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What if this is acute hemoglobinopathy? Reminds me of MetHemoglobinemia-hypoxia out of proportion to symptoms or lung exam or lung imaging. AND 2019-SARS-CoV is active against hemoglobin according to THIS Chinese articles published March 23, 2020: https://chemrxiv.org/articles/COVID-19_Disease_ORF8_and_Surface_Glycoprotein_Inhibit_Heme_Metabolism_by_Binding_to_Porphyrin/11938173 #COVID19 https://twitter.com/cameronks/status/1243582723945566208
2019-SARS-nCoV virus attacks beta2 unit of hemoglobin in order to capture porphyrin, thereby making partially deoxyHemoglobin, causing less oxygen affinity, & releasing iron. Is this related to profound hypoxia seen in some patients? #COVID19 (Photo from: http://tiny.cc/eh62lz
And could this explain why things active at hemoglobin are making a difference? Hydroxychloroquine has side effect of MetHemoglobinemia. Could this effect on hemoglobin be protective? Nitrogen oxide is an inducer of heme oxidase, also active with hemoglobin.... ? #COVID19
Zinc has reportedly had a good effect too. Zinc increases oxygen affinity 3.7-fold, because of it's effects related to hemoglobin, as zinc is involved in multiple zinc-dependent enzymes in heme synthesis. Could this support hemoglobinopathy theory for #COVID19?
Since 2019-SARS-nCoV (novel Coronavirus) splits heme to get porphyrin (apparently a thing for primitive viruses like coronavirus), I looked for more information about porphyrin and viruses and found that alkylated porphyrins have been investigated for antiviral activity. #COVID19
In one investigation, chlorin-e6, "a metal free, chlorophyllide-like molecule" had profound antiviral effects against other enveloped viruses (such as dengue and others).
Article here: https://aac.asm.org/content/55/2/478
#COVID19
@drexelmed @DrexelMedGrad
Article here: https://aac.asm.org/content/55/2/478
#COVID19
@drexelmed @DrexelMedGrad
What if iron released when 2019-SARS-nCoV attacks/breaks heme is causing acute cellular iron toxicity? Iron-mediated cell apoptosis? Could this be a piece of the progression of #COVID19? Would Vitamin D or calcium blockers (protective against Fe-mediated cell death) be helpful?
So many questions & brainstorming ideas. If you are caring for #COVID19 patient with severe hypoxia out of proportion to overall clinical picture, could you send co-oximetry instead of just arterial blood gases? Maybe we can determine if a hemoglobinopathy is present or not?
As we continue to brainstorm, I still think hemoglobinopathy, with decreased oxygen affinity, so less like MetHb and more like abnormal Hb that can't hold O2 well, and also more like high altitude as @cameronks suggests. #COVID19
