Abstract
Introduction: according to the World Health Organization (WHO), COVID-19 is an infectious disease caused by the SARS-CoV-2 virus, responsible for an increasing number of cases and deaths. From a preventive and therapeutic point of view, there are two concerns that affect institutions and healthcare professionals: global immunization (which is still far from being achieved) and the availability of drugs capable of preventing its consequences in the infected patient. In this sense, the role that melatonin can play is has been assessed in the recent literature. Justification and Objectives: the serious health, social and economic consequences of COVID-19 have forced an urgent search for preventive methods, such as vaccines, among others, and therapeutic methods that could be alternatives to the drugs currently used. In this sense, it must be accepted that one of the most recommended has been the administration of melatonin. The present study proposes to carry out a systematic review of its possible role in the treatment and/or prevention of COVID-19. Material and methods: a systematic review of the literature related to the prevention of COVID-19 through the administration of melatonin was carried out, following the sequence proposed by the Prisma Declaration regarding the identification and selection of documents, using the specialized health databases Trip Medical Database, Cochrane Library, PubMed, Medline Plus, BVS, Cuiden and generic databases such as Dialnet, Web of Science and Google Scholar for their retrieval. Appropriate inclusion and exclusion criteria are described for the articles assessed. The main limitation of the study has been the scarcity of works and the lack of defining a specific protocol in terms of dosage and administration schedule. Results: once the selection process was completed, and after an in-depth critical analysis, 197 papers were selected, and 40 of them were finally used. The most relevant results were: (1) melatonin prevents SARS-CoV-2 infection, (2) although much remains to be clarified, at high doses, it seems to have a coadjuvant therapeutic effect in the treatment of SARS-CoV-2 infection and (3) melatonin is effective against SARS-CoV-2 infection. Discussion: until group immunization is achieved in the population, it seems clear that we must continue to treat patients with SARS-CoV-2 infection, and, in the absence of a specific and effective antiviral therapy, it is advisable to continue researching and providing drugs that demonstrate validity based on the scientific evidence. In this regard, we believe that the available studies recommend the administration of melatonin for its anti-inflammatory, antioxidant, immunomodulatory, sleep-inducing, CD147, Mpro, p65 and MMP9 protein suppressing, nephrotoxicity-reducing and highly effective and safe effects. Conclusions: (1) melatonin has anti-inflammatory, antioxidant, immunomodulatory, and Mpro and MMP9 protein-inhibitory activity. (2) It has been shown to have a wide margin of safety. (3) The contributions reviewed make it an effective therapeutic alternative in the treatment of SARS-CoV-2 infection. (4) Further clinical trials are recommended to clearly define the administration protocol.
Highlights
The COVID-19 coronavirus pandemic, responsible for the “severe acute respiratory syndrome” SARS-CoV-2, continues to rise around the world
To analyze the therapeutic potential of melatonin to counteract the consequences of COVID-19 infection
Once the contributions selected for this review were analyzed, we believe that the following considerations are relevant: (1) Melatonin is a simple molecule, with well-documented pathophysiological functions, such as: the anti-inflammatory, antioxidant, and immunomodulatory action, as well as its inhibitory capacity of the main protease (Mpro) protease and the matrix metallopeptidase 9 (MMP9) protein, which would make it a therapeutic alternative to consider against various infectious diseases
Summary
The COVID-19 coronavirus pandemic, responsible for the “severe acute respiratory syndrome” SARS-CoV-2, continues to rise around the world. The level of antibody seropositivity in the general population is still low [10,11], indicating that most of the world’s population remains susceptible. Transfusion of convalescent plasma has been indicated as an effective therapy against COVID-19 infection [13]. This evidence, together with other evidence of various characteristics, recommended initiating the development of vaccines against COVID-19. The genome of this coronavirus contains four main structural proteins: the spike protein (S), membrane (M), envelope (E) and nucleocapsid (N). The main target of the antigenic epitopes of the COVID-19 vaccine are the S protein [14]; the S1 domain, which contains the receptor-binding domain (RBD) for the host cell receptor angiotensin-converting enzyme-2 (ACE2) [15]; the N-terminal domain (NTD), which has been demonstrated as another site with potent neutralizing activity [16,17,18]; the S2 domain, which contains the fusion peptide [19,20]
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