Trials of arsenic trioxide therapy should be envisioned for severely respiratory distress syndrome related to a cytokine storm in COVID-19 patients

Abstract

It is becoming more and more obvious, and even consensual, that the Coronavirus Disease 2019 (COVID-19) is composed of two distinct phases. The first one is the early episode of infection by the highly contagious SARSCoV- 2 virus. The virus gains access to the type- 2 surfactant secreting alveolar cells of the host lungs via the angiotensin converting enzyme 2 (corresponding gene: ACE2) as a main membrane receptor [1]. It then enters the cells thanks to Janus kinases (JAKs)-mediated endocytosis process, as discussed by Stebbing et al., 2020 or Favalli et al., 2020) [2,3] and starts replicating. The second one is clearly related to an excessive release of immune mediators, cytokines or chemokines, which are very recently thought to lead to some 15-20 % of the COVID 19 patients, who develop life threathening severe respiratory distress syndrome [4-6]. However, the treatment of these patients is particularly difficult, as no specific drug therapy is currently recommended.