COVID-19: Is There Evidence for the Use of Herbal Medicines as Adjuvant Symptomatic Therapy?

BACKGROUND: Current recommendations for the self-management of SARS-Cov-2 disease (COVID-19) include self-isolation, rest, hydration, and the use of NSAID in case of high fever only. It is expected that many patients will add other symptomatic/adjuvant treatments, such as herbal medicines. AIMS: To provide a benefits/risks assessment of selected herbal medicines traditionally indicated for "respiratory diseases" within the current frame of the COVID-19 pandemic as an adjuvant treatment. METHOD: The plant selection was primarily based on species listed by the WHO and EMA, but some other herbal remedies were considered due to their widespread use in respiratory conditions. Preclinical and clinical data on their efficacy and safety were collected from authoritative sources. The target population were adults with early and mild flu symptoms without underlying conditions. These were evaluated according to a modified PrOACT-URL method with paracetamol, ibuprofen, and codeine as reference drugs. The benefits/risks balance of the treatments was classified as positive, promising, negative, and unknown. RESULTS: A total of 39 herbal medicines were identified as very likely to appeal to the COVID-19 patient. According to our method, the benefits/risks assessment of the herbal medicines was found to be positive in 5 cases (Althaea officinalis, Commiphora molmol, Glycyrrhiza glabra, Hedera helix, and Sambucus nigra), promising in 12 cases (Allium sativum, Andrographis paniculata, Echinacea angustifolia, Echinacea purpurea, Eucalyptus globulus essential oil, Justicia pectoralis, Magnolia officinalis, Mikania glomerata, Pelargonium sidoides, Pimpinella anisum, Salix sp, Zingiber officinale), and unknown for the rest. On the same grounds, only ibuprofen resulted promising, but we could not find compelling evidence to endorse the use of paracetamol and/or codeine. CONCLUSIONS: Our work suggests that several herbal medicines have safety margins superior to those of reference drugs and enough levels of evidence to start a clinical discussion about their potential use as adjuvants in the treatment of early/mild common flu in otherwise healthy adults within the context of COVID-19. While these herbal medicines will not cure or prevent the flu, they may both improve general patient well-being and offer them an opportunity to personalize the therapeutic approaches.

Triterpenes from Pouteria ramiflora (Mart.) Radlk. Leaves (Sapotaceae).

Pouteria ramiflora (Mart.) Radlk. (Sapotaceae) is a species used by inhabitants from the Cerrado for its edible fruits and medicinal value. Hexane crude extracts from leaves and fractions were evaluated for in vitro α-amylase inhibitory activity and antioxidant potential. The fraction with the highest α-amylase inhibitory activity was submitted to a phytochemical study. Three triterpenes were isolated, friedelin, epi-friedelanol, and taraxerol. This is the first report of these compounds isolated from P. ramiflora. Moreover, this is the first report of friedelin isolated from Pouteria sp. Epi-friedelanol was present in significant amounts, suggesting that this compound could be a candidate marker for this species.

Evaluation of the genotoxicity/mutagenicity and antigenotoxicity/antimutagenicity induced by propolis and Baccharis dracunculifolia, by in vitro study with HTC cells.

The ethanolic extract of propolis, especially the Brazilian green type, is widely and mainly used for therapeutic purposes despite the lack of knowledge about its effects and its cellular mode of action. This type of propolis, derived from Baccharis dracunculifolia (alecrim-do-campo), has been extensively commercialized and the consumers use it to enhance health. This work aimed to assess the genotoxic/mutagenic and antigenotoxic/antimutagenic potentials of the ethanolic extracts of Brazilian green propolis and of B. dracunculifolia, on mammalian cells. It was not observed genotoxic and mutagenic effects by both extracts. After evaluate the exposure of the cells to each extract with a recognized mutagen, simultaneously, the results showed a significant reduction on DNA damage. The experiment carried out with a pre-incubation period was more effective than without incubation test, showing that the tested extracts were able to inactivate the mutagen before it could react with the DNA.

Chemical analysis and toxicity of seaweed extracts with inhibitory activity against tropical fruit anthracnose fungi.

BACKGROUND: Banana and papaya are among the most important crops in the tropics, with a value amounting to millions of dollars per year. However, these fruits suffer significant losses due to anthracnose, a fungal disease. It is well known that certain seaweed extracts possess antifungal activity, but no published data appear to exist on the practical application of this property. In the present study, five organic Brazilian seaweed extracts were screened for their activity against banana and papaya anthracnose fungi. Furthermore, cytotoxic and mutagenic effects of the extracts were evaluated by the brine shrimp lethality assay and the Allium cepa root-tip mutagenicity test respectively, while their major components were identified by gas chromatography/mass spectrometry. RESULTS: Strong fungus-inhibitory effects of Ochtodes secundiramea and Laurencia dendroidea extracts were observed on both papaya (100 and 98% respectively) and banana (89 and 78% respectively). This impressive activity could be associated with halogenated terpenes, the major components of both extracts. Only Hypnea musciformis extract showed cytotoxic and mutagenic effects. CONCLUSION: The results of this study suggest the potential use of seaweed extracts as a source of antifungal agents with low toxicity to control anthracnose in papaya and banana during storage.

