Acute Respiratory Distress Syndrome (ARDS) is a potentially fatal condition in which the lungs are severely damaged. Experts often associate ARDS with severe COVID-19. There is a link between high mortality and ARDS caused by COVID-19, so there is an urgent need for effective treatment.
Uncontrolled, excessive immune response to rapid SARS-CoV-2 replication is involved in the development of ARDS. A new study suggests that metoprolol, a beta-blocker approved for the treatment of high blood pressure, may alleviate pneumonia and improve clinical outcomes in patients with ARDS associated with COVID-19. About 14-33% of people with SARS-CoV-2 infection develop severe disease, and about two-thirds of people develop ARDS.
ARDS involves damage to lung tissue caused by inflammation and the accumulation of fluid in the alveoli where gas is exchanged with the blood vessels.
Fluid build-up in alveoli due to leaky blood vessels reduces the lungs' ability to deliver oxygen to the rest of the body. ARDS therefore requires admission to an intensive care unit (ICU) and the use of invasive mechanical ventilation to compensate for the reduced lung function.
ARDS is the leading cause of COVID-19 death and there is a lack of effective treatments for its severe COVID-19 disease.
A recent study in the Journal of the American College of Cardiology reports that metoprolol may reduce pneumonia and improve respiratory function in people with ARDS caused by COVID-19. Metoprolol is a beta blocker designed to treat high blood pressure and may be an inexpensive treatment for severe COVID-19.
In some cases of severe COVID-19, uncontrolled and over-activation of the immune system may occur in response to a rapidly replicating virus, causing ARDS and other complications, such as organ failure.
Beta-blockers that suppress the immune response
Beta-blockers are a class of drugs that block the action of two fight-or-flight hormones: adrenaline and norepinephrine. Doctors often use beta-blockers to treat cardiovascular conditions.
Dr. Sverre Kjeldsen, professorThe University of Oslo, which was not involved in the study, said:
"Patients with severe COVID-19 have the strongest sympathetic nervous system activation imaginable. The release of massive amounts of norepinephrine (norepinephrine) and adrenaline (epinephrine) damages almost every organ, including the lungs, and treatment with metoprolol at least partially inhibits the harmful effects of these catecholamines in the plasma. ”
As it turns out, beta-blockers may be candidates for treating patients with severe COVID-19 due to their ability to reduce inflammation and fight fluid build-up in the lungs.
A team led by scientists at the Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC) has shown that the beta-blocker metoprolol can reduce lung inflammation and improve blood oxygen levels. The results are from a small pilot study in COVID-19 patients with ARDS.
The first author of the study, Dr. Agustín Clemente-Moragón. CNIC employee said:
"In recent years, our research group (Translational Laboratory for Cardiovascular Therapy and Imaging) at Spain's National Center for Cardiovascular Research (CNIC) has generated a great deal of knowledge about the destructive and unique role of metoprolol beta-blocker against neutrophils."
"These experimental data prompted us to investigate in the MADRID-COVID pilot study whether a 3-day intravenous administration of metoprolol (15 milligrams each day) could produce promising results in patients with ARDS associated with COVID-19."
The course of the study
The study involved 20 COVID-19 patients with ARDS who received mechanical ventilation for less than 3 days. Patients were randomly assigned to receive metoprolol intravenously, i.e. directly into the vein, or standard care in the control group.
The experimental group consisted of 12 patients who received metoprolol daily for 3 days, while the remaining 8 patients in the control group received standard care.
Researchers collected blood samples and fluid from the lungs of the patients prior to treatment and on day four, 24 hours after the last dose of metoprolol.
They found that administration of metoprolol, compared to standard care, resulted in a reduction in the number of specific immune cells in fluid samples taken from the lungs of COVID-19 patients.
In particular, there was a decrease in neutrophil counts in fluid samples collected from the lungs of patients who had received metoprolol.
In addition, treatment with metoprolol lowered the level of pro-inflammatory cytokines such as MCP-1 inlungs and IL-8 in the blood.
Scientists also observed a decrease in markers related to the production of NET by neutrophils after treatment with metoprolol, indicating a reduction in activation of neutrophils.
These results suggest that metoprolol may reduce pneumonia and limit neutrophil recruitment and activation in COVID-19 patients with ARDS.
Clinical Results
By studying the effects of metoprolol on clinical outcomes, scientists found that administration of metoprolol improved blood oxygen levels.
It is worth noting that there were no side effects associated with the treatment with metoprolol.
The authors state that "administering the clinically approved metoprolol beta-blocker to critically ill patients with COVID-19-induced ARDS is safe and alleviates exacerbated disease-related pneumonia."
Treatment could be beneficial for all COVID-19 patients with no contraindications to metoprolol.
Limitations and restrictions
The researchers admit that the study had several limitations. First, they note that the study was of a small sample size and was conducted at a single location. In addition, there was a potential for bias as clinicians were aware of which patients were in the treatment and control groups.
To address these concerns, preparations have begun for a larger randomized, controlled trial to further test the ability of metoprolol to reduce pneumonia in patients with ARDS associated with COVID-19.
"While all these data have yet to be confirmed, our recent study may be sufficient to consider its use in some patients, such as young ICU patients with severe COVID-19," said Clemente-Moragón.
"This is not a COVID-19 treatment, but rather a way to ease an intense inflammatory response that is showing beneficial effects. This drug was administered to critically ill patients on a ventilator at the onset of the disease. Patients who were very ill and unstable could not receive this drug. ”- Dr. Senussi, medical director of Baylor St. Luke's Medical Center in Houston, Texas.
Author
Marcelina Dzięciołowska Editor for many years associated with the medical industry. He specializes in he alth and an active lifestyle. A private passion for psychology inspires her to take up difficult topics in this field. Author of a series of interviews in the field of psycho-oncology, the aim of which is to build awareness and break stereotypes about cancer. He believes that the right mental attitude can work wonders, that's whypromotes professional knowledge based on consultations with specialists.