Annals of the Russian academy of medical sciencesAnnals of the Russian academy of medical sciencesВестник Российской академии медицинских наук0869-60472414-3545"Paediatrician" Publishers LLC136010.15690/vramn1360РATHOPHYSIOLOGY: CURRENT ISSUESАКТУАЛЬНЫЕ ВОПРОСЫ ПАТОФИЗИОЛОГИИResearch ArticleCOVID-19: oxidative stress and the relevance of antioxidant therapyCOVID-19: окислительный стресс и актуальность антиоксидантной терапииhttps://orcid.org/0000-0003-3255-20133327-4213DarenskayaMarina A.ДаренскаяМарина Александровна
Russian Federation

PhD

д.б.н.

marina_darenskaya@inbox.ruhttps://orcid.org/0000-0003-3354-29921584-0281KolesnikovaLubov I.КолесниковаЛюбовь Ильинична
Russian Federation

MD, PhD, Professor

д.м.н., профессор, академик РАН

kolesnikova20121@mail.ruhttps://orcid.org/0000-0003-2124-63281752-6695KolesnikovSergey I.КолесниковСергей Иванович
Russian Federation

MD, PhD, Professor

д.м.н., профессор, академик РАН

sikolesnikov2012@gmail.comScientific Centre for Family Health and Human Reproduction ProblemsНаучный центр проблем здоровья семьи и репродукции человека21092020141020207543183252005202024082020Copyright ©; 2020, "Paediatrician" Publishers LLCCopyright ©; 2020, Издательство "Педиатръ"2020"Paediatrician" Publishers LLCИздательство "Педиатръ"https://vestnikramn.spr-journal.ru/jour/about/submissionshttps://vestnikramn.spr-journal.ru/jour/article/view/1360

The emergence of viral respiratory pathogens with high pandemic potential, such as the SARS-CoV-2, poses a serious public health problem, with a very limited arsenal of effective tools and techniques to prevent and treat a new pandemic infection. The literature on the involvement of reactive oxygen species in the pathogenesis of coronavirus infections and the potential for antioxidant therapy was reviewed. Because of available evidence on the involvement of oxidative stress in the mechanisms of initiation and maintenance of homeostasis disorders in SARS-CoV-2, approaches combining reduction of ROS synthesis, inhibition of virus replication, anti-inflammatory action, reduction of hypoxia, and reduction of the toxic effects of drug therapy may be very effective. The hypothesis of the expediency of treating systemic inflammation aimed at “quenching” the cytokine “storm”, caused largely by the production of reactive oxygen species, seems essential. In this connection, it is pathophysiologically justified to use for prophylactic and therapeutic purposes antioxidant drugs, which have proven themselves on the example of other viral respiratory infections. Thus, the high activity of preparations of vitamin C, N-acetylcysteine, melatonin, quercetin, glutathione, astaxanthin, polyphenols, polyunsaturated fatty acids, etc. was noted. In addition, these drugs effectively protect the vascular wall, which has been proven for a number of cardiovascular diseases and that can be effective in developing with COVID-19 vasculitis. There is a more pronounced combined effect of these drugs, which is already used in treatment protocols for patients with SARS-CoV-2. Special attention should also be paid to the use of antioxidant drugs as a means to reduce the toxic manifestations of antiviral therapy. Thus, the use of drugs with antioxidant activity can be justified and will certainly improve the effectiveness of the fight against the pandemic of new coronavirus infection.

Появление вирусных респираторных патогенов, обладающих высоким пандемическим потенциалом, таких как SARS-CoV-2, представляет серьезную проблему для здоровья человечества, при этом арсенал эффективных средств и методов профилактики и лечения пандемии новой инфекции крайне ограничен. Проведен анализ литературных источников, посвященных участию реактивных форм кислорода в патогенезе коронавирусных инфекций и возможностям антиоксидантной терапии. В связи с имеющимися данными об участии окислительного стресса в механизмах инициирования и поддержания нарушений гомеостаза при SARS-CoV-2 весьма эффективными могут быть подходы, сочетающие в себе снижение синтеза АФК, ингибирование репликации вируса, противовоспалительное действие, снижение уровня гипоксии, а также понижение токсичного действия лекарственной терапии. Существенной представляется гипотеза о целесообразности купирования системного воспаления, направленного на «гашение» цитокинового «шторма», обусловленного в большей степени продукцией активных форм кислорода. В связи с этим патофизиологически обоснованно использование в профилактических и лечебных целях препаратов антиоксидантного действия, хорошо зарекомендовавших себя на примере других вирусных респираторных инфекций. Так, отмечена высокая активность препаратов витамина С, N-ацетилцистеина, мелатонина, кверцетина, глутатиона, астаксантина, полифенолов, полиненасыщенных жирных кислот и др. Кроме того, данные препараты эффективно защищают сосудистую стенку, что доказано для ряда сердечно-сосудистых заболеваний и может быть эффективно при развивающемся при COVID-19 васкулите. Отмечается более выраженное комбинированное действие указанных препаратов, что уже находит свое применение в протоколах лечения пациентов с SARS-CoV-2. Отдельного внимания заслуживает также вопрос использования антиоксидантных препаратов в качестве средств, снижающих токсичные проявления антивирусной терапии. Таким образом, применение средств с антиоксидантной активностью может быть обоснованно и, безусловно, позволит повысить эффективность борьбы с пандемией новой коронавирусной инфекции.

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