Therapeutic potential of 5-aminolevulinic acid and sodium-ferrous citrate for viral insults: relevance to the COVID-19 crisis

ABSTRACT

Introduction

: 5-Aminolevulinic acid (5-ALA) is a naturally synthesized amino acid present in most plants as well as animals, and it is routinely consumed by humans. This brief report sought to describe the potential of 5-ALA and sodium-ferrous citrate (5-ALA/SFC) to ameliorate the course of coronavirus disease 2019 (COVID-19).

Areas covered

: Studies have shown that 5-ALA is converted to protoporphyrin IX (PPIX), then to heme. Recent studies have demonstrated that PPIX has antiviral effects against several viruses, including Zika virus, dengue virus, and influenza A virus. The anti-inflammatory effects of 5-ALA have also been reported in humans. Preliminary in vitro and clinical studies have shown that the combination of 5-ALA/SFC could reduce severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-mediated insults. The SARS-CoV-2 genome contains guanine-quadruplex sequences, and the administration of 5-ALA/SFC can lead to the generation of porphyrins that have the ability to bind to guanine-quadruplexes and reduce the replication of SARS-CoV-2. Furthermore, 5-ALA is a metabolic precursor of heme, which is a potent inducer of the enzyme heme oxygenase-1, the levels of which are decreased in patients with severe COVID-19. Oral administration of 5-ALA/SFC induced heme oxygenase-1 in the peripheral blood of uninfected healthy individuals.

Expert opinion

: Based on the available information, it appears likely that 5-ALA/SFC has therapeutic value in clinically controlling SARS-CoV-2-mediated insults in COVID-19 patients. Multicenter randomized controlled trials are needed for determining the long-term clinical utility of 5-ALA/SFC.

KEYWORDS:

• 5-aminolevulinic acid
• antiviral
• COVID-19
• pandemic
• HO-1
• G4s

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.