Obesity is associated with a pro-inflammatory state. Aging is also associated with changes in the immune system. Dr. Ajay Gupta, MD, MBBS (Chief Scientific Officer of Rockwell Medical, Inc) thinks there be a common change in inflammatory mediators in both of these populations that contributes to the increased risk of developing severe COVID-19. He thinks the connection is prostanoids, in particular prostaglandin D2 and thromboxane A2. Prostaglandin D2, in particular, increases with age and obesity, providing a potential molecular link between these two conditions and the risk of developing severe COVID-19. Dr. Gupta thinks that Ramatroban, an allergy medicine used in Japan, may be beneficial for COVID-19 treatment, especially in the elderly and obese.

“Ramatroban, a dual antagonist of prostaglandin D2 and thromboxane A2, appears to be a most promising agent being repurposed both for prophylaxis and treatment of COVID-19. As an anti-platelet and anti-thrombotic agent it is hundred-fold more potent than aspirin and targets the downstream effects of COX-2, the key enzyme activated in COVID-19, while aspirin is a COX-1 inhibitor. As a receptor antagonist of PGD2 Ramatroban will serve as an immunomodulator, by first restoring the interferon response suppressed by the virus thereby bolstering innate immune defenses; and second, suppress the overactive TH2 immune response, a hallmark of severe COVID-19 disease, thereby repairing adaptive immune response to the virus. Ramatroban has been safely used for allergic rhinitis and asthma in Japan for past 20 years and efforts are underway to repurpose this drug for prophylaxis and treatment of COVID-19 including in hospitals, outpatient, or nursing homes”- Ajay Gupta, M.B.,B.S., M.D.

Note: This article was corrected on 11 December 2020 to correct the term prostanoids. The original incorrectly had the term prostacyclins.

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Cite as: N. R. Gough, Altered Prostacyclins Link Obesity and Age to COVID-19 Severity. BioSerendipity (10 November 2020)