Blocking mineralocorticoid receptor with spironolactone may have a wide range of therapeutic actions in severe COVID-19 disease

SEE PDF] Dysregulated RAS signaling with enhanced aldosterone-mediated MR activation could represent an important link between SARS-CoV-2/ACE2 interaction and inflammatory lung injury, suggesting an interesting therapeutic potential of RAS inhibitors [1] and in particular MR antagonists. [...]effects may be particularly useful in the context of SARS-CoV-2 infection, by inhibiting the androgen-dependent expression of TMPRSS2, a transmembrane protease crucial for viral entry through its priming effect on the viral S protein [5]. [...]by its dual actions as an MR antagonist and an androgenic inhibitor, spironolactone might provide significant benefits in COVID-19 ARDS. [...]the primary action of spironolactone (reduction of pulmonary edema) would also be beneficial in COVID-19 ARDS. [...]we hypothesize that through its combined pharmacological actions, spironolactone may provide therapeutic benefit, when applied in the later stage of COVID-19 ARDS.