Melatonin and Vitamin C May Be Useful in the Treatment of COVID-19 by Inhibiting the NLRP3 Inflammasomes of SARS-CoV-2
March 20, 2020
From Ahvie Herskowitz, MD and Devin Wilson, ND
Once SARS-CoV-2 is activated inside a human cell it releases NLRP3 inflammasomes which quickly initiates a cascade of largely uncontrolled cytokines and subsequent immune reactions.
Inflammasomes are an important part of our innate immune system as they sense viruses or other pathogens and respond by releasing a controlled amount of inflammatory cytokines to defend host cells. Cytokines are a double edged sword. When controlled they can support an appropriate immune response to defend our bodies. When uncontrolled or increased due to a virus they can lead to a cytokine storm and wreak havoc on the body. Cytokine storms can result in death due to severe organ damage and organ failure.
Recently, NLRP3 inflammasomes and the inflammatory cytokines it releases including IL-1beta and IL-18 have been implicated with severe inflammation, cytokine storm, tissue damage and the development of acute respiratory distress syndrome (ARDS) and acute lung injury (ALI).
Cardiovascular complications are also seen in COVID-19 patients. Reports from China show that a significant portion of COVID-19 patients with severe symptoms had underlying high blood pressure, heart disease and arrhythmia. 35% of patients who died from COVID-19 had a history of high blood pressure and 17% had a history of coronary heart disease.
The NLRP3 inflammasome of SARS-CoV-2’s is also responsible for negative effects on cardiovascular health. Inflammasomes have been clearly shown to be associated with the progression of atherosclerosis, heart attack and heart failure. This effect on cardiovascular health was also seen in SARS-Cov infection of 2003.
Melatonin, most commonly known for promoting sleep may be useful for mitigating the harmful effects of COVID-19 on lung and cardiovascular health. Melatonin may also be the reason why children under the age of 9 rarely show severe symptoms and why older patients have higher death rates.
Compared to healthy seniors, young children can easily have up to ten times the amount of melatonin levels. Melatonin concentration is highest in young children then declines with age. This decline becomes very steep after age 50 where production of melatonin is in negligible amounts.
According to a study, the maximal melatonin levels in healthy adults aged 65 to 75 years old is around 49.3 picograms while the maximal level of adults over the age of 75 is around 27.8 picograms. In contrast, the maximal melatonin level for children between 1 and 5 years old is 325 picograms while the maximal level of children ages 5 to 11 is around 133 picograms.
Melatonin may also be useful for preventing ventilator induced lung damage. COVID-19 patients with ARDS and ALI often require mechanical ventilation to assist with breathing. However, lung injury can be caused by the high ventilation pressures and high tidal volumes used by such devices. Melatonin has recently been shown to prevent ventilator induced lung damage in rodent models.
Vitamin C (Ascorbic acid), a common supplement used to support the immune system may also be useful in COVID-19. Similar to melatonin, vitamin C has also been shown to inhibit the NLRP3 inflammasome and decrease the release of inflammatory cytokines. In addition, vitamin C has strong anti-oxidant effects, reduces inflammation and improves endothelial function. Vitamin C also has anti-viral properties and can prevent ARDS and ALI. Currently, there a number of clinical trials taking place in China to investigate oral and intravenous vitamin C in COVID-19 patients. In fact, the government of Shanghai, China recently announced its official recommendation that COVID-19 should be treated with intravenous vitamin C.
Therefore, the combined use of melatonin and vitamin c may be an effective strategy for treating and preventing COVID-19. I recommended to Anatara Medicine staff to use 3 mg of melatonin at night and to take oral vitamin c 1000-3000 mg per day. If you have Vit C powder, you can likely take more Vit C, understanding that when you saturate your Vit C receptors, you will have a watery bowel movement.
For specific individualized treatment and prevention recommendations please contact our patient coordinators at 415-345-0099 or at firstname.lastname@example.org to schedule an appointment.
About Ahvie Herskowitz, MD
Dr. Herskowitz’s extensive training includes a medical degree from The Albert Einstein College of Medicine, residencies in Anatomic Pathology and Internal Medicine, and Fellowship training in Cardiology at The Johns Hopkins Medical Center. During his 12 years at Johns Hopkins, he became Associate Professor of Medicine and Immunology and Molecular Microbiology and led a research team in the study of molecular and immunological mechanisms of inflammation, autoimmunity, ischemia, heart transplantation rejection and congestive heart failure.
Dr. Herskowitz’s latest academic appointment was as Clinical Professor of Medicine at UC San Francisco. To learn more about Dr. Herskowitz, you can read it bio here.
About Devin Wilson, ND
Dr. Devin Wilson is a licensed Naturopathic Doctor in the state of California. He treats an array of acute and chronic diseases using a holistic and integrative approach to health. Dr. Wilson is also a health consultant, researcher and writer focusing on anti-aging and longevity medicine.
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