Beta-adrenergic blocker treatment for COVID-19

More than 2.5 million people were affected by COVID-19 and it had caused around 175000 deaths as of April 23, 2020. Currently no effective treatment option is present for COVID-19 patients. Even though many drugs have been proposed, none of them showed its efficacy in clinical trials. In this article, I had briefly reviewed the current scenario of COVID-19 condition, and focused on the Adrenergic system- RAAS relation in COVID-19 and proposed a vicious Adrenergic system-RAAS-ACE2-SARS-CoV-2 (ARAS) loop. Hyperactivation of ARAS loop may be the underlying pathophysiological mechanism in COVID-19. I had proposed beta-adrenergic blockers as a potential treatment option for treating COVID-19. Beta-adrenergic blockers by its negative regulation of RAAS pathway may decrease ACE2 receptors expression and CD147 in various cells in the body including typeII pulmonary alveolar epithelial cells and decrease the SARS-CoV-2 virus cellular entry. Beta-adrenergic blocker may also exert beneficial affects through inhibition of NLRP3 inflammasome, and reduction of proinflammatory cytokines like IL-6, reduced expression of MUC5AC, and decreasing airway mucus secretion. Beta-adrenergic blockers may decrease the morbidity and mortality in COVID-19 patients by preventing or reducing the ARDS, pulmonary embolism, pulmonary edema, refractory hypoxemia, and Septic shock complications. Considering potential beneficial effects of beta-adrenergic blockers in COVID-19, retrospective and prospective clinical trials needs to conducted to check the validity of the hypothesis and clarify its role in COVID-19. I had speculated that Beta2-adrenergic agonists use in the nebulizers and norepinephrine use in the COVID-19 patients having septic shock may worsen the condition. I suggest that Beta-adrenergic blockers should be used in the treatment of COVID-19, and norepinephrine, beta2-adrenergic agonists should be avoided in COVID-19.