LETTER TO THE EDITOR Year : 2020  |  Volume : 52  |  Issue : 6  |  Page : 526-528  

Convergence of divergent approaches to control COVID-19

Shivani Desai1, Shivani R Sainani1, Ketki R Rode1, Ramesh R Bhonde2
1 Department of Pharmacology, Dr. D. Y. Patil Institute of Pharmaceutical Sciences and Research, Pune, Maharashtra, India
2 Research, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India

Date of Submission04-May-2020Date of Decision13-Aug-2020Date of Acceptance04-Jan-2021Date of Web Publication19-Feb-2021

Correspondence Address:
Dr. Ramesh R Bhonde
Dr. D. Y. Patil Vidyapeeth, Sant Tukaram Nagar, Pimpri - 411 018, Pune, Maharashtra
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/ijp.IJP_395_20

How to cite this article:
Desai S, Sainani SR, Rode KR, Bhonde RR. Convergence of divergent approaches to control COVID-19. Indian J Pharmacol 2020;52:526-8

Sir,

The new coronavirus (COVID-19) disease is instigated due to Severe Acute Respiratory Syndrome coronavirus 2, i.e., is one of the recently diagnosed pathogens that chiefly boards the human respiratory system. The disease is extremely contagious and rapidly transmitted from person to person and spreading worldwide. The clinical features discovered are pneumonia, acute respiratory distress syndrome, RNAaemia, acute cardiac injury, and occurrence of grand-glass opacities.[1] Currently, no proven treatments have been reported for this life-threatening condition and there is an urgent need for effective drugs. Several antiviral therapies have been well-thought-out to manage COVID-19. In addition, the most commonly used drugs worldwide include remdesivir, hydroxychloroquine, chloroquine, lopinavir/ritonavir, and favipiravir.[2] In the absence of vaccine and appropriate antibiotics, coronavirus has created a pandemic. Since ministry of AYUSH is working hard to propagate the alternative medicines, we thought to catalog a different approaches focused toward both, the control and management, of COVID-19.

COVID-19 infection causes increase in leukocyte count with irregular respiratory results and increased proinflammatory cytokines. A few targets for COVID-19 and the techniques which can be considered to breach them are enlisted here.

  Oxidative Stress 

The cytokine storm produce abundant reactive oxygen species which lead to oxidation of cellular proteins and membrane lipids causing organ failure.[1] Antioxidants such as Vitamin C, Vitamin E, and some herbal molecules like Curcumin and Baicalin can be considered in such scenario as they possess anti-oxidative property.

  Free Iron Ion 

The virus attacks heme of hemoglobin and separate the iron which causes inflammation in pulmonary cells.[1] To reduce overproduction of oxidative iron ions, iron chelation drugs, such as deferoxamine, deferiprone, and deferasirox, can be considered. Red blood cell (RBC) transfusion and oxygen therapy can also be also recommended as there is lack of oxygen due to RBC destruction.

  Cytokine Storm 

COVID-19 causes organ damage due to cytokine storm[1] which can be targeted by anti-inflammatory agents and neutralizing monoclonal antibodies against elevated cytokine.

  Lung Dysfunctions Intervened by Stem Cells 

This novel disease mostly affects the lungs which is disrupted by immune disturbances.[1] Stem cells can be considered here because they have proven immunomodulatory activity as well as they first target the lungs on administration and might protect the epithelial cells of alveoli, avert pulmonary fibrosis, retrieve the microenvironment of pulmonary system, and treat the dysfunction associated with lungs. Studies have supported efficient application of stem cells in treatment of various immunomodulatory disease.[3] Hence, they can be considered as best drug of choice to prevent multiorgan failure during COVID-19.

  Complementary or Alternative Medicines 

During this pandemic and crisis, the prophylactic and therapeutic potential of our traditional and alternative medicine systems such as Ayurveda and homeopathy can be considered for prevention and treatment because they have shown wonders in managing various symptoms and complications. Approaches including hot water consumption, cooked food, herbal decoctions, steam inhalation, medicated water gargles, may be supportive for symptomatic relief in mild cases. [Table 1] enumerates various ayurvedic and homeopathic options which can be considered for the management of COVID-19 due to their mentioned properties.[4],[5]

Table 1: Convergence of divergent approaches to various targets of coronavirus disease-19 pathogenesis

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  Passive Immunization 

Recovered COVID-19 patients develop virus-neutralizing antibodies. Hence, we can consider to administer the serum which contains these antibodies as a prophylaxic option to avert infection in high-risk population, including susceptible individuals with comorbid medical conditions, health care professionals, and individuals who are exposed to confirmed cases of COVID-19.

COVID-19 acts by various mechanisms to cause organ damage and eventually death as a unidirectional progress. Targeting these mechanisms can prevent and manage the infection through convergent approach. [Table 1] collates and summarizes the divergent targets and approaches to manage them. Along with these remedies, social distancing is also one major step to be taken to prevent infection as it is rapidly transmitted from person to person.

To conclude, COVID-19 infection is spreading all over the globe at the speed of forest-fire and has an extremely complex mechanism. This virus enters the host cell and plays havoc through various mechanisms, especially by disturbing immune system. We can hence target these points via antiviral agents, anti-oxidants, iron chelation, RBC transfusion, oxygen therapy, anti-inflammatory agents, and most importantly, immunomodulatory mesenchymal stem cells. Moreover, passive immunization can also be considered as therapeutic measures to reduce the mortality in infected patients. It is essential to combine allopathic approaches with complementary or alternative approaches to attack the infection from multidirections. It is difficult to draw a common denominator in treating COVID-19 patients but a combination of physical, chemical, biological, and pharmacological approach can be converged to manage this lethal infection. Together, we can fight against this fatal infection and make this globe a better place to live.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 

  References 
1.Liu W, Li H. COVID-19: Attacks the 1-beta chain of hemoglobin and captures the porphyrin to inhibit human heme metabolism. ChemRxiv. 2020; Preprint. doi.org/10.26434/chemrxiv.11938173.v9.  
    2.Yousefifard M, Zali A, Mohamed Ali K, Madani Neishaboori A, Zarghi A, Hosseini M, et al. Antiviral therapy in management of COVID-19: A systematic review on current evidence. Arch Acad Emerg Med 2020;8:e45.  
    3.Golchin A, Seyedjafari E, Ardeshirylajimi A. Mesenchymal stem cell therapy for COVID-19: Present or future. Stem Cell Reviews and Reports 2020;16:427-33.  
    4.Baskoy SA, Cengiz M, Teksoy O, Ayhanci A. Dietary Antioxidants in Experimental Models of Liver Diseases, Strawberry - Pre- and Post-Harvest Management Techniques for Higher Fruit Quality, Toshiki Asao and Md Asaduzzaman, IntechOpen, DOI: 10.5772/intechopen.83485. Available from: https://www.intechopen.com/books/strawberry-pre-and-post-harvest-management-techniques-for-higher-fruit-quality/dietary-antioxidants-in-experimental-models-of-liver-diseases. [Last accessed om 24 Jun 2019].  
    5.Kalliantas D, Kallianta M, Karagianni CS. Homeopathy combat against coronavirus disease (Covid-19) [published online ahead of print, 2020 Jun 5]. Z Gesundh Wiss. 2020;1-4. doi:10.1007/s10389-020-01305-z.  
    

 
 

  [Table 1]