Ингаляционная терапия коморбидного пациента с COVID-19 высокими дозами оксида азота: клинический случай

В статье описан клинический случай терапии коморбидной пациентки с тяжелым течением COVID-19 с использованием ингаляционной терапии высокими дозами оксида азота (NO). Воздушный поток, содержащий NO, был генерирован при помощи аппарата «ПЛАЗОН». Данная терапия проводилась в качестве жизнеспасающей в связи с отсутствием эффекта от лечения, проводимого согласно действующим национальным клиническим рекомендациям по терапии COVID-19. Продемонстрирована безопасность и клиническая эффективность примененной методики.

1. Ichinose F., Roberts J.D. Jr., Zapol W.M. Inhaled nitric oxide: A selective pulmonary vasodilator: Current uses and therapeutic potential. Circulation. 2004;109(25):3106–3111. DOI: 10.1161/01.CIR.0000134595.80170.62.

2. Mehta D.R., Ashkar A.A., Mossman K.L. The Nitric Oxide Pathway Provides Innate Antiviral Protection in Conjunction with the Type I Interferon Pathway in Fibroblasts. PLoS One. 2012;7(2):e31688. DOI: 10.1371/journal.pone.0031688.

3. Åkerström S., Gunalan V., Keng C.T., Tan Y.-J., Mirazimi A. Dual effect of nitric oxide on SARS-CoV replication: Viral RNA production and palmitoylation of the S protein are affected. Virology. 2009;395(1):1–9. DOI: 10.1016/j.virol.2009.09.007.

4. Xu W., Zheng S., Dweik R.A., Erzurum S.C. Role of epithelial nitric oxide in airway viral infection. Free Radic. Biol. Med. 2006;41(1):19–28. DOI: 10.1016/j.freeradbiomed.2006.01.037.

5. Klingstrom J., Åkerström S., Hardestam J., Stoltz M., Simon M., Falk K.I. et al. Nitric oxide and peroxynitrite have different antiviral effects against hantavirus replication and free mature virions. Eur. J. Immunol. 2006;36(10):2649–2657. DOI: 10.1002/eji.200535587.

6. Jung K., Gurnani A., Renukaradhya G.J., Saif L.J. Nitric oxide is elicited and inhibits viral replication in pigs infected with porcine respiratory coronavirus but not porcine reproductive and respiratory syndrome virus. Vet. Immunol. Immunopathol. 2010;136(3-4):335–339. DOI: 10.1016/j.vetimm.2010.03.022.

7. Uehara E.U., de Stefano Shida B., de Brito C.A. The role of nitric oxide in immune responses against viruses is beyond microbicidal activity. Inflamm. Res. 2015;64(11):845–852. DOI: 10.1007/s00011-015-0857-2.

8. Vanin A.F. Dinitrosyl iron complexes with thiolate ligands: Physico-chemistry, biochemistry and physiology. Nitric. Oxide. 2009;21(1):1–13. DOI: 10.1016/j.niox.2009.03.005.

9. Vanin A.F. Dinitrosyl Iron сomplexes as a “working form” of nitric oxide in living organisms. Cambridge, UK: Cambridge Scholars Publ.; 2019:276.

10. Vanin A.F. Dinitrosyl iron complexes with thiol-containing ligands can suppress viral infections as donors of the nitrosonium cation (hypothesis). Biophysics (Oxf.). 2020;65(4):698–702. DOI: 10.1134/ S0006350920040260.

11. Deppisch C., Herrmann G., Graepler-Mainka U., Wirtz H., Heyder S., Engel C. et al. Gaseous nitric oxide to treat antibiotic resistant bacterial and fungal lung infections in patients with cystic fibrosis: A phase I clinical study. Infection. 2016;44(4):513–520. DOI: 10.1007/s15010-0160879-x.

12. Miller C., McMullin B., Ghaffari A., Stenzler A., Pick N., Roscoe D. et al. Gaseous nitric oxide bactericidal activity retained during intermittent high-dose short duration exposure. Nitric. Oxide. 2009;20(1):16–23. DOI: 10.1016/j.niox.2008.08.002.

13. Ma L., Wang W., Le Grange J.M., Wang X., Du S. Li C. et al. Coinfection of SARS-CoV-2 and other respiratory pathogens. Infect. Drug Resist. 2020;13:3045–3053. DOI: 10.2147/IDR.S267238.

14. Kim D., Quinn J., Pinsky B., Shah N.H., Brown I. Rates of co-infection between SARS-CoV-2 and other respiratory pathogens. JAMA. 2020;323(20):2085–2086. DOI: 10.1001/jama.2020.6266.

15. Kobayashi J., Murata I. Nitric oxide inhalation as an interventional rescue therapy for COVID-19-induced acute respiratory distress syndrome. Ann. Intensiv. Care. 2020;10(1):61. DOI: 10.1186/s13613-020-00681-9.

16. Kamenshchikov N.O., Berra L., Carroll R.W. Therapeutic effects of inhaled nitric oxide therapy in COVID-19 patients. Biomedicines. 2022;10(2):369. DOI: 10.3390/biomedicines10020369.

17. Kamenshchikov N.O., Kozlov B.N., Dish A.Y., Podoksenov Y.K., Anfinogenova N.D., Boshchenko A.A. et al. Abstract 11986: A Safety Study of Intermittent versus Continuous Inhaled NO Therapy in Spontaneously Breathing COVID-19 Patients: A Randomized Controlled Trial. Circulation. 2021;144(1):A11986.

18. McMahon T.J., Doctor A. Extrapulmonary effects of inhaled nitric oxide: Role of reversible S-nitrosylation of erythrocytic hemoglobin. Proc. Am. Thorac. Soc. 2006;3(2):153–160. DOI: 10.1513/pats.200507-066BG.