Ivermectin for COVID-19
4th treatment shown to reduce risk in
August 2020, now with p < 0.0000000001 from 106 studies, recognized in 24 countries.
No treatment is 100% effective.
Protocols combine treatments.
In vitro and animal study showing immunomodulatory benefits of ivermectin against SARS-CoV-2 via cholinergic (α7nAChR) and purinergic (P2X4) receptor pathways.
78 preclinical studies support the efficacy of ivermectin for COVID-19:
Ivermectin, better known for antiparasitic activity, is a broad spectrum antiviral with activity against many viruses including H7N775, Dengue40,76,77 , HIV-177, Simian virus 4078, Zika40,79,80 , West Nile80, Yellow Fever81,82, Japanese encephalitis81, Chikungunya82, Semliki Forest virus82, Human papillomavirus60, Epstein-Barr60, BK Polyomavirus83, and Sindbis virus82.
Ivermectin inhibits importin-α/β-dependent nuclear import of viral proteins75,77,78,84 , shows spike-ACE2 disruption at 1nM with microfluidic diffusional sizing41, binds to glycan sites on the SARS-CoV-2 spike protein preventing interaction with blood and epithelial cells and inhibiting hemagglutination44,85, shows dose-dependent inhibition of wildtype and omicron variants39, exhibits dose-dependent inhibition of lung injury65,70, may inhibit SARS-CoV-2 via IMPase inhibition40, may inhibit SARS-CoV-2 induced formation of fibrin clots resistant to degradation10, inhibits SARS-CoV-2 3CLpro57, may inhibit SARS-CoV-2 RdRp activity1,29, may minimize viral myocarditis by inhibiting NF-κB/p65-mediated inflammation in macrophages64, may be beneficial for COVID-19 ARDS by blocking GSDMD and NET formation86, may interfere with SARS-CoV-2's immune evasion via ORF8 binding5, may inhibit SARS-CoV-2 by disrupting CD147 interaction87-90, may inhibit SARS-CoV-2 attachment to lipid rafts via spike NTD binding3, shows protection against inflammation, cytokine storm, and mortality in an LPS mouse model sharing key pathological features of severe COVID-1962,91, may be beneficial in severe COVID-19 by binding IGF1 to inhibit the promotion of inflammation, fibrosis, and cell proliferation that leads to lung damage9, significantly mitigates bleomycin-induced pulmonary fibrosis by reducing collagen accumulation and inflammatory cell infiltration63, improves oxidative stress markers while suppressing myofibroblast proliferation63, mitigates lung pathology and anosmia in vivo while regulating the CXCL10/CXCL5 inflammatory axis via P2X4 and α7nAChR receptor modulation92, may minimize SARS-CoV-2 induced cardiac damage43,51, may counter immune evasion by inhibiting NSP15-TBK1/KPNA1 interaction and restoring IRF3 activation93, may disrupt SARS-CoV-2 N and ORF6 protein nuclear transport and their suppression of host interferon responses2, reduces TAZ/YAP nuclear import, relieving SARS-CoV-2-driven suppression of IRF3 and NF-κB antiviral pathways38, increases Bifidobacteria which play a key role in the immune system94, has immunomodulatory54 and anti-inflammatory74,95 properties, and has an extensive and very positive safety profile96.
1.
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2.
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3.
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9.
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13.
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17.
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18.
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19.
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20.
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37.
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38.
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40.
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41.
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42.
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43.
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48.
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49.
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Perraud et al., 26 Oct 2026, France, preprint, 8 authors.
Contact: florence.larrous@pasteur.fr.
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| 1 | Host response against SARS-CoV-2 infection is impacted by allosteric |
|-----|------------------------------------------------------------------------------------------------|
| 2 | modulation of cholinergic and purinergic receptors |
| 3 | |
| 4 | Victoire Perraud 1 , Guilherme Dias de Melo 1 , Marco Cecchini 2 , Lauriane Kergoat 1 , Julien |
| 5 | Lannoy 1 , Jean-Pierre Changeux 3 , HervŽ Bourhy 1 , and Florence Larrous 1 * . |
| 6 | 1 Institut Pasteur, UniversitŽ Paris CitŽ, Unit Lyssavirus, Epidemiology and Neuropathology, |
| 7 | WHO Collaborating centre for Reference and Research on Rabies, F-75015 Paris, France |
| 8 | 2 Institut de Chimie de Strasbourg, UMR7177, CNRS, UniversitŽ de Strasbourg, F-67083, |
| 9 | Strasbourg Cedex, France |
| | 3 Neuroscience Department, Institut Pasteur, Coll ge de France, Paris, France |
| | *: corresponding author |
| | Email address: florence.larrous@pasteur.fr (F. Larrous) |
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Abstract
The COVID-19 pandemic has caused nearly 8 million deaths and a broad spectrum of clinical manifestations driven by dysregulated host inflammation, notably involving key signalling proteins IL-6, CXCL10, and CXCL5. We previously demonstrated that ivermectin (IVM) improves clinical outcomes and reduces the IL-6/IL-10 ratio in the lungs of SARSCoV-2-infected hamsters. Here, combining high-throughput confocal microscopy and transcriptomics in human cell co-cultures and a hamster model, we dissected how IVM modulates host cells responses via α7nAChR and purinergic receptors. In vitro, IVM acted independently of α7nAChR, instead triggering a P2X4-dependent drop in intracellular ATP, rapidly upregulating CXCL10 in macrophages, and suppressing CXCL5 and IL-6. In vivo, however, α7nAChR antagonists abolished IVMÕs clinical benefit, as did the P2X4 blocker BX430; moreover, whereas the orthosteric agonist EVP-6124 was ineffective, the positive allosteric modulators (PAMs) IVM and GAT-107 reduced lung pathology and anosmia. Thus, IVM operates through a dynamic, context-dependent interplay: P2X4 drives early innate responses in cellular systems including macrophages, whereas the situation in vivo is more complex with α7nAChR being essential for tissue protection. These data position selective PAMs and the CXCL10/CXCL5 axis as promising targets for host-directed therapy in COVID19.
