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. 2021 Oct 19;912:174582. doi: 10.1016/j.ejphar.2021.174582

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Fig. 1 — The potential mechanistic pathways and treatments suggested for COVID-19-related smell loss. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) enters nasal epithelium, particularly with angiotensin-converting enzyme 2 (ACE2) and transmembrane protease serine 2 (TMPRSS2) receptors on sustentacular cells (SUSs). Damage to the olfactory sensory neurons (OSNs) could lead to a decrease in cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate cGMP levels, which can be inhibited by phosphodiesterase inhibitors (pentoxifylline, caffeine, and theophylline). Neuroprotective agents such as statins, minocycline, intranasal vitamin A, intranasal insulin, omega-3, and melatonin could regenerate olfactory receptor neurons (ORNs). Also, the inflammatory effects of the virus in the nasal epithelium can be blocked by corticosteroids, statins, and melatonin. BG, bowman's gland; GC, granule cell; MC, mitral cell; MVC, microvillar cell.