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Reactive oxygen species (ROS) and reactive nitrogen species (RNS) are produced in the cells through the mitochondrial respiratory chain during aerobic metabolism and in hypoxic conditions. Aged peoples have co-morbid diseases associated with depletion of endogenous anti-oxidants are in oxidative state, hyperresponsive lung with raised levels of IL-6.COVID-19 infection of the respiratory tract increases activation of pulmonary epithelial, endothelial cells and macrophages causes overproduction of cytokines, chemokines and free radicals induce massive sequestration of neutrophils within the pulmonary microvasculature transmigrate into alveolar space and release varieties of cytotoxic, pro-inflammatory compounds and free radicals prodigiously that perpetuates a vicious circle by recruiting additional inflammatory cells. Overproduction ROS causes depletion of anti-oxidants leading to oxidative stress and induces bystander injury in the host. Any critical illness associated with overproduction of ROS, which act as second messenger to activate the nuclear factor kappa-β(NF-kβ) and transcription factor activator protein-1(APC-1) cause aberrant production of many cytokines (IL-2,IL-1,IL-6 and TNF-α), hematopoietic growth factors and adhesion molecules. Cytokines such as IL-2, IL-1, IL-6 and TNFα have binding sites for NFkβ and APC-1 further perpetuating cytokine production in the vicious circle leading to cytokine storm with loss of immune regulation. Thus, ROS can regulate the production of cytokines. Edaravone as a broad spectrum anti-oxidant scavenges both water soluble and lipid soluble ROS have multiple pleotropic effects such as anti-inflammatory, immunomodulatory, anti-cytokine, anti-apoptotic, anti-necrotic, anti-fibrotic, membrane stabilizing, lung protective effects appears to be potentially useful agent in the prevention and therapy of COVID-19 induced cytokine storm and ARDS.

journal of medical science and clinical research

Edaravone: A Free Radical Scavenger with Multiple Pleotropic Actions can be a Potential Game Changer Agent in Prevention and Alleviation of COVID-19 - Induced Cytokine Storm