Potential Targets for Treatment of Coronavirus Disease 2019 (COVID-19): A Review of Qing-Fei-Pai-Du-Tang and Its Major Herbs
Abstract
COVID-19 has been declared a pandemic by WHO on March 11, 2020. No specific treatment and vaccine with documented safety and efficacy for the disease have been established. Hence it is of utmost importance to identify more therapeutics such as Chinese medicine formulae to meet the urgent need. Qing Fei Pai Du Tang (QFPDT), a Chinese medicine formula consisting of 21 herbs from five classical formulae has been reported to be efficacious on COVID-19 in 10 provinces in mainland China. QFPDT could prevent the progression from mild cases and shorten the average duration of symptoms and hospital stay. It has been recommended in the 6th and 7th versions of Clinical Practice Guideline on COVID-19 in China. The basic scientific studies, supported by network pharmacology, on the possible therapeutic targets of QFPDT and its constituent herbs including Ephedra sinica, Bupleurum chinense, Pogostemon cablin, Cinnamomum cassia, Scutellaria baicalensis were reviewed. The anti-oxidation, immuno-modulation and antiviral mechanisms through different pathways were collated. Two clusters of actions identified were cytokine storm prevention and angiotensin converting enzyme 2 (ACE2) receptor binding regulation. The multi-target mechanisms of QFPDT for treating viral infection in general and COVID-19 in particular were validated. While large scale clinical studies on QFPDT are being conducted in China, one should use real world data for exploration of integrative treatment with inclusion of pharmacokinetic, pharmacodynamic and herb-drug interaction studies.
References
- . COVID-19: An update on the epidemiological, clinical, preventive and therapeutic evidence and guidelines of integrative Chinese-Western medicine for the management of 2019 novel coronavirus disease. Am. J. Chin. Med. 48: 1–26, 2020. Link, ISI, Google Scholar
- . Synergistic activity of baicalein with ribavirin against influenza A (H1N1) virus infections in cell culture and in mice. Antiviral Res. 91: 314–320, 2011. Crossref, Medline, ISI, Google Scholar
- . Inhibitory activities of baicalin against renin and angiotensin-converting enzyme. Pharm. Biol. 50: 401–406, 2012. Crossref, Medline, ISI, Google Scholar
- . Antiasthmatic activity and selective inhibition of type 2 helper T cell response by aqueous extract of semen armeniacae amarum. Immunopharmacol. Immunotoxicol. 28: 213–225, 2006. Crossref, Medline, ISI, Google Scholar
- . Saikosaponin a inhibits lipopolysaccharide-oxidative stress and inflammation in human umbilical vein endothelial cells via preventing TLR4 translocation into lipid rafts. Free Radic. Biol. Med. 89: 777–785, 2015. Crossref, Medline, ISI, Google Scholar
- . Misguided drug advice for COVID-19. Science, 2020, https://doi.org/10.1126/science.abb8034. ISI, Google Scholar
- . Agents to reduce cytokine storm. F1000Res. 5: 2909–2909, 2016. Crossref, Medline, Google Scholar
- . Clinical characteristics of coronavirus disease 2019 in China. N. Engl. J. Med. 382: 1708–1720, 2020. Crossref, Medline, ISI, Google Scholar
- . Promotion of regulatory T cell induction by immunomodulatory herbal medicine licorice and its two constituents. Sci. Rep. 5: 14046–14046, 2015. Crossref, Medline, ISI, Google Scholar
- . Superoxide Ion: generation and chemical implications. Chem. Rev. 116: 3029–3085, 2016. Crossref, Medline, ISI, Google Scholar
- . Analysis of TCM prevention and treatment schemes for COVID-19 in various regions of China. Acta Chin. Med., 2020. Google Scholar
- . Thoughts on Qingfei Paidu decoction for quickly treating new Coronavirus pneumonia based on syndrome differentiation. J. Tradit. Chin. Med., 2020. Google Scholar
- . Chemical composition and antioxidant, anti-inflammatory, and antiproliferative activities of Lebanese Ephedra Campylopoda Plant. Med. Sci. Monit. Basic Res. 23: 313–325, 2017. Crossref, Medline, ISI, Google Scholar
- . Analysis of chemical composition of polysaccharides from Poria cocos Wolf and its anti-tumor activity by NMR spectroscopy. Carbohydr. Polym. 80: 31–34, 2010. Crossref, ISI, Google Scholar
