TREATMENT OF COVID-19 ASSOCIATED COGNITIVE DYSFUNCTION BY NUTRACEUTICAL PREPARATIONS

Abstract

Disclosed are means and methods of treating cognitive dysfunction associated with COVID-19 and/or other associated with inflammatory conditions. In one embodiment treatment of COVID-19 cognitive dysfunction performed by administration of nutraceutical means, wherein said nutraceuticals are administered at a frequency and/or concentration sufficient to induce proliferation of endogenous neural progenitor cells and/or protect cells from inflammatory damage. In one embodiment said nutraceuticals are comprised of green tea extract, and/or nigella sativa, and/or pterostilbene, and/or sulforaphane. In some embodiments nutraceutical compositions are utilized to overcome treatment resistant of currently used antidepressants.

Description

FIELD OF THE INVENTION

The teachings herein related to the treatment of Covid related cognitive dysfunction or an inflammatory trigger related cognitive disorder through the administration of nutraceuticals.

BACKGROUND

SARS-CoV-2 is an enveloped, positive-sense, single-stranded RNA virus of the subgenus Sarbecovirus which belongs to the genus Betacoronavirus [1, 2]. The main strains of this family are 229E (alpha coronavirus), NL63 (alpha coronavirus), OC43 (beta coronavirus), and HKU1 (beta coronavirus), which are relatively innocuous and cause the common cold, as well as more virulent strains such as MERS-CoV (the beta coronavirus that causes Middle East Respiratory Syndrome, or MERS) [3-10]. Rapidly after its identification, scientists found that SARS-CoV-2 possesses 88% identity to two bat-derived severe acute respiratory syndrome (SARS)-like coronaviruses, bat-SL-CoVZC45 and bat-SL-CoVZXC21 which were collected in 2018 in Zhoushan, eastern China. It was also found that SARS-CoV-2 has 79% homology to SARS-CoV and 50% homology to MERS-CoV [11].

SUMMARY

Preferred embodiments include methods for preventing or reducing cognitive decline in a patient suffering from COVID-19 or other inflammatory triggers, the method comprising administering a therapeutically effective amount of a nutraceutical containing at least one of the following: a) pterostilbene; b) sulforaphane; c) green tea extract; and d) nigella sativa.

Preferred embodiments include methods us using a therapeutically effective amount of a composition containing a) pterostilbene; b) sulforaphane; c) green tea extract; and d) nigella sativa in the manufacture of a medicament for use in preventing or reducing cognitive decline in a patient following a planned inflammatory trigger in said patient.

Preferred embodiments include methods and agents for use in preventing or reducing cognitive decline in a patient following a planned inflammatory trigger in said patient, wherein the agent comprises a therapeutically effective amount of at least one of a) pterostilbene; b) sulforaphane; c) green tea extract; and d) nigella sativa..

Preferred methods include embodiments wherein the planned inflammatory trigger is surgery and the method, use or agent is for preventing or reducing postoperative cognitive dysfunction (POCD) in said patient.

Preferred methods and agents include embodiments wherein the planned inflammatory trigger is chemotherapy.

Preferred methods include embodiments of reducing cognitive decline in a patient with a cognitive disorder, wherein said patient has been exposed to an inflammatory trigger, the method comprising administering a therapeutically effective amount of a therapeutically effective amount of at least one of a) pterostilbene; b) sulforaphane; c) green tea extract; and d) nigella sativa.. after exposure of said patient to said inflammatory trigger.

Preferred methods include embodiments of using a therapeutically effective amount of at least one of a) pterostilbene; b) sulforaphane; c) green tea extract; and d) nigella sativa after exposure of said patient to said inflammatory trigger in the manufacture of a medicament for use in reducing cognitive decline in a patient with a cognitive disorder, wherein said patient has been exposed to an inflammatory trigger.

