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Activation of the Cholinergic Anti-Inflammatory Pathway as a Novel Therapeutic Strategy for COVID-19
Zhen Qin1,2, Kefa Xiang1, Ding-Feng Su1
1Department of Clinical Pharmacy, School of Pharmacy, Second Military Medical University, Shanghai, China.
Abstract:
The outbreak of coronavirus disease 2019 (COVID-19) underlined the urgent need for alleviating cytokine storm. We propose here that activating the cholinergic anti-inflammatory pathway (CAP) is a potential therapeutic strategy. However, there is currently no approved drugs targeting the regulatory pathway. It is evident that nicotine, anisodamine and some herb medicine, activate the CAP and exert anti-inflammation action in vitro and in vivo. As the vagus nerve affects both inflammation and specific immune response, we propose that vagus nerve stimulation by invasive or non-invasive devices and acupuncture at ST36, PC6, or GV20, are also feasible approaches to activate the CAP and control COVID-19. It is worth to investigate the efficacy and safety of the strategy in patients with COVID-19.
Insights
Activating the cholinergic anti-inflammatory pathway (CAP) may help control COVID-19 cytokine storms. Strategies include vagus nerve stimulation and acupuncture, offering potential therapeutic avenues for this inflammatory response.
Area of Science:
- Immunology
- Neuroscience
- Pharmacology
Background:
- The COVID-19 pandemic highlighted the critical need to manage cytokine storms.
- The cholinergic anti-inflammatory pathway (CAP) presents a potential therapeutic target.
- Currently, no approved drugs specifically target this regulatory pathway.
Purpose of the Study:
- To explore the activation of the CAP as a therapeutic strategy for COVID-19.
- To investigate non-pharmacological methods for CAP activation.
Main Methods:
- Review of existing evidence on CAP activators like nicotine, anisodamine, and herbal medicines.
- Proposal of vagus nerve stimulation (invasive/non-invasive) and acupuncture (ST36, PC6, GV20) as methods to activate CAP.
- In vitro and in vivo studies on anti-inflammatory actions.
Main Results:
- Nicotine, anisodamine, and certain herbs activate CAP, demonstrating anti-inflammatory effects.
- Vagus nerve stimulation and acupuncture are proposed as feasible approaches to modulate inflammation.
- The CAP's role in regulating inflammation and immune response is recognized.
Conclusions:
- Activating the CAP is a promising strategy for controlling COVID-19-induced cytokine storms.
- Vagus nerve stimulation and acupuncture offer potential non-drug interventions.
- Further investigation into the efficacy and safety of these CAP-activating strategies in COVID-19 patients is warranted.
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