HS in Critical Illness-A New Horizon for Sodium Thiosulfate?

Ever since the discovery of endogenous HS and the identification of its cytoprotective properties, efforts have been made to develop strategies to use HS as a therapeutic agent. The ability of HS to regulate vascular tone, inflammation, oxidative stress, and apoptosis might be particularly useful in the therapeutic management of critical illness. However, neither the inhalation of gaseous HS, nor the administration of inorganic HS-releasing salts or slow-releasing HS-donors are feasible for clinical use. NaSO is a clinically approved compound with a good safety profile and is able to release HS, in particular under hypoxic conditions. Pre-clinical studies show promise for NaSO in the acute management of critical illness. A current clinical trial is investigating the therapeutic potential for NaSO in myocardial infarct. Pre-eclampsia and COVID-19 pneumonia might be relevant targets for future clinical trials.