Does Nicotine Prevent Cytokine Storms in COVID-19?

Abstract

COVID-19 has a benign outcome in most cases, yet it can also be fatal and no specific treatment is available as of yet. Older age and several medical comorbidities are risk factors for COVID-19 complications. We report on an elderly man with a longstanding history of bipolar affective disorder associated with heavy smoking, alcohol abuse and multiple comorbidities, including severe chronic obstructive pulmonary disease and recurrent pulmonary sepsis, who contracted COVID-19 during his inpatient treatment of a manic episode, and who fully recovered from COVID-19 without any need for respiratory support. We discuss how his excessive use of nicotine replacement therapy may have contributed to his emerging unscathed from COVID-19. Nicotine, an α7-nACh receptor agonist, may boost the cholinergic anti-inflammatory pathway and hinder the uncontrolled overproduction of pro-inflammatory cytokines triggered by the SARS-CoV-2 virus, which is understood to be the main pathway to poor outcomes and death in severe COVID-19.

Keywords: alpha-7-nach receptor; bipolar affective disorder; cholinergic anti-inflammatory pathway; chronic obstructive pulmonary disease; cigarette smoking; covid-19; nicotine; nicotine replacement therapy; pro-inflammatory cytokines; sars-cov-2.

Figure 1. Chest radiograph taken on arrival to accident and emergency

Radiograph shows lung hyperinflation, consistent with chronic obstructive airways disease, and diffuse peripheral infiltrates suggestive of viral pneumonia.