A Randomized Controlled Trial of the Efficacy of Systemic Enzymes and Probiotics in the Resolution of Post-COVID Fatigue

Rathi, Abhijit; Jadhav, Swati B.; Shah, Neha

doi:10.3390/medicines8090047

Cited by 46 publications

(54 citation statements)

References 54 publications

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“…Results of a randomized controlled trial involving 200 patients with COVID-19 showed that a 14-day probiotic supplementation of Bacillus coagulans , Bacillus subtilis and Bacillus clausii combined with systemic enzymes with immunomodulatory potential (serratiopeptidase, bromelain, amylase, lysozyme, peptidase, catalase, papain, glucoamylase and lactoferrin) improved physical and mental fatigue in individuals recovered from COVID-19 (ref. 177 ). Another randomized controlled trial of 300 participants also found that supplementation of a probiotic formula consisting of Lactiplantibacillus plantarum and Pediococcus acidilactici in patients with COVID-19 was associated with a reduction in nasopharyngeal viral load, lung infiltrates, shortened duration of clinical symptoms by 2–7 days and improved immune response in the intervention group compared with the control group receiving placebo 178 .…”

Section: Microbiota-based Interventionsmentioning

confidence: 99%

Gut microbiota in COVID-19: key microbial changes, potential mechanisms and clinical applications

Zhang

Lau

Liu

et al. 2022

Nat Rev Gastroenterol Hepatol

139

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The gastrointestinal tract is involved in coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The gut microbiota has important roles in viral entry receptor angiotensin-converting enzyme 2 (ACE2) expression, immune homeostasis, and crosstalk between the gut and lungs, the ‘gut–lung axis’. Emerging preclinical and clinical studies indicate that the gut microbiota might contribute to COVID-19 pathogenesis and disease outcomes; SARS-CoV-2 infection was associated with altered intestinal microbiota and correlated with inflammatory and immune responses. Here, we discuss the cutting-edge evidence on the interactions between SARS-CoV-2 infection and the gut microbiota, key microbial changes in relation to COVID-19 severity and host immune dysregulations with the possible underlying mechanisms, and the conceivable consequences of the pandemic on the human microbiome and post-pandemic health. Finally, potential modulatory strategies of the gut microbiota are discussed. These insights could shed light on the development of microbiota-based interventions for COVID-19.

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Section: Microbiota-based Interventionsmentioning

confidence: 99%

Gut microbiota in COVID-19: key microbial changes, potential mechanisms and clinical applications

Zhang

Lau

Liu

et al. 2022

Nat Rev Gastroenterol Hepatol

139

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“…Lumbrokinases are another orally active [ 960 ] set of fibrinolytic enzymes that have been found in earthworms [ 961–965 ], and may also be produced recombinantly [ 966 , 967 ]; they may also have some tPA activity [ 965 ]. Each has been proposed as of value in acute and/or Long COVID treatment [ 751 , 958 , 968 ]. With two (positive) exceptions [ 968 , 969 ], and another planned [ 970 ], randomised controlled trials are awaited.…”

Section: Anticoagulants Platelet Inhibitors and The Triple Treatmentmentioning

confidence: 99%

“…Each has been proposed as of value in acute and/or Long COVID treatment [ 751 , 958 , 968 ]. With two (positive) exceptions [ 968 , 969 ], and another planned [ 970 ], randomised controlled trials are awaited. In the plant kingdom, bromelain (from pineapples) is a cysteine protease found in pineapple tissue [ 971–974 ].…”

Section: Anticoagulants Platelet Inhibitors and The Triple Treatmentmentioning

confidence: 99%

The potential role of ischaemia–reperfusion injury in chronic, relapsing diseases such as rheumatoid arthritis, Long COVID, and ME/CFS: evidence, mechanisms, and therapeutic implications

