ACE2 receptor, TRL-4 and SARS CoV-2: Do long acting opioids and opioid
antagonists have potential for therapy?
Abstract
Despite the advent of a vaccine, broadening the arsenal of drugs
effective in the treatment and prevention of COVID-19 disease remains
critical in the global effort to control the SARSCoV2 pandemic. Opioids
and opioid antagonists may have a role in treating and in the prevention
of this disease based on a number of observations: an unexpectedly low
incidence of COVID-19 has been observed in patients treated for opioid
dependency with long acting opioid drugs such as methadone; opioids bind
to the ACE2 transmembrane protein, a molecule that is widely considered
to be main host cell receptor for SARS CoV2 cell entry; opioids have
systemic immunomodulatory effects which may influence the response to
the virus; studies aimed at repurposing drugs for treatment of COVID-19
have identified that opioids have therapeutic potential and finally
there are ongoing trials of some of these drugs. The interaction of long
acting opioids or opioid antagonists with the ACE2 receptor and the
possible effects on TLR4 function in SARS CoV2 infection should be given
serious consideration when developing effective therapies.
Note an updated version of this preprint is under review with the British Journal of Anaesthesia