What is the impact of nicotine on the Post-COVID-19 syndrome - a severe impairment of acetylcholine-orchestrated neuromodulation: A case series

Abstract

Abstract Following SARS-CoV-2 infection, many individuals suffer from post-COVID-19 syndrome. It makes them unable to proceed with ordinary everyday activities due to weakness, memory lapses, pain, dyspnea, and other unspecific physical complaints. Several investigators have demonstrated that the SARS-CoV-2-related spike glycoprotein (SGP) not only attaches to angiotensin-converting enzyme-2 (ACE-2) receptors but also shows DNA sections highly affine to nicotinic acetylcholine receptors (nAChRs). The nAChR is the principal structure of cholinergic neuromodulation and is responsible for coordinated neuronal network interactions. Nonintrinsic viral nAChR attachment substantially compromises integrative interneuronal communication. This explains the cognitive, neuromuscular, and mood impairment and the vegetative symptoms characterizing post-COVID-19 syndrome. The agonist ligand nicotine shows an up to 30-fold higher affinity for nACHRs than acetylcholine (ACh). We hypothesize that this molecule could extrude the virus from nAChR attachment and pave the way for unimpaired cholinergic signal transmission. Treating several individuals suffering from post-COVID-19 syndrome with a nicotine patch application, we observed an immediately substantial improvement of the symptoms up to complete remission after several days.