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Sialylated Glycan Bindings from SARS-CoV-2 Spike Protein to Blood and Endothelial Cells Govern the Severe Morbidities of COVID-19

Scheim et al., International Journal of Molecular Sciences, doi:10.3390/ijms242317039
Dec 2023  
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Ivermectin for COVID-19
4th treatment shown to reduce risk in August 2020
 
*, now with p < 0.00000000001 from 104 studies, recognized in 22 countries.
No treatment is 100% effective. Protocols combine treatments. * >10% efficacy, ≥3 studies.
4,300+ studies for 75 treatments. c19ivm.org
Review of evidence suggesting that binding of the SARS-CoV-2 spike protein to sialylated glycans on red blood cells, platelets, and endothelial cells plays a key role in COVID-19 morbidity by inducing red blood cell aggregation, microvascular occlusion, and hypoxia.
Authors highlight in vitro, animal, and clinical evidence supporting spike protein-mediated hemagglutination and its reversal using compounds like ivermectin that can competitively inhibit spike protein glycan binding.
68 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 H7N766, Dengue32,67,68, HIV-168, Simian virus 4069, Zika32,70,71, West Nile71, Yellow Fever72,73, Japanese encephalitis72, Chikungunya73, Semliki Forest virus73, Human papillomavirus52, Epstein-Barr52, BK Polyomavirus74, and Sindbis virus73.
Ivermectin inhibits importin-α/β-dependent nuclear import of viral proteins66,68,69,75, shows spike-ACE2 disruption at 1nM with microfluidic diffusional sizing33, binds to glycan sites on the SARS-CoV-2 spike protein preventing interaction with blood and epithelial cells and inhibiting hemagglutination36,76, shows dose-dependent inhibition of wildtype and omicron variants31, exhibits dose-dependent inhibition of lung injury56,61, may inhibit SARS-CoV-2 via IMPase inhibition32, may inhibit SARS-CoV-2 induced formation of fibrin clots resistant to degradation5, inhibits SARS-CoV-2 3CLpro49, may inhibit SARS-CoV-2 RdRp activity24, may minimize viral myocarditis by inhibiting NF-κB/p65-mediated inflammation in macrophages55, may be beneficial for COVID-19 ARDS by blocking GSDMD and NET formation77, shows protection against inflammation, cytokine storm, and mortality in an LPS mouse model sharing key pathological features of severe COVID-1954,78, may be beneficial in severe COVID-19 by binding IGF1 to inhibit the promotion of inflammation, fibrosis, and cell proliferation that leads to lung damage4, may minimize SARS-CoV-2 induced cardiac damage35,43, increases Bifidobacteria which play a key role in the immune system79, has immunomodulatory46 and anti-inflammatory65,80 properties, and has an extensive and very positive safety profile81.
Reviews covering ivermectin for COVID-19 include76-78,80,82-115.
Scheim et al., 1 Dec 2023, peer-reviewed, 4 authors. Contact: dscheim@alum.mit.edu (corresponding author), vottero@ualberta.ca, alessandro.santin@yale.edu, allenhir@earthlink.net.
This PaperIvermectinAll
Sialylated Glycan Bindings from SARS-CoV-2 Spike Protein to Blood and Endothelial Cells Govern the Severe Morbidities of COVID-19
David E Scheim, Paola Vottero, Alessandro D Santin, Allen G Hirsh
International Journal of Molecular Sciences, doi:10.3390/ijms242317039
Consistent with well-established biochemical properties of coronaviruses, sialylated glycan attachments between SARS-CoV-2 spike protein (SP) and host cells are key to the virus's pathology. SARS-CoV-2 SP attaches to and aggregates red blood cells (RBCs), as shown in many pre-clinical and clinical studies, causing pulmonary and extrapulmonary microthrombi and hypoxia in severe COVID-19 patients. SARS-CoV-2 SP attachments to the heavily sialylated surfaces of platelets (which, like RBCs, have no ACE2) and endothelial cells (having minimal ACE2) compound this vascular damage. Notably, experimentally induced RBC aggregation in vivo causes the same key morbidities as for severe COVID-19, including microvascular occlusion, blood clots, hypoxia and myocarditis. Key risk factors for COVID-19 morbidity, including older age, diabetes and obesity, are all characterized by markedly increased propensity to RBC clumping. For mammalian species, the degree of clinical susceptibility to COVID-19 correlates to RBC aggregability with p = 0.033. Notably, of the five human betacoronaviruses, the two common cold strains express an enzyme that releases glycan attachments, while the deadly SARS, SARS-CoV-2 and MERS do not, although viral loads for COVID-19 and the two common cold infections are similar. These biochemical insights also explain the previously puzzling clinical efficacy of certain generics against COVID-19 and may support the development of future therapeutic strategies for COVID-19 and long COVID patients.
Abbreviations The following abbreviations are used in this manuscript:
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SARS-CoV-2 SP attachments to the heavily sialylated ' 'surfaces of platelets (which, like RBCs, have no ACE2) and endothelial cells (having minimal ' 'ACE2) compound this vascular damage. Notably, experimentally induced RBC aggregation in vivo ' 'causes the same key morbidities as for severe COVID-19, including microvascular occlusion, ' 'blood clots, hypoxia and myocarditis. Key risk factors for COVID-19 morbidity, including ' 'older age, diabetes and obesity, are all characterized by markedly increased propensity to ' 'RBC clumping. For mammalian species, the degree of clinical susceptibility to COVID-19 ' 'correlates to RBC aggregability with p = 0.033. Notably, of the five human betacoronaviruses, ' 'the two common cold strains express an enzyme that releases glycan attachments, while the ' 'deadly SARS, SARS-CoV-2 and MERS do not, although viral loads for COVID-19 and the two common ' 'cold infections are similar. 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Med.'}], 'container-title': 'International Journal of Molecular Sciences', 'original-title': [], 'language': 'en', 'link': [ { 'URL': 'https://www.mdpi.com/1422-0067/24/23/17039/pdf', 'content-type': 'unspecified', 'content-version': 'vor', 'intended-application': 'similarity-checking'}], 'deposited': { 'date-parts': [[2023, 12, 1]], 'date-time': '2023-12-01T13:51:18Z', 'timestamp': 1701438678000}, 'score': 1, 'resource': {'primary': {'URL': 'https://www.mdpi.com/1422-0067/24/23/17039'}}, 'subtitle': [], 'short-title': [], 'issued': {'date-parts': [[2023, 12, 1]]}, 'references-count': 359, 'journal-issue': {'issue': '23', 'published-online': {'date-parts': [[2023, 12]]}}, 'alternative-id': ['ijms242317039'], 'URL': 'http://dx.doi.org/10.3390/ijms242317039', 'relation': {}, 'ISSN': ['1422-0067'], 'subject': [ 'Inorganic Chemistry', 'Organic Chemistry', 'Physical and Theoretical Chemistry', 'Computer Science Applications', 'Spectroscopy', 'Molecular Biology', 'General Medicine', 'Catalysis'], 'container-title-short': 'IJMS', 'published': {'date-parts': [[2023, 12, 1]]}}
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