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Review
. 2021 Aug 31;10(9):852.
doi: 10.3390/biology10090852.

The Role of Acidosis in the Pathogenesis of Severe Forms of COVID-19

Yury D Nechipurenko  1 , Denis A Semyonov  2   3 , Igor A Lavrinenko  4 , Denis A Lagutkin  5 , Evgenii A Generalov  6 , Anna Y Zaitceva  7 , Olga V Matveeva  8 , Yegor E Yegorov  9
Affiliations
Review

The Role of Acidosis in the Pathogenesis of Severe Forms of COVID-19

Yury D Nechipurenko et al. Biology (Basel). .

Abstract

COVID-19 has specific characteristics that distinguish this disease from many other infections. We suggest that the pathogenesis of severe forms of COVID-19 can be associated with acidosis. This review article discusses several mechanisms potentially linking the damaging effects of COVID-19 with acidosis and shows the existence of a vicious cycle between the development of hypoxia and acidosis in COVID-19 patients. At the early stages of the disease, inflammation, difficulty in gas exchange in the lungs and thrombosis collectively contribute to the onset of acidosis. In accordance with the Verigo-Bohr effect, a decrease in blood pH leads to a decrease in oxygen saturation, which contributes to the exacerbation of acidosis and results in a deterioration of the patient's condition. A decrease in pH can also cause conformational changes in the S-protein of the virus and thus lead to a decrease in the affinity and avidity of protective antibodies. Hypoxia and acidosis lead to dysregulation of the immune system and multidirectional pro- and anti-inflammatory reactions, resulting in the development of a "cytokine storm". In this review, we highlight the potential importance of supporting normal blood pH as an approach to COVID-19 therapy.

Keywords: Bohr effect; COVID-19; SARS-CoV-2; acidosis; hypoxia; lactate; pH; saturation.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
A diagram illustrating the relationship between viral lung damage and the occurrence of hypoxia.
Figure 2
Figure 2
A diagram illustrating the complex relationship between hypoxia and acidosis on the one hand and the development of inflammation.
Figure 3
Figure 3
Different factors influencing oxygen saturation of hemoglobin. During pH change from 7.4 to 7.2, saturation decreases two times. The concentration of 2,3-diphosphoglycerate provides saturation of hemoglobin with oxygen, along with CO2 pressure. pH, negative of the base 10 logarithm of the activity of the H+ ion; pCO2, partial pressure of carbon dioxide gas; 2,3-DPG, 2,3-diphosphoglycerate; p50, oxygen tension at 50% hemoglobin saturation.
Figure 4
Figure 4
Scheme of possible interventions to combat acidosis in patients with COVID-19.
Figure 5
Figure 5
A diagram illustrating the system of direct and inverse relationships between inflammation, hypoxia, and saturation.
See this image and copyright information in PMC

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