The COVID-19 pandemic needs therapies that are presently available and safe. We propose that subjects with metabolic syndrome, old age, and male gender have the greatest morbidity and mortality and have low stress proteins, in particular, low intracellular heme oxygenase (HO-1), making them particularly vulnerable to the disease. Additionally, COVID-19’s heme reduction may contribute to even lower HO-1. Low-grade inflammation associated with these risk factors contributes to triggering a cytokine storm that spreads to multi-organ failure and near death. The high mortality of those treated with ventilator assistance may partially be explained by ventilator-induced inflammation. The cytoprotective and anti-inflammatory properties of HO-1 can limit the infection’s damage. A paradox of COVID-19 hospital admissions data suggests that fewer cigarette-smokers are admitted compared with non-smokers in the general population. This unexpected observation may result from smoke induction of HO-1. Therapies with anti-viral properties that raise HO-1 include certain anesthetics (sevoflurane or isoflurane), hemin, estrogen, statins, curcumin, resveratrol, and melatonin. Controlled trials of these HO-1 inducers should be done in order to prevent or treat COVID-19 disease.

中文翻译：

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COVID-19 和血红素加氧酶：对该疾病和潜在疗法的新见解。

COVID-19 大流行需要目前可用且安全的治疗方法。我们认为，患有代谢综合征、老年和男性的受试者的发病率和死亡率最高，并且应激蛋白较低，特别是细胞内血红素加氧酶（HO-1）较低，使他们特别容易感染该疾病。此外，COVID-19 的血红素减少可能导致 HO-1 更低。与这些危险因素相关的低度炎症会引发细胞因子风暴，进而导致多器官衰竭和濒临死亡。接受呼吸机辅助治疗的患者死亡率高，部分原因可能是呼吸机引起的炎症。HO-1 的细胞保护和抗炎特性可以限制感染的损害。COVID-19 入院数据的一个悖论表明，与一般人群中不吸烟的人相比，入院的吸烟者较少。这一意外的观察结果可能是由于 HO-1 的烟雾诱导所致。具有提高 HO-1 水平的抗病毒疗法包括某些麻醉剂（七氟烷或异氟烷）、氯高铁血红素、雌激素、他汀类药物、姜黄素、白藜芦醇和褪黑激素。应对这些 HO-1 诱导剂进行对照试验，以预防或治疗 COVID-19 疾病。