4.7 Article

COVID-19: Famotidine, Histamine, Mast Cells, and Mechanisms

Journal

FRONTIERS IN PHARMACOLOGY
Volume 12, Issue -, Pages -

Publisher

FRONTIERS MEDIA SA
DOI: 10.3389/fphar.2021.633680

Keywords

famotidine (PubChem CID; 3325); mast cell activating disorder; COVID-19; hyperinflammation state; GPCR (G Protein Coupled Receptors); histamine (H2) receptor

Funding

  1. Air Force [FA8702-15-D-0001]
  2. Defense Advanced Research Projects Agency [HR0011-19-2-0020]
  3. CRIP (Center for Research for Influenza Pathogenesis)
  4. NIAID [HHSN272201400008C, U19AI135972]
  5. DoD [W81XWH-20-1-0270]

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SARS-CoV-2 infection is necessary but not sufficient for COVID-19 development, and currently there are no approved prophylactic measures for COVID-19. Clinical data suggests that famotidine may help mitigate COVID-19 symptoms, but the mechanism of action remains unclear. New multi-drug treatment strategies for COVID-19 based on repurposing existing drugs are being developed and tested worldwide.
SARS-CoV-2 infection is required for COVID-19, but many signs and symptoms of COVID-19 differ from common acute viral diseases. SARS-CoV-2 infection is necessary but not sufficient for development of clinical COVID-19 disease. Currently, there are no approved pre- or post-exposure prophylactic COVID-19 medical countermeasures. Clinical data suggest that famotidine may mitigate COVID-19 disease, but both mechanism of action and rationale for dose selection remain obscure. We have investigated several plausible hypotheses for famotidine activity including antiviral and host-mediated mechanisms of action. We propose that the principal mechanism of action of famotidine for relieving COVID-19 symptoms involves on-target histamine receptor H-2 activity, and that development of clinical COVID-19 involves dysfunctional mast cell activation and histamine release. Based on these findings and associated hypothesis, new COVID-19 multi-drug treatment strategies based on repurposing well-characterized drugs are being developed and clinically tested, and many of these drugs are available worldwide in inexpensive generic oral forms suitable for both outpatient and inpatient treatment of COVID-19 disease.

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