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\title{Another new application of heparin in COVID-19: more than
anticoagulation and antiviral}



\author[1]{Xianqiang Yu}%
\affil[1]{Southeast University - Dingjiaqiao Campus}%


\vspace{-1em}



  
  \date{May 16, 2024}


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\begin{abstract}
Heparin is used as a classic anticoagulant in clinic. In addition, with
the ongoing pandemic and unknown challenges, the mechanism of action of
heparin in antiviral and anti-inflammatory aspects has been constantly
discovered and clarified. This also provides effective support for the
treatment of COVID-19 in specific contexts. Most importantly, heparin
may act as a multi-drug.%
\end{abstract}%



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\textbf{Another new application of heparin in COVID-19: more than
anticoagulation and antiviral}

Xianqiang Yu\textsuperscript{1} PhD

\textsuperscript{1} Southeast University, Medical School, Nanjing, China

\textsuperscript{\#}Correspondence: Xianqiang Yu, PhD, E-mail:
yuxianqiang302@126.com, Medical School of Nanjing University, Nanjing,
China, Telephone: +86 18553263899.

\textbf{Abstract:} Heparin is used as a classic anticoagulant in clinic.
In addition, with the ongoing pandemic and unknown challenges, the
mechanism of action of heparin in antiviral and anti-inflammatory
aspects has been constantly discovered and clarified. This also provides
effective support for the treatment of COVID-19 in specific contexts.
Most importantly, heparin may act as a multi-drug.

\textbf{Keywords:} COVID-19; heparin; anticoagulant, anti-inflammatory,
antiviral

Dear editor, we read with great interest an article in your journal
about heparin inhibits the infection of novel coronavirus {[}1{]}.
Therefore, we were surprised to learn that heparin is a classic
anticoagulant that has antiviral effects. Especially in the context of
the pandemic, it provides hope for clinician decision making for the
treatment of COVID-19 patients. In particular, there is still no
accurate and effective anti-novel coronavirus intervention drugs in
clinical practice. However, we would like to emphasize that heparin may
have a key anti-inflammatory effect on severe COVID-19.

Heparin has been widely used clinically for its classical anticoagulant
effects, including sepsis induced coagulopathy. It is reported that
heparin has been shown to have a significant effect on blocking the
inflammatory storm of sepsis in an unprecedented way. In general,
heparin inhibits HMGB1 - lipopolysaccharide (LPS) interactions and
prevents macrophage heparinase from degrading glycocalyx {[}2{]}. To the
best of our knowledge, HMGB1 is an important part of the
damage-associated molecular patterns (DAMPs) family. In addition, the
study suggests that even if the anticoagulant part of heparin was
removed, it could also play a significant anti-inflammatory effect in
sepsis through the HMGB1 pathway. In other words, modified heparin can
be used in other inflammatory diseases without concern for its classical
pharmacological side effects.

As COVID-19 continues and it presents new challenges, efficient
antiviral and anti-inflammatory drugs are urgently needed clinically.
Most important of all, antiviral, anti-inflammatory, and anti-coagulant
therapies are three important aspects of COVID-19 therapy. Intriguingly,
heparin has exactly three potential therapeutic effects, and it is
therefore possible to kill many birds with one arrow. There may be a
basis for using heparin aggressively in these patients in the future.
Despite the fact that it is an old drug, we still have reason to be
optimistic.

\emph{Declarations}

*Ethics approval and consent to participate

Not applicable

*Consent for publication

Not applicable

*Availability of data and materials

Not applicable

*Competing interests

The authors declare that they have no competing interests

*Funding

Scholarship of Southeast University (No. 189351)

*Authors' contributions

Xianqiang Yu completed the design and writing of the article and all the
relevant content of the manuscript.

*Acknowledgements

Not applicable

References

1 Tree, J. A. and J. E. Turnbull, et al. (2021). ''Unfractionated
heparin inhibits live wild type SARS-CoV-2 cell infectivity at
therapeutically relevant concentrations.'' Br J Pharmacol \textbf{178}
(3): 626-635.

2 Tang, Y. and X. Wang, et al. (2021). ''Heparin prevents
caspase-11-dependent septic lethality independent of anticoagulant
properties.'' Immunity.

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