Preferred methods include embodiments of using an agent for reducing cognitive decline in a patient with a cognitive disorder, wherein said patient has been exposed to an inflammatory trigger, and, wherein the agent comprises a therapeutically effective amount of at least one of a) pterostilbene; b) sulforaphane; c) green tea extract; and d) nigella sativa.. after exposure of said patient to said inflammatory trigger.

Preferred methods include embodiments wherein the cognitive disorder is delirium, Alzheimer’s Disease, multiple sclerosis, stroke, Parkinson’s Disease, Huntington’s Disease, dementia, frontotemporal dementia, vascular dementia, HIV dementia, COVID-19 associated dementia, Post-Traumatic Stress Disorder and/or Rheumatoid Arthritis.

Preferred methods include embodiments wherein the inflammatory trigger is infection, trauma, surgery, vaccination, arthritis, obesity, diabetes, stroke, radiation therapy, cardiac arrest, burns, chemotherapy, blast injury, urinary tract infection (UTI), respiratory tract infection (RTI), HIV, poisoning, alcohol or other medication withdrawal, hypoxia, and/or head injury.

Preferred methods include embodiments wherein the POCD is manifested as one or more of memory loss, memory impairment, concentration impairment, delirium, dementia and sickness behaviour.

Preferred methods include embodiments further comprising administering a therapeutically effective amount of n-acetylcysteine to said patient.

Preferred methods include embodiments wherein the medicament or agent is for administration in combination with a therapeutically effective amount of n-acetylcysteine to said patient.

Preferred methods include embodiments wherein the n-acetylcysteine is administered, or is for administration, before, after or simultaneously with a therapeutically effective amount of at least one of a) pterostilbene; b) sulforaphane; c) green tea extract; and d) nigella sativa.

Preferred methods include embodiments wherein the n-acetylcysteine is coadministered with the therapeutically effective amount of at least one of a) pterostilbene; b) sulforaphane; c) green tea extract; and d) nigella sativa.

Preferred methods include embodiments wherein the therapeutically effective amount of at least one of a) pterostilbene; b) sulforaphane; c) green tea extract; and d) nigella sativa is administered, or is for administration to the patient; before commencement of a surgical procedure; during a surgical procedure; or after completion of a surgical procedure, on said patient.

Preferred methods include embodiments wherein the therapeutically effective amount of at least one of a) pterostilbene; b) sulforaphane; c) green tea extract; and d) nigella sativa are administered, or is for administration, immediately before or up to 1 hour after completion of said surgical procedure.

Preferred methods include embodiments wherein the therapeutically effective amount of at least one of a) pterostilbene; b) sulforaphane; c) green tea extract; and d) nigella sativa are administered, or is for administration to the patient; before commencement of chemotherapy; during chemotherapy; or after completion of a round of treatment of chemotherapy on said patient.

Preferred methods include embodiments wherein the patient has, or is at risk of developing, delirium, Alzheimer’s Disease, multiple sclerosis, stroke, Parkinson’s Disease, Huntington’s Disease, dementia, frontotemporal dementia, vascular dementia, HIV dementia, Post-Traumatic Stress Disorder or Rheumatoid Arthritis.

Preferred methods include embodiments wherein the patient is a human.

Preferred methods include embodiments wherein the patient is less than 20 years of age, or over 50 years of age.

Preferred methods include embodiments wherein the therapeutically effective amount of at least one of a) pterostilbene; b) sulforaphane; c) green tea extract; and d) nigella sativa is administered as a combination of all four products together with quercetin.

Preferred methods include embodiments wherein a histone deacetylase inhibitor is added to said compositions.

Preferred methods include embodiments wherein said histone deacetylase inhibitor is valproic acid.

Preferred methods include embodiments wherein said histone deacetylase inhibitor is sodium butyrate.

Preferred methods include embodiments wherein said histone deacetylase inhibitor is istodax.

Preferred methods include embodiments wherein said histone deacetylase inhibitor is vorinostat.

Preferred methods include embodiments wherein said histone deacetylase inhibitor is panobinostat.

