Review on Immunological Perspectives and Therapeutic Management Strategies for COVID-19

Rushikesh K. Kakde; Nitin R.  Kale; Gajanan  Sanap

doi:10.55544/jrasb.3.5.25

Authors

Rushikesh K. Kakde Student, Late Bhagirathi Yashwantrao Pathrikar College of Pharmacy, Pathri, Phulambri, Chhatrapati Sambhajinagar, Maharashtra, INDIA. https://orcid.org/0009-0007-5418-2910
Nitin R. Kale Assistant Professor, Bachelor of Pharmacy, Late Bhagirathi Yashwantrao Pathrikar College of Pharmacy, Pathri, Phulambri, Chhatrapati Sambhajinagar, Maharashtra, INDIA.
Dr. Gajanan Sanap Principal, Late Bhagirathi Yashwantrao Pathrikar College of Pharmacy, Pathri, Phulambri, Chhatrapati Sambhajinagar, Maharashtra, INDIA.

DOI:

https://doi.org/10.55544/jrasb.3.5.25

Keywords:

COVID-19, SARS-CoV-2, Immunity booster, Herbs, Ayurvedic treatment

Abstract

The global spread of COVID-19 due to SARS-CoV-2 has posed unique challenges to public health. This review was carried out from the perspective of immunological and pathological changes affecting epidemiological features of the disease during progression and therapy. COVID-19 primarily affects the respiratory system but may also affect cardiovascular and neurological systems, manifesting various symptoms from fever and cough to such severe complications as acute respiratory distress syndrome (ARDS) and organ failure. Patterns in immune responses involving decreases in peripheral T cells and natural killer cells have been recognized as being part of a potential biomarker and therapeutic target. Finally, it discusses the dynamic of the transmission of SARS-CoV-2, including droplet mode spread and possible fecal-oral pathway. The virus's structural and pathological attributes are emphasized, complemented by a historical overview that chronicles its transformation from a non-threatening variant to a worldwide hazard. Various management approaches, encompassing traditional Indian medicinal practices and immune-enhancing measures such as zinc, iron, magnesium, vitamins, and herbal treatments, are assessed regarding their effectiveness in bolstering immunity and facilitating recovery. Additionally, lifestyle habits such as physical activity, sufficient rest, and proper hydration contribute to the maintenance of immune health. This extended review presents analyses of SARS-CoV-2 mechanisms of immune alteration and a unified approach toward the understanding and combat of COVID-19.

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References

Zhu, N. et al. A Novel Coronavirus from patients with Pneumonia in China, 2019. N. Engl. J. Med.

Huang, C. et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China.

Chen, N. et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study.

Wang, D. et al. Clinical characteristics of 138 hospitalized patients with 2019 Novel Coronavirus-infected Pneumonia in Wuhan, China.

Li, T. et al. Significant changes of peripheral T lymphocyte subsets in patients with severe acute respiratory syndrome. J. Infect.

Cui, W. et al. Expression of lymphocytes and lymphocyte subsets in patients with severe acute respiratory syndrome.

Cimini, E. et al. Different features of Vdelta2 T and NK cells in fatal and non-fatal human Ebola infections.

Reynard, S. et al. Immune parameters and outcomes during Ebola virus diseas

Fehr A.R., Perlman S., “Coronaviruses: An overview of their replication and pathogenesis”, Methods in Molecular Biology 2005

Wuhan Municipal Health Commission. Information about the current situation of pneumonia in Wuhan, 2019.

WHO. Coronavirus disease 2019 (COVID-19) Situation Report – 117, 2020

Linton NM, Kobayashi T, Yang Y, et al.. Incubation period and other epidemiological characteristics of 2019 novel coronavirus infections with right truncation: a statistical analysis of publicly available case data. J Clin Med. 2020;9:538.

Chan JF, Yuan S, Kok KHet al.. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet. 2020;395:514–23.

Wu P, Duan F, Luo C, et al.. Characteristics of ocular findings of patients with coronavirus disease 2019 (COVID-19) in Hubei Province, China. JAMA Ophthalmol. 2020. doi:10.1001/jamaophthalmol.2020.1291.

Yeo C, Kaushal S, Yeo D. Enteric involvement of coronaviruses: is faecal–oral transmission of SARS-CoV-2 possible?. Lancet Gastroenterol Hepatol. 2020;5:335–7. doi:10.1016/s2468-1253(20)30048-0.

Xu Y, Li X, Zhu B, et al.. Characteristics of pediatric SARS-CoV-2 infection and potential evidence for persistent fecal viral shedding. Nat Med. 2020;26:502–5. doi:10.1038/s41591-020-0817-4.

