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Ask HN: Could Ibuprofen worsen Covid-19?

7 points by klft ↗ HN
Sorry for the clickbaity title but this is currently being discussed in Europe.

SARS-CoV-2 accesses host cells via the enzyme ACE2[1][2]

On March 11 a correspondence[3] in the Lancet claimed that “the increased expression of ACE2 would facilitate infection with COVID-19” and “ACE2 can also be increased by thiazolidinediones and ibuprofen”

While the first claim seems sensical the authors did not provide a reference for the second claim.

I am not an expert in this area and a search if ibuprofen or NSAIDs[4] really increase ACE2 expression revealed just articles like [5] “Ibuprofen could ameliorate the cardiac fibrosis in diabetic rats by reduction of the ACE/AngII/AT1-R axis and enhancement of the ACE2/Ang(1-7)/Mas-R axis …” which does not really answer my question.

[1] https://en.wikipedia.org/wiki/Coronavirus_disease_2019

[2] https://www.cell.com/cell/fulltext/S0092-8674(20)30229-4

[3] https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30116-8/

[4] https://en.wikipedia.org/wiki/Nonsteroidal_anti-inflammatory_drug

[5] https://www.ncbi.nlm.nih.gov/pubmed/25896805

4 comments

[ 3.2 ms ] story [ 20.9 ms ] thread
mtmail
I saw conflicting news. https://www.theguardian.com/world/2020/mar/14/anti-inflammat... which I regard as trustworthy says yes.

On the other hand in Germany there were several articles, e.g. https://www.deutschlandfunk.de/covid-19-coronavirus-warnunge... warning about fake whatapp messages (seems it was forwarded voice messages) regarding Ibuprofen.

If your research points to University of Vienna, they issued a denial https://twitter.com/MedUni_Wien/status/1238782938344554496

js1980
The original source for this scaremongering story is the report which you linked in #3 above. This supposed association has received wide coverage in Germany and is being debunked by official sources.

There has simply been a correlation between hypertensive/diabetic patients and graver Covid-19 symptoms. The article speculates that ACE2 inhibitors could be the cause. And Ibuprofen is not an ACE2 inhibitor in the real sense of the term.

If there really were a link, then common blood pressure and diabetes medication would be far more risky than ibuprofen.

However, it should also be noted that women express ACE2 more than men do. And yet women are known to have a lower mortality rate than me with respect to SARS-COV-2.

Correlation does not imply causality and the article is simply an unconfirmed hypothesis.

matheist
None of what you just said is responsive to OP's question, which is simply wondering to what extent ibuprofen increases expression of ACE2.

When you say that a supposed association is being debunked, do you mean to say that the debunkers are citing research that ibuprofen does not increase ACE2 expression? Because that is the kind of debunking that would answer OP's question.

If the debunking is instead "people are spreading unfounded rumors, pay no attention", then maybe that's useful as a default posture to hold regarding unsubstantiated rumors, but it doesn't help anyone arrive at the truth of the matter.

OJFord
> None of what you just said is responsive to OP's question, which is simply wondering to what extent ibuprofen increases expression of ACE2.

I had the same confusion. I eventually found a quote here (published today, not available at time of up-thread comments):

https://kvia.com/health/2020/03/17/france-says-ibuprofen-may...

> NSAIDs might affect how Covid-19 binds to human cells, according to Dr. Yogen Kanthi, assistant professor of cardiology at the University of Michigan, who studies inflammation. > > "There is data from basic science studies that have shown that Covid-19 itself binds to a protein at the surface of cells called ACE2,” he said. “There is a hypothetical risk that giving NSAIDs like ibuprofen could increase levels of ACE2 shown in animal models, but not in patients."

That's the best I can find searching for '"ibuprofen" "ace2"' or 'NSAID' or 'COX2' in place of 'ibuprofen', so maybe take it with a pinch of salt, and it's not even saying 'yes definite link'.