Macrophages, lymphocytes, and eosinophils appear to be hyperactive in COVID19. So here’s my list of things to take to turn the cytokine storm into a drizzle. Note that many drugs are over the counter (OTC), meaning that the general public can protect themselves hopefully, too.
1. Losartan/Ramipril to block ACE1. ACE1 = CD143, inserted into the macrophage membrane during activation. All immune cells respond to angiotensin II, the product of ACE1.
2. Aspirin (e.g. enteric coated aspirin 81 mg a day). OTC
3. Omeprazole 20 mg a day (OTC; all other -prazole drugs can substitute. So can ANTABUSE! ) The idea is to keep the virus from entering the cytoplasm. The endosomes that deliver the virus to the cytoplasm must become more acidic. The vacuolar proton pump which does this can be inhibited by gastric proton pump inhibitors
4. Claritin-D or Allegra-D. (OTC) Yes, antihistamines can block the eosinophils involved in COVID19. Pseudo-ephedrine may maintain pulmonary endothelial cells'' tight junctions, preventing leak of protein-rich fluid into the air spaces (the “ground glass” on chest X-rays and CT scans).
5. Advair Diskus inhaler or any similar combination of steroid/beta2 agonist, e.g. fluticasone/beclomethasone and salmeterol/formoterol/albuterol. Note that Flonase is OTC.
6. Celebrex (to inhibit prostaglandin production by COX-2) (see ref. #7)
7. Pioglitazone (PPARgamma agonist) [PMC5068224]
8. Vitamins B3 (niacin) and D3 (to hasten macrophage maturation rather than proliferation)
9. NUCALA anti-IL5 mAb (GSK) for ECMO patients.
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