Preferred methods include embodiments wherein said histone deacetylase inhibitor is belinostat.

Preferred methods include embodiments wherein said histone deacetylase inhibitor is trichostatin A.

Preferred methods include embodiments wherein said histone deacetylase inhibitor is CCL996.

Preferred methods include embodiments wherein the therapeutically effective amount of at least one of a) pterostilbene; b) sulforaphane; c) green tea extract; and d) nigella sativa is administered to the patient either before commencement of a surgical procedure; during a surgical procedure; or after completion of a surgical procedure, on said patient.

Preferred methods include embodiments wherein the therapeutically effective amount of at least one of a) pterostilbene; b) sulforaphane; c) green tea extract; and d) nigella sativa is administered or is for administration to the patient; before commencement of chemotherapy; during chemotherapy; or after completion of a round of treatment of chemotherapy on said patient.

Preferred methods include embodiments wherein the surgical procedure is a cardiothoracic, an orthopaedic, a neurological, a vascular, a plastic & reconstructive, a gynaecological, an obstetric, a urological, a general, a head & neck, an ear, nose & throat (ENT), a paediatric, a dental, a maxillofacial, an ophthalmic, a pain management, a trauma, or a minor surgical procedure.

Preferred methods include embodiments wherein the general surgical procedure is a colorectal, a hepatobiliary, or an upper gastro-intestinal surgical procedure.

Preferred methods include embodiments wherein the minor surgical procedure is a catheterisation, a minor skin procedure, a minor orthopedic procedure, a nerve block, an endoscopy, a transoesophageal echocardiogram or another minor procedure.

Preferred methods include embodiments wherein the surgical procedure is carried out under general anaesthesia, regional anaesthesia, local anaesthesia, sedation or a combination thereof.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a bar graph showing the cognitive function of BALB/c mice that were administered low (500 ng) and high (1 mg) QuadraMune per mouse diluted in saline by gavage.

DETAILED DESCRIPTION OF THE INVENTION

The invention provides means of stimulating endogenous neurogenesis by administration of nutraceutical compounds alone or in combination with anti-inflammatories and/or other therapeutic agents.

In one embodiment the invention teaches administration of QuadraMune™ as a means of treating major depressive disorder and/or overcoming resistance to therapeutic effects of antidepressants in treatment of major depressive disorder. In some embodiments probiotics are administered to augment therapeutic efficacy.

QuadraMune™ or ingredients thereof, alone, or in combination, are disclosed by the current invention for treatment of schizophrenia and/or suicidal ideations. QuadraMune™ is comprised of Nigella Sativa, Sulforaphane, Pterostilbene, and EGCG.

Pterostilbene (trans-3,5-dimethoxy-4-hydroxystilbene) is a natural polyphenolic compound, primarily found in fruits, such as blueberries, grapes, and tree wood. It has been demonstrated to possess potent antioxidant and anti-inflammatory properties. It is a dimethylated analog of resveratrol which is found in blueberries [12], and is believed to be one of the active ingredients in ancient Indian Medicine [13]. The pterostilbene molecule is structurally similar to resveratrol, the antioxidant found in red wine that has comparable anti-inflammatory, and anticarcinogenic properties; however, pterostilbene exhibits increased bioavailability due to the presence of two methoxy groups which cause it to exhibit increased lipophilic and oral absorption [14-18]. In animal studies, pterostilbene was shown to have 80% bioavailability compared to 20% for resveratrol making it potentially advantageous as a therapeutic agent [14].

We have demonstrated the pterostilbene administered in the form of nanostilbene in cancer patients results in increased NK cell activity, as well as interferon gamma production. Additionally, pterostilbene has shown to inhibit inflammatory cytokines associated with ARDS. For example, studies have demonstrated inhibition of interleukin-1 [19], interleukin-6 [20, 21], interleukin-8 [22], and TNF-alpha [23], by pterostilbene.

