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Nicotine may protect against severe COVID-19, Greek scientists support

Two studies released by researchers from Greece shed more light into the potential effects of nicotine on coronavirus infection. The first, published by researchers from the Laboratory of Molecular Biology and Immunology of the University of Patras in the peer-reviewed journal European Respiratory Journal, analyzed 11 cases series with a total of 11654 hospitalized COVID-19 patients from China and the US. They found that the prevalence of smoking was 1/5th the expected prevalence based on population smoking rates, even after the latter was strictly adjusted for age.

The authors suggest that nicotine is the only possible component of tobacco cigarette smoke that could offer protection. They hypothesize that the coronavirus attacks the nicotinic cholinergic receptors which are widely available in the lungs, the brain, the vascular wall, immune cells and other organs and systems. While the authors clearly state that “smoking cannot be considered protective for COVID-19 (or any other disease)”, pharmaceutical nicotine products are widely available and their role in COVID-19, protecting the function of cholinergic receptors, should be explored.

 In another study, released as pre-publication in Preprints, scientists from the University of Patras, the Agricultural University of Athens and the University of Thessaly used complex computational molecular docking models to examine the 3-dimensional structures of the coronavirus and the nicotinic acetylcholine receptors. They found that the virus can interact and bind to the receptors, potentially inhibiting their activity. The interaction site is similar to the site where snake venom toxins act on these receptors.

Snake venoms are known to exert many of their adverse effects by inhibiting acetylcholine receptors activity. These receptors are part of the cholinergic anti-inflammatory pathway, a system that controls inflammatory response. It has been widely accepted that severe COVID-19 represent a hyper-inflammatory response, known as “cytokine storm”, and it is possible that failure to control the immune response may be, at least in part, due to disruption of nicotinic acetylcholine receptors. Nicotine could restore the function of these receptors and thus suppress the cytokine storm which is characteristic of severe COVID-19.

 Both studies were led by Dr Konstantinos Farsalinos and Prof Konstantinos Poulas from the Laboratory of Molecular Biology and Immunology of the University of Patras in Greece. They emphasized that smoking is clearly harmful and smokers should still be strongly encouraged to quit. However, pharmaceutical nicotine products or other nicotinic agonists are available and should be urgently tested in clinical trials. Until clinical trial results are available, people should not buy over the counter nicotine products for self-medication against COVID-19.