Association between ARA:EPA/DHA ratio and inflammation in the plasma of patients with COVID 19

Studies have shown that beyond the onset symptoms of Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) infection, excessive coagulation, cytokine storm, leukopenia, lymphopenia, hypoxemia and oxidative stress have also been observed in critically ill patients. Taking into account that there are still no approved drugs or vaccines, the potential effect of dietary supplements to improve the patient's recovery can be considered. Omega-3 fatty acids, specifically eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), present an anti-inflammatory effect that could ameliorate the recovery of patients requiring hospitalization or/and ventilatory support. EPA and DHA replace arachidonic acid (ARA) in the phospholipid membranes. When oxidized by enzymes, EPA and DHA contribute to the synthesis of less inflammatory eicosanoids and specialized pro-resolving lipid mediators (SPMs), such as resolvins, maresins and protectins, contributing to inflammation resolution. In contrast, some studies have reported that EPA and DHA can make cell membranes more susceptible to non-enzymatic oxidation mediated by reactive oxygen species, leading to the formation of potentially toxic oxidation products and increasing the oxidative stress. In order to check if EPA+ DHA could be a strategy to act as adjuvant to treat patients infected with SARS-Cov-2, our objective is to evaluate the relation between ARA:EPA+DHA ratio, that is a biomarker of omega-3 fatty acids consumption, and the prognosis of patients with COVID-19. Our hypothesis is that patients that present a lower ARA:EPA+DHA ratio present higher concentration of SPMs and a general better recovery when compared with patients that present a higher ARA:EPA+DHA ratio. It will be collected blood samples from about 180 patients that are being recruited by other experimental study (FAPESP 2020/05752-4). The samples will be kept at -80oC until the analysis. Fatty acids profile, cytokines, prostagladins and oxidative markers will be analyzed in the samples. A multivariate statistical approach will be applied to correlate data obtained from the patient plasma analysis with the patient clinical outcomes