Potential new treatment strategies for COVID-19: is there a role for bromhexine as add-on therapy?
Depfenhart et al.
, Potential new treatment strategies for COVID-19: is there a role for bromhexine as add-on therapy?
, Internal and Emergency Medicine, doi:10.1007/s11739-020-02383-3 (Theory)
Proposal to use bromhexine to inhibit TMPRSS2-specific viral entry for prophylaxis and treatment of COVID-19.
Depfenhart et al., 26 May 2020, peer-reviewed, 5 authors.
Abstract: Internal and Emergency Medicine (2020) 15:801–812
IM - REVIEW
Potential new treatment strategies for COVID‑19: is there a role
for bromhexine as add‑on therapy?
Markus Depfenhart1,2 · Danielle de Villiers3 · Gottfried Lemperle4 · Markus Meyer5 · Salvatore Di Somma6,7
Received: 19 April 2020 / Accepted: 18 May 2020 / Published online: 26 May 2020
© Società Italiana di Medicina Interna (SIMI) 2020
Of huge importance now is to provide a fast, cost-effective, safe, and immediately available pharmaceutical solution to curb
the rapid global spread of SARS-CoV-2. Recent publications on SARS-CoV-2 have brought attention to the possible benefit
of chloroquine in the treatment of patients infected by SARS-CoV-2. Whether chloroquine can treat SARS-CoV-2 alone and
also work as a prophylactic is doubtful. An effective prophylactic medication to prevent viral entry has to contain, at least,
either a protease inhibitor or a competitive virus ACE2-binding inhibitor. Using bromhexine at a dosage that selectively
inhibits TMPRSS2 and, in so doing, inhibits TMPRSS2-specific viral entry is likely to be effective against SARS-CoV-2.
We propose the use of bromhexine as a prophylactic and treatment. We encourage the scientific community to assess bromhexine clinically as a prophylactic and curative treatment. If proven to be effective, this would allow a rapid, accessible,
and cost-effective application worldwide.
Keywords SARS-CoV-2 · COVID-19 · Prophylactic · Treatment · Bromhexine · Protease inhibitor
“Pandemic is not a word to use lightly or carelessly.” stated
Dr Tedros Adhanom Ghebreyesus, World Health Organization (WHO) Director-General, at a media briefing in March
2020 . According to the WHO, as of April 18, 2020,
coronavirus (CoV) disease 2019 (COVID-19) has caused
more than 2,000,000 confirmed cases globally, and close
to 150,000 deaths . As the world witnesses the alarming
* Markus Depfenhart
Faculty of Medicine, Venlo University B.V, Venlo,
Medical One Clinic Hamburg, Hamburg, Germany
Research and Development, Medika SA, Pretoria,
Division of Plastic Surgery, University of California,
San Diego, USA
Faculty of Medicine, Universitas Indonesia, Jakarta,
Department of Medical‑Surgery Sciences and Translational
Medicine, University of Rome Sapienza, Rome, Italy
GREAT Network Italy, Rome, Italy
levels of spread and severity of atypical pneumonia COVID19, strategies to combat this outbreak are in dire need. The
ripple effect of the COVID-19 outbreak is already starting
to come to fruition, having devastating effects on human
lives, globally impacting health systems and economies. The
flourishing COVID-19 outbreak is reminiscent of epidemics that have caused panic in recent memory. These include
SARS, MERS, the Zika virus, swine flu, and Ebola. This is
the third documented coronavirus (CoV) transmission from
animals to humans (zoonosis) in 2 decades. Previous outbreaks were severe acute respiratory syndrome coronavirus
(SARS-CoV) [3, 4] and Middle-East respiratory syndrome
coronavirus (MERS-CoV) . We are now dealing with
the novel CoV causing severe acute respiratory syndrome
(SARS), originally termed 2019-nCoV, and now designated
SARS-CoV-2 [6, 7].
CoVs are spherical enveloped single-stranded positivesense RNA viruses, characterized by club-like spikes that
project from their surface giving them..
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