Keywords:
SARS-CoV-2 - α7nAChR Ð Purinergic receptors Ð Immunomodulation Ð Cells interplay - Hamster model Ð Transwell
Author summary
COVID-19 has killed millions of people worldwide, and much of its harm comes not from the virus itself but from the patient's own immune response spiralling out of control. To understand how this inflammation is controlled, we used ivermectin (a well-known anti45 parasitic drug) as a research tool, building on our earlier finding that it improved the health 46 of SARS-CoV-2-infected hamsters. In human immune cells grown in the laboratory, 47 ivermectin..
DOI record:
{
"DOI": "10.64898/2026.10.22.761280",
"URL": "http://dx.doi.org/10.64898/2026.10.22.761280",
"abstract": "<jats:title>Abstract</jats:title>\n <jats:p>\n The COVID-19 pandemic has caused nearly 8 million deaths and a broad spectrum of clinical manifestations driven by dysregulated host inflammation, notably involving key signalling proteins IL-6, CXCL10, and CXCL5. We previously demonstrated that ivermectin (IVM) improves clinical outcomes and reduces the IL-6/IL-10 ratio in the lungs of SARS-CoV-2-infected hamsters. Here, combining high-throughput confocal microscopy and transcriptomics in human cell co-cultures and a hamster model, we dissected how IVM modulates host cells responses via α7nAChR and purinergic receptors.\n <jats:italic>In vitro</jats:italic>\n , IVM acted independently of α7nAChR, instead triggering a P2X4-dependent drop in intracellular ATP, rapidly upregulating CXCL10 in macrophages, and suppressing CXCL5 and IL-6.\n <jats:italic>In vivo</jats:italic>\n , however, α7nAChR antagonists abolished IVM’s clinical benefit, as did the P2X4 blocker BX430; moreover, whereas the orthosteric agonist EVP-6124 was ineffective, the positive allosteric modulators (PAMs) IVM and GAT-107 reduced lung pathology and anosmia. Thus, IVM operates through a dynamic, context-dependent interplay: P2X4 drives early innate responses in cellular systems including macrophages, whereas the situation\n <jats:italic>in vivo</jats:italic>\n is more complex with α7nAChR being essential for tissue protection. These data position selective PAMs and the CXCL10/CXCL5 axis as promising targets for host-directed therapy in COVID-19.\n </jats:p>\n <jats:sec>\n <jats:title>Author summary</jats:title>\n <jats:p>COVID-19 has killed millions of people worldwide, and much of its harm comes not from the virus itself but from the patient’s own immune response spiralling out of control. To understand how this inflammation is controlled, we used ivermectin (a well-known anti-parasitic drug) as a research tool, building on our earlier finding that it improved the health of SARS-CoV-2-infected hamsters. In human immune cells grown in the laboratory, ivermectin modulated an ATP-sensing receptor, protected these cells, and shifted the inflammatory signals they released. In infected hamsters, however, protecting the animals’ health and their sense of smell required both this receptor and a second one, which responds to acetylcholine, one of the body’s natural chemical messengers, while protecting the lungs relied in particular on this second receptor. These findings do not support treating patients with ivermectin. Rather, they map the machinery behind harmful inflammation and point to a promising path forward: purpose-built drugs that fine-tune the body’s immune response in COVID-19 and other inflammatory diseases.</jats:p>\n </jats:sec>",
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"URL": "http://biorxiv.org/lookup/doi/10.64898/2026.10.22.761280"
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"title": "Host response against SARS-CoV-2 infection is impacted by allosteric modulation of cholinergic and purinergic receptors",
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