Can Adenosine Fight COVID-19 Acute Respiratory Distress Syndrome?

Falcone, Carmela; Caracciolo, Massimo; Correale, Pierpaolo; Macheda, Sebastiano; Vadalà , Eugenio Giuseppe; La Scala, Stefano; Tescione, Marco; Danieli, Roberta; Ferrarelli, Anna; Tarsitano, Maria Grazia; Romano, Lorenzo; De Lorenzo, Antonino

Coronavirus disease 2019 (COVID-19) patients can develop interstitial pneumonia, which, in turn, can evolve into acute respiratory distress syndrome (ARDS). This is accompanied by an inflammatory cytokine storm. severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) has proteins capable of promoting the cytokine storm, especially in patients with comorbidities, including obesity. Since currently no resolutive therapy for ARDS has been found and given the scientific literature regarding the use of adenosine, its application has been hypothesized. Through its receptors, adenosine is able to inhibit the acute inflammatory process, increase the protection capacity of the epithelial barrier, and reduce the damage due to an overactivation of the immune system, such as that occurring in cytokine storms. These features are known in ischemia/reperfusion models and could also be exploited in acute lung injury with hypoxia. Considering these hypotheses, a COVID-19 patient with unresponsive respiratory failure was treated with adenosine for compassionate use. The results showed a rapid improvement of clinical conditions, with negativity of SARS-CoV2 detection.