The use of antioxidants against high ferritin-induced oxidation in COVID-19 patients: a biochemical approach
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CE - LETTER TO THE EDITOR
The use of antioxidants against high ferritin‑induced oxidation in COVID‑19 patients: a biochemical approach Mustafa Şahin1 Received: 24 April 2020 / Accepted: 27 August 2020 © Società Italiana di Medicina Interna (SIMI) 2020
Dear Editor, The novel Coronavirus (SARS-CoV-2) outbreak, which began in Wuhan, China, in December 2019, was declared a pandemic by the World Health Organization (WHO) and the disease was named COVID-19. As of August 20, 2020, the disease was reported in 213 countries, with 22,613,985 cases and 791,709 deaths around the world. The outbreak is still spreading; the number of cases, the death rate, and the number of patients in intensive care units are increasing. However, no therapeutic agents or vaccines effective against coronavirus have been announced. Research about different treatment options is ongoing around the world to end the outbreak. Some laboratory tests, such as CK, LDH, D-dimer, ESR, CRP, procalcitonin and ferritin, have been shown to detect abnormalities in COVID-19 patients. Ferritin is known as an acute phase reactant, but evaluation of it as an acute phase reactant alone may be a deficiency for prognosis in this group of patients. In recent years, increasing evidence supports the idea that circulating high ferritin not only reflects the acute phase response, but also plays a critical role in inflammation. Ferritin is an important intracellular iron storage protein and has two subunits, H and L. H-ferritin plays a role not only in immunomodulatory functions but also in pro-inflammatory activity that results in the induction of expression of different inflammatory mediators, including IL-1β [1]. The concentration of free ferritin in circulation increases as a result of the binding of coronavirus to the iron molecule that binds oxygen in the hemoglobin molecule. Thus, the iron ion becomes a free molecule and the hemoglobin * Mustafa Şahin [email protected] 1
Department of Medical Biochemistry, Hitit University Erol Olçok Training and Research Hospital, Çorum, Turkey 19300
molecule cannot bind to oxygen. Thus, oxygen saturation is reduced. There is no data, yet that the virus interacts with the iron ion. Otherwise, the formation of free oxygen radicals increases with the increased concentration of ferritin, and typical oxidant effects occur in tissues and organs. Reactive oxygen species (ROS) play a key role in the acute respiratory distress syndrome (ARDS) pathophysiology in COVID19 and constitute the basis of the injury process. Increased free radical formation caused by high ferritin levels can be a marker of poor prognosis in these patients. However, considering the cytokine storm in COVID-19 patients, hyperferritinemia can be considered to be only part of inflammation and ROS formation, or one of many factors contributing to inflammation and ROS formation. It is not accurate to show that only hyperferritinemia is responsible for all inflammation in COVID-19 patients. Liu et al. emphasized that iron ions are necessary in replicatio
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