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Comment by thenerdhead | Hacker News Reader

Does it help those with long Covid?

Possible but untested. You may be interested to see this recent study that draws a mechanistic link (broadly, microglial inflammation) between the symptoms of long covid and "chemobrain" following chemotherapy [0]. The authors do suggest treatments proposed to restore cognition post-chemotherapy may also be applicable to long covid, e.g. metformin [1].

[0] https://www.cell.com/cell/fulltext/S0092-8674(22)00713-9

[1] https://www.nature.com/articles/s41591-020-0985-2

Metformin is looking like the aspirin of the 21st century.

Nir Barzilai and a team of researchers are leading a large clinical trial to test the benefits of metformin in slowing the aging process, which is upstream of so many diseases that yeah, it could just be a cheap cure-all. Sadly requires a prescription in the US. But berberine is the off-the-shelf equivalent.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7347426/

Yeah agreed. Is berberine really an equivalent though if the mechanisms are different and the not knowing metformin’s complete mechanism although it has a pleitropic effect? Metformin is heavily studied in comparison too.

The claim is that metformin greatly reduces viral load. If your long COVID is caused by the virus continuing to linger on 8n some tissues, as there is evidence might be the case for s9me patience, then it might. But if your long COVID is caused by microclots or lung scarring or other physiological damage caused by COVID, then no.

Makes sense. I found this too in a science journal:

> The exact pathophysiology of long COVID is unknown but is likely to be multifactorial, including the inflammatory cascade during acute infection and persistent viral replication. Mechanistic in-silico modelling predicts that translation of SARS-CoV-2 viral proteins is a particularly sensitive target for inhibition of viral replication, and previous studies have shown that metformin is capable of suppressing protein translation via mammalian target of rapamycin (mTOR) inhibition

https://www.science.org/content/blog-post/long-covid-shows-c...

Only in obese and overweight patients (that is the group the drug was tested on).

So, only found to be helpful in obese and overweight patients. It could be effective in other patients, just no data in this study.

And yet they have the clickbait headline. Overweight and obese people already have their body in a constant state of inflammation, and their blood sugar control probably isn't great either. I wonder if they controlled for insulin resistance and prediabetes, which is related to obesity.

It appears to be prophylactic, it reduces the occurrence of long Covid in those recently testing positive.

Surely it would be like other antivirals(paxlovid) which have shown to help certain long Covid phenotypes?

I.e. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9537824/

> Though not indicated for the treatment of PASC, the treating physician felt that her prolonged nasopharyngeal antigen positivity warranted the treatment. Indeed, the patient’s PASC symptoms fully resolved 3 weeks after completing antiviral treatment

It's not clear it's acting as an antiviral, in the classic sense of directly interfering with the virus, by directly bonding with and neutralizing viral proteins, or supplying lookalike proteins for the cells to make defective viral particles with.

Metformin affects glucose metabolism. It may be similar to how metformin seems to help with HIV infection; an immune cell infected with HIV goes into metabolic overdrive as it starts producing virus. Metformin seems to block that boosting mechanism through its effect on glucose, preferentially on the most over-driven cells. A similar story with certain glucose-fed cancers, which metformin is also used in treating.

Yeah that is fair. I think it is very uplifting that even though we don’t know the mechanism, it may be used for potential long Covid treatment

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