Nocturnal oxygen therapy as an option for early COVID-19
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Currently, there is no effective antiviral therapy or immune-based treatments for COVID-19, and the urgent challenge is to prevent the transition of COVID-19 from mild to severe. This paper provides nocturnal oxygen therapy as a new option for the patients with COVID-19 under home quarantine, and suggest that nocturnal oxygen therapy at the early stage may be helpful to prevent the disease from mild to worse by inhibiting the rapid replication of the virus and improving the body's antiviral ability.

Viruses rely on the host cell’s infrastructure and metabolism to complete their life cycle.The mechanisms of viral activation of the glycolysis are sophisticated. Some investigations have found that hepatitis B virus, H1N1 virus, vaccinia virus, and human papillomavirus can stabilize hypoxia-inducible factor 1α(HIF-1α) from degradation under normoxic condition. It is well-known that HIF-1α is a transcriptional activator of cellular metabolic state by hypoxia and stabilizing HIF-1α induces metabolic transformation from mitochondrial biogenesis to glycolysis. Furthermore, evidence also revealed that hypoxia could enhance human B19 erythrovirus gene expression and hepatitis c virus replication.

These results indicate that HIF 1α may play a pivotal role in promoting virus replication. From the analysis of clinical data, the development of COVID-19 is a process of gradual hypoxia, which is more conducive to virus replication. However, HIF-1α activity is suppressed by hydroxylate two proline residues within HIF-1α under sufficient oxygen (O2) conditions.

Although there is no direct evidence that oxygen supplementation could reduce the HIF-1α expression in virus-infected cells, researchers have reported that HIF-1α expression in the kidney significantly decreased after exposure to high oxygen concentrations in vivo. A recent study also showed that hyperoxic breathing of 60% O2 markedly down-regulated HIF-1α expression in tumor cells and inhibited tumor growth compared with breathing of 20% O2. Thus, researchers speculated that early appropriate oxygen therapy for COVID-19 patients is expected to disrupt the virus replication by decreasing HIF-1α.

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