HCQ: THE UNPROVEN ‘MAGIC PILL’.

Content Courtesy Vivek Vasudevan

Not just the US president Donald Trump, but about 30 countries have requested India to lift the ban on the export of Hydroxychloroquine or HCQ. The requirement for this very familiar anti-malarial drug skyrocketed since the global outbreak of the pandemic. What is this ‘magic pill’? Why they think it might work against the coronavirus? Are we in a position to help others? 

Chloroquine, or chloroquine phosphate, invented in 1934. Hydroxychloroquine is an alternative version of the drug, with fewer side effects, as its predecessor Chloroquine, or CQ had some toxicity such as vision problems, muscle damage, seizures, and low blood cell levels. 

During World War II, the US Army had fought yet another war side by side. The army deployed against the Japanese in the Pacific region was being challenged by another enemy. It was Malaria. This mosquito-borne parasitic protozoan disease cut the efficiency of US troops drastically. While their troops were defending the Philippines from Japanese, back home they perfected this shield against the mosquito bayonets. After the world war 2, when farmers cleared forest to an unprecedented level and expanded the area under cultivation, the ‘magic pill’ worked for them too. 

HCQ’s effect on SARS-COV2 is still on debate. However, the researchers on HIV are investigating this drug for a very long time. HCQ is now a potential drug in the treatment of AIDS because of its immune modulation capabilities. That means the use of HCQ in the treatment of the new coronavirus was not purely by intuition. The lab experiments during the SARS-COV1 outbreak, and the human clinical trials in India, has shown benefits against the coronaviruses. Though, they do not prescribe it for patients with heart conditions.

Chemically HCQ is a weak base. This salts raise the pH of the organelles within the cell, such as endosomes and lysosomes. These organelles are acidic in character and is essential for the normal functioning of cell membranes. 

HCQ might prevent SARS-CoV’s spike protein from attaching to the cell membrane receptor, or the ACE2 receptor. Laboratory experiment confirmed that HCQ effectively inhibits the entry step and the post-entry stages of SARS-CoV-2.

Acidification is important for the endosome growth and function. The pH difference will prevent these organelles from maturing and functioning normally. It also prevents intermediate stages of endocytosis, reducing the number of new viruses escaping and infecting new cells. This may also reduce the shedding of viruses from a patient. 

High concentration of cytokines or cytokine storm is a potentially dangerous immune response of the body against the virus. This hyperimmune response is the reason for clogging of lungs, and the need for ventilators are high in the treatment of COVID19. Apart from its antiviral activity, HCQ is a safe and successful anti-inflammatory drug. Doctors around the world are using this drug in the treatment of autoimmune diseases such as Lupus and rheumatoid arthritis.

India is the leading manufacturer of HCQ. The government has already placed a huge domestic order for this drug to the pharmaceutical companies. If the government secures the supply chain of active ingredients of this drug, our companies can deliver up to the global demand. However, according to many researchers, the newly gained ‘miracle pill’ status of the old drug is questionable.