Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2 or COVID-2019) is a novel emerging global health threatening pathogen, originating from Wuhan, China in December 2019 [1]. Understanding immunopathogenesis of COVID-19 is very important, not only in the management of complications, but also developing efficient treatment regimens. Why elderly adults with COVID-19 have poor treatment response and greater mortality than younger individuals? [2].
IL-6 is known to be potent mediator of inflammatory processes of elderly named Alzheimer disease. Improvement of dementia with cytotoxic treatment was reported in a case of Alzheimer disease. It has also been shown that decreased estrogen and testosterone level in elderly patient is unable to downregulate IL-6 gene expression [3], [4], [5]. Also, estrogen result in decrease pro-inflammatory cytokine IFN, IL-2, IL-6 TNF a production, and increased anti- inflammatory cytokine IL-4 and IL-5 production [6].
On the other hand, a variety of potantial anti-inflammatory agents are currently investigating in COVID-19. One of them is hydroxychloroquine via to inhibit immune response to the COVID-19 [1], [7]. It inhibits the production of TNF, IFNα, IL-6 and natural killer cell [8], [9], [10]. Moreover, co-medication of selective estrogen receptor modulatory with hydroxychloroquine is associated with eye toxicity due to synergistic inhibition of lysosomal enzymes [11].
Taken all together, it may be suggested that endogenous pro- inflamatory modulation agent (estrogen and testesteron) may be effective in management of elderly COVID-19 by decreasing pro-inflammatory cytokine. Also, doping administration of anabolizan steroids may slow progression of elderly COVID-19 with the effects mentioned above.
Declaration of Competing Interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Acknowledgement and financial support
We hereby declare that all authors have made a substantial contribution to the information submitted for publication; all have read and approved the final manuscript and the manuscript or portionsthereof are not under consideration by another journal. Also, we have no conflict of interest to report.
References:
- 1.Huang C., Wang Y., Li X. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497–506. doi: 10.1016/S0140-6736(20)30183-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Weiss P., Murdoch D.R. Clinical course and mortality risk of severe COVID-19. Lancet. 2020 doi: 10.1016/S0140-6736(20)30633-4. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Ozen M., Karaahmet F., Tezcan M.E., Bulut N., Altundag K. Estrogen or testosterone may be effective agents in the management of both multiple myeloma and Alzheimer's disease. Med Hypotheses. 2007;1:231–232. doi: 10.1016/j.mehy.2006.07.002. [DOI] [PubMed] [Google Scholar]
- 4.Ershler W.B., Keller E.T. Age-associated increased interleukin-6 gene expression, late-life diseases, and frailty. Annu Rev Med. 2000;51:245–270. doi: 10.1146/annurev.med.51.1.245. [DOI] [PubMed] [Google Scholar]
- 5.Keimowitz R.M. Dementia improvement with cytotoxic chemotherapy: a case of alzheimer disease and multiple myeloma. Arch Neurol. 1997;54(4):485. doi: 10.1001/archneur.1997.00550160111024. [DOI] [PubMed] [Google Scholar]
- 6.Mathad J.S., Gupta A. Pulmonary Infections in Pregnancy. Semin Respir Crit Care Med. 2017;38:174–184. doi: 10.1055/s-0037-1602375. [DOI] [PubMed] [Google Scholar]
- 7.Chen L., Liu H.G., Liu W. Analysis of clinical features of 29 patients with 2019 novel coronavirus pneumonia. Zhonghua Jie He He Hu Xi Za Zhi. 2020;43:E005. doi: 10.3760/cma.j.issn.1001-0939.2020.0005. [DOI] [PubMed] [Google Scholar]
- 8.Van den Borne, B. E, Dijkmans BA, de Rooij HH, le Cessie S, Verweij CL. Chloroquine and hydroxychloroquine equally affect tumor necrosis factor-alpha, interleukin 6, and interferon-gamma production by peripheral blood mononuclear cells.J. Rheumatol. 1997, 24, 55–60. [PubMed]
- 9.Wallace D.J., Linker-Israeli M., Hyun S., Klinenberg J.R., Stecher V. The effect of hydroxychloroquine therapy on serum levels of immunoregulatory molecules in patients with systemic lupus erythematosus. J Rheumatol. 1994;375–376 [PubMed] [Google Scholar]
- 10.Wallace D.J., Linker-Israeli M., Metzger A.L., Stecher V.J. The relevance of antimalarial therapy with regard to thrombosis, hypercholesterolemia and cytokines in SLE. Lupus. 1993;2:13–15. [PubMed] [Google Scholar]
- 11.Toimela T., Tahti H., Salminen L. Retinal pigment epithelium cell culture as a model for evaluation of the toxicity of tamoxifen and chloroquine. Ophthalmic Res. 1995;27:150–153. doi: 10.1159/000267861. [DOI] [PubMed] [Google Scholar]