atorvastatin + nicorandil + l-arginine + folic acid + vitamin B complex

The Endothelial Protocol is a combination therapeutic regimen developed by the Lebanese American University Medical Center (LAUMC) specifically to address endothelial dysfunction in critically ill COVID-19 patients. The protocol consists of five components: atorvastatin, nicorandil, l-arginine, folic acid, and a vitamin B complex. The rationale behind this combination is to restore endothelial homeostasis, which is severely disrupted by SARS-CoV-2 infection, leading to systemic inflammation, microvascular thrombosis, and multi-organ failure. Atorvastatin, an HMG-CoA reductase inhibitor, provides pleiotropic effects including anti-inflammatory and endothelial-protective properties. Nicorandil acts as both a potassium channel opener and a nitric oxide donor, while l-arginine serves as a substrate for nitric oxide synthase, together enhancing nitric oxide bioavailability to promote vasodilation and inhibit platelet aggregation. Folic acid and vitamin B complex are included to support metabolic pathways and potentially reduce levels of homocysteine, a known mediator of endothelial injury. This protocol was evaluated in a Phase 3 clinical trial (NCT04750616) to determine its impact on clinical outcomes in severe COVID-19 cases.

Other names

Endothelial Protocol-Lebanese American University Medical Center-COVID-19-endothelial dysfunctionLAUMC Endothelial ProtocolEndothelial Protocol in Critically Ill COVID-19