. It is interesting to note that numerous studies have demonstrated endothelial protective effects of pterostilbene. For example, Zhang et al. investigated the anti-apoptotic effects of pterostilbene in vitro and in vivo in mice. Exposure of human umbilical vein VECs (HUVECs) to oxLDL (200 µg/ml) induced cell shrinkage, chromatin condensation, nuclear fragmentation, and cell apoptosis, but pterostilbene protected against such injuries. In addition, PT injection strongly decreased the number of TUNEL-positive cells in the endothelium of atherosclerotic plaque from apoE(-/-) mice. OxLDL increased reactive oxygen species (ROS) levels, NF-κB activation, p53 accumulation, apoptotic protein levels and caspases-9 and -3 activities and decreased mitochondrial membrane potential (MMP) and cytochrome c release in HUVECs. These alterations were attenuated by pretreatment. Pterostilbene inhibited the expression of lectin-like oxLDL receptor-1 (LOX-1) expression in vitro and in vivo. Cotreatment with PT and siRNA of LOX-1 synergistically reduced oxLDL-induced apoptosis in HUVECs. Overexpression of LOX-1 attenuated the protection by pterostilbene and suppressed the effects of pterostilbene on oxLDL-induced oxidative stress. Pterostilbene may protect HUVECs against oxLDL-induced apoptosis by downregulating LOX-1-mediated activation through a pathway involving oxidative stress, p53, mitochondria, cytochrome c and caspase protease [24]. Endothelial protection by pterostilbene [25, 26], and its analogue resveratrol are well known [27, 28].

The seeds of Kalonji (Nigella sativa Linneaus) are used by the Egyptian public as carminative and flavoring agents in bread and across the Middle East for a variety of food purposes [29]. This black cumin herb goes by many different names. For example, in old Latin it is called as ‘Panacea’ meaning ‘cure all’ while in Arabic it is termed as ‘Habbah Sawda’ or ‘Habbat el Baraka’ translated as ‘Seeds of blessing’. In India it is called as Kalonji while in China it is referred as Hak Jung Chou. The plant belongs to the Ranunculaceae family of flowering plants and genus of about 14 species including Nigella arvensis, Nigella ciliaris, Nigella damascene, Nigella hispanica, Nigella integrifolia, Nigella nigellastrum, Nigella orientalis and Nigella sativa, respectively. Among these, Nigella sativa is the species most exhaustively investigated for therapeutic purposes although other species have also been implicated for therapeutic uses [30]. Generally therapeutic properties of Nigella sativa have including antimicrobial [31-37], antiviral [38-41], antifungal [42, 43], anti-asthmatic/antiairway inflammation [44-58], anti-oxidant [59-63], anti-diabetic [64-74], anti-cancerous [75-90], hepatoprotective [91-104], cardioprotective [105-119], neuroprotective [120-157], renoprotective [158-171], anti-coagulant [172, 173], protects from sepsis [174-176], protects the endothelium [177-181], anti-inflammatory [182-194], and immune stimulatory [174, 195-205].

First. Taking Kalonji increases the potency of the immune system [206, 207]. Specifically, it has been shown that kalonji activates the natural killer cells of the immune system. Natural killer cells, also called NK cells are the body’s first line of protection against viruses. It is well known that patients who have low levels of NK cells are very susceptible to viral infections. Kalonji has been demonstrated to increase NK cell activity. In a study published by Dr. Majdalawieh from the American University of Sharjah, Sharjah, United Arab Emirates [199], it was shown that the aqueous extract of Nigella sativa significantly enhances NK cytotoxic activity. According to the authors, this supports the idea that NK cell activation by Kalonji can protect not only against viruses, but may also explain why some people report this herb has activity against cancer. It is known that NK cells kill virus infected cells but also kill cancer cells. There are several publications that show that Kalonji has effects against cancer [75, 77, 86, 208-219].

