Zinc and respiratory tract infections: Perspectives for COVID‑19 (Review)

Skalny,Anatoly   V.; Rink,Lothar; Ajsuvakova,Olga   P.; Aschner,Michael; Gritsenko,Viktor   A.; Alekseenko,Svetlana  I.; Svistunov,Andrey   A.; Petrakis,Demetrios; Spandidos,Demetrios  A.; Aaseth,Jan; Tsatsakis,Aristidis; Tinkov,Alexey   A.

doi:10.3892/ijmm.2020.4575

Zinc and respiratory tract infections: Perspectives for COVID‑19 (Review)

Authors:
- Anatoly V. Skalny
- Lothar Rink
- Olga P. Ajsuvakova
- Michael Aschner
- Viktor A. Gritsenko
- Svetlana I. Alekseenko
- Andrey A. Svistunov
- Demetrios Petrakis
- Demetrios A. Spandidos
- Jan Aaseth
- Aristidis Tsatsakis
- Alexey A. Tinkov
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Affiliations: I.M. Sechenov First Moscow State Medical University (Sechenov University), 119146 Moscow, Russia, Institute of Immunology, Medical Faculty, RWTH Aachen University, D-52062 Aachen, Germany, Yaroslavl State University, 150003 Yaroslavl, Russia, Institute of Cellular and Intracellular Symbiosis, Russian Academy of Sciences, 460000 Orenburg, Russia, I.I. Mechnikov North‑Western State Medical University, 191015 St. Petersburg, Russia, Center of Toxicology Science and Research, Medical School, University of Crete, 71409 Heraklion, Greece, Laboratory of Clinical Virology, Medical School, University of Crete, 71409 Heraklion, Greece
Published online on: April 14, 2020 https://doi.org/10.3892/ijmm.2020.4575
Pages: 17-26
Copyright: © Skalny et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

In view of the emerging COVID‑19 pandemic caused by SARS‑CoV‑2 virus, the search for potential protective and therapeutic antiviral strategies is of particular and urgent interest. Zinc is known to modulate antiviral and antibacterial immunity and regulate inflammatory response. Despite the lack of clinical data, certain indications suggest that modulation of zinc status may be beneficial in COVID‑19. In vitro experiments demonstrate that Zn2+ possesses antiviral activity through inhibition of SARS‑CoV RNA polymerase. This effect may underlie therapeutic efficiency of chloroquine known to act as zinc ionophore. Indirect evidence also indicates that Zn2+ may decrease the activity of angiotensin‑converting enzyme 2 (ACE2), known to be the receptor for SARS‑CoV‑2. Improved antiviral immunity by zinc may also occur through up‑regulation of interferon α production and increasing its antiviral activity. Zinc possesses anti‑inflammatory activity by inhibiting NF‑κB signaling and modulation of regulatory T‑cell functions that may limit the cytokine storm in COVID‑19. Improved Zn status may also reduce the risk of bacterial co‑infection by improving mucociliary clearance and barrier function of the respiratory epithelium, as well as direct antibacterial effects against S. pneumoniae. Zinc status is also tightly associated with risk factors for severe COVID‑19 including ageing, immune deficiency, obesity, diabetes, and atherosclerosis, since these are known risk groups for zinc deficiency. Therefore, Zn may possess protective effect as preventive and adjuvant therapy of COVID‑19 through reducing inflammation, improvement of mucociliary clearance, prevention of ventilator‑induced lung injury, modulation of antiviral and antibacterial immunity. However, further clinical and experimental studies are required.

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