Stains and Entry Pathway CD147

• Statins alter expression, structure, and function of CD147 by inhibiting protein isoprenylation and N-glycosylation to down regulate CD147. This could impair virus infection in cells .

Statins and Lipid Rafts

• Lipid rafts play a role in the attachment and internalization of the virus
• Statins modulate raft by inhibiting cholesterol biosynthesis via HMG-CoA reductase inhibition to ultimately prevent of reverse lipid raft alternations by COVID infections

Stains and Autophagy

• COVID-19 exploits autophagy by using the double membrane compartment created during autophagy for replication to shield the virus from the innate immunity
• Statins have a role in regulating essential autophagy proteins and could help with COVID by targeting the modulation of autophagy

Statins and Inflammasomes

• The exacerbated inflammatory response in COVID-19 leads to a cytokine storm
• Statins have an anti-inflammatory effect; it has been associated with a reduced risk of exacerbation hospitalization in patients with a history of frequent COPD exacerbation

Statins and Coagulation Complications

• In COVID-19, increased fibrinogen, elevated clotting factors and mild thrombocytopenia has been seen and associated with a higher risk of mechanical ventilation, ICU admission and death
• Statins have an anti-coagulation effect by interfering with the activation of the coagulation cascade
• Fluvastatin impairs tissue factor activity which is responsible for the proteolytic activation of zymogens

Overall statins have effects including but not limited to the down regulation of CD147 expression and function, autophagy activation, lipid raft disruption, anti inflammatory effects and anti coagulant effects. There use has also been associated with low hospital mortality from COVID-19. Use of statin treatments in a study of 96,032 hospitalized COVID patients showed that statin treatment was more frequent among survivors compared to patients that passed away.