Abstract
As the COVID-19 pandemic is progressing, the therapeutic gaps in conventional management have highlighted the need for the integration of traditional knowledge systems with modern medicine. Ayurvedic medicines, especially Ashwagandha (Withania somnifera (L.) Dunal, WS), may be beneficial in the management of COVID-19. WS is a widely prescribed Ayurvedic botanical known as an immunomodulatory, antiviral, anti-inflammatory, and adaptogenic agent. The chemical profile and pharmacological activities of WS have been extensively reported. Several clinical studies have reported its safety for use in humans. This review presents a research synthesis of in silico, in vitro, in vivo, and clinical studies on Withania somnifera (L.) Dunal (WS) and discusses its potential for prophylaxis and management of COVID-19. We have collated the data from studies on WS that focused on viral infections (HIV, HSV, H1N1 influenza, etc.) and noncommunicable diseases (hypertension, diabetes, cancer, etc.). The experimental literature indicates that WS has the potential for 1) maintaining immune homeostasis, 2) regulating inflammation, 3) suppressing pro-inflammatory cytokines, 4) organ protection (nervous system, heart, lung, liver, and kidney), and 5) anti-stress, antihypertensive, and antidiabetic activities. Using these trends, the review presents a triangulation of Ayurveda wisdom, pharmacological properties, and COVID-19 pathophysiology ranging from viral entry to end-stage acute respiratory distress syndrome (ARDS). The review proposes WS as a potential therapeutic adjuvant for various stages of COVID-19 management. WS may also have beneficial effects on comorbidities associated with the COVID-19. However, systematic studies are needed to realize the potential of WS for improving clinical outcome of patients with COVID-19.
Highlights
The COVID-19 or coronavirus disease 2019 is a contagious disease caused by SARS-CoV-2
The experimental trends generated from healthy and disease models indicate that WS has a potential for 1) maintaining immune homeostasis, 2) regulating inflammation, 3) suppressing pro-inflammatory cytokines, 4) organ protection, and 5)
50–200 mg/kg of different extracts of WS and 2 mg/kg of withaferin A tested in animal models significantly showed anti-inflammatory, cytokine regulatory, and immunomodulatory effects
Summary
The COVID-19 or coronavirus disease 2019 is a contagious disease caused by SARS-CoV-2. Few therapeutic approaches are suggesting to target GM-CSF to mitigate cytokine storm (Ayisha Sharma and Vaidya, 2020) In this background, withanolide A might be beneficial as it is found to have a substantial binding affinity with GM-CSF receptor in a molecular docking study (Posa et al, 2016). These studies have been aimed to understand WS applications in the management of COVID-19 (CTRI/2020/05/ 025429) Viral infections such as SARS-CoV-2 trigger excessive generation of pro-inflammatory cytokines known as cytokine storm (Tang et al, 2020). It was recommended to restrict the tocilizumab treatment to patients with high IL-6 levels (“WHO R&D Blueprint COVID-19 Informal Consultation on the Potential Role of IL-6/IL-1 Antagonists in the Clinical Management of COVID 19 Infection” 2020) (Michot et al, 2020) In such a scenario, WS may be helpful to suppress IL-1β and IL-6 as evident in several models. WS ethanolic extract attenuated IL-1β expression in PBMCs of healthy individuals and arthritic patients (Singh D. et al, 2007)
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