Department of Pharmacology, Faculty of Medicine, Assiut University, Assiut, Egypt.
Faculty of Agriculture, Assiut University, Assiut, Egypt.
Inflammopharmacology. 2022 Dec;30(6):1977-1992. doi: 10.1007/s10787-022-01062-3. Epub 2022 Sep 22.
Breakthrough infections have been reported in fully vaccinated persons. Furthermore, rebound symptoms have been reported following the new FDA granted emergency use to combat SARS-CoV-2. Glycyrrhizin (GR) and boswellic acids (BAs) combination has been shown to have highly successful actions against COVID-19 in our recent clinical trial. However, the study is limited by the small sample size, and therefore, the aim of this article is to comprehensively evaluate recent evidence on the efficacy of GR and BAs in preventing the development of COVID-19 in patients with mild and moderate infections and in preventing post-COVID-19 cognitive impairment, which is the most important symptom after recovery from Covid-19 disease. We have reviewed and discussed information published since the outbreak of the COVID-19 pandemic until July 2022 on preclinical (in vivo, in vivo and bioinformatics) and clinical studies related to the antiviral, anti-inflammatory and immunomodulatory activity of Gr and BAs. Sixteen studies were performed to determine the efficacy of GR against SARS-CoV-2. Ten studies were used primarily for in vitro and in vivo assays and six used molecular docking studies. However, the antiviral activity of BAs against SARS-CoV-2 was determined in only five studies using molecular modeling and bioinformatics. All these studies confirmed that GR n and BAs have strong antiviral activity and can be used as a therapeutic agent for COVID-19 and as a protective agent against SARS-CoV-2. They may act by inhibiting the main protease SARS-CoV-2 (Mpro) responsible for replication and blocking spike protein-mediated cell entry. Only seven rigorously designed clinical trials regarding the usefulness of GR, BAs or their combinations in the treatment of COVID-19 have been published as of July 2022. Although there is no clinical study regarding the treatment of cognitive impairment after COVID-19 that has been published so far, several preclinical and clinical studies have demonstrated the potential effect of GR and BAs in the prevention and treatment of cognitive impairment by inhibiting the activity of several molecules that activate inflammatory signaling pathway. In conclusion, the findings of our study documented the beneficial use of GR and BAs to treat SARS-CoV-2 and its variants and prevent post-COVID cognitive impairment. However, it warrants further studies with a larger randomized sample size to ensure that the studies have sufficient evidence of benefits against COVID-19 and post-COVID-19 symptoms.
突破性感染已在完全接种疫苗的人群中报告。此外，在新的 FDA 批准紧急使用以对抗 SARS-CoV-2 后，已报告出现反弹症状。我们最近的临床试验表明，甘草酸（GR）和乳香酸（BAs）的组合对 COVID-19 具有非常成功的作用。然而，该研究受到样本量小的限制，因此，本文的目的是全面评估最近关于 GR 和 BAs 预防轻度和中度感染患者 COVID-19 发展以及预防 COVID-19 后认知障碍的疗效的证据，这是从 COVID-19 疾病康复后最重要的症状。我们审查和讨论了自 COVID-19 大流行爆发以来至 2022 年 7 月发表的关于 GR 和 BAs 的抗病毒、抗炎和免疫调节活性的临床前（体内、体内和生物信息学）和临床研究的信息。进行了 16 项研究来确定 GR 对 SARS-CoV-2 的疗效。十项研究主要用于体外和体内测定，六项研究使用分子对接研究。然而，仅使用分子建模和生物信息学在五项研究中确定了 BAs 对 SARS-CoV-2 的抗病毒活性。所有这些研究都证实，GR n 和 BAs 具有很强的抗病毒活性，可作为 COVID-19 的治疗剂和 SARS-CoV-2 的保护剂。它们可能通过抑制负责复制的 SARS-CoV-2（Mpro）主蛋白酶和阻断刺突蛋白介导的细胞进入来发挥作用。截至 2022 年 7 月，仅发表了七项关于 GR、BAs 或其组合在 COVID-19 治疗中的有用性的严格设计的临床试验。尽管迄今为止尚无关于 COVID-19 后认知障碍治疗的临床研究发表，但一些临床前和临床研究表明，GR 和 BAs 通过抑制几种激活炎症信号通路的分子的活性，具有预防和治疗认知障碍的潜力。总之，我们的研究结果记录了 GR 和 BAs 用于治疗 SARS-CoV-2 及其变体以及预防 COVID-19 后认知障碍的有益用途。然而，需要进一步进行具有更大随机样本量的研究，以确保研究具有针对 COVID-19 和 COVID-19 后症状的充分益处证据。
