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Mourouzis I, Apostolaki V, Trikas A, Kokkinos L, Alexandrou N, Avdikou M, Giannoulopoulou M, Vassi A, Tseti I, Pantos C. The Potential of Thyroid Hormone Therapy in Severe COVID-19: Rationale and Preliminary Evidence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19138063. [PMID: 35805716 PMCID: PMC9265958 DOI: 10.3390/ijerph19138063] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/27/2022] [Accepted: 06/27/2022] [Indexed: 02/01/2023]
Abstract
Tissue hypoxia is one of the main pathophysiologic mechanisms in sepsis and particularly in COVID-19. Microvascular dysfunction, endothelialitis and alterations in red blood cell hemorheology are all implicated in severe COVID-19 hypoxia and multiorgan dysfunction. Tissue hypoxia results in tissue injury and remodeling with re-emergence of fetal programming via hypoxia-inducible factor-1α (HIF-1a)-dependent and -independent pathways. In this context, thyroid hormone (TH), a critical regulator of organ maturation, may be of relevance in preventing fetal-like hypoxia-induced remodeling in COVID-19 sepsis. Acute triiodothyronine (T3) treatment can prevent cardiac remodeling and improve recovery of function in clinical settings of hypoxic injury as acute myocardial infarction and by-pass cardiac surgery. Furthermore, T3 administration prevents tissue hypoxia in experimental sepsis. On the basis of this evidence, the use of T3 treatment was proposed for ICU (Intensive Care Unit) COVID-19 patients (Thy-Support, NCT04348513). The rationale for T3 therapy in severe COVID-19 and preliminary experimental and clinical evidence are discussed in this review.
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Affiliation(s)
- Iordanis Mourouzis
- Department of Pharmacology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Ave., Goudi, 11527 Athens, Greece; (I.M.); (V.A.); (A.T.); (I.T.)
| | - Vassiliki Apostolaki
- Department of Pharmacology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Ave., Goudi, 11527 Athens, Greece; (I.M.); (V.A.); (A.T.); (I.T.)
| | - Athanasios Trikas
- Department of Pharmacology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Ave., Goudi, 11527 Athens, Greece; (I.M.); (V.A.); (A.T.); (I.T.)
| | - Leonidas Kokkinos
- Department of Anesthesiology, ELPIS General Hospital of Athens, 11522 Athens, Greece; (L.K.); (N.A.); (M.A.); (M.G.); (A.V.)
| | - Natassa Alexandrou
- Department of Anesthesiology, ELPIS General Hospital of Athens, 11522 Athens, Greece; (L.K.); (N.A.); (M.A.); (M.G.); (A.V.)
| | - Maria Avdikou
- Department of Anesthesiology, ELPIS General Hospital of Athens, 11522 Athens, Greece; (L.K.); (N.A.); (M.A.); (M.G.); (A.V.)
| | - Myrto Giannoulopoulou
- Department of Anesthesiology, ELPIS General Hospital of Athens, 11522 Athens, Greece; (L.K.); (N.A.); (M.A.); (M.G.); (A.V.)
| | - Aimilia Vassi
- Department of Anesthesiology, ELPIS General Hospital of Athens, 11522 Athens, Greece; (L.K.); (N.A.); (M.A.); (M.G.); (A.V.)
| | - Ioulia Tseti
- Department of Pharmacology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Ave., Goudi, 11527 Athens, Greece; (I.M.); (V.A.); (A.T.); (I.T.)
| | - Constantinos Pantos
- Department of Pharmacology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Ave., Goudi, 11527 Athens, Greece; (I.M.); (V.A.); (A.T.); (I.T.)
- Correspondence: ; Tel.: +30-210-746-2560; Fax: +30-210-746-2562
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