results in ARDS. ARDS can be assisted by angiotensinII type-1 receptor (AT-1R) blocker and ACE-2 upregulator. AT-1R blocker will prevent vasoconstriction, the proinflammatory effect seen otherwise upon its activation. ACE-2 upregulation will ensure less formation of angiotensin II,
vasodilatory effects due to the formation of angiotensin (1-7), increased breakdown of bradykinin at lung level. Overall,
decreased vasoconstriction of vessels supplying lungs and decreased vasodilation of lung tissues will ensure decreased
pulmonary permeability and eventually relieve ARDS. It should also be considered that all components of the reninangiotensin-aldosterone system (RAAS) are located in the lung tissues. A drug with the least plasma protein binding is
required to ensure its distribution across these lung tissues. Cotinine appears to be a promising candidate for COVID-19-
induced ARDS. It acts across the board and acts as both an AT-1R blocker, ACE-2 upregulator. It also has a weak plasma
protein binding that helps to spread through the lung tissues. In this review, we summarized that cotinine, along with
COVID-19 virus replication blocker anti-virals, may prove to be a promising therapy for the treatment of COVID-19
induced ARDS.