- . Saikosaponin a, an active compound of Radix Bupleuri, attenuates inflammation in hypertrophied 3T3-L1 adipocytes via ERK/NF-B signaling pathways. Int. Mol. Med. 35: 1126–1132, 2015. Crossref, Medline, ISI, Google Scholar
- . A crucial role of angiotensin converting enzyme 2 (ACE2) in SARS coronavirus–induced lung injury. Nat. Med. 11: 875–879, 2005. Crossref, Medline, ISI, Google Scholar
- . Therapeutic modulation of virus-induced oxidative stress via the Nrf2-dependent antioxidative pathway. Oxid. Med. Cell. Longev. 2018: 6208067, 2018. Crossref, Medline, ISI, Google Scholar
- . Influenza A virus induction of oxidative stress and MMP-9 is associated with severe lung pathology in a mouse model. Virus. Res. 178: 411–422, 2013. Crossref, Medline, ISI, Google Scholar
- . Enhancement of the immune responses to vaccination against foot-and-mouth disease in mice by oral administration of an extract made from Rhizoma Atractylodis Macrocephalae (RAM). Vaccine 27: 2094–2098, 2009. Crossref, Medline, ISI, Google Scholar
- . Angiotensin-converting enzyme 2 is a functional receptor for the SARS coronavirus. Nature 426: 450–454, 2003. Crossref, Medline, ISI, Google Scholar
- . A comprehensive review and perspectives onpharmacology and toxicology of saikosaponins. Phytomedicine 50: 73–87, 2018. Crossref, Medline, ISI, Google Scholar
- . Rhodiola crenulata attenuates gamma-ray induced cellular injury via modulation of oxidative stress in human skin cells. Am. J. Chin. Med. 46: 175–190, 2018. Link, ISI, Google Scholar
- . Defining the epidemiology of Covid-19 - studies needed. N. Engl. J. Med. 382: 1194–1196, 2020. Crossref, Medline, ISI, Google Scholar
- . Anti-oxidant in China: A thirty-year journey. Am. J. Chin. Med. 47: 1005–1024, 2019. Link, ISI, Google Scholar
- . Saikosaponin a and its epimer saikosaponin D exhibit anti-inflammatory activity by suppressing activation of NF-B signaling pathway. Int. Immunopharmacol. 14: 121–126, 2012. Crossref, Medline, ISI, Google Scholar
- . Molecular cloning of a Poria cocos protein that activates Th1 immune response and allays Th2 cytokine and IgE production in a murine atopic dermatitis model. J. Agric. Food Chem. 62: 2861–2871, 2014. Crossref, Medline, ISI, Google Scholar
- . Clinical observation on 63 cases of suspected cases of new coronavirus pneumonia treated by Chinese medicine Lianhua Qingwen. J. Tradit. Chin. Med., 2020. Google Scholar
- . Immunoregulatory effects of Glycyrrhizic acid exerts anti-asthmatic effects via modulation of Th1/Th2 cytokines and enhancement of CD4CD25Foxp3 regulatory T cells in ovalbumin-sensitized mice. J. Ethnopharmacol. 148: 755–762, 2013. Crossref, Medline, ISI, Google Scholar
- . Anti-inflammation effects and potential mechanism of Saikosaponins by regulating nicotinate and nicotinamide metabolism and arachidonic acid metabolism. Inflammation 239(4): 1453–1461, 2016. Crossref, Google Scholar
- . Summary of TCM syndromes and treatment of new coronavirus (2019-nCoV) syndrome. Beijing. J. Tradit. Chin. Med., 2020. Google Scholar
- . Potential effects of coronaviruses on the cardiovascular system: A review. JAMA Cardiol. 2020, https://doi.org/10.1001/jamacardio.2020.1286. Crossref, Medline, Google Scholar
- National Health Comission and National Administration of Traditional Chinese Medicine. Diagnosis and treatment of pneumonia caused by new coronavirus (trial version 7). National Health Comission, National Administration of Traditional Chinese Medicine, Beijing, 2020. Google Scholar
- . Efficient utilization of licorice root by alkaline extraction. In Vivo 28: 785–794, 2014. Medline, ISI, Google Scholar
- . DPPH (1,1-diphenyl-2-picrylhydrazyl) radical scavenging activity of flavonoids obtained from some medicinal plants. Biol. Pharm. Bull. 24: 1202–1205, 2001. Crossref, Medline, ISI, Google Scholar
- . Protective effect of safflower seed on cisplatin-induced renal damage in mice via oxidative stress and apoptosis-mediated pathways. Am. J. Chin. Med. 46: 157–174, 2018. Link, ISI, Google Scholar
- . Angiotensin-converting enzyme 2 and anti-hypertensives (angiotensin receptor blockers and angiotensin converting enzyme inhibitors) in Coronavirus Disease 2019 (COVID-19). J. Mayocp. 95(6): 1222–1230, 2020. Google Scholar