Second. Kalonji suppresses viruses from multiplying. If the virus manages to sneak past the immune system and enters the body, studies have shown that Kalonji, and its active ingredients such as thymoquinone, are able to directly stop viruses, such as coronaviruses and others from multiplying. For example, a study published from University of Gaziantep, in Turkey demonstrated that administration of Kalonji extract to cells infected with coronavirus resulted in suppression of coronavirus multiplication and reduction of pathological protein production [220]. Antiviral activity of Kalonji was demonstrated in other studies, for example, for example, viral hepatitis, and others [221].

Third. Kalonji protects the lungs from pathology. Kalonji was also reported by scholars to possess potent anti-inflammatory effects where its active ingredient thymoquinone suppressed effectively the lipopolysaccharide-induced inflammatory reactions and reduced significantly the concentration of nitric oxide, a marker of inflammation [222]. Moreover, Kalonji has been proven to suppress the pathological processes through blocking the activities of IL-1, IL-6, nuclear factor-κB [223], IL-1 β, cyclooxygenase-1, prostaglandin-E2, prostaglandin-D2 [224], cyclocoxygenase-2, and TNF-α [225] that act as potent inflammatory mediators and were reported to play a major role in the pathogenesis of Coronavirus infection.

Fourth. Kalonji protects against sepsis/too much inflammation. In peer reviewed study from King Saud University, Riyadh, Saudi Arabia, scientists examined two sets of mice (n=12 per group), with parallel control groups, were acutely treated with thymoquinone (ingredient from Kalonji) intraperitoneal injections of 1.0 and 2.0 mg/kg body weight, and were subsequently challenged with endotoxin Gram-negative bacteria (LPS O111:B4). In another set of experiments, thymoquinone was administered at doses of 0.75 and 1.0 mg/kg/day for three consecutive days prior to sepsis induction with live Escherichia coli. Survival of various groups was computed, and renal, hepatic and sepsis markers were quantified. Thymoquinone reduced mortality by 80-90% and improved both renal and hepatic biomarker profiles. The concentrations of IL-1α with 0.75 mg/kg thymoquinone dose was 310.8 ± 70.93 and 428.3 ± 71.32 pg/ml in the 1 mg/kg group as opposed to controls (1187.0 ± 278.64 pg/ ml; P<0.05). Likewise, IL-10 levels decreased significantly with 0.75 mg/kg thymoquinone treatment compared to controls (2885.0 ± 553.98 vs. 5505.2 ± 333.96 pg/ml; P<0.01). Mice treated with thymoquinone also exhibited relatively lower levels of TNF-α and IL-2 (P values=0.1817 and 0.0851, respectively). This study gives strength to the potential clinical relevance of thymoquinone in sepsis-related morbidity and mortality reduction and suggests that human studies should be performed [226].

Sulforaphane [1-isothiocyanato-4-(methylsulfinyl)-butane], an isothiocyanate, is a chemopreventive photochemical which is a potent inducer of phase II enzyme involved in the detoxification of xenobiotics [227]. Sulforaphane is produced from the hydrolysis of glucoraphanin, the most abundant glucosinolate found in broccoli, and also present in other Brassicaceae [228]. Numerous studies have reported prevention of cancer [229-233], as well as cancer inhibitory properties of sulforaphane [234-239]. Importantly, this led to studies which demonstrated anti-inflammatory effects of this compound.

