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Review
. 2021 Sep;35(9):4988-5006.
doi: 10.1002/ptr.7131. Epub 2021 Apr 29.

New perspectives on natural flavonoids on COVID-19-induced lung injuries

Fernanda Paula R Santana  1   2 , Fernanda Thevenard  3 , Kaio S Gomes  3 , Laura Taguchi  1 , Niels Olsen S Câmara  2 , Roberta S Stilhano  4 , Rodrigo P Ureshino  5 , Carla Maximo Prado  1 , João Henrique Ghilardi Lago  3
Affiliations
Review

New perspectives on natural flavonoids on COVID-19-induced lung injuries

Fernanda Paula R Santana et al. Phytother Res. 2021 Sep.

Abstract

The SARS-CoV-2 virus, responsible for COVID-19, spread rapidly worldwide and became a pandemic in 2020. In some patients, the virus remains in the respiratory tract, causing pneumonia, respiratory failure, acute respiratory distress syndrome (ARDS), and sepsis, leading to death. Natural flavonoids (aglycone and glycosides) possess broad biological activities encompassing antiinflammatory, antiviral, antitumoral, antiallergic, antiplatelet, and antioxidant effects. While many studies have focused on the effects of natural flavonoids in experimental models, reports based on clinical trials are still insufficient. In this review, we highlight the effects of flavonoids in controlling pulmonary diseases, particularly the acute respiratory distress syndrome, a consequence of COVID-19, and their potential use in coronavirus-related diseases. Furthermore, we also focus on establishing a relationship between biological potential and chemical aspects of related flavonoids and discuss several possible mechanisms of action, pointing out some possible effects on COVID-19.

Keywords: ACE2; COVID-19; SARS-CoV-2; acute lung injury; flavonoids.

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Conflict of interest statement

The authors have no conflicts of interest to declare related to the data shown on this publication.

Figures

FIGURE 1
FIGURE 1
General and subgroup structures of the flavonoids class
FIGURE 2
FIGURE 2
Chemical structure of flavonoids 1–101. (a) Chemical structure of glycosylated flavonoids; (b) Chemical structure of free flavonoids; and (c) Chemical structure of theaflavins and procyanidin derivatives
FIGURE 3
FIGURE 3
Possible effects of flavonoids on COVID‐19‐induced acute lung injury: COVID‐19 affects several organs, especially the pulmonary system. Severe COVID‐19 is characterized by a cytokine storm and acute lung inflammation that can progress to acute lung injury and systemic inflammation. Acute lung injury is well characterized by endothelium and/or epithelial injury, macrophage activation, neutrophil recruitment, and oxidative stress as well as high cytokine release. The binding of SARS‐CoV‐2 to ACE2 in epithelial cells induces infection and virus replication. The flavonoid has well‐described antiinflammatory, antioxidant, and antiviral effects. The evidence reviewed in the literature shows that flavonoid could be a potential therapeutic target for COVID‐19, since it inhibits the cytokine storm and lung inflammation. In addition, evidence suggests that it can block the entry and replication of the virus, and should be further explored
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