- . Restoring effects of natural anti-oxidant quercetin on cellular senescent human dermal fibroblasts. Am. J. Chin. Med. 46: 853–873, 2018. Link, ISI, Google Scholar
- . Antihypertensive drugs and risk of COVID-19?. Lancet Respir. Med. 8(5): e28, 2020. Crossref, Medline, Google Scholar
- . Renin-Angiotensin-Aldosterone system inhibitors in patients with Covid-19. N. Engl. J. Med. 382: 1653–1659, 2020. Crossref, Medline, ISI, Google Scholar
- . Clinical observation of Qingfeipaidu Decoction in the treatment of novel coronavirus pneumonia. Pharmacol. Chin. Mat. Med., 2020a. Google Scholar
- . TCM clinical features and syndrome differentiation of new coronavirus (2019-nCoV) pneumonia. J. Tradit. Chin. Med. 61: 1–7, 2020b. Google Scholar
- . Screening of antiviral components of ma huang tang and investigation on the ephedra alkaloids efficacy on influenza virus type A. Front. Pharmacol. 10: 961, 2019. Crossref, Medline, ISI, Google Scholar
- . Baicalin attenuates angiotensin II-induced endothelial dysfunction. Biochem. Biophys. Res. Commun. 465: 101–107, 2015. Crossref, Medline, ISI, Google Scholar
- . Immunologic mechanism of Patchouli alcohol anti-H1N1 influenza virus may through regulation of the RLH signal pathway in vitro. Curr. Microbiol. 67: 431–436, 2013. Crossref, Medline, ISI, Google Scholar
- . Effect of a polysaccharide from Poria cocos on humoral response in mice immunized by H1N1 influenza and HBsAg vaccines. Int. J. Biol. Macromol. 91: 248–257, 2016. Crossref, Medline, ISI, Google Scholar
- . Preliminary exploration of the mechanism of Qingfei Paidu decoction against novel coronavirus pneumonia based on network pharmacology and molecular docking technology. Acta Pharm. Sinica 1–18, 2020. Google Scholar
- . Clinical study on 34 cases of new coronavirus pneumonia treated with integrated traditional Chinese and Western medicine. J. Tradit. Chin. Med., 2020. Medline, Google Scholar
- . Anti-inflammatory effect of patchouli alcohol isolated from Pogostemonis Herba in LPS-stimulated RAW264.7 macrophages. Exp. Ther. Med. 2: 545–550, 2011. Crossref, Medline, ISI, Google Scholar
- . Structural analysis and immunomodulatory effect of polysaccharide from Atractylodis macrocephalae Koidz. on bovine lymphocytes. Carbohydr. Polym. 174: 1213–1223, 2017. Crossref, Medline, ISI, Google Scholar
- . Mechanism of qingfeipaidu decoction on COVID-19 based on network pharmacology. Pharmacol. Chin. Mat. Med., 2020. Google Scholar
- . Network pharmacology studies on the effect of Chai-Ling decoction in coronavirus disease. J. Tradit. Chin. Med. 12: 1–15, 2019. Google Scholar
- . Retrospective clinical analysis on treatment of novel coronavirus-infected pneumonia with traditional Chinese medicine Lianhua Qingwen. Chin. J. Exper. Tradit. Med. Formula, 2020. Google Scholar
- . Anti-inflammatory effects of Scutellaria baicalensis water extract on LPS-activated RAW 264.7 macrophages. J. Ethnopharmacol. 125: 286–290, 2009. Crossref, Medline, ISI, Google Scholar
- . Screening for anti-inflammatory and bronchorelaxant activities of 12 commonly used Chinese herbal medicines. Phytother. Res. 26: 915–925, 2012. Crossref, Medline, ISI, Google Scholar
- . Angiotensin-converting enzyme 2 (ACE2) as a SARS-CoV-2 receptor: Molecular mechanisms and potential therapeutic target. Intensive Care. Med. 46: 586–590, 2020. Crossref, Medline, ISI, Google Scholar
- . Effects of 3-phenyl-propenal on the expression of toll-like receptors and downstream signaling components on raw264.7 murine macrophages. Am. J. Chin. Med. 36: 159–169, 2008. Link, ISI, Google Scholar
- . Investigating the mechanism of Qing-Fei-Pai-Du-Tang for the treatment of novel coronavirus pneumonia by network pharmacology. Chin. Tradit. Herbal Drugs, 2020. Google Scholar
- . In vivo effect of quantified flavonoids-enriched extract of Scutellaria baicalensis root on acute lung injury induced by influenza A virus. Phytomedicine 57: 105–116, 2019. Crossref, Medline, ISI, Google Scholar
- . Baicalin inhibits autophagy induced by influenza A virus H3N2. Antivir. Res. 113: 62–70, 2015. Crossref, Medline, ISI, Google Scholar
| Remember to check out the Most Cited Articles! |
|---|
|
Check out our Chinese Medicine Titles today. |


