Potential mechanisms of Chinese Herbal Medicine that implicated in the treatment of COVID-19 related renal injury

Highlight: • It was proven that renal injury in Corona Virus Disease 2019 (COVID-19) patients has been a real concern. • There are three possible mechanisms of renal injury in COVID-19 infection: direct viral mediated, prolonged cytokine storm mediated, and drug-induced renal injury. • There is no targeted drug therapy in the treatment of renal injury, while Chinese Herbal Medicine can be a potential solution. • Huang Qi, Fu Ling, Di Huang, Shan Yao and Bai Zhu are the core herbs in Chinese Herbal Medicine to treat renal injury. • Chinese Herbal Medicine may act on PTGS2, PTGS1, IL6 and CASP3, etc., to prevent the pharmacological and non-pharmacological COVID-19 related renal injury.

Clinical studies have shown that renal injury in Corona Virus Disease 2019 (COVID-19) patients has been a real concern, which is associated with high mortality and an inflammation/apoptosis-related causality. Effective target therapy for renal injury has yet been developed. Besides, potential anti-COVID-19 medicines have also been reported to cause adverse side effects to kidney. Chinese Herbal Medicine (CHM), however, has rich experience in treating renal injury and has successfully applied in China in the battle of COVID-19. Nevertheless, the molecular mechanisms of CHM treatment are still unclear. In this study, we searched prescriptions in the treatment of renal injury extensively and the potential mechanisms to treat COVID-19 related renal injury were investigated. The association rules analysis showed that the core herbs includes Huang Qi, Fu Ling, Bai Zhu, Di Huang, Shan Yao. TCM herbs regulate core pathways, such as AGE-RAGE, PI3K-AKT, TNF and apoptosis pathway, etc. The ingredients (quercetin, formononetin, kaempferol, etc.,) from core herbs could modulate targets (PTGS2 (COX2), PTGS1 (COX1), IL6, CASP3, NOS2, and TNF, etc.), and thereby prevent the pharmacological and non-pharmacological renal injury comparable to that from COVID-19 infection. This study provides therapeutic potentials of CHM to combat COVID-19 related renal injury to reduce complications and mortality.