Targeting SARS-CoV-2-Induced Cardiovascular Injury: Exploring the Potential of Ponatinib in Mitigating Cardiovascular Necroptosis in COVID-19

The incidence of Coronavirus Disease 2019 (COVID-19) has increased dramatically in recent years, affecting millions of people worldwide. The primary cause of morbidity and mortality in COVID-19 patients is respiratory illness. However, the disease can also significantly impact the cardiovascular system. SARS-CoV-2, the virus responsible for COVID-19, enters cells using the angiotensin-converting enzyme 2 (ACE-2) receptor. ACE-2 is a component of the renin-angiotensin system (RAS) and plays a crucial role in regulating various pathological processes. The interaction of the virus with ACE-2 in the myocardium can lead to direct heart damage. Several mechanisms may contribute to myocardial damage in COVID-19 patients, including systemic inflammation, myocardial interstitial fibrosis, interferon-mediated immune response, exaggerated cytokine response, T-cell-mediated damage, coronary plaque instability, and hypoxia. There has been concern that ACE inhibitors (ACE-Is) and angiotensin receptor blockers (ARBs) may increase vulnerability to SARS-CoV-2 by upregulating ACE-2 expression. However, it may be advisable to continue medications for patients with underlying cardiovascular disorders. The precise mechanisms of cardiomyocyte injury in COVID-19 are not fully understood, but necroptosis appears to play a significant role. Current treatments for cardiac damage in COVID-19 patients include IL-6 blockers and antiplatelet therapy. Ponatinib, a small molecule tyrosine kinase inhibitor designed using computational and structural approaches, has shown the potential to affect cell death through its impact on tyrosine kinase activity. By reviewing studies related to ponatinib's effects on necroptosis and cell death, we propose a novel approach to potentially reduce the cardiotoxic effects of COVID-19 on cardiomyocytes. Further research is needed to fully elucidate the mechanisms of cardiac injury in COVID-19 and to develop targeted therapies to protect the heart from the devastating effects of this disease.