Kell

2022

Biochemical Journal

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Ischaemia–reperfusion (I–R) injury, initiated via bursts of reactive oxygen species produced during the reoxygenation phase following hypoxia, is well known in a variety of acute circumstances. We argue here that I–R injury also underpins elements of the pathology of a variety of chronic, inflammatory diseases, including rheumatoid arthritis, ME/CFS and, our chief focus and most proximally, Long COVID. Ischaemia may be initiated via fibrin amyloid microclot blockage of capillaries, for instance as exercise is started; reperfusion is a necessary corollary when it finishes. We rehearse the mechanistic evidence for these occurrences here, in terms of their manifestation as oxidative stress, hyperinflammation, mast cell activation, the production of marker metabolites and related activities. Such microclot-based phenomena can explain both the breathlessness/fatigue and the post-exertional malaise that may be observed in these conditions, as well as many other observables. The recognition of these processes implies, mechanistically, that therapeutic benefit is potentially to be had from antioxidants, from anti-inflammatories, from iron chelators, and via suitable, safe fibrinolytics, and/or anti-clotting agents. We review the considerable existing evidence that is consistent with this, and with the biochemical mechanisms involved.

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“…[47][48][49] ImmunoSEB and ProbioSEB CSC3 were shown in combination in a randomized controlled trial to have benefit in treating fatigue symptoms (91% resolution of fatigue vs. 15% in treatment vs. placebo groups after 14 days). 47 ImmunoSEB is a multienzyme formulation, which contains enzymes such as bromelain and papain, and Pro-bioSEB CSC3 contains various strains of Bacillus probiotics. Similarly, Apportal, which is a nutritional supplement that contains various vitamins, minerals, amino acids, and plant extracts, and Pycnogenol, an extract from French Maritime pine bark, were shown separately in 2 prospective, open-label studies to have benefit in treating fatigue symptoms after short treatment courses of a few weeks to a month.…”

Section: Scoping Reviewmentioning

confidence: 99%

A Scoping Review of Pharmacological Management of Postacute Sequelae of Severe Acute Respiratory Syndrome Coronavirus 2 Infection in 2021

Carson¹,

Hemenway²

2022

American Journal of Therapeutics

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Background: Postacute sequelae of severe acute respiratory syndrome coronavirus 2 infection (PASC), or long-COVID, are signs and symptoms that persist after the acute phase of Coronavirus disease 2019 infection has passed. PASC is newly recognized, and research is ongoing to answer questions about pathology, symptoms, diagnosis, and optimal treatment. Areas of Uncertainty: Use of pharmacologic treatment for symptoms of PASC is currently evolving. This scoping review aims to assess medical literature for any evidence supporting or refuting use of any medications to specifically treat PASC.Data Sources: PubMed, EMBASE, Web of Science, and gray literature sources were searched for any study of medication use for PASC. Studies were included if they described medication use in patients with PASC. There were no exclusion criteria based on study type or if results were reported. Studies were divided into completed works and ongoing research.Results: Fifty-two records were included in final analysis from an initial 3524 records found, including 2 randomized controlled trials, 7 prospective, open-label or observational studies, 14 case reports or case series, 1 survey, 1 correspondence, 1 retrospective analysis, and 26 studies in progress. Seven of the 26 completed works investigate ivabradine or beta-blockers, whereas 7 investigate local or systemic corticosteroids. Three investigate multi-ingredient nutritional supplements. The other 9 completed works as well as the 26 studies in progress investigate a wide variety of other treatments including drugs in development, drugs used for other conditions, herbals, supplements, and vitamins.Conclusions: There is limited, but evolving, literature on medication treatment for PASC. Providers who opt to use pharmacologic therapy for PASC need to be vigilant in their knowledge of these evolving data.

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A Randomized Controlled Trial of the Efficacy of Systemic Enzymes and Probiotics in the Resolution of Post-COVID Fatigue

Cited by 46 publications

References 54 publications

Gut microbiota in COVID-19: key microbial changes, potential mechanisms and clinical applications

Gut microbiota in COVID-19: key microbial changes, potential mechanisms and clinical applications

The potential role of ischaemia–reperfusion injury in chronic, relapsing diseases such as rheumatoid arthritis, Long COVID, and ME/CFS: evidence, mechanisms, and therapeutic implications

A Scoping Review of Pharmacological Management of Postacute Sequelae of Severe Acute Respiratory Syndrome Coronavirus 2 Infection in 2021

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