Harnessing nitric oxide for preventing, limiting and treating the severe pulmonary consequences of COVID-19.

The ongoing outbreak of COVID-19 has quickly become a daunting challenge to global health. In the absence of targeted therapy and a reported 5.5% case fatality rate in the United States, treatments preventing rapid cardiopulmonary failure are urgently needed. Clinical features, pathology and homology to better understood pathogens suggest that uncontrolled inflammation and a cytokine storm likely drive COVID-19's unrelenting disease process. Interventions that are protective against acute lung injury and ARDS can play a critical role for patients and health systems during this pandemic. Nitric oxide is an antimicrobial and anti-inflammatory molecule with key roles in pulmonary vascular function in the context of viral infections and other pulmonary disease states. This article reviews the rationale for exogenous nitric oxide use for the pathogenesis of COVID-19 and highlights its potential for contributing to better clinical outcomes and alleviating the rapidly rising strain on healthcare capacity. • SARS-CoV-2's pathophysiology is increasingly understood, from entry through ACE2 to the cytokine storm of severe disease. • The rapidly growing body of literature identifies several mechanisms that may be targeted with nitric oxide. • Reported proofs of concept for inhaled nitric oxide treating COVID-19 demonstrate the need for randomized control trials. [ABSTRACT FROM AUTHOR]