Role of antioxidant therapy in patients with moderate and severe COVID-19


1Peoples' Friendship University of Russia (RUDN), Moscow, Russian Federation;

2V.V.Vinogradov City Clinical Hospital, Moscow Healthcare Department, Moscow, Russian Federation

The coronavirus disease COVID-19 is characterized by high mortality and the lack of effective etiotropic therapy. Activation of oxidative stress may be one of the links in the pathogenesis of organ damage of this infection. Objective. To assess the ability of Mexidol® to influence the rate of clinical improvement in pneumonia caused by the SARSCoV-2 virus in hospitalized patients with the novel coronavirus disease COVID-19 and concomitant discirculatory encephalopathy. 62 patients over the age of 18 years with confirmed new coronavirus disease COVID-19 according to computed tomography (CT) of the lungs (stages CT1, CT2, CT3) and PCR of a swab from the nasopharynx and oropharynx for SARS-CoV-2 virus RNA were included. After randomization patients of group 1 received an infusion of Mexidol® at a dose of 1000 mg/day, patients of group 2 – an infusion of isotonic sodium chloride solution for 7 days. Compared with the control group, the patients receiving Mexidol® therapy showed a significantly more pronounced decrease in body temperature, a tendency towards a decrease in the severity of shortness of breath. In the Mexidol® group, the concentration of superoxidedismutase did not change, while in the control group there was a tendency to its decrease, C-reactive protein decreased 2.2 times more than in the control group (p = 0.09). There was a tendency for a more rapid decrease in ferritin in the active intervention group. Mexidol® therapy can have a positive effect on the clinical manifestations and severity of laboratory-inflammatory syndrome in patients with the new coronavirus disease COVID-19. Key words: coronavirus disease COVID-19, oxidative stress, Mexidol.

Effects of mexidol in patients with chronic brain ischemia and chronic heart failure (II-III functional class)

1People’ Friendship University of Russia, Moscow, Russia;
2Pavlov Ryazan State Medical University, Ryazan, Russia

Aim. To study the effect of mexidol on N-terminal pro B-type natriuretic peptide (NT-proBNP), markers of oxidative stress, inflammatory reaction and endothelial dysfunction in patients with chronic brain ischemia and chronic heart failure II-III NYHA functional class while 13 weeks of sequential intravenous and oral therapy with mexidol and standard therapy. Material and methods. Study included 44 patients with chronic brain ischemia and chronic heart failure II-III NYHA functional class with ejection fraction less 50%. Mean age: 65.5±11.8 years, 75% men. 21 patients of group mexidol plus standard therapy of chronic heart failure received mexidol at a dose of 1000 mg/day by intravenous infusion for 7 days followed by oral doses of 250 mg three times a day for twelve weeks, 23 patients received standard therapy. 34 patients completed the trial, in 10 patient the final visit was performed as telephone call due to epidemiologic situation. Concentration of N-terminal pro B-type natriuretic peptide (NT-proBNP), markers of oxidative stress (malonic dialdehyde (MDA), superoxide dismutase (SOD)), inflammatory reaction (C-reactive protein (CRP), tumor necrosis factor α (TNFα)), homocysteine and cystatin C were examined in blinded manner in all patients initially, on day 7 and week 13. Results. Statistically significant more prominent decrease of NT-proBNP, MDA, CRP and TNFα and increase of SOD by day 7 and week 13 were observed in patients treated with mexidol along with standard therapy in comparison with group treated with standard therapy. Conclusion. Mexidol added to standard therapy of patients with chronic brain ischemia and chronic heart failure II-III functional class decreases concentration of NT-proBNP, has proven antioxidant activity, decreases the degree of inflammatory reaction, slows down the increase of homocysteine, does not influence the kidney function (by measurement of cystatin C).
Key words: chronic brain ischemia, heart failure, oxidative stress, antioxidants, N-terminal pro B-type natriuretic peptide (NT-proBNP), malonic dialdehyde, superoxide dismutase, CRP, TNFα, ethyl-methyl-hydroxipyridin succinate, mexidol.

Role of free radical oxidation, hypoxia and their correction in COVID-19 pathogenesis


Academician I.P. Pavlov Ryazan State Medical University of the Ministry of Healthcare of Russia

In following review, the pathogenesis of coronavirus disease of 2019 (COVID-19), the features of the SARS-CoV-2 virus, are shown in peculiarities. Due to big importance of oxidative stress and hypoxia in the development of this infection paid to, it has been suggested that the use of antioxidants and antihypoxants in the complex treatment of COVID-19 may be useful and significantly improve the course of the disease.
Key words: COVID-19, coronaviruses, oxidative stress, hypoxia.

Antioxidants/antihypoxants: the missing puzzle piece in effective pathogenetic therapy for COVID-19

V.V.Zakusov Research Institute of Pharmacology, Moscow, Russian Federation

This review focuses on the specific characteristics of COVID-19 disease, which leads not only to respiratory impairments (bronchoalveolar epithelium does not retain oxygen, etc.), but also decreases the level of hemoglobin and its ability to transfer oxygen to the organs and tissues and increases the level of heme, resulting in anoxemia, hypoxia in all organs and tissues, and oxidative stress. Mexidol, a drug developed in Russia, is widely used in clinical practice, including the treatment of diseases accompanied by ischemia and hypoxia. Mexidol has antihypoxic and antioxidant effects, can treat mitochondrial respiratory dysfunction, thereby affecting the key processes in different cells of organs and tissues that develop due to hypoxia. Mexidol can be useful in the comprehensive therapy of patients with COVID-19. Key words: COVID-19, antioxidant, antihypoxant, hemoglobin, hypoxia, Mexidol, mitochondrial dysfunction, oxidative stress.

The role of oxidative stress in the development of vascular cognitive disorders

Pirogov Russian National Research Medical University, Moscow, Russia;
Federal Center of Brain Research and Neurotechnologies, Moscow, Russia

Vascular cognitive impairment (VCI) is one of the most serious problems of clinical neurology, being the second most common cause of dementia. VCI covers a range of disorders in which vascular factors cause or contribute to cognitive decline. Among the main risk factors for VCI are old age and vascular factors, which lead to endothelial dysfunction and damage, which, in turn, can cause neurovascular dysfunction, increased permeability of the blood-brain barrier, and microvascular thrombosis. Oxidative stress is one of the most important mechanisms for the development of VCI that indicates the need for the use of agents with antioxidant activity. One of these drugs is ethylmethylhydroxypyridine succinate (mexidol). Mexidol is a drug with marked antioxidant and antihypoxic activities. The clinical efficacy of mexidol in relation to VCI has been demonstrated in many studies. Keywords: chronic cerebrovascular insufficiency, oxidative stress, vascular cognitive impairment, endothelial dysfunction, mexidol.