Covid -19 is a viral disease play important role in danger pathogens for human, it is infecting on respiratory, hepatic, central nervous systems and gastrointestinal, in addition to that, the triggers included cytokine storm is inflammatory response to viral infection
Therefore, excessive enhance of immune cells lead to new of pro-inflammatory cytokines. COVID-19 interaction with the cardiovascular system on different levels, rising death percent in people underlying cardiovascular state provoking myocardial injury. Respiratory infection varying from mild cold to the severe illness like as Middle East Respiratory Syndrome and Severe Acute Respiratory Syndrome the most important coronavirus (COVID-19) complications, however individuals with asymptomatic disease were also suspected of possible infectious transmission, which further adds to the uncertainty of the dynamic of disease transmission in COVID-19 infections, Suppression of angiotensin-converting enzyme (ACE2) expression by inflammatory cytokines accompanied by the decrease of estrogens and androgens of the elderly, establish a negative correlation between ACE2 expression and mortality in other cases may lead to infertility. Early detection by PCR has aided the identification of the pathogen at an early level. Furthermore, the treatment includes the effectiveness of glucocorticoid drugs (dexamethasone), anti-malaria drug (hydroxychloroquine), azithromycin (antibacterial drug) and favipiravir are all drugs recommended in illness with Covid-19. Remdesivir suppression COVID-19 replication and decreases viral load, alleviates clinical signs and improves pulmonary injury, therefore Remdesivir drug has been used as a compassionate medicine for treating COVID-19 patients.
Hepatotoxicity is a term used to describe serious health complications of liver disease caused by a variety of factors. Nuclear factor erythroid-2 linked factor (Nrf2) as a potential mediator of hepatotoxicity via inflammatory and induction of oxidative stress, oxidation
produces more toxic compounds caused more pathogenic cases; therefore, to maintain sufficient homeostasis, involve antioxidant materials and detoxification factors. Controlling cytokine activity in normal cells is a useful way to regulate the signaling pathway of Nrf2. Recent studies found a relation between each Nrf2 and NF-κB activation and drug-induced liver injury. This review presents a detailed and conformation update of Nrf2 roles in hepatotoxicity which considers that drug-induced liver injury is the main problem to draw attention in medical clinics and to develop new drugs with less harmful to the liver. In addition to that. Kept each of normal oxidation and cytokines levels is crucial responses for cells alteration and remaining to survive.
Hepatic encephalopathy (HE) is a neurological and psychological syndrome related to acute and chronic liver failure especially during cirrhosis, it is associated with over production of ammonia in gastrointestinal tract with failure excretion by the liver in addition to increased free radical and bacterial transmission have played an important role. A symptom of disease includes coma, ophthalmia, irregular sleeping, stress and difficult breathing. It may be develop to intestinal bleeding; reduced blood pressure and electrolyte disturbances. Myasthenia is early symptoms of muscle dystrophies and prevalence of antibodies against acetylcholine receptors, nicotine receptors, tyrosine kinase and low-density lipoprotein proteins thus severely weakening muscles and skeletons have been demonstrated, it is playing important role in myasthenia progressing especially after five years of liver antibodies detection. Recently, the treatment is mainly depending on the reduced intestinal ammonia with non-absorbent disaccha¬rides from intestine and MRI should be used to follow up in addition to newer immunosuppressive drugs such as Rifaxamin, an inhibitor of interleukins and steroids is very important to treat this disease.
Nrf2 is active protein presents in the cytoplasm in the cells of the body. In the presence of an activators, Nrf2 can enter the nucleus which bind to Antioxidant Responses Elements (ARE) or otherwise named human ARE (hARE) which control the whole antioxidants activity in
human cell. Many factors may contribute to defective or overwhelmed cellular antioxidants activities for instances aging and cellular damages. These cellular damages can be produced by free radicals or oxidative stress. In the mechanism, if Nrf2 activated in the nucleus, can caused the production of collaborative antioxidants enzymes especially: catalase, glutathione (GLT) and superoxide dismutase (SOD) as a responsible for detoxification of free radical inside the cells.
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