Wang W, Xu Y, Gao R, et al.. Detection of SARS-CoV-2 in different types of clinical specimens. JAMA. 2020. doi:10.1001/jama.2020.3786.

Dong L, Tian J, He S, et al.. Possible vertical transmission of SARS-CoV-2 from an infected mother to her newborn. JAMA. 2020. doi:10.1001/jama.2020.4621.

Chen H, Guo J, Wang C, et al.. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet. 2020;395:809–15. doi:10.1016/S0140-6736(20)30360-3.

Wei M, Yuan J, Liu Y, et al.. Novel coronavirus infection in hospitalized infants under 1 year of age in China. JAMA. 2020. doi:10.1001/jama.2020.2131.

Zeng H, Xu C, Fan J, et al.. Antibodies in infants born to mothers with COVID-19 pneumonia. JAMA. 2020. doi:10.1001/jama.2020.4861.

Liu W, Zhang Q, Chen J, et al.. Detection of Covid-19 in children in early january 2020 in Wuhan, China. N Engl J Med. 2020;382:1370–1. doi:10.1056/NEJMc2003717.

Dharmendra Kumar, Rishabha Malviya, Pramod Kumar Sharma, Corona Virus: A Review of COVID-19

Q. Li, X. Guan, P. Wu, X. Wang, L. Zhou, Y. Tong, et al. Early transmission dynamics in wuhan, China, of novel coronavirus-infected pneumonia N. Engl. J. Med. (2020),

W. Wang, J. Tang, F. Wei Updated understanding of the outbreak of 2019 novel coronavirus (2019-nCoV) in Wuhan, China.

) L.L. Ren, Y.M. Wang, Z.Q. Wu, Z.C. Xiang, L. Guo, T. Xu, et al. Identification of a novel coronavirus causing severe pneumonia in human: a descriptive study Chinese Med J (2020)

C. Huang, Y. Wang, X. Li, L. Ren, J. Zhao, Y. Hu, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China.

W.G. Carlos, C.S. Dela Cruz, B. Cao, S. Pasnick, S. Jamil Novel wuhan (2019-nCoV) coronavirus Am. J. Respir. Crit. Care Med., 201 (4) (2020).

CT imaging of the 2019 novel coronavirus (2019-nCoV) pneumonia Radiology (2020),

S. van Boheemen, M. Graaf, C. Lauber, T.M. Bestebroer, V.S. Raj, A.M. Zaki, et al. Genomic characterization of a newly discovered coronavirus associated with acute respiratory distress syndrome in humans.

V.S. Raj, H. Mou, S.L. Smits, D.H. Dekkers, M.A. Müller, R. Dijkman, et al.Dipeptidyl peptidase 4 is a functional receptor for the emerging human coronavirus-EMC.

S. Perlman, J. Netland Coronaviruses post-SARS: update on replication and pathogenesis.

I. Glowacka, S. Bertram, M.A. Müller, P. Allen, E. Soilleux, S. Pfefferle, et al. Evidence that TMPRSS2 activates the severe acute respiratory syndrome coronavirus spike protein for membrane fusion and reduces viral control by the humoral immune response.

S. Bertram, I. Glowacka, M.A. Müller, H. Lavender, K. Gnirss, I. Nehlmeier, et al. Cleavage and activation of the severe acute respiratory syndrome coronavirus spike protein by human airway trypsin-like protease.

F. Wu, S. Zhao, B. Yu, Y.-M. Chen, W. Wang, Z.-G. Song, et al. A new coronavirus associated with human respiratory disease in China.

P. Zhou, X. Yang, X. Wang, B. Hu, L. Zhang, W. Zhang, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin.

X. Xu, P. Chen, J. Wang, J. Feng, H. Zhou, X. Li, et al. Evolution of the novel coronavirus from the ongoing Wuhan outbreak and modeling of its spike protein for risk of human transmission.

Y . Wan, J. Shang, R. Graham, R.S. Baric, F. Li Receptor recognition by novel coronavirus from Wuhan: an analysis based on decade-long structural studies of SARS j virol (2020)

Sungnak W, Huang N, Bécavin C, et al. SARS-CoV-2 entry factors are highly expressed in nasal epithelial cells together with innate immune genes. Nat Med 2020; 26: 681–687.

Bourgonje AR, Abdulle AE, Timens W, et al. Angiotensin-converting enzyme 2 (ACE2), SARS-CoV-2 and the pathophysiology of coronavirus disease 2019 (COVID-19). J Pathol 2020; 251: 228–248.

Dos Santos WG. Natural history of COVID-19 and current knowledge on treatment therapeutic options. Biomed Pharmacother 2020

Shi S, Qin M, Shen B, et al. Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China. JAMA Cardiol 2020; 5: 802–810.

