Bromhexine Hydrochloride: Potential Approach to Prevent or Treat Early Stage COVID-19

Abstract

The most critical step during viral infection is when viruses enter the cell. A novel coronavirusSARS-CoV-2 penetrates into alveolar cells through the transmembrane serine proteaseTMPRSS2. Extensive studies show that a clinically approved drug from Japan and South Korea,camostat mesylate inactivates TMPRSS2 in order to prevent the infection. However, these basicstudies have not been translated to “bedside”, and their effectiveness has not been clinicallyconfirmed yet. Here, we describe another potential antiviral substance, commonly used in theclinical practice as a mucolytics – bromhexine hydrochloride. Causing only few mild sideeffects, it may serve as either a new therapeutic strategy during early stages of the disease or apreventive agent blocking SARS-CoV-2 entry into alveolar cells through TMPRSS2.Therefore, in this review, we discuss these possible approaches based on the current data.

Bromhexine Hydrochloride Prophylaxis of COVID-19 for Medical Personnel: A Randomized Open-Label Study

“…8 The viral S-protein is attached to angiotensin-converting enzyme 2 (ACE2) of pneumocytes. Then it adheres to TMPRSS2 in S1 and S2-subunits, 2, 7, 8, 9, 10, 11, 12 providing the possibility for the virus to enter the cell. According to this mechanistic perspective, the protease TMPRSS2 can be targeted for preventing the penetration of the SARS-CoV-2 into cells.…”

“…The viral S-protein is attached to angiotensin-converting enzyme 2 (ACE2) of pneumocytes. Then it adheres to TMPRSS2 in S1 and S2-subunits [2, 7, 8, 9, 10, 11, 12]. providing the possibility for the virus to enter the cell.…”

A hypothesis on the role of the human immune system in covid-19

“…According to Rancé et al [26], sensitivity to allergens is more frequent among children older than 6 years; sensitivity increases over time as dermatological changes affect respiratory symptoms and result in more severe anaphylaxis in older children [27]. Reviewing these hypersensitivity theories is suggested as the cause of mild symptoms of COVID-19 in children.…”