Inhalation of Nitric Oxide in the Treatment of Severe Acute Respiratory Syndrome: A Rescue Trial in Beijing

Abstract

Inhalation of nitric oxide (NO) improved arterial oxygenation and enabled the reduction of inspired oxygen therapy and airway pressure support in patients with severe acute respiratory syndrome (SARS). In addition, chest radiography showed decreased spread or density of lung infiltrates, and the physiological effects remained after termination of inhaled NO therapy. These findings suggest not only a pulmonary vasodilator effect of inhaled NO, but also an effect on SARS.

Broad-spectrum antivirals for the emerging Middle East respiratory syndrome coronavirus

“…39,64 Inhalational nitric oxide was used as rescue therapy for SARS and might be useful for treating MERS-CoV infection if organic nitric oxide donors such as S-nitro-N-acetylpenicillamine also show anti-MERS-CoV activity. 65,66 Antiviral peptides or neutralizing antibodies designed against heptad repeat region 2 of S2 which may inhibit membrane fusion and cell entry of SARS-CoV could theoretically be harnessed for MERS-CoV since the S2 region shared significant homology amongst betacoronaviruses. 67e70 Other agents with in vitro anti-SARS-CoV activities such as glycyrrhizin, baicalin, reserpine, aescin, valinomycin, niclosamide, aurintricarboxylic acid, mizoribine, indomethacin, chloroquine, and experimental agents like small interfering RNA (siRNA) and inhibitors targeting the binding interface between the S1 domian and receptor in vivo, should also be evaluated.…”

Nitric oxide up-regulates the glucocorticoid receptor and blunts the inflammatory reaction in porcine endotoxin sepsis*

“…Whether the modest effect of steroids in acute respiratory distress syndrome (20 -23) is due to down-regulation of the glucocorticoid receptor remains, however, to be shown. Similarly, the good result of INO, although anecdotal, in patients with severe acute respiratory syndrome during the epidemic in Beijing in 2003 might in part have been due to increased efficiency of the simultaneous high-dose steroid treatment (29). However, at present, it remains a speculation.…”

SARS: clinical presentation, transmission, pathogenesis and treatment options

“…In a controlled study comparing the use of NO (n = 6) and supportive treatment (n = 8) for severe respiratory failure, there was improvement in oxygenation after inhaled NO was administered and this allowed ventilatory support to be discontinued. Interestingly, the beneficial effects persisted after termination of NO inhalation [135]. NO has been shown to inhibit the replication cycle of SARS-CoV in vitro [136].…”