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Review
. 2021 Jul;35(7):e22795.
doi: 10.1002/jbt.22795. Epub 2021 May 11.

Drug-induced organ injury in coronavirus disease 2019 pharmacotherapy: Mechanisms and challenges in differential diagnosis and potential protective strategies

Mohammad Mehdi Ommati  1   2 , Ali Mobasheri  3   4   5   6 , Reza Heidari  2
Affiliations
Review

Drug-induced organ injury in coronavirus disease 2019 pharmacotherapy: Mechanisms and challenges in differential diagnosis and potential protective strategies

Mohammad Mehdi Ommati et al. J Biochem Mol Toxicol. 2021 Jul.

Abstract

The world is currently facing an unprecedented pandemic caused by a newly recognized and highly pathogenic coronavirus disease 2019 (COVID-19; induced by SARS-CoV-2 virus), which is a severe and ongoing threat to global public health. Since COVID-19 was officially declared a pandemic by the World Health Organization in March 2020, several drug regimens have rapidly undergone clinical trials for the management of COVID-19. However, one of the major issues is drug-induced organ injury, which is a prominent clinical challenge. Unfortunately, most drugs used against COVID-19 are associated with adverse effects in different organs, such as the kidney, heart, and liver. These side effects are dangerous and, in some cases, they can be lethal. More importantly, organ injury is also a clinical manifestation of COVID-19 infection. These adverse reactions are increasingly recognized as outcomes of COVID-19 infection. Therefore, the differential diagnosis of drug-induced adverse effects from COVID-19-induced organ injury is a clinical complication. This review highlights the importance of drug-induced organ injury, its known mechanisms, and the potential therapeutic strategies in COVID-19 pharmacotherapy. We review the potential strategies for the differential diagnosis of drug-induced organ injury. This information can facilitate the development of therapeutic strategies, not only against COVID-19 but also for future outbreaks of other emerging infectious diseases.

Keywords: COVID-19; antiviral drug; biomarker; drug-induced organ injury; inflammation; oxidative stress; viral infection.

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Conflict of interest statement

The authors declare that there are no conflict of interests.

Figures

Figure 1
Figure 1
The diagnosis of COVID‐19‐induced organ injury from drug‐induced toxicities is a major clinical challenge
Figure 2
Figure 2
A schematic representative of inflammatory cell‐mediated reactive metabolites formation. Myeloperoxidase enzyme could produce reactive metabolites, leading to oxidative stress and/or directly affect different cellular targets
Figure 3
Figure 3
Prevent oxidative stress and protect cellular mitochondria as potential strategies to reduce/prevent drug‐induced organ injury in COVID‐19 pharmacotherapy
See this image and copyright information in PMC

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