One of the fundamental features of inflammation is production of TNF-alpha from monocytic lineage cells. Numerous studies have shown that sulforaphane is capable of suppressing this fundamental initiator of inflammation, in part through blocking NF-kappa B translocation. For example, Lin et al. compared the anti-inflammatory effect of sulforaphane on LPS-stimulated inflammation in primary peritoneal macrophages derived from Nrf2 (+/+) and Nrf2 (-/-) mice. Pretreatment with sulforaphane in Nrf2 (+/+) primary peritoneal macrophages potently inhibited LPS-stimulated mRNA expression, protein expression and production of TNF-alpha, IL-1beta, COX-2 and iNOS. HO-1 expression was significantly augmented in LPS-stimulated Nrf2 (+/+) primary peritoneal macrophages by sulforaphane. Interestingly, the anti-inflammatory effect was attenuated in Nrf2 (-/-) primary peritoneal macrophages. We concluded that SFN exerts its anti-inflammatory activity mainly via activation of Nrf2 in mouse peritoneal macrophages [240]. In a similar study, LPS-challenged macrophages were observed for cytokine production with or without sulforaphane pretreatment. Macrophages were pre-incubated for 6 h with a wide range of concentrations of SFN (0 to 50 µM), and then treated with LPS for 24 h. Nitric oxide (NO) concentration and gene expression of different inflammatory mediators, i.e., interleukin (IL)-6, tumor necrosis factor (TNF)-α, and IL-1β, were measured. sulforaphane neither directly reacted with cytokines, nor with NO. To understand the mechanisms, the authors performed analyses of the expression of regulatory enzyme inducible nitic oxide synthase (iNOS), the transcription factor NF—E2—related factor 2 (Nrf2), and its enzyme heme-oxygenase (HO)-1. The results revealed that LPS increased significantly the expression of inflammatory cytokines and concentration of NO in non-treated cells. sulforaphane was able to prevent the expression of NO and cytokines through regulating inflammatory enzyme iNOS and activation of Nrf2/HO-1 signal transduction pathway [241]. These data are significant because studies have shown both TNF-alpha but also interleukin-6 are involved in pathology of COVID-19 [242-252]. The utilization of sulforaphane as a substitute for anti-IL-6 antibodies would be more economical and potentially without associated toxicity. Other studies have also demonstrated ability of sulforaphane to suppress IL-6 [253-255]. Interestingly, a clinical study was performed in 40 healthy overweight subjects (ClinicalTrials.gov ID NCT 03390855). Treatment phase consisted on the consumption of broccoli sprouts (30 g/day) during 10 weeks and the follow-up phase of 10 weeks of normal diet without consumption of these broccoli sprouts. Anthropometric parameters as body fat mass, body weight, and BMI were determined. Inflammation status was assessed by measuring levels of TNF-α, IL-6, IL-1β and C-reactive protein. IL-6 levels significantly decreased (mean values from 4.76 pg/mL to 2.11 pg/mL with 70 days of broccoli consumption, p < 0.001) and during control phase the inflammatory levels were maintained at low grade (mean values from 1.20 pg/mL to 2.66 pg/mL, p < 0.001). C-reactive protein significantly decreased as well [256].

An additional potential benefit of sulforaphane is its ability to protect lungs against damage. It is known that the major cause of lethality associated with COVID-19 is acute respiratory distress syndrome (ARDS). It was demonstrated that sulforaphane is effective in the endotoxin model of this condition. In one experiments, BALB/c mice were treated with sulforaphane (50 mg/kg) and 3 days later, ARDS was induced by the administration of LPS (5 mg/kg). The results revealed that sulforaphane significantly decreased lactate dehydrogenase (LDH) activity (as shown by LDH assay), the wet-to-dry ratio of the lungs and the serum levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) (measured by ELISA), as well as nuclear factor-κB protein expression in mice with LPS-induced ARDS. Moreover, treatment with sulforaphane significantly inhibited prostaglandin E2 (PGE2) production, and cyclooxygenase-2 (COX-2), matrix metalloproteinase-9 (MMP-9) protein expression (as shown by western blot analysis), as well as inducible nitric oxide synthase (iNOS) activity in mice with LPS-induced ALI. Lastly, the researchers reported pre-treatment with sulforaphane activated the nuclear factor-E2-related factor 2 (Nrf2)/antioxidant response element (ARE) pathway in the mice with LPS-induced ARDS [257].

