Non-Cardiogenic Pulmonary Oedema as the first pathogenic feature in
COVID-19 and potential benefit of nitrates in SARS-CoV-2 infection
We wish to highlight a new hypothesis, that the early phase of COVID-19
is characterised by non-cardiogenic pulmonary oedema (‘leaky lungs’). We
hypothesize that COVID-19 complications in lungs might progress through
the initial stages of ‘leaky lungs’, to ‘cytokine storm’ and Acute
Respiratory Distress Syndrome (ARDS ) , with high case fatality rates
once ARDS sets in. SARS-CoV spike protein binding to Angiotensin
Converting Enzyme 2 cell membrane receptors with down-regulation of the
latter, followed by increased Angiotensin II, has been shown to increase
pulmonary vascular permeability, potentially inducing pulmonary oedema.
This hypothesis is supported by serial computerised tomographic scan
findings on COVID-19 patients from China and post-mortem studies from
around the world. Early attention and targeted treatment towards this
pathological feature of non-cardiogenic pulmonary oedema may be of
benefit, and warrants a clinical trial.