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Balancing immunotherapy for COVID-19: anti-inflammatory (✓) versus immunosuppressive (✗) activity

Pieter J. Gaillard

Balancing immunotherapy for COVID-19: anti-inflammatory (✓) versus immunosuppressive (✗) activity

- May 12, 2020 - Soothing vascular inflammation whilst eradicating the virus

As long as the COVID-19 disease is amongst us, and as long as there is no safe and effective vaccine, or affordable and widely applicable anti-viral drug available to all people around the globe, our world will not return to as it was before. Meanwhile the virus will continue to cause (hyper)inflammatory responses in the blood, the vasculature and thereby have major impact on the functioning of all major organs, foremost in lungs, heart, skin and brain. These responses were so far found to be most detrimental to people of older age and with underlying vascular pathologies. Yet, as long as this pandemic continues, all of us at least stand at risk of developing the perhaps milder and more manageable vascular inflammatory and thrombotic conditions, albeit with sometimes severe complications as a result (like cerebrovascular accidents / stroke).
  • So other than direct anti-viral therapies (vaccines and drugs) and emergency medicines addressing the hyper-inflammation, we also urgently require anti-inflammatory treatments that are safe, affordable and widely available for the majority of individuals who will get exposed to the virus. 
  • Obviously, such anti-inflammatory treatments should not limit the body’s capacity to fight off the virus with its immune system. 
  • For this we need to look at existing anti-inflammatory compounds that have or are designed to have minimal (systemic) immunosuppressive activity, such as palmitoylethanolamide (PEA) or locally administered solvent-free cyclosporine A (CsA).
The first conventional option is to apply the systemic and potent anti-inflammatory (emergency) medicines such as methylprednisolone (Solu-Medrol®) or dexamethasone, and/or cyclosporine A (CsA, Sandimmune®). The first have already been published to be effective in some conditions in the fight against COVID-19 (and tested in several ongoing clinical studies), while the latter for some reason has not been documented to be used or tested in clinical trials, despite strong advocacy for it by independent physicians. This is likely because of CsA’s known systemic immunosuppressive effects and sub-optimal side effect profile (caused mainly by its vehicle Cremophor® EL) for patients with lung and kidney distress, which would perhaps outweigh the positive effects that CsA could have as potent anti-inflammatory compound that can effectively limit the excessive cytokine and chemokine production. Regardless, CsA also has documented beneficial activity as direct anti-viral compound against coronaviruses, and on limiting reperfusion injury, reducing reactive oxygen species damage, protecting against mitochondrial damage, restoring local hypo-perfusion, repairing vascular barrier leakage and reversal of multidrug resistance for anti-viral co-medication. To date, unfortunately, these beneficial properties of CsA have remained untapped and not even properly investigated. 

Underway is a specifically designed CsA-product using innovative advanced drug delivery technologies (based on serum-stable, solvent-free lipid nano-particles), to enhance the local delivery to the lungs. When applied in low doses through an inhaler, preferably early in the disease progression (i.e. before pulmonary edema would limit distribution deep into the lungs), these products could provide for an optimal way to balance the required local pulmonary anti-inflammatory activity whilst reducing the systemic exposure and thereby immunosuppressive effects of these classic medicines.

The second innovative and readily available option would be to make smart use of the supportive health benefits of specific food supplements / nutraceuticals. Food supplement compounds are neither drugs nor medicines, and have no proven pharmacological effect on specific diseases or indications, but rather support the natural physiological response of the body to help cope with diseases. To date, several supplements, such as vitamin C, vitamin D, melatonin, resveratrol, have already been coined to be potentially of benefit in help reducing (leptin and/or angiotensin II-induced) reactive oxygen species damage, thereby acting as anti-inflammatory compounds without immunosuppressive side effects. 