Inciardi RM, Adamo M, Lupi L, et al. Characteristics and outcomes of patients hospitalized for COVID-19 and cardiac disease in Northern Italy. Eur Heart J 2020; 41: 1821–1829.

Hu H, Ma F, Wei X, et al. Coronavirus fulminant myocarditis treated with glucocorticoid and human immunoglobulin. Eur Heart J 2021; 42: 206.

Kesici S, Aykan HH, Orhan D, et al. Fulminant COVID-19-related myocarditis in an infant. Eur Heart J 2020; 41: 3021.

Dolhnikoff M, Ferreira Ferranti J, de Almeida Monteiro RA, et al. SARS-CoV-2 in cardiac tissue of a child with COVID-19-related multisystem inflammatory syndrome. Lancet Child Adolesc Health 2020; 4: 790–794.

Rajpal S, Tong MS, Borchers J, et al. Cardiovascular magnetic resonance findings in competitive athletes recovering from COVID-19 infection. JAMA Cardiol 2020; 6: 116–118.

Puntmann VO, Carerj ML, Wieters I, et al. Outcomes of cardiovascular magnetic resonance imaging in patients recently recovered from coronavirus disease 2019 (COVID-19). JAMA Cardiol 2020; 5: 1265–1273.

Tschöpe C, Ammirati E, Bozkurt B, et al. Myocarditis and inflammatory cardiomyopathy: current evidence and future directions. Nat Rev Cardiol 2021; 18 169–193.

Nicin L, Abplanalp WT, Mellentin H, et al. Cell type-specific expression of the putative SARS-CoV-2 receptor ACE2 in human hearts. Eur Heart J 2020; 41: 1804–1806.

Lindner D, Fitzek A, Bräuninger H, et al. Association of cardiac infection with SARS-CoV-2 in confirmed COVID-19 autopsy cases. JAMA Cardiol 2020; 5: 1281–1285.

Tavazzi G, Pellegrini C, Maurelli M, et al. Myocardial localization of coronavirus in COVID-19 cardiogenic shock. Eur J Heart Fail 2020; 22: 911–915.

Mao L, Jin H, Wang M, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol 2020; 77: 683–690.

Paterson RW, Brown RL, Benjamin L, et al. The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings. Brain 2020; 143: 3104–3120.

Hampshire A, Trender W, Chamberlain SR, et al. Cognitive deficits in people who have recovered from COVID-19 relative to controls: an N=84,285 online study. medRxiv 2020.

Solomon IH, Normandin E, Bhattacharyya S, et al. Neuropathological features of Covid-19. N Engl J Med 2020; 383: 989–992.

Kantonen J, Mahzabin S, Mäyränpää MI, et al. Neuropathologic features of four autopsied COVID-19 patients. Brain Pathol 2020; 30: 1012–1016.

Moriguchi T, Harii N, Goto J, et al. A first case of meningitis/encephalitis associated with SARS-Coronavirus-2. Int J Infect Dis 2020; 94: 55–58.

Huang YH, Jiang D, Huang JT. SARS-CoV-2 detected in cerebrospinal fluid by PCR in a case of COVID-19 encephalitis. Brain Behav Immun 2020; 87: 149.

Puelles VG, Lütgehetmann M, Lindenmeyer MT, et al. Multiorgan and renal tropism of SARS-CoV-2. N Engl J Med 2020; 383: 590–592.

Paniz-Mondolfi A, Bryce C, Grimes Z, et al. Central nervous system involvement by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). J Med Virol 2020; 92: 699–702.

Matschke J, Lütgehetmann M, Hagel C, et al. Neuropathology of patients with COVID-19 in Germany: a post-mortem case series. Lancet Neurol 2020; 19: 919–929.

Iadecola C, Anrather J, Kamel H. Effects of COVID-19 on the nervous system. Cell 2020; 183: 16–27.e1.

Morbini P, Benazzo M, Verga L, et al. Ultrastructural evidence of direct viral damage to the olfactory complex in patients testing positive for SARS-CoV-2. JAMA Otolaryngol Head Neck Surg 2020; 146: 972–973.

Jin X, Lian JS, Hu JH, et al. Epidemiological, clinical and virological characteristics of 74 cases of coronavirus-infected disease 2019 (COVID-19) with gastrointestinal symptoms. Gut 2020; 69: 1002–1009.

Cheung KS, Hung IFN, Chan PPY, et al. Gastrointestinal manifestations of SARS-CoV-2 infection and virus load in fecal samples from a Hong Kong cohort: systematic review and meta-analysis. Gastroenterology 2020; 159: 81–95.

