The Application of a Reduced Dye Used in Orthopedics as a Novel Treatment against Coronavirus (COVID-19): A Suggested Therapeutic Protocol

Document Type : SHORT COMMUNICATION

Authors

1 Associate Professor, Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Associate Professor, Department of Anaesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

3 Professor, Anaesthesiology and critical care lung research centre, Faculty of Medicine, Mashhad, Iran

4 Student, Research Committee, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran

5 PhD Student, Department of Clinical Biochemistry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

The severe acute respiratory syndrome caused by COVID-19 is now a global catastrophic event. Currently there
is no approved drug or vaccine for the disease. Methylene blue (MB, oxidized form, blue color) has been used in
many different areas of clinical medicine, ranging from malaria to orthopedics. Leucomethylene Blue (reduced form
of MB, colorless) may be applied for the treatment of COVID-19 according to the scientific evidences. In severe
patients, there is a cytokine storm (hyperinflammation) and high oxidative stress (OS). Inflammation and OS has
a mutual correlation and exacerbate each other. In human body, MB first induces OS through absorbing electron
(like a free radical) from other molecules, if the body could counteract to this OS, then reduced MB decreases
OS through other mechanisms. Reduced MB could prevent inflammation, propagation of the virus RNA, and also
improves hypoxia through reducing methemoglobin. Therefore, to avoid the increment of OS, we suggest using
Leucomethylene Blue through the following protocol: The IV cocktail contains 50 mg MB (1mg/kg, 50-kg weight),
1000-2000 mg vitamin C, 500-1000 mg N-Acetylcysteine (or glutathione or cysteine or α-lipoic acid) and 10-20 gr
urea (optional) in 100 ml dextrose 5%. Before the injection, the cocktail should be kept in a dark place for 1-2 hour
to become fade or colorless.
Level of evidence: V

Keywords

References

1. Xie M, Chen Q. Insight into 2019 novel coronavirusan
updated intrim review and lessons from SARS-CoV
and MERS-CoV. Int J Infect Dis. 2020; In Press.
2. Grech V. Unknown unknowns - COVID-19 and
potential global mortality. Early Hum Dev. 2020;
144(1):105026.
3. Giles GM. Recent German researches on malaria: its
treatment by methylene blue. With introductory
remarks. Ind Med Gaz. 1892; 27(11):326-30.
4. Moore J. The use of methylene blue in Gonorrhoea. Br
Med J. 1897; 1(1881):140.
5. Frost GH. Methylene-blue in fevers. Ind Med Gaz.
1908; 43(10):395.
6. Kongmalai P, Chernchujit B. Arthroscopic treatment
of popliteal cyst: a direct posterior portal by insideout
technique for intracystic debridement. Arthrosc
Techn. 2015; 4(2):e143-8.
7. Shaw JD, Miller S, Plourde A, Shaw DL, Wustrack R,
Hansen EN. Methylene blue-guided debridement as
an intraoperative adjunct for the surgical treatment
of periprosthetic joint infection. J Arthroplasty. 2017;
32(12):3718-23.
8. Su Y, Nan G. Using methylene blue as a marker to find
and remove tiny metallic foreign bodies embedded in
the soft tissues of children: a randomised controlled
trial. Int J Surg. 2016; 29(1):43-8.
9. Oz M, Lorke DE, Hasan M, Petroianu GA. Cellular and
molecular actions of methylene blue in the nervous
system. Med Res Rev. 2011; 31(1):93-117.
10. Kovacs E. Prevention of cytopathic effect and
propagation of poliovirus by methylene blue. Z
Naturforsch B. 1960; 15(B):588-92.
11. Skold A, Cosco DL, Klein R. Methemoglobinemia:
pathogenesis, diagnosis, and management. South Med
J. 2011; 104(11):757-61.
12. Wang L, Chen B, Lin B, Ye Y, Bao C, Zhao X, et al.
methylene blue attenuates lung injury induced by
hindlimb ischemia reperfusion in rats. Mediators
Inflamm. 2018; 2018(1):2508620.
13. Kast RE. Inhibiting the NLRP3 inflammasome
with methylene blue as treatment adjunct in
myelodysplasia. Front Oncol. 2018; 8(1):280.
14. Privistirescu AI, Sima A, Duicu OM, Timar R, Roș􀇟ca MG,
Sturza A, et al. Methylene blue alleviates endothelial
dysfunction and reduces oxidative stress in aortas
from diabetic rats. Can J Physiol Pharmacol. 2018;
96(10):1012-6.
15. Sahebari M, Shakeri F, Azadi HG, Arjmand MH,
Ghayour-Mobarhan M, Parizadeh MR, et al. Prooxidant-
antioxidant balance (PAB) in rheumatoid
arthritis and its relationship to disease activity. Curr
Rheumatol Rev. 2015; 11(1):28-33.
16. Felice DL, Sun J, Liu RH. A modified methylene blue
assay for accurate cell counting. J Functional Foods.
2009; 1(1):109-18.
17. Miclescu A, Wiklund L. Methylene blue, an old drug
with new indications. J Rom Anest Terap Int. 2010;
17(1):35-41.
18. Duicu OM, Privistirescu A, Wolf A, Petruş A, Dănilă
MD, Raţiu CD, et al. Methylene blue improves
mitochondrial respiration and decreases oxidative 
stress in a substrate-dependent manner in
diabetic rat hearts. Can J Physiol Pharmacol. 2017;
95(11):1376-82.
19. Henry M, Summa M, Patrick L, Schwartz L. A cohort of
cancer patients with no reported cases of SARS-CoV-2
infection: the possible preventive role of Methylene
Blue. Substantia. 2020; 30(1):888.
20. Nassar SJ, Wills C, Harriman A. Inhibition of the
photobleaching of methylene blue by association with
urea. Chem Photo Chem. 2019; 3(10):1042-9.
21. Leaist DG. The effects of aggregation, counterion
binding, and added NaCl on diffusion of aqueous
methylene blue. Can J Chem. 1988; 66(9):2452-7.
22. Celleno L. Topical urea in skincare: a review. Dermatol
Ther. 2018; 31(6):e12690.
23. Jenkins RB. Severe chickenpox encephalopathytreatment
with intravenous urea, hypothermia, and
dexamethasone. Am J Dis Child. 1965; 110(2):137-9.
24. Pariser S, Katz A. Treatment of sickle cell trait
hematuria with oral urea. J Urol. 1994; 151(2):401-3.
25. Nervo A, D’Angelo V, Rosso D, Castellana E, Cattel F,
Arvat E, et al. Urea in cancer patients with chronic
SIAD-induced hyponatremia: Old drug, new evidence.
Clin Endocrinol (Oxf). 2019; 90(6):842-8.
The Archives of Bone and Joint Surgery
Volume 8, Supplement 1
April 2020
Pages 291-294

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History

  • Receive Date: 10 April 2020
  • Accept Date: 12 April 2020

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