Likewise, and perhaps even more remarkable, activators of the (corticosteroid-induced) nuclear receptor peroxisome proliferator-activated receptors alpha (PPAR-α), such as the food supplement palmitoylethanolamide (PEA), have a direct anti-inflammatory effect on PPAR-α expressing cells and tissues like in the liver, the endothelial cells in the vascular wall, smooth muscle cells, monocytes/macrophages, and foam cells. Upon activation, these PPAR-α receptors induce relevant activities that collectively contribute to an anti-inflammatory response (leading to reduced von Willebrand factor release), without the unwanted immunosuppressive effects that are required to eliminate the virus: 

  • attenuate angiotensin II-induced vascular inflammation; 
  • reduce vascular barrier leakage; 
  • reduce leptin levels; 
  • increase expression of SOD (reducing formation of reactive oxygen species), Ob-Rb (restoring leptin sensitivity);
  • reduce pro-inflammatory transcription factors, cytokines, chemokine, adhesion molecules, enzymes and related mediators (NF-kB, iNOS, AP-1, tissue factor, IL-6, MCP-1, ICAM-1, VCAM-1, MMP-9, TNF-α, PGF, COX-2, prostaglandins).

Collectively, these PPAR-α activating nutraceutical effects could help to soothe the vascular inflammation whilst maintaining the body's full capacity to eradicate the virus.

|  "About PEA, and why to use it as food supplement to help maintain and support a healthy lifestyle:" |


Biological mechanism fully characterised: 

PEA is an endogenous (body-own) fatty acid amide with a wide range of biological functions involved in the body’s response to help reduce chronic pain and inflammation. PEA is clinically and scientifically proven to directly activate PPAR-α, GPR55 and GPR119, and indirectly CB1 & CB2 receptors and TRPV1 channels, collectively known as the “entourage effect” (Petrosino et al (2017)).


Supporting role in many human and animal uses: 

There are numerous scientific publications on the physiologically supportive role of PEA on the immune system and the natural cellular response in conditions involving chronic pain complaints (neuropathic, musculoskeletal, fibromyalgia, endometriosis, pelvic pain, migraine); epilepsy, amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), Parkinson's disease (PD), Alzheimer's disease (AD), autism, sleep disturbance, depression, stroke; glaucoma, diabetic retinopathy (DR); geographical tongue, psoriasis, atopic dermatitis, rosacea, acne; hay fever, cough, asthma, idiopathic pulmonary fibrosis and cystic fibrosis, COPD, colds and flu. These publications are summarised in this extensive blog about PEA.


PEA has been freely available for consumers as a food supplement for many years: 

Physiological PEA levels can become reduced, yet never depleted, and since PEA is also highly present in food sources, such as from soybean, egg yolk and peanuts, PEA is regarded as a "vitamin" and marketed as food supplement, freely available for consumers. PEA is therefore readily available in many (web)shops and drugstores for all interested consumers. These PEA supplements (capsules, powders, liposomes, creams, spray) support the consumer to keep the brain, eyes, lungs, skin and hair healthy and free of pain. The capsules, powders and liposomes containing PEA must be swallowed several times a day for several weeks in order to observe efficacy. Instead, the PEArlboost spray solution, when applied under the tongue or on the skin, provides a fast and long-lasting effect, at a low dose in an easy to administer form.