Zhang H, Kang Z, Gong H, et al. Digestive system is a potential route of COVID-19: an analysis of single-cell coexpression pattern of key proteins in viral entry process. Gut 2020; 69: 1010–1018.

Wu Y, Guo C, Tang L, et al. Prolonged presence of SARS-CoV-2 viral RNA in faecal samples. Lancet Gastroenterol Hepatol 2020; 5: 434–435.

Yang L, Tu L. Implications of gastrointestinal manifestations of COVID-19. Lancet Gastroenterol Hepatol 2020; 5: 629–630.

Guo Y-R, et al. The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak–an update on the status. Mil Med Res. 2020;7(1):1–10.

Zeng F, et al. Association of inflammatory markers with the severity of COVID-19: a meta-analysis. Int J Infect Dis. 2020;96:467–74.

Goothy SSK, et al. Ayurveda’s holistic lifestyle approach for the management of coronavirus disease (COVID-19): Possible role of tulsi. Int J Res Pharm Sci. 2020.

Janiaud P, et al. Association of convalescent plasma treatment with clinical outcomes in patients with COVID-19: a systematic review and meta-analysis. JAMA. 2021;325(12):1185–95.

Maurya, DK, Sharma D. Evaluation of traditional ayurvedic kadha for prevention and management of the novel coronavirus (SARS-CoV-2) using in silico approach. J Biomol Struct Dyn. 2022;40(9):3949–64.

Hirsch JS, et al. Acute kidney injury in patients hospitalized with COVID-19. Kidney Int. 2020;98(1):209–18.

Delves PJ, Roitt IM. The immune system. First of two parts. N Engl J Med 2000;343(1):37-49.

Percival SS. Nutrition and immunity: balancing diet and immune function. Nutrition Today 2011;46(1):12-7.

Wessels I, Maywald M, Rink L. Zinc as a Gatekeeper of Immune Function. 2017, Nutrients; 9(12), 1286-1298.

Spritzler F. Ten Magnesium-Rich Foods that are Super Healthy. https://www.healthline. com/nutrition/10-foods -high-in-magnesium# section7 (Accessed August 22, 2018).

Anywara G, Kakudidia E, Byamukamab R, Mukonzoc J, Schubertd A, Oryem-Origaa H. Indigenous traditional knowledge of medicinal plants used by herbalists in treating opportunistic infections among people living with HIV/AIDS in Uganda. J Ethnopharmacol, 2020; 246: 1-13.

Chauhan RS. Efficacy of herbal immune plus in enhancing humoral and cell mediated immunity dogs. Livest Int, 2001; 5: 12-18.

. Kuttan G. Use of Withania somnifera as an adjuvant during radiation therapy. Indian J Exp Biol, 1996; 34: 854-856.

Upadhyay SN, Dhawan S, Garg S, Talwar GP. Immunomodulatory effect of neem (Azadirachta indica) oil. Int J Immunopharmacol, 1992; 14: 1187- 1193.

Vasudevan SK. Augmentation of murine natural killer cell and antibody dependent cellular cytotoxicity activities by Phylanthus emblica, a new immunomodulator. J Ethnopharmacol, 1994; 44: 55- 60.

Gupta MS, Shivaprasad HN, Kharya MD. Immunomodulatory Activity of the Ayurvedic Formulation “Ashwagandha Churna”. Pharm Biol, 2006; 44(4): 263-265.

Somasundaram S, Sadique J, Subramoniam A. Influence of extraintestinal inflammation on the in vitro absorption of 14C-glucose and the effects of anti-inflammatory drugs in the jejunum of rats. Clin Exp Pharmacol Physiol, 1983; 10: 147-152.

Mahady GB, Gyllenhall C, Fong HH, Farnsworth NR. Ginsengs: a review of safety and efficacy. Nutr Clin Care, 2000; 3: 90-101.

Tarver T. The Review of Natural Products. J Consum Health Internet, 2014; 18(3): 291-292.

Seely D, Dugoua JJ, Perri D. Safety and efficacy of Panax ginseng during pregnancy and lactation. J Clin Pharmacol, 2008; 15: 87-94.

Scaglione F, Ferrara F, Dugnani S, Falchi M, Santoro G, Fraschini F. Immunomodulatory effects of two extracts of Panax ginseng C.A. Meyer. Drugs Exp Clin Res, 1990; 16(10): 537-542.

Schroeder HW, Cavacini L. Structure and function of immunoglobulins. J Allergy Clin Immunol, 2010; 125(2): 41-52.

Lindsay B. The immune system. Essays Biochem, 2016; 60(3): 275-301.

Ryu HS, Kim HS. Effect of Zingiber officinale Roscoe extracts on mice immune cell activation. Korean J Nutr, 2004; 37(1): 23-30.