This manuscript hypothesises that the cardiovascular drug nicorandil may be useful as an adjunct therapy for the treatment of severe CoVID-19 infection. The authors propose this due to the documented positive effects that the drug has in improving a number of parameters thought to be involved in the pathogenesis of severe CoVID-19 infection. These include scavenging of free radicals, protection against hypoxia, reduction in inflammatory signalling and suppression of apoptosis, reduction in pulmonary fibrosis, reduction in thromboembolic events, reduction in cardiotoxicity and reduction in podocyte damage in renal tissue.
Most of the studies cited are experimental studies in animals or tissue culture, although there are a few studies in relation to renal failure and cardiotoxicity that have been undertaken in humans.
Significant issues:
1. Importantly, I could not find any studies where nicorandil has been used in ARDS, which seems to be central to the severity of CoVID-19. The lack of previous studies for ARDS in humans, a condition that has been studied for decades, would suggest that nicorandil is unlikely to be an effective agent in this setting.
2. On the other hand, there are specific contraindications for nicorandil, including shock, hypotension, and LV dysfunction with low filling pressures. A number of these features are present in patients during severe CoVID-19 infection, potentially placing the patients at risk of severe decompensation in their cardiovascular status upon administration of nicorandil, which possesses significant vasodilatory function.
3. Regrettably, the standard of English writing is very poor, which made understanding some points quite difficult. The manuscript will require substantial editing by a first-language English speaker.