door Pieter J. Gaillard 6 september 2024
Leiden, The Netherlands, September 3rd, 2024 - Eyesiu Medicines BV, a Leiden Bio Science Park company that creates innovative therapeutics and nutraceuticals based on advanced delivery technology, received the news today that on August 26th 2024 the Korean Intellectual Property Office has granted Eyesiu a patent entitled “Pegylated lipid nanoparticle with bioactive lipophilic compound” ( No. KR20187006989 ). South Korea is the sixth country in a row - following USA, Taiwan, Russia, Japan and India - to provide a granted patent to Eyesiu for its inventions described in the patent application ““Pegylated lipid nanoparticle with bioactive lipophilic compound”. Now the application is only still pending in the EU and China. The Korean Intellectual Property Office granted claims for the solvent-free and serum-stable lipid (nano)particles comprising two neutral phospholipids (DSPE and HSPC) and at least one of palmitoylethanolamide (PEA), an endocannabinoid from the group of acylethanolamides, and a macrolide (such as CsA, tacrolimus or sirolimus), wherein the lipid particle has a surface comprising a water soluble polymer (PEG). Eyesiu’s therapeutics and nutraceuticals Eyesiu has developed therapeutics, in pre-clinical stage, targeting a wide range of indications in neurology, ophthalmology, dermatology and pulmonology. The company has also developed nutraceuticals (food supplements) that support its users to maintain pain-free and healthier brain, eyes, lungs, skin and/or hair: the first one is a spray bottle with PEA, comprising a lipid-based sublingual, skin and mouth spray formulation for convenient, effective, fast and sustained delivery, and is for sale through Eyesiu’s health care division (Eyesiu Care) via www.PEArlboost.com About Eyesiu Medicines BV See www.eyesiu.com for more information, and to see how you can join and own shares in the company, or close a product partnership . For further information, please contact Eyesiu Medicines BV | Pieter J. Gaillard | info@eyesiu.com
Afbouwen van een medicijnverslaving:  de pijn van pijnstillers
door Pieter J. Gaillard 25 december 2023
Dit blog gaat over medicijnverslaving, met name over hoe pijnlijk moeilijk het is om daarvan af te kicken, mijn persoonlijke verbazing over de medische adviezen om van deze verslaving af te komen, en [dus] mijn motivatie om bij te willen dragen aan het anderen helpen slagen met overwinnen van deze pijn. En wat blijkt: er is nog een wereld te winnen, en er is gelukkig ook houvast en hoop te vinden in reeds beschikbare mogelijkheden die tot nu toe - ik vind onterecht - onvoldoende benut zijn gebleven.
Voedingssupplementen strijden mee tegen COVID-19
door Pieter J. Gaillard 23 mei 2023
- 23 mei 2020 - Gerichte ondersteuning van gezonde voeding en leefstijl. Zo lang het virus onder ons is zal COVID-19 de maatschappij in de greep houden, en daarbij angst en verdeeldheid blijven zaaien. Hoe lang we in die situatie zullen blijven zal in grote mate afhangen van de wereldwijde beschikbaarheid van een nieuw te ontwikkelen, veilig en effectief vaccin en/of therapie tegen het virus en de gevolgen ervan op het lichaam. Er zijn inmiddels een heel aantal vaccin-kandidaten in de race, en er worden veel nieuwe therapieën getest (I). Ook is er weer meer aandacht voor het versterken van de weerstand van ons lichaam tegen infecties en ziektes, met name door middel van gezonde voeding en leefstijlinterventies (II). De rol van voedingssupplementen om mee te strijden tegen COVID-19 komt hier nu ook aan de orde (III).
Balancing immunotherapy for COVID-19: anti-inflammatory (✓) versus immunosuppressive (✗) activity
door Pieter J. Gaillard 12 mei 2023
- May 12, 2020 - Soothing vascular inflammation whilst eradicating the virus. As long as the COVID-19 disease is amongst us, and as long as there is no safe and effective vaccine, or affordable and widely applicable anti-viral drug available to all people around the globe, our world will not return to as it was before. Meanwhile the virus will continue to cause (hyper)inflammatory responses in the blood, the vasculature and thereby have major impact on the functioning of all major organs, foremost in lungs, heart, skin and brain. These responses were so far found to be most detrimental to people of older age and with underlying vascular pathologies. Yet, as long as this pandemic continues, all of us at least stand at risk of developing the perhaps milder and more manageable vascular inflammatory and thrombotic conditions, albeit with sometimes severe complications as a result (like cerebrovascular accidents / stroke).
door Pieter J. Gaillard 12 april 2023