EGCG is similar to sulforaphane in that it has been reported to possess cancer preventative properties. This compound has been shown to be one of the top therapeutic ingredients in green tea. It is known from epidemiologic studies that green tea consumption associates with chemoprotective effects against cancer [258-268]. In addition, similarly to sulforaphane, EGCG has been shown to inhibit inflammatory mediators. The first suggestion of this were studies shown suppression of the pro-inflammatory transcription factor NF-kappa B. In a detailed molecular study, EGCG, a potent antitumor agent with anti-inflammatory and antioxidant properties was shown to inhibit nitric oxide (NO) generation as a marker of activated macrophages. Inhibition of NO production was observed when cells were cotreated with EGCG and LPS. iNOS activity in soluble extracts of lipopolysaccharide-activated macrophages treated with EGCG (5 and 10 microM) for 6-24 hr was significantly lower than that in macrophages without EGCG treatment. Western blot, reverse transcription-polymerase chain reaction, and Northern blot analyses demonstrated that significantly reduced 130-kDa protein and 4.5-kb mRNA levels of iNOS were expressed in lipopolysaccharide-activated macrophages with EGCG compared with those without EGCG. Electrophoretic mobility shift assay indicated that EGCG blocked the activation of nuclear factor-kappaB, a transcription factor necessary for iNOS induction. EGCG also blocked disappearance of inhibitor kappaB from cytosolic fraction. These results suggest that EGCG decreases the activity and protein levels of iNOS by reducing the expression of iNOS mRNA and the reduction could occur through prevention of the binding of nuclear factor-kappaB to the iNOS promoter [269]. Another study supporting ability of EGCG to suppress NF-kappa B examined a model of atherosclerosis in which exposure of macrophage foam cells to TNF-α results in a downregulation of ABCA1 and a decrease in cholesterol efflux to apoA1, which is attenuated by pretreatment with EGCG. Moreover, rather than activating theLiver X receptor (LXR) pathway, inhibition of the TNF-α-induced nuclear factor-κB (NF-κB) activity is detected with EGCG treatment in cells. In order to inhibit the NF-κB activity, EGCG can promote the dissociation of the nuclear factor E2-related factor 2 (Nrf2)-Kelch-like ECH-associated protein 1 (Keap1) complex; when the released Nrf2 translocates to the nucleus and activates the transcription of genes containing an ARE element inhibition of NF-κB occurs and Keap1 is separated from the complex to directly interact with IKKβ and thus represses NF-κB function [270].

The anti-inflammatory effects of EGCG can be seen in the ability of this compound to potently inhibit IL-6, the COVID-19 associated cytokine, in a variety of inflammatory settings. For example, in a cardiac infarct model, rats were subjected to myocardial ischemia (30 min) and reperfusion (up to 2 h). Rats were treated with EGCG (10 mg/kg intravenously) or with vehicle at the end of the ischemia period followed by a continuous infusion (EGCG 10 mg/kg/h) during the reperfusion period. In vehicle-treated rats, extensive myocardial injury was associated with tissue neutrophil infiltration as evaluated by myeloperoxidase activity, and elevated levels of plasma creatine phosphokinase. Vehicle-treated rats also demonstrated increased plasma levels of interleukin-6. These events were associated with cytosol degradation of inhibitor kappaB-alpha, activation of IkappaB kinase, phosphorylation of c-Jun, and subsequent activation of nuclear factor-kappaB and activator protein-1 in the infarcted heart. In vivo treatment with EGCG reduced myocardial damage and myeloperoxidase activity. Plasma IL-6 and creatine phosphokinase levels were decreased after EGCG administration. This beneficial effect of EGCG was associated with reduction of nuclear factor-kB and activator protein-1 DNA binding [271]. In an inflammatory model of ulcerative colitis (UC) mice were randomly divided into four groups: Normal control, model (MD), 50 mg/kg/day EGCG treatment and 100 mg/kg/day EGCG treatment. The daily disease activity index (DAI) of the mice was recorded, changes in the organizational structure of the colon were observed and the spleen index (SI) was measured. In addition, levels of interleukin (IL)-6, IL-10, IL-17 and transforming growth factor (TGF)-β1 in the plasma and hypoxia-inducible factor (HIF)-1α and signal transducer and activator of transcription (STAT) 3 protein expression in colon tissues were evaluated. Compared with the MD group, the mice in the two EGCG treatment groups exhibited decreased DAIs and SIs and an attenuation in the colonic tissue erosion. EGCG could reduce the release of IL-6 and IL-17 and regulate the mouse splenic regulatory T-cell (Treg)/T helper 17 cell (Th17) ratio, while increasing the plasma levels of IL-10 and TGF-β1 and decreasing the HIF-1α and STAT3 protein expression in the colon. The experiments confirmed that EGCG treated mice with experimental colitis by inhibiting the release of IL-6 and regulating the body Treg/Th17 balance [272].

