Glutathione In Respiratory Health and Covid 19 Outcome

If you are interested in antioxidants, you sure have heard of glutathione. If you want to learn more about its possible effects, then you are in for a good read. In this article I will share some recent studies regarding its use, especially against some respiratory diseases.


Glutathione, a Monarch Antioxidant.


Glutathione is an antioxidant involved in DNA synthesis and repair, prevention of oxidative cell damage, metabolism of toxins and carcinogens and even immune system function.


It is a tripeptide which plays a key role in the control of pro-inflammatory processes. Several studies show the protective effects of glutathione and its precursors against inflammatory pathologies of the lung.



Lung is Constantly Exposed to Oxidants.





Lung is unlike other organs, as it is constantly exposed to air and airborne pollutants including oxidant gasses. Inhaled oxidants initiate a number of pathologic processes, including inflammation of the airways which may contribute to the pathogenesis and/or exacerbation of airways disease.


Since glutathione not only deals with oxidants but also affects inflammation, changes in alveolar and lung glutathione metabolism are widely recognized as main features of many inflammatory lung diseases.


Lungs Benefits from Glutathione, Studies Say.


The study on Acute Respiratory Distress Syndrome (ARDS) patients reported that supplementation of glutathione precursor, N-acetylcysteine (NAC), resulted in the prevention of this aggravating condition which includes lung cell injury and inflammation.


Same is true for patients with idiopathic pulmonary fibrosis who were subjected to a therapy with NAC to restore depleted pulmonary glutathione levels that turned out better than standard therapy alone. It significantly slows the rate of deterioration and preserves vital capacity for these patients.

Higher levels of glutathione have also been associated with better individual’s responsiveness to viral infections and resistance to viral diseases. A study revealed a significant decrease in the frequency of influenza-like episodes, severity, and length of time confined to bed, especially in higher risk elderly populations.


CoronaVirus (Covid 19) and Glutathione.





Up to this date, no published treatment has been shown to adequately control the inflammation and respiratory symptoms associated with COVID-19 aside from oxygen therapy and assisted ventilation but recent studies show great potential.


Polonikov studied four moderate-severe COVID-19 cases and found that patients with normal/ high glutathione plasma level recovered rapidly while the one with low levels experienced the most severe illness. Case study by Horowitz et al. reported using high dose glutathione in the treatment of two patients with difficulty of breathing secondary to COVID-19 pneumonia that improved their dyspnea within 1 hour of use. Repeated use proved to be effective in further relieving respiratory symptoms according to the study. In another case report, nine severely ill patients successfully treated with NAC.


These studies, although referring to only fifteen cases, highlight the relevance of poor glutathione levels in COVID-19 clinical progression. Suggesting that low levels of glutathione could be one of the major causes of the excessive inflammatory response linked to severe COVID-19 symptoms and increasing body glutathione could reduce the number of symptomatic patients.




Conclusion:


It is important to note that the major risk factors for severe COVID-19 illness are aging, comorbidities, smoking, all characterized by low glutathione level and linked with high oxidative stress. Hence, further depletion of glutathione stores should be carefully avoided.


Glutathione levels should be maintained especially in patients with severe inflammatory response syndrome to counteract oxidative stress and end-organ damage. Further knowledge of the mechanisms of glutathione regulation and balance could lead to the development of novel therapies in preventing lung inflammation and injury.


In this current time, Glutathione and its precursors may give us hope and represent a novel treatment approach in addressing life-threatening systemic inflammation and respiratory distress in patients, like with COVID-19 pneumonia.


References:


Ciencewicki, J., Trivedi, S., & Kleeberger, S. R. (2008). Oxidants and the pathogenesis of lung diseases. The Journal of allergy and clinical immunology, 122(3), 456–470. https://doi.org/10.1016/j.jaci.2008.08.004


Ghezzi P. (2011). Role of glutathione in immunity and inflammation in the lung. International journal of general medicine, 4, 105–113. https://doi.org/10.2147/IJGM.S15618

Horowitz, R. I., Freeman, P. R., & Bruzzese, J. (2020). Efficacy of glutathione therapy in relieving dyspnea associated with COVID-19 pneumonia: A report of 2 cases. Respiratory medicine case reports, 30, 101063.


Ibrahim, H., Perl, A., Smith, D., Lewis, T., Kon, Z., Goldenberg, R., et al. (2020). Therapeutic blockade of inflammation in severe COVID-19 infection with intravenous N-acetylcysteine. Clin. Immunol. 219, 108544. doi: 10.1016/j.clim.2020.108544


Polonikov, A. (2020). Endogenous deficiency of glutathione as the most likely cause of serious manifestations and death in COVID-19 patients. ACS infectious diseases, 6(7), 1558-1562.


Rahman, I., & MacNee, W. (2000). Oxidative stress and regulation of glutathione in lung inflammation. European Respiratory Journal, 16(3), 534-554.


Sestili, P., & Fimognari, C. (2020). Paracetamol-induced glutathione consumption: is there a link with severe COVID-19 illness?. Frontiers in pharmacology, 11, 1597.


Silvagno, F., Vernone, A., & Pescarmona, G. P. (2020). The role of glutathione in protecting against the severe inflammatory response triggered by COVID-19. Antioxidants, 9(7), 624.