Na jaren van zorgvuldig opbouwen is de dag gekomen om Eyesiu (lees “I see you”, oftewel ”ik zie je”; wat betekent “ik heb respect voor je”) open te stellen voor iedereen om een aandeel in het succes te kunnen nemen. Iedereen is welkom die geloof heeft in de missie en visie van de onderneming, en die vertrouwen heeft in de kunde en ervaring van de betrokken professionals. Zo help je om betaalbare innovatieve producten sneller beschikbaar te maken voor consumenten en patiënten die noodzaak of behoefte hebben aan gezondere hersenen, ogen, huid en longen. Kom erbij en doe mee via https://www.eyevestor.com/members/eyeventures/NL_YCU
door Pieter J. Gaillard 27 februari 2023
Is het lastig om pillen, capsules of vloeistoffen door te slikken? Zorgt moeite met slikken voor sociale en gezondheidsproblemen, en voor het uitstellen, weigeren of vergeten van het dagelijks innemen van geneesmiddelen of belangrijke vitamines en voedingssupplementen welke kunnen helpen het lichaam fit, sterk, pijnvrij en veerkrachtig te houden? Is meer controle gewenst over de hoeveelheid of portie van een pil of capsule die gebruikt wordt? En wil je wél snelle afgifte en opname bereiken? Dan is een toediening van de vitamines en voedingssupplementen met behulp van een handig spray flesje de ideale oplossing.
door Pieter J. Gaillard 27 juni 2022
Leiden, 17 september 2022 - Tijdens de Leidse Nacht van Ontdekkingen kan je bij Eyesiu de Pikante Peper Smaakt Test komen doen. Zo ga je ontdekken welke pittigheid score jij geeft aan een shotje Virgin Bloody Mary (tomatensap met Tabasco). Hierdoor ontdek je wat activatie van het TRPV1 kanaal door de capsaïcine uit rode pepers bij jou in je mond doet op een schaal van 0 (“niets merkbaar”) tot 5 (“ik wil geen volgende meer testen”). En er zijn testflesjes van Eyesiu’s mondspray met het voedingssupplement PEArlboost++, waarvan we weten dat het ingrediënt palmitoylethanolamide (PEA) de gevoeligheid van het TRPV1 kanaal kan beïnvloeden. Dit mag je zelf testen. Zo leer je ter plekke hoe je kan onderzoeken of remming van het TRPV1 kanaal bij jou misschien een verandering van de smaaksensatie van pikante peper kan geven! Who Knows!
Eyesiu's Pikante Peper Smaak Test op het Leids Goeds Festival
door Pieter J. Gaillard 24 maart 2022
Op het Leids Goeds Festival van 11 mei 2022, kan je bij Eyesiu de Pikante Peper Smaak Test komen doen, en zo uitvinden welke pittigheid score jij aan een Virgin Bloody Mary geeft. Vervolgens mag je dan testen wat jouw gratis mondspray TESTFLESJE met het voeddingssupplement PEArlboost bij jou doet op je Pikante Peper Smaak Sensatie.
Eyesiu zet lipidedeeltjes in tegen ontstekingen
door Pieter J. Gaillard 7 februari 2022
Het Leidsch Dagblad heeft een serie verhalen over het Leiden Bio Science Park, mede mogelijk gemaakt door het Leids Mediafonds. Het Bio Science Park is de economische motor van Leiden, de kurk waar de stad op drijft. Honderden bedrijven werken er aan de wereld van morgen. Maar wat doen ze precies? De komende maanden duikt het Leidsch Dagblad in de wereld van de biotech in de regio. Deze keer: Eyesiu, een bedrijf dat een parelmoerspray op basis van lipide microdeeltjes op de markt brengt die ontstekingsremmend werkt. En de ontstekingsremmers in de lipide nanodeeltjes zijn in ontwikkeling als geneesmiddel. Het stuk is ook te vinden op: https://www.leidschdagblad.nl/cnt/dmf20220204_24742831. Journalist & ondernemer Martijn de Meulder interviewde oprichter en directeur van Eyesiu, Pieter J. Gaillard, over zijn professionele leven, en wat inmiddels zijn levenswerk is geworden: het passeren van de bloed-hersenbarrière.
Figure 5. TRPV1 and PIEZO2 channels... from www.nobelprize.org
door Pieter J. Gaillard 5 oktober 2021
“The 2021 Nobel Prize in Physiology or Medicine is awarded to David Julius and Ardem Patapoutian for their discoveries of thermal and mechanical transducers”, as cited from the Scientific Background on www.nobelprize.org; “David Julius wished to identify the cellular target of capsaicin, the pungent ingredient of chili peppers, as he believed this could provide fundamental insights into mechanisms of pain. He used a cDNA library from sensory neurons in a functional screen to look for a gene that could confer capsaicin sensitivity to cells that were normally unresponsive. The screen identified a cDNA encoding a novel ion channel (now called TRPV1) belonging to the family of transient receptor potential ion channels. Importantly, TRPV1 was shown to be activated by temperatures perceived as painful.” Eyesiu congratulates the laureates and welcomes the acknowledgement of these important scientific discoveries
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