Hamidi Alamdari Daryoush, Bagheri Moghaddam Ahmad, Amini Shahram, Hamidi Alamdari Aida, Damsaz Mohammadamin, Yarahmadi Amir
Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
Department of Anaesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Arch Bone Jt Surg. 2020 Apr;8(Suppl1):291-294. doi: 10.22038/abjs.2020.47745.2349.
The severe acute respiratory syndrome caused by COVID-19 is now a global catastrophic event. Currently there is no approved drug or vaccine for the disease. Methylene blue (MB, oxidized form, blue color) has been used in many different areas of clinical medicine, ranging from malaria to orthopedics. Leucomethylene Blue (reduced form of MB, colorless) may be applied for the treatment of COVID-19 according to the scientific evidences. In severe patients, there is a cytokine storm (hyperinflammation) and high oxidative stress (OS). Inflammation and OS has a mutual correlation and exacerbate each other. In human body, MB first induces OS through absorbing electron (like a free radical) from other molecules, if the body could counteract to this OS, then reduced MB decreases OS through other mechanisms. Reduced MB could prevent inflammation, propagation of the virus RNA, and also improves hypoxia through reducing methemoglobin. Therefore, to avoid the increment of OS, we suggest using Leucomethylene Blue through the following protocol: The IV cocktail contains 50 mg MB (1mg/kg, 50-kg weight), 1000-2000 mg vitamin C, 500-1000 mg N-Acetylcysteine (or glutathione or cysteine or α-lipoic acid) and 10-20 gr urea (optional) in 100 ml dextrose 5%. Before the injection, the cocktail should be kept in a dark place for 1-2 hour to become fade or colorless.
由新冠病毒引起的严重急性呼吸综合征现已成为一场全球灾难性事件。目前尚无针对该疾病的获批药物或疫苗。亚甲蓝(MB,氧化形式,呈蓝色)已在临床医学的许多不同领域中使用,范围从疟疾到骨科。根据科学证据,亚甲蓝的还原形式——无色亚甲蓝(Leucomethylene Blue)可用于治疗新冠病毒。在重症患者中,会出现细胞因子风暴(炎症反应过度)和高氧化应激(OS)。炎症和氧化应激相互关联且相互加剧。在人体中,MB首先通过从其他分子吸收电子(类似自由基)诱导氧化应激,如果身体能够对抗这种氧化应激,那么还原型MB会通过其他机制降低氧化应激。还原型MB可以预防炎症、病毒RNA的传播,还可以通过降低高铁血红蛋白来改善缺氧状况。因此,为避免氧化应激增加,我们建议通过以下方案使用无色亚甲蓝:静脉注射混合液包含50毫克MB(1毫克/千克,体重50千克)、1000 - 2000毫克维生素C、500 - 1000毫克N - 乙酰半胱氨酸(或谷胱甘肽或半胱氨酸或α - 硫辛酸)以及10 - 20克尿素(可选),溶于100毫升5%的葡萄糖溶液中。注射前,混合液应在暗处保存1 - 2小时,直至褪色或变为无色。