Role of Nasal concentrations of Cl¯ ions by Jala Neti in COVID-19 Infection
Arohi Chauhan, Aparajita Shukla
Of all the sites in the body, the lung is perhaps the most common target of the microbial pathogens, many times, which proves to be lethal if unopposed. One such relevant example in the current time is the COVID-19 pandemic that emerged in Wuhan, China caused by SARS-CoV-2 virus and now has entered into almost every part of the world. Respiratory droplets and close contacts mainly spread COVID-19 infection. The droplets generated during coughing and sneezing by symptomatic patients transmit the virus. SARS-CoV-2 binds to the Angiotensin Converting Enzyme 2 (ACE2) receptor. An essential prerequisite for the innate immune response of the infected person mediated by phagocytes and neutrophils is the Chloride ion. Within phagosomes, myeloperoxidase mediates the conversion of Cl¯ and hydrogen peroxide to hypochlorous acid (HOCl). Non-myeloid cells such as respiratory epithelial cells utilize available Cl ions to produce HOCl, which in turn has antiviral activity and reduces viral replication. Hence, HOCl production is an innate antiviral mechanism that works against RNA enveloped viruses which requires a continuous supply of chloride for HOCl generation. Nasal irrigation techniques such as Jala neti helps in mechanical removal of mucus, infective pathogens, and inflammatory mediators, promotes ciliary beat frequency and strengthens the antimicrobial and antiviral barrier function. Jala Neti with the help of lukewarm NaCl solution provides a continuous supply of Cl¯ ions, which may have a role in inhibiting viral replication. Since SARS-CoV-2 Receptor Binding Domain attaches loosely to ACE 2 receptor, Jala neti could have a role in limiting the shedding of virus in the infected patients by detachment of the virus from the receptor. Further research in the form of Randomized control trials are required to study the effect of Jala neti against COVID-19 infection in humans.