Dr. Galwankar started this week's discussions by revisiting a concept proposed in early 2020 meetings by Dr. Irshad Choudry - that obesity is already a chronic inflammatory state. We visited the question of whether there is scope to control the state of inflammation, however given the prolonged, or rather sustained, state of inflammation, it unlikely for there to be a quick solution. Thiazolidinediones (glitazones) were proposed with a similar hypothesis in parts of the world, but held back because of their adverse effect profile. Lifestyle modifications are important, however, not a quick solution either. COVID-19 infections need us to act swiftly and often aggressively.
With that, we move to the combination of montelukast, colchicine, and aspirin - 'COVI-MAC'. Following from Dr. Sean Downing's theory, initially discussed in early 2020 as well, Dr. Vivek Chauhan shared his brilliant presentation. The pathophysiology of COVID-19 illness centers around hypoxia and multiorgan failure caused due to a cytokine release syndrome (and at its worst, a cytokine storm). It is proposed that montelukast and aspirin both inhibit the eicosanoid storm and NF-kappaB activation. Aspirin, of course, is also an antiplatelet agent. Colchicine is thought to be an inhibitor of inflammasomes. Individually, they have their own benefits, however, it is proposed that used in combination, the COVI-MAC regime would produce results, particularly when used as an early intervention in SARS-COV-2 positive patients. With due permissions and precautions, our teams are embarking on studies to move this beyond the hypothetical, to the practical and applicable.