Example

BALB/c mice, 10 per group, were administered recombinant spike protein intraperitoneally at a concentration of 100 ng/mouse daily for 7 days. Mice were administered low (500 ng) and high (1 mg) QuadraMune per mouse diluted in saline by gavage. Cognitive function was measured on days 7, 10 and 12. Results are shown in FIG. 1.

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Claims

1. A method for preventing or reducing cognitive decline in a patient suffering from COVID-19 or an inflammatory trigger related cognitive disorder, the method comprising administering a therapeutically effective amount of a nutraceutical comprising the following: a) pterostilbene; b) sulforaphane; c) green tea extract; and d) nigella sativa.

2. The method of claim 1, wherein the inflammatory trigger is surgery or chemotherapy.

3. The method of claim 1, wherein the cognitive disorder is selected from the group consisting of: delirium, Alzheimer’s Disease, multiple sclerosis, stroke, Parkinson’s Disease, Huntington’s Disease, dementia, frontotemporal dementia, vascular dementia, HIV dementia, COVID-19 associated dementia, Post-Traumatic Stress Disorder, and Rheumatoid Arthritis.

4. The method of claim 1, wherein the inflammatory trigger is selected from the group consisting of: infection, trauma, surgery, vaccination, arthritis, obesity, diabetes, stroke, radiation therapy, cardiac arrest, burns, chemotherapy, blast injury, urinary tract infection (UTI), respiratory tract infection (RTI), HIV, poisoning, alcohol or other medication withdrawal, hypoxia, and head injury.

5. The method of claim 1, further comprising administering a therapeutically effective amount of n-acetylcysteine to said patient.

6. The method of claim 1, further comprising administering a therapeutically effective amount of histone deacetylase inhibitor to said patient.

7. The method of claim 6, wherein said histone deacetylase inhibitor is valproic acid.

8. The method of claim 6, wherein said histone deacetylase inhibitor is sodium butyrate.

9. The method of claim 6, wherein said histone deacetylase inhibitor is istodax.

10. The method of claim 6, wherein said histone deacetylase inhibitor is vorinostat.

11. The method of claim 6, wherein said histone deacetylase inhibitor is panobinostat.

12. The method of claim 6, wherein said histone deacetylase inhibitor is belinostat.

13. The method of claim 6, wherein said histone deacetylase inhibitor is trichostatin A.

14. The method of claim 6, wherein said histone deacetylase inhibitor is CCL996.

15. The method of claim 4, wherein the surgery is selected from the group consisting of: a cardiothoracic, an orthopaedic, a neurological, a vascular, a plastic & reconstructive, a gynaecological, an obstetric, a urological, a general, a head & neck, an ear, nose & throat (ENT), a paediatric, a dental, a maxillofacial, an ophthalmic, a pain management, a trauma, or a minor surgical procedure.

16. The method of claim 15, wherein the surgery is selected from the group consisting of: a colorectal, a hepatobiliary, and an upper gastro-intestinal surgical procedure.

17. The method of claim 15, wherein the surgery is selected from the group consisting of: a catheterisation, a minor skin procedure, a minor orthopedic procedure, a nerve block, an endoscopy, and a transoesophageal echocardiogram.