5. Conclusion
Symptomatic COVID-19 patients develop renal complications and patients
with pre-existing renal conditions also have a high chance of disease
progression and mortality. Currently, there are no approved drugs that
offer renal protection in COVID-19 patients although a number of
vaccines have been approved by FDA for emergency use. With a new viral
pandemic which has significant renal involvement, there is a need for
future studies to determine the risk factors of kidney disease among
COVID-19 patients. It is important to also determine the link between
genetic polymorphisms and the risk of developing kidney diseases among
certain races of people including those of African ancestry, who have
genetic polymorphisms to kidney diseases, and to know whether there is
an association between APOL1 high-risk carriers and risk of developing
COVID-19-associated nephropathy. As the search for pharmacological
agents for effective treatment of COVID-19 is underway, there are
studies that are suggesting the potential clinical use of
H2S donors, as these agents fall under all three
classifications of COVID-19 treatment - antiviral treatment, cytokine
storm treatment, and thrombosis treatment. A growing body of evidence
show that H2S donors interact with ACE2, TMPRSS2 and
other potential SARS-CoV-2 receptors on the host cell surface, alter
SARS-CoV-2 membrane, thereby inhibiting the entry of the virus into the
host cell and consequently preventing its replication (assembly and
release). This mechanism is thought to suppress SARS-CoV-2-induced
inflammatory pathway, leading to organ protection (Fig. 2). Other
studies also suggest inhibition of gene transcription by
H2S donors along with antiviral immunosuppressive
effect. In the light of these mechanisms of the antiviral action of
H2S donors, more experimental and clinical studies with
H2S donors, especially those that are already
FDA-approved and are in human clinical trials such as STS, NAC, ATB-346
and zofenopril, should be considered for preventive treatment or
effective therapy against COVID-19 infection, and should include their
use in nebulizer for aerosol inhalation into the lungs and dissemination
to extra-pulmonary organs such as the kidney.