Ali Adel Dawood
Department of Anatomy, College of Medicine, University of Mosul, Mosul, Iraq.
In March 2020 the world officially released its first approach to the coronaviral pandemic to explain the rationale for using hydroxychloroquine. It was also believed to calm down the immune system during viral infections. The FDA warned using hydroxychloroquien for SARS-CoV-2. In this short letter we address why the FDA discontinued the treatment of the novel coronavirus with hydroxychloroquine.
Since the 1950s, hydroxychloroquine has been used to deal with malaria and arthritis. For the prevention and treatment of SARS-CoV-2, hydroxychloroquine has shown promise. In March 2020, to explain the reasoning of using hydroxychloroquine, the world formally launched its first solution to the coronavirus pandemic1.
We would look at how this operates. The medication should not interfere specifically with the virion particle. It alters instead the environment inside the host cell in which the virus replicates. To make copies of viral particles, the virus requires an acidic environment. However once hydroxychloroquine enters the cell, its function is decreased, making reproduction impossible for the virus figure (1). Hydroxychloroquine was also believed to calm down the immune system during viral infections. At the site of infection, more immune cells are recruited. Inflammation is called this method.
Viral infections can also be serious, which means that the body attracts even more immune cells. Large clusters of immune cells finally fall together on the side of infection and destroy healthy cells. Other pathways were thought to reduce the immune response by hydroxychloroquine2,3.
The FDA then warns physicians that the treatment is too dangerous to treat patients with coronavirus. The FDA revokes its authorisation to use COVID-19 hydroxychloroquine, saying that the possible risks of using the medication are higher than the potential advantages. The FDA notes that hydroxychloroquine can cause heart rhythms and disturbance. Since evaluating available drug studies, the FDA has not met the regulatory standards for authorisation for emergency use. Hydroxychloroquine was not working for COVID-19 for certain reasons4,5.
The first study, which shows strong results, is based on experiments and what works in the laboratory may not necessarily translate in real life. The benefit from animal and cell models may not translate to humans. In lab tests, examining a drug on an individual or cluster of cells, whereas inside the human body together as a complex machine, we are ignoring hundreds of thousands of processes that may make the drug unsuitable for use. Not to mention that the physiology of animals is different from that of humans, which makes it difficult to obtain the same results inside the human body. This happens all the time which may spend 10 years developing a drug that would prove effective for a certain disease under lab conditions. But when it comes to human testing, it might not work and the lab tests have to start over again6,7.
The second explanation is that its chemical structure is not successful. When an established medication reveals its advantage against an infectious illness, scientists may enhance its chemical structure by adapting it. As far as our understanding is concerned, nobody has made any changes to hydroxychloroquine to boost its efficacy. It is probable and certain that adverse outcomes will occur if the efficacy of a medication does not increase, resulting in possible harmful side effects. Then why would a drug work of the same chemical structure if it had not worked yesterday? The treatments do not necessarily respond magically to the virus, which takes us to the third explanation why the virus did not work8,9.
It is important to note that not all patients with COVID-19 are the same. Each patient has a particular medical history. Some of these medications may have the effect of hydroxychloroquine which may interfere, resulting in severe complications. Not to mention, when it comes to the same drug, our genes play an important part. The general response to the disease is that genes are necessary, and that's why women are less affected by SARS-CoV-2 from mild to extreme. All in all, expecting hydroxychloroquine to be a one-fits-all solution to every COVID-19 patient didn't make any sense and this was reflected by the result of clinical trials10,11.
A last reason for not performing was illustrated. In recent research, hydroxychloroquine was tested in patients with SARS-CoV-2. It turned out that a certain form of WBC (monocytes) which acts as a protection against the infections in the first line was blocking hydroxychloroquine. This cells may build a non-specific memory that helps the organ to respond rapidly to virus and bacterial invaders. This is known as qualified immunity. Sincerely because hydroxychloroquine inhibits the function of monocytes, the virus is gaining in the first line of protection12,13.
Owing to the dissemination of hydroxychloroquine myths, many people began self-healing without consulting their physicians. Although empirical research has demonstrated that hydroxychloroquine does not function with COVID-19, it is still known as the pandemical miracle medication. The COVID-19 pandemic is here to live until we avoid believing reliable scientific data.
Fig. 1: The effect of hydroxychloroquine (HXC). A: Virus particles were multiplied as normal case with a light acid medium. B: In the presence of HXC, the viral activity is blocked.
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Received on 04.12.2020 Revised on 01.02.2021
Accepted on 05.03.2021 ©Asian Pharma Press All Right Reserved
Asian Journal of Pharmaceutical Analysis. 2021; 11(2):179-180.