Is Inhaled Furosemide a Potential Therapeutic for COVID-19?

Abstract

The potentially lethal infection caused by the novel Severe Acute Respiratory Disease Coronavirus-2 (SARS-CoV-2) has evolved into a global crisis. Following the initial viral infection is the host inflammatory response that frequently results in excessive secretion of inflammatory cytokines (e.g., IL-6 and TNFα), developing into a self-targeting, toxic "cytokine storm" causing critical pulmonary tissue damage. The need for a therapeutic that is available immediately is growing daily but the de novo development of a vaccine may take years. Therefore, repurposing of approved drugs offers a promising approach to address this urgent need. Inhaled furosemide, a small molecule capable of inhibiting IL-6 and TNFα, may be an agent capable of treating the Coronavirus Disease 2019 cytokine storm in both resource-rich and developing countries. Furosemide is a "repurpose-able" small molecule therapeutics, that is safe, easily synthesized, handled, and stored, and is available in reasonable quantities worldwide.

Keywords: COVID-19; Cytokine storm; Furosemide; IL-6; SARS-CoV-2.

FIGURE 1

Chemical structures of the loop diuretics furosemide (A), piretanide (B), azosemide (C) and bumetanide (D); 3-HAA = 3-hydroxyanthranilic acid.

FIGURE 2

Chemical structure of the osmotic diuretic mannitol.