Boswellic acids/Boswellia serrata extract as a potential COVID-19 therapeutic agent in the elderly

Abstract

The most severe cases of COVID-19, and the highest rates of death, are among the elderly. There is an urgent need to search for an agent to treat the disease and control its progression. Boswellia serrata is traditionally used to treat chronic inflammatory diseases of the lung. This review aims to highlight currently published research that has shown evidence of potential therapeutic effects of boswellic acids (BA) and B. serrata extract against COVID-19 and associated conditions. We reviewed the published information up to March 2021. Studies were collected through a search of online electronic databases (academic libraries such as PubMed, Scopus, Web of Science, and Egyptian Knowledge Bank). Several recent studies reported that BAs and B. serrata extract are safe agents and have multiple beneficial activities in treating similar symptoms experienced by patients with COVID-19. Because of the low oral bioavailability and improvement of buccal/oral cavity hygiene, traditional use by chewing B. serrata gum may be more beneficial than oral use. It is the cheapest option for a lot of poorer people. The promising effect of B. serrata and BA can be attributed to its antioxidant, anti-inflammatory, immunomodulatory, cardioprotective, anti-platelet aggregation, antibacterial, antifungal, and broad antiviral activity. B. serrata and BA act by multiple mechanisms. The most common mechanism may be through direct interaction with IκB kinases and inhibiting nuclear factor-κB-regulated gene expression. However, the most recent mechanism proposed that BA not only inhibited the formation of classical 5-lipoxygenase products but also produced anti-inflammatory LOX-isoform-selective modulators. In conclusion a small to moderate dose B. serrata extract may be useful in the enhancing adaptive immune response in mild to moderate symptoms of COVID-19. However, large doses of BA may be beneficial in suppressing uncontrolled activation of the innate immune response. More clinical results are required to determine with certainty whether there is sufficient evidence of the benefits against COVID-19.

Molecular and structural insights of β-boswellic acid and glycyrrhizic acid as potent SARS-CoV-2 Envelope protein inhibitors

“…With the advantage of being a natural compound, and certain pharmacological studies showed no harmful side effects, these novel compounds could be a good choice to be used for the treatment of COVID-19 patients. This study is in concordance to important antecedents with boswellic and glycyrrhinic acids against SARS-CoV2 and could be a probable treatment of COVID-19 ( Caliebe et al, 2021 ; Gomaa et al, 2021 ; Li et al, 2021 ; Roy and Menon, 2021 ; Sun et al, 2021 ; van de Sand et al, 2021 ; Yu et al, 2021 ).…”

“…Eventually with increasing concentration from 50 to 100 µg/ml noticeable structural loss was observed by both these β-boswellic and glycyrrhicic acids. This might be the possible reason for the loss of activity in SARS-CoV-2 E. Effect on the active site of the SARS-CoV-2 E after binding by these acids was noticed ( Gomaa et al, 2021 ; Sun et al, 2021 ; van de Sand et al, 2021 ). Hence the fluorescence quenching in both β-boswellic and glycyrrhicic acids indicated major changes in the immediate microenvironment of the SARS-CoV-2 E protein.…”

Perspectives on nano-nutraceuticals to manage pre and post COVID-19 infections

“…Licorice extract and Boswellia Serrata gum have pharmacological properties which could support the therapeutic approach for COVID-19. Their antiviral, anti-inflammatory, anti-lung damage, anti-bacteria, antithrombic development, and immunostimulatory properties are all well-known and extensively utilized [ 74 , 75 ]. Another research in the phase 2/3 of the study proposed to study the immunity to COVID-19 with different treatment methods.…”

Advancing combination treatment with glycyrrhizin and boswellic acids for hospitalized patients with moderate COVID-19 infection: a randomized clinical trial

“…We discussed the rationale for the use of licorice extract and boswellia extract for the treatment of COVID-19, focusing on the antiviral effect against SARS-CoV-2 and the control of systemic inflammation and immune dysregulation caused by SARS-CoV-2 infection ( Gomaa et al 2021 ; Gomaa and Abdel-Wadood 2021 ). Recently, van de Sand et al ( 2021 ) suggested that the consumption of products containing glycyrrhizin may be of great benefit to people infected with SARS-CoV-2 as it effectively inhibits SARS-CoV-2 replication in vitro by blocking the main viral protease M pro essential for viral replication.…”