key: cord-0751111-cws6uj3c
authors: Wang, Yali; Zeng, Xian; Zhao, Yufen; Chen, Weiping; Chen, Yu Zong
title: The pros and cons of traditional Chinese medicines in the treatment of COVID-19
date: 2020-05-03
journal: Pharmacol Res
DOI: 10.1016/j.phrs.2020.104873
sha: 75b9ae9fbb04b58ce6b5c613fdb5f5f066e86658
doc_id: 751111
cord_uid: cws6uj3c

nan

Health Commission of China (NHCC) [1] for the treatment of COVID-19. Their clinical beneficiary [2] and adverse [3] effects to the COVID-19 patients have been discussed based on the direct and related clinical evidences. An important question is whether the pros of these traditional medicines outweigh the cons or vice versa for the COVID-19 patients, which is to be clinically resolved. Inflammation regulation is a key mechanism of these traditional medicines against COVID-19 [4] . The discussed adverse effects are largely related to inflammation [3] . Therefore, some indications may be learned from the clinical profiles of the inflammation-associated diseases that involve similar sets of regulators as COVID-19 and have been treated by the same traditional medicines.

The NHCC-recommended traditional medicines have been clinically used or studied for several inflammation-related disease conditions other than viral infections, with the inflammation processes regulated by similar sets of regulators as COVID-19 (Supplementary Table S1 ). Examples are bacterial infections, diarrhea, chronic obstructive pulmonary disease, pulmonary injury, cancers, and diabetes. In-vitro and in-vivo studies have led to useful clues to certain common inflammation-regulatory mechanisms of these traditional medicines against COVID-19 [4] , viral infections [5] and other inflammation-related disease conditions (Supplementary Table S1 ). These preclinical clues combined with clinical data analysis are useful for assessing the clinical effects of the traditional medicines against these diseases, particularly with the J o u r n a l P r e -p r o o f aid of multi-omics analysis [6] . The assessment results provide useful indications on the pros and cons of these traditional medicines for the COVID-19 patients.

Starting from the chemical ingredients of these traditional medicines (TCM-ID database http://bidd2.nus.edu.sg/TCMID/), we extracted the potent targets (targets of the chemical ingredients with activities ≤1M) (Supplementary Table S3 ). The regulatory roles of these targets (Supplementary Table S4 ) are consistent with the differentiallyrecommended clinical utilities of these traditional medicine ( Table 1) . These traditional medicines universally reduce innate immunity induced inflammation and tissue damage, by targeting specific regulators, including several key regulators that J o u r n a l P r e -p r o o f are critical or required for the inflammation processes ( Table 1) . In particular, a key regulator ALOX15 and a non-key regulator CDK6 is the target of 5 and 6 of the 8 traditional medicines respectively. Significantly, all three medicines for the clinical treatment period target two key regulators, while three of the four medicines for the fever cases of the medical observation period target one key regulator, and the medicine for the non-fever cases target non-key regulators only.

Despite the incomplete investigations, the multi-omics data analysis revealed the inflammation-promoting adverse effects by 5 of the 8 traditional medicines (Table 1) , consistent with the reported pneumonitis and lung injury in the patients of interstitial lung diseases given various kampo formulations [3] . These adverse effects mostly arise from the dual pro-and anti-inflammatory effects of the specific regulators targeted by these traditional medicines ( Table 1) . For instance, some medicines contain both AR inhibitory and activating chemical ingredients, resulting on dual antiand pro-inflammatory effects. In another case, the targeting of a regulator HTR7 reduces both DC cell mediated inflammation and macrophage-mediated antiinflammatory activity.

The multi-omics data analysis also provides useful indications about whether the pros of these traditional medicines outweigh the cons for the patients of the inflammationrelated disease conditions. For each of the 5 medicines of dual pro and con activities, the largest percentage of the patients with the pro effects vs. those with the con effects J o u r n a l P r e -p r o o f 5 are 17% vs. 17%, 32% vs. 7%, 16% vs. 11%, 18% vs. 7%, and 20% vs. 12% ( Table   1) . Extrapolating these patient profiles into COVID-19, it is indicated that in most cases the pros of these medicines may substantially outweigh the cons for the COVID-19 patients. The beneficiary effects may be more than what were accounted here, considering the additional therapeutic activities of the traditional medicines against COVID-19 [4] . There is a need for further investigations into the pros and cons of the traditional medicines to the COVID-19 patients, and for more attention to the study and monitoring of the potential adverse effects [3] .

There are no conflicts to declare.

There are no conflicts to declare. 

Research Team E-BMCoCIE, Promotive Association for M, Health C. A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version)

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