- 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.
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"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.