Friday, April 24, 2020

Can Nicotine Treat COVID-19? French Researchers Think So.

By Elizabeth Nolan Brown - April 24, 2020 at 09:30AM

New study will test whether nicotine patches can keep the coronavirus away. The more we find out about COVID-19, the less sense it makes. Originally seen as a standard respiratory ailment that primarily affected the lungs, there's mounting evidence that COVID-19 can cause serious damage to the heart, neurological system, and kidneys, too. In young people, it's been shown to sometimes cause sudden strokes, even absent other symptoms. Doctors are also reporting COVID-19 patients with blood clots.

One particularly weird element is conflicting reports on whether cigarette smokers are more or less likely to get COVID-19 and whether they have worse cases if they do.

Now, in France, they're testing whether nicotine may help prevent COVID-19 infections.

It might sound zany at first, or like a piece of bad satire about French people (What's next, testing to see if baguettes and brie cure COVID-19?), but there's actually good evidence that nicotine plays a role in regulating humans' response to the virus.

"It's an interesting possibility," and "we'll know more soon," French Health Minister Olivier Veran said on France Inter radio this week.

The mitigating effect of nicotine could explain conflicting results on smokers and COVID-19.

Initially, high rates of smoking in places like China and Italy were offered as reasons why the illness might be striking these places especially hard. In Wuhan, China, "the percent of current and former smokers were higher among the severe cases: 17% and 5%, respectively, than among the nonsevere cases (12% and 1%, respectively)," according to an article published in Nicotine & Tobacco Research on April 3.

Worse outcomes for smokers still might be the case—smoking involves a lot more than just nicotine, and many of the health issues seen in long-term smokers are the same underlying conditions that have been found to provoke more severe symptoms of COVID-19.

Yet "doctors at the Pitie-Salpetriere hospital in Paris observed that few Covid-19 patients hospitalized were smokers," notes Bloomberg.

Some have theorized this away by noting that old age is a hospitalization risk factor, and smokers are less likely to live to an older age. But others are trying to tease out whether there's a possible mechanism by which smoking could prove protective.

"Based on the current scientific literature and on new epidemiological data which reveal that current smoking status appears to be a protective factor against the infection by [COVID-19], we hypothesize that the nicotinic acetylcholine receptor (nAChR) plays a key role in the pathophysiology of Covid-19 infection and might represent a target for the prevention and control of Covid-19 infection," wrote French researchers in an April 21 paper.

How would this work? Well, it's known that COVID-19 binds to a protein in the human body called angiotensin-converting enzyme 2 (ACE2), and previous research has shown that nicotine helps regulate ACE2 expression. The authors of the paper hypothesize a way in which this could contribute to a lessening of the hyper-inflammation thought to be responsible for some of the worst cases of COVID-19.

"Until recently, no firm conclusions could be drawn from studies evaluating the rates of current smokers in Covid-19," states the paper. More:

All these studies, although reporting low rates of current smokers, ranging from 1.4% to 12.5%, did not take into account the main potential confounders of smoking including age and sex.

In the study that two of us are reporting, the rates of current smoking remain below 5% even when main confounders for tobacco consumption, i.e. age and sex, in- or outpatient status, were considered. Compared to the French general population, the Covid-19 population exhibited a significantly weaker current daily smoker rate by 80.3 % for outpatients and by 75.4 % for inpatients. Thus, current smoking status appears to be a protective factor against the infection by SARS-CoV-2.

Although the chemistry of tobacco smoke is complex, these data are consistent with the hypothesis that its protective role takes place through direct action on various types of nAChRs expressed in neurons, immune cells (including macrophages), cardiac tissue, lungs, and blood vessels.

No one is suggesting that people take up smoking to ward off the new coronavirus. But nicotine can be introduced into the body in ways other than smoking—French scientists will be using nicotine patches for their upcoming study. And synthetic substitutes for nicotine may be able to overcome any possible addiction issues.

"There are substitutes to nicotine that can be developed in laboratories that would enable [users] to avoid its addictive effects," Veran said on French radio.

Back in the U.S., health regulators were warning that smoking cigarettes or vaping could increase COVID-19 complications. Food and Drug Administration officials have since backed down on the vaping aspect. "E-cigarette use can expose the lungs to toxic chemicals, but whether those exposures increase the risk of COVID-19 is not known," it told Bloomberg News.

Meanwhile, at the White House: President Donald Trump suggested in a televised Thursday night address that since disinfectants (like bleach and Lysol) work at killing the new coronavirus on surfaces outside the body, perhaps an "injection" could work as a cure. (Yes, really.)

Since then, companies like Lysol have put out statements declaring that—contra the leader of the country—injecting, ingesting, or otherwise imbibing disinfectant cleaners is not safe. (The New York Times would only attribute the don't-drink-bleach position to "some experts," as if this is really a matter up for debate…)


QUICK HITS

• New Jersey tried to tell prisoners released because of COVID-19 that they weren't allowed to talk to the media. The American Civil Liberties Union (ACLU) intervened.

• "A federal court extended relief for Ohio patients today by continuing to block the Ohio Department of Health from using its COVID-19 order to ban abortion access," the ACLU announced Thursday. In addition, the U.S. Court of Appeals for the 11th Circuit rejected Alabama's attempt to reverse an earlier court ruling against its attempted abortion ban.

• Researchers wonder whether COVID-19 will create demographic change, disproportionately killing off Trump voters, who tend to skew older.

• In case you had any doubt about whether to voluntarily participate in contact tracing app efforts, this should swing you firmly into stay-the-hell-away territory.


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