Evaluation of the antifungal activity of plant extracts and oral antiseptics against Candida albicans / Avaliação da atividade antifúngica de extratos vegetais e antissépticos bucais em Candida albicans

Objective: Oral candidiasis is the most common fungal infection of the oral cavity, and Candida albicans is the most frequently isolated species. Material and Methods: In this study, the potential antifungal effect of extracts from Gossypium hirsutum L., Arctium lappa, Equisetum sp., Cecropia pachystachya Trécul and Pogostemon heyneanus plants were evaluated on non-adhered cells of C. albicans, and the effect of oral antiseptics A (cetylpyridinium chloride 0.500 mg), B (chlorhexidine gluconate 0.12%), C (hydrogen peroxide 1.5%) and D (thymol, eucalyptol, menthol and methyl salicylate) were evaluated on non-adhered cells and biofilms of C. albicans, using turbidimetry and minimal inhibitory concentration (MIC) of the extracts and the maximal inhibitory dilution (MID) of the antiseptics. Results: The most promising results on non-adhered cells were obtained with Cecropia pachystachya Trécul extracts, with MIC values between 7.81 and 3.91 μg/mL. Antiseptics A and B showed the lowest MID values, between 0.20 and 0.10% (Kruskal-Wallis, p < 0.0001). Regarding biofilm inhibition, the MID values found were similar for the tested antiseptics, varying from 50% to 0.20% (Kruskal-Wallis, p = 0.6915). Conclusion: These results show that some plant extracts has potential use in the prevention and treatment of oral candidiasis...

Objetivo: A candidíase oral é a infecção fúngica mais comum na cavidade oral e Candida albicans é a espécie frequentemente relacionada. Material e Métodos: Neste estudo foi avaliado o potencial efeito antifúngico de extratos das plantas Gossypium hirsutum L., Arctium lappa, Equisetum sp., Cecropia pachystachya Trécul. e Pogostemon heyneanus sobre células não aderidas de C. albicans e o efeito dos antissépticos bucais A (cloreto de cetilpiridínio 0,500 mg); B (gluconato de clorexidina 0,12%); C (peróxido de hidrogênio 1,5%) e D (timol, eucaliptol, mentol e salicilato de metila) sobre células não aderidas e biofilmes de Candida albicans. A susceptibilidade dos isolados clínicos de C. albicans foi avaliada através da determinação da inibição de crescimento celular por turbidimetria e por determinação da Concentração Inibitória Mínima (CIM) dos extratos e da Máxima Diluição Inibitória (MDI) dos antissépticos. Resultados: Os resultados mais promissores dos testes com células não aderidas foram obtidos com extratos de Cecropia pachystachya Trécul., com valores de CIM entre 7,81 e 3,91 μg/ mL. Os antissépticos A e B apresentaram os menores valores de MDI, entre 0,20 e 0,10% (Kruskal-Wallis, p < 0,0001). Em relação a inibição de formação de biofilmes, os valores de MDI encontrados foram similares para os antissépticos testados, variando de 50% a 0,20% (Kruskal-Wallis, p = 0,6915). Conclusão: Os resultados mostraram que todos os antissépticos bucais e extratos vegetais analisados apresentaram atividade antifúngica contra os isolados de C. albicans, e as espécies medicinais apresentam potencial uso na prevenção e tratamento de candidíase oral...

Plantas medicinais utilizadas pela população atendida no programa de saúde da família, Governador Valadares, MG, Brasil / Medicinal plants used by the population assisted by the programa de saúde da família (family health program) in Governador Valadares county, MG, Brazil

Este trabalho teve como objetivo realizar um estudo sobre a utilização de plantas medicinais pela população atendida no Programa de Saúde da Família em Governador Valadares, Estado de Minas Gerais, a fim de resgatar, preservar e utilizar este conhecimento em trabalhos com a comunidade. Foi usada a metodologia de questionários pré-estabelecidos, que foram aplicados pelos Agentes de Saúde da Família. O estudo foi feito em 27 bairros da cidade, sendo aplicados 2454 questionários, resultando em 232 plantas citadas como medicinais pela população entrevistada. As principais indicações de uso das plantas medicinais foram como calmante (10%), contra gripe (18%) e infecções (9%). A maioria das plantas utilizadas são preparadas na forma de chá (78%) e obtidas em cultivo próprio (57%), sendoque, em geral, o conhecimento sobre o uso e modo de preparo da plantas medicinais foi obtido dos familiares (67%). A maioria das espécies citadas e utilizadas popularmente possui atividade farmacológica já comprovada na literatura necessitando, entretanto, de orientação correta sobre seu cultivo e emprego terapêutico.

This study was conducted to evaluate the use of medicinal plants by the population assisted by the ôPrograma de Saúde da Famíliaõ in Governador Valadares -MG, in order to rescue, preserve and use this knowledge in works carried out with the community. The preestablished questionnaire methodology was used. Those questionnaires were applied by the Family Health Agents. The study was accomplished in 27 residential quarters, as being applied 2454 questionnaires,and 232 plants were mentioned as medicinal ones by the interviewed population. The main indications for using the medicinal plants were: as sedative (10%), against influenza(18%) and infections (9%). Most plants under use are prepared as tea (78%) and are obtained in own cropping(57%). In general, the knowledge on the use and preparation of the medicinal plants proceeded from their relatives (67%). Most mentioned and popularly used species have pharmacological activity already proven in the literature. However, this population needs a correct orientation on their cropping and therapeutic use.