Long COVID – a critical disruption of cholinergic neurotransmission?, 2025, Marco Leitzke et al

Mij

Mij

Senior Member (Voting Rights)
Abstract
Background
Following the COVID-19 pandemic, there are many chronically ill Long COVID (LC) patients with different symptoms of varying degrees of severity. The pathological pathways of LC remain unclear until recently and make identification of path mechanisms and exploration of therapeutic options an urgent challenge. There is an apparent relationship between LC symptoms and impaired cholinergic neurotransmission.

Methods
This paper reviews the current literature on the effects of blocked nicotinic acetylcholine receptors (nAChRs) on the main affected organ and cell systems and contrasts this with the unblocking effects of the alkaloid nicotine. In addition, mechanisms are presented that could explain the previously unexplained phenomenon of post-vaccination syndrome (PVS). The fact that not only SARS-CoV-2 but numerous other viruses can bind to nAChRs is discussed under the assumption that numerous other post-viral diseases and autoimmune diseases (ADs) may also be due to impaired cholinergic transmission. We also present a case report that demonstrates changes in cholinergic transmission, specifically, the availability of α4β2 nAChRs by using (-)-[18F]Flubatine whole-body positron emission tomography (PET) imaging of cholinergic dysfunction in a LC patient along with a significant neurological improvement before and after low-dose transcutaneous nicotine (LDTN) administration. Lastly, a descriptive analysis and evaluation were conducted on the results of a survey involving 231 users of LDTN.

Results
A substantial body of research has emerged that offers a compelling explanation for the phenomenon of LC, suggesting that it can be plausibly explained because of impaired nAChR function in the human body. Following a ten-day course of transcutaneous nicotine administration, no enduring neuropathological manifestations were observed in the patient. This observation was accompanied by a significant increase in the number of free ligand binding sites (LBS) of nAChRs, as determined by (-)-[18F]Flubatine PET imaging. The analysis of the survey shows that the majority of patients (73.5%) report a significant improvement in the symptoms of their LC/MEF/CFS disease as a result of LDTN.

Conclusions
In conclusion, based on current knowledge, LDTN appears to be a promising and safe procedure to relieve LC symptoms with no expected long-term harm.
LINK
 
Someone should tell them that paragraphs exist…

Following our hypothesis (Leitzke 2023), many people with LC/ME/CFS have used LDTN to improve their symptoms and have shared their experiences in various forums. The results of a 60-question survey in one of these forums are appended to this paper (Supplement 1) and summarized in the discussion section.
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It’s actually supplement 3:
https://static-content.springer.com...8/MediaObjects/42234_2025_167_MOESM3_ESM.docx

The primary measure is the testers' perceived quantitative change intheir Bells’ quality-of-life score from 0% to 100% after completing at least one round of nicotine patches and a breakperiod. Remission events were a secondary measure.Remission events represent short periods (from six to 48 hours) of sickness remission where the patient feels“normal/healthy” (level 1), “better than normal” (level 1+), oreuphoria (level 2).
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Does anyone know what the Bell’s QoL score is? I can’t find any info about it.
 
I'd like to add some more info because Leitzke has been heavily promoting this nicotine patch treatment in social media and it really concerns me since there is literally zero evidence it works.

The above study is based on one case study and a survey that claims 73% of respondents showed significant improvement. This retrospective survey was a questionnaire posted online in Leitzke's Facebook group for his nicotine patch theory.

This is unfortunately important to mention as people in my group are posting this study as proof that these patches are proven treatments/have been shown to work scientifically/give hope to people. And it is very weak science.

In the same study, Leitzke also claims ivermectin alleviates the symptoms of covid and long covid. I think this should give anyone enough pause.

I also saw this tweet from him on X and I find it hair-raising medical advice:

"Vomiting and diarrhoea are classical side effects of nicotine and may be taken as a sign, that nicotine started its job pushing out the viral residuals."

https://twitter.com/user/status/1664274542397890562


There are a million red flags about this guy and his nicotine treatment.
 


A warning about nicotine patches for long covid​

by CTV News

The suggestion of using nicotine patches originated from research in April 2020. A team in Paris noticed that smokers seemed underrepresented among hospitalized COVID patients in China. They theorized that nicotine could bind to a receptor on our cells that the virus also binds to, possibly blocking the virus and offering protection. However, further testing did not support this theory, and initial studies from China had flaws, such as misclassification of smokers. Moreover, the study suggesting smoking might protect against COVID was funded by the tobacco industry.

Regarding nicotine patches, while they appear safe for smokers quitting and have been tested in non-smokers for conditions like Parkinson's, there is no data on whether they could lead to addiction, especially in non-smokers. Nicotine patches provide a slow, continuous dose of nicotine, which is less likely to cause addiction compared to cigarettes, but the long-term effects are still uncertain.
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Many people continue to experience the effects of COVID long after the initial illness, a condition known as Long COVID. It is complex and can be debilitating. On social media, some recommend using nicotine patches to treat symptoms.

Jonathan Jerry from the McGill Office for Science and Society explains that even though the COVID pandemic was declared over by the WHO in 2023, the virus is still present, and people continue to get sick. In Canada, approximately 1 in 61 people are currently infected. Around 1 in 100 to 1 in 10 people who get COVID may develop long-term symptoms, known as Long COVID.

The suggestion of using nicotine patches originated from research in April 2020. A team in Paris noticed that smokers seemed underrepresented among hospitalized COVID patients in China. They theorized that nicotine could bind to a receptor on our cells that the virus also binds to, possibly blocking the virus and offering protection. However, further testing did not support this theory, and initial studies from China had flaws, such as misclassification of smokers. Moreover, the study suggesting smoking might protect against COVID was funded by the tobacco industry.

Regarding nicotine patches, while they appear safe for smokers quitting and have been tested in non-smokers for conditions like Parkinson's, there is no data on whether they could lead to addiction, especially in non-smokers. Nicotine patches provide a slow, continuous dose of nicotine, which is less likely to cause addiction compared to cigarettes, but the long-term effects are still uncertain.

As for Long COVID, it is real and affects people differently. To prevent it, experts recommend avoiding infection through methods like wearing high-quality masks (N95, KN95, or KF94), cleaning the air, and getting vaccinated. These preventive measures have not changed in recent years.
 
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