Artemisia annua: trials are needed for COVID-19

Faiz Ul Haq1, 2,*

, Muhammad Roman2, Kashif Ahmad1, 5, Saeed Ur Rahman3, Dr. Syed
Murtaza Ali Shah2, Naveed Suleman6, Sami Ullah4, Iftekhar Ahmad1, Wajahat Ullah1,
1 Center for Biotechnology and Microbiology University of Swat, Pakistan
Accepted Article
2 Department of Microbiology University of Health Sciences Lahore, Pakistan
3 Department of Nursing University of Health Sciences Lahore, Pakistan
4 Department of Forensic Science University of Health Sciences Lahore, Pakistan
5 Department of Microbiology, Hazara University, Pakistan
6 Department of Pharmacology University of Health Sciences Lahore, Pakistan
*For correspondence: [email protected] Cell# +923155747346

Keywords: Coronavirus: antiviral agents: Covid-19; Artemisia annua; bioactive compound;

SARS-CoV-2
Running Title: Artemisia annua and COVID-19 treatment

Abstract
In December 2019, a number of pneumonia cases associated with 2019 novel coronavirus
occurred in Wuhan, China. Later taxonomist name the virus SARS-CoV-2 and disease called
COVID-19. No approved vaccine or treatment are available for this virus. Current technical
guide is related to address therapeutic option for SARS-CoV-2. COVID-19 is great challenge for
scientist across the globe. Bioactive compound present in Artemisia annua against, hepatitis B
virus, bovine viral diarrhea virus and Epstein-Barr virus. Artemisia annua have shown significant
activity against SARS coronavirus that occur in 2002. This agent is cheap and easily available
and will be of great value if they have efficacy against SARS-COV-2. Scientific attention is
needed towards these agent to address for the treatment of COVID-19.

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differences between this version and the Version of Record. Please cite this article as doi:
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 Beginning in December 2019, an increasing number of cases of novel coronavirus, designated
SARS-CoV-2, has caused worldwide outbreak of respiratory infection now termed coronavirus
disease 2019 (COVID-19) (Cao et al., 2020). As of March 26, 2020, coronavirus disease 2019
(COVID-19) has been confirmed in 462684 people and the death had reached over 20834
Accepted Article
globally (WHO, 2020). Until yet, there are no vaccine and no specific antiviral agents for
coronavirus infections, so it is a great challenge for scientists to find antiviral agent to treat this
disease. Researcher endeavoring for antiviral agents, some of them are natural products,
ritonavir, chloroquine phosphate, arbidol, ribavirin and traditional Chinese medicines that
demonstrated preliminary efficacy against SARS-CoV, the virus that causes SARS in humans
(Dong et al., 2020). Scientific attention is needed towards efficacious therapies against COVID-
19.

There are relevant information regarding therapies from the 2002-2003 outbreak of SARS CoV
in China. The researcher tested in vitro antiviral activities of Artemisia annua whole plants
preparation in ethanolic extract against SARS-CoV, with 50% effective concentration (EC50)
value of 34.5 ± 2.6 µg/ml and 50% cytotoxic concentration (CC50) of 1053 ± 92.8 µg/ml. The
result afford strong support for the usage of Artemisia annua to treat SARS-CoV infectious
diseases (Li et al., 2005). In China, natural compounds has been frequently used in combination
with conventional medicine to treat SARS. Some evidence demonstrated that the traditional
herbal medicine is effective against SARS-CoV infectious diseases (Lin et al., 2003).
Artemisinin is derivatives of Artemisia annua that have been commercialized as antimalarial
drugs (Efferth et al., 2008). As well as the value of artemisinin is not limited to the treatment of
malaria, it is most promising natural products that is important candidates accounting for the
antiviral effects (Karamoddini et al., 2011). In addition Artemisia annua contain sterols that
show virus inhibitory potential (Khan et al., 1991).
Currently there are supportive and non-specific treatment to relieve patient symptom. For
prophylaxis and treatment of virus the antiviral agent must be safe, adequate and cost should be
preferably low. In China, most of the infected patient receiving traditional Chinese medicine for
treatment of COVID-19 (Yang et al., 2020). The subset methanolic extracts obtained from aerial
parts of A. annua had the highest antiviral activity than acyclovir against Herpes Simplex virus
type 1. Aerial subsets extracts of A. annua contain bioactive compound that may be an
appropriate candidate for antiviral therapies (Karamoddini et al., 2011). It has a history of being
safe and easily available for therapies.
Pulmonary fibrosis are observed in SARS coronavirus-2 (SARS-CoV-2) infection with increased
severity, mediated by Interleukin-1 (Conti et al., 2020). Several studies suggesting that oxidative
stress is associated with pulmonary diseases and it is likely that the consumption of natural
antioxidant are effective in lung fibrosis (Day, 2008). Artemisia annua extract exhibit significant
antioxidant activity that is most likely due to its high phenolic content (Ferreira et al., 2010).

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 Artemisia annua derivatives, artesunate, is a promising novel drug to treat pulmonary fibrosis by
inhibiting pro-fibrotic molecules associated with pulmonary fibrosis (Wang et al., 2015). The
rationale for testing antioxidants and anti-fibrotic effect in Artemisia annua is appealing that
might play a key role in lung fibrosis.
The recent emergence of COVID-19 warrants the urgent development of potential antiviral
Accepted Article
therapies to protect population from high risk of infection (Mitjà & Clotet, 2020). There is
immediate need for approved therapies to reduce the ongoing mortality, so it is important to
emphasis the proven safety profiles of Artemisia annua for the treatment of COVID-19. Natural
products found in Artemisia annua as chemical weapons to protect against infections by viruses,
specifically herpes simplex virus type 1, hepatitis B virus, hepatitis C virus, bovine viral diarrhea
virus and Epstein-Barr virus (Efferth et al., 2008). Meanwhile this plant Artemisia annua is
cheap and widely available, although the final analysis is therefore technically demanding. It will
be of the great value to know the efficacy of these compound associated specifically SARS-
COV-2. If a distinct antiviral compound are identified in Artemisia annua, it may be lead to
active pharmaceutical compound production. These compound may contribute to reducing the
use of high cost agent. The option of using Artemisia annua in the treatment of COVID-19 from
SARS Cov-19 should be studied with attention in light of the previous studies. The experimental
study on Artemisia annua may contribute to the identification of anti-coronavirus compounds
that may successful and safe antiviral in in the treatment of COVID-19. We urge international
scientific community to get focused on the efficacy of proposed agent against current ongoing
pandemic. Further careful analysis of Artemisia annua for anti-coronavirus will be crucial
before the discovery of new antiviral agent.
There is the possibility that studies on Artemisia annua preparations have been not carried
according to more recent scientific qualitative standards for plant-derived products (Heinrich et
al., 2020). As the pandemic spreads, scientists around the globe are actively exploring drugs for
combating an ongoing challenge. It is important to develop safe drugs for treatment of COVID-
19. The efficacy and safety of A. annua in the therapy of COVID-19 is needed to be assessed in
clinical trials.

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 Declarations
Author’s contribution: All authors have contributed equally in this commentary.
Funding: The authors have not declared a specific grant for this study.
Accepted Article
Competing interests: the authors declared no competing interest

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