Zhou, Fang-Qiang, Fresenius Medical Care, Dialysis Centers in Chicago, IL., 60008 USA; Shanghai Sandai Pharmaceutical R&D Co., Ltd., Pudong, Shanghai 200127 China

Abstract
The focus of present review is on the proposal that pyruvate may be a potential candidate in treating critical care patients with Covid-19 virus infection. The pyruvate anion has beneficial properties to protect organ function by increase of hypoxia/anoxia tolerance, correction of hypoxic lactic acidosis, exertion of anti-oxidative stress/inflammation, protection of mitochondrial function and inhibition of apoptosis. The key effect is reactivation of depressed pyruvate dehydrogenase in various pathogenic insults. These benefits are unparalleled with anions in current medical fluids. Pyruvate in intravenous or oral rehydration salt (ORS) may be a powerful supportive care in treatment of severe virus infection with Covid-19 and critical care patients. Recent studies demonstrate that intravenous pyruvate is superior to regular fluids and pyruvate-enriched ORS (Pyr-ORS) is advantageous over WHO-ORS in organ protection, acidosis correction and survival improvement in severe shock resuscitation in animals. While pyruvate is not yet approved by the FDA, there were many clinical studies on treatment of various diseases with a large dosage of its intravenous or oral form since 1940s. These studies, using the products at the time, indicate pyruvate’s clinical effectiveness and absence of adverse effects, which resembled the phase II clinical trial of a novel drug. Therefore, it is logical to consider randomized clinical trials of pyruvate in treatment of Covid-19 or Ebola infection as well as critical care patients as a beneficial supportive therapy, albeit it is not an anti-virus agent, particularly using a low pyruvate dose in Pyr-ORS formulas, under protocols of compassionate use.

Keywords
Hypoxia, Lactic acidosis, Oral rehydration salt, Pyruvate, Resuscitation, Virus, Covid-19

Cite this paper
Zhou, Fang-Qiang, Pyruvate in Potential Supportive Therapy in Critical Covid-19 , SCIREA Journal of Clinical Medicine. Volume 5, Issue 3, June 2020 | PP. 50-65.

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