ABSTRACT
Objective: To discuss the potential and molecular mechanism of Carthamus tincorius derived hydroxysafflor yellow A (HSYA) as an alternative herbal adjuvant that may regulate various signaling pathways that might be related to the regulatory effects in COVID-19 patients with ALI and ARDS. Methods: We search Web of Science, PubMed, and Scopus using keywords: Carthamus tinctorius, adjuvant, cytokine storm, COVID-19, SARS-Cov-2, acute lung injury (ALI), and Acute Respiratory Distress Syndrome (ARDS), on 11 September 2020, and 18 December 2020. Results and Discussions: In COVID-19 patients, SARS-CoV-2 replication might be associated with hyper induction of pro-in-flammatory cytokine, which is known as a cytokine storm, and may cause acute lung injury (ALI) that leads to Acute Respiratory Distress Syndrome (ARDS). Carthamus tincorius derived HSYA were used in many studies, in vivo in animal models or in vitro in cell lines and showed inhibition of multiple inflammatory pathways that were involved in ALI and ARDS, which might occur in covid-19 patients. HSYA showed pleiotropic effects in regulating cytokine levels. It regulated TNF-α, IL-1β, IL-6, IFN-β, and showed protective effect by blocking TLR4, MyD88, TRIF, IRF3, NF-κB to avoid cytokine storm and prevent tissue damage. HSYA was showed to reduce oxidative stress-mediated damage, and down-regulate inflammatory cytokines. Further, it was relatively safe when studied as an adjuvant in HIV and cancer patients. Conclusion: We supposed that HSYA could be used as an alternative adjuvant in COVID-19 patients with ARDS. However, clinical trials are needed to prove its efficacy in COVID-19 patients with ARDS.
ABSTRACT
Objective: To highlight the potential of mesenchymal stem cells (MSCs) as an adjuvant therapy for severe COVID-19 patient. Materials and Methods: We searched Pubmed and Google Scholar, using keywords: 'MSC AND lung injury', 'MSC AND ARDS', 'MSC AND COVID-19', 'Stem cell AND Lung injury' and 'Stem cell AND ARDS', on 19 Mei and 19 July 2020. Results and Discussions: Severe manifestations in COVID-19 patients are due to immune system response. MSCs have immunomodulatory and anti-inflammatory effect and therefore may be beneficial to alleviate acute respiratory distress syndrome (ARDS). A small published study showed that MSCs had beneficial effect on COVID-19 patients, who showed clinical symptom improvements. Further, application of MSCs from several sources such as bone marrow, menstrual blood, and umbilical cord-derived MSCs, which were used in patients suffering from lung injury/ARDS due to conditions other than COVID-19, showed that a dose of up to 1.0 x 107 cells/kg body weight was well tolerated. Conclusion: administration of MSCs to COVID-19 patients showed improvement in clinical symptoms, and a dose up to 1.0 x 107 cells/kg body weight showed tolerance in ARDS patients with moderate to severe conditions. However, the results came from studies with small number of patients, so the results need to be interpreted with caution, and more well design studies with a larger number of patients are needed.
ABSTRACT
Severe COVID-19 cases are mostly due to severe inflammatory reaction and cytokine storm, which may lead to multiple organ failure and death. Until recently, there is no proven effective treatment for severe COVID-19. Mesenchymal stem cells (MSCs) have anti-inflammatory and regenerative properties. Therefore, they are supposed to work on COVID-19, which has failed to recover using other treatments. Therefore, studies are needed to determine the best tissue source of MSCs, the dose, repeat, and route of administration. For this review, we searched various databases, i.e. Pubmed, Science Direct, Springer, and WHO website using keywords: “mesenchymal stem cells” and “COVID-19” at 7 May 2020, without time limits. Various clinical trials on the use of MSCs for COVID-19 were registered, and initial results were reported. Initial results were promising but should be interpreted cautiously, as one was a case report, another one was case series, and one was a preliminary study of seven treated patients compared to three controls, where the baseline conditions were unequal. Therefore, well design randomized clinical trials are needed to get more robust prove. © 2020 The Authors.