DR. S.V. SINGH, OMBUDSPERSON - E-mail ID: ombudsperson@santosh.ac.in

It is highly unlikely that people can contract COVID-19 from food or food packaging. COVID-19 is a respiratory illness and the primary transmission route is through person-to- person contact and through direct contact with respiratory droplets generated when an infected person coughs or sneezes.

But, COVID-19 may be worsened in patients who ingest foods with high purine content, promoting an increase in uric acid concentrations. Probably, people with hyperuricemia or gout can be considered a risk group in cases of COVID-19

Biological purines are small molecules found inside and outside cells. They consist of organic, aromatic, and heterocyclic compounds formed by a pyrimidine ring attached to an imidazole ring. Purine bases are present in all plant and animal cells, are essential for life, as components of cellular energy systems (ATP and NAD), signaling (GTP, cAMP, and cGMP), and are associated with pyrimidines form RNA and DNA (adenine and guanine).

Foods of animal and vegetable origin contain different amounts of purines, that when degraded generate uric acid, of which approximately 80% of excretion occurs through the kidneys. Uric acid is considered an antioxidant due to the ability of urates to scavenge free radicals.

However, the consumption of diets rich in purine can cause the overproduction of uric acid, which has low solubility in biological fluids, leading to the accumulation of serum urate in the blood above the saturation level (hyperuricemia). This clinical condition is responsible for causing health problems such as gout and is a risk factor for cardiovascular, renal, and metabolic syndrome.

When infected by viruses, human cells increase the demand for purine nucleotides, which are necessary for the synthesis of RNA and viral DNA. As a result, viruses obtain purine nucleotides through the action of the enzyme Inosine Monophosphate Dehydrogenase (IMPDH), which is essential for viral cell growth and differentiation.

Thus, COVID-19 may be worsened in patients who ingest foods with high purine content, promoting an increase in uric acid concentrations. Probably, people with hyperuricemia or gout can be considered a risk group in cases of COVID-19. This proposition is reinforced by Ahn et al., who suggested that coronaviruses use purine nucleotides to promote RNA synthesis. Due to the global urgency to answer this clinical question, the international rheumatology community created the COVID-19 Global Rheumatology Alliance to allow healthcare professionals from around the world to exchange information on case reports of patients with rheumatic disease diagnosed with COVID-19 to assist healthcare providers. Currently, an anti-inflammatory widely used to treat patients with gout, colchicine, is undergoing clinical tests for the treatment of COVID-19. In addition to other drugs commonly prescribed by rheumatologists, hydroxychloroquine, glucocorticoids, intravenous immunoglobulin, anti-interleukin (IL) -1 and anti-IL-6 therapies, and Janus kinase inhibitors have also been tested.

Nutritional therapy is a promising adjunct to drug therapy, helping to reduce the intake of purines and control the concentrations of uric acid in the blood. This strategy could improve the clinical condition of patients with hyperuricemia resulting from viral infections, such as in COVID-19.

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