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"Hypoalbuminemia is a frequent finding in patients with COVID‐19 and it also appears to be linked to the severity of lung injury [
13]. Therefore, ivermectin could have sufficient bioavailability when used in such a setting."
Considering the urgency of the ongoing COVID-19 pandemic, detection of new mutant strains and potential re-emergence of novel coronaviruses, repurposing of drugs such as ivermectin could be worthy of attention. This review article aims to discuss the probable mechanisms of action of ivermectin...
www.nature.com
The role of ivermectin against the SARS-CoV-2 virus
The targets of activity of ivermectin can be divided into the following four groups:
A. Direct action on SARS-CoV-2
Level 1: Action on SARS-CoV-2 cell entry.
Level 2: Action on importin (IMP) superfamily.
Level 3: Action as an ionophore.
B. Action on host targets important for viral replication
Level 4: Action as an antiviral.
Level 5: Action on viral replication and assembly.
Level 6: Action on posttranslational processing of viral polyproteins.
Level 7: Action on karyopherin (KPNA/KPNB) receptors.
C. Action on host targets important for inflammation
Level 8: Action on interferon (INF) levels.
Level 9: Action on Toll-like receptors (TLRs).
Level 10: Action on nuclear factor-κB (NF-κB) pathway.
Level 11: Action on the JAK-STAT pathway, PAI-1, that could be involved with COVID-19 sequalae.
Level 12: Action on P21 activated kinase 1 (PAK1).
Level 13: Action on interleukin-6 (IL-6) levels.
Level 14: Action on allosteric modulation of P2X4 receptor.
Level 15: Action on high mobility group box 1 (HMGB1).
Level 16: Action as an immunomodulator on lung tissue and olfaction.
Level 17: Action as an anti-inflammatory.
D. Action on other host targets
Level 18: Action on plasmin and annexin A2.
Level 19: Action on CD 147 on the red blood cell (RBC).
Level 20: Action on mitochondrial ATP under hypoxia on cardiac function.
The direct “antiviral targets” may be useful in the early stages while the anti-inflammatory targets might be addressed in the later stages of the disease.