Anu taila, an herbal nasal-drop, suppresses mucormycosis by regulating host TNF-α response and fungal ergosterol biosynthesis

Anu Taila, an herbal nasal-drop, delays spore germination in Cunninghamella bertholletiae by reducing cAMP-PKA dependent ROS in mucorale pathogen and extrinsic ROS in human host cells

The rare, fastest-germinating, frequently invasive mucorale, Cunninghamella bertholletiae, is intractable due to its imprecise etiology. Cunninghamella bertholletiae spores can infect both immunocompromised and immunocompetent individuals to cause mucormycosis. Sub-optimal drug-susceptibility further limits its treatment options. The classical nasal drop, Anu Taila, is reported to be effective against the rather prevalent mucorales, Mucor spp., making its anti-mucormycotic effect against C. bertholletiae worth testing. The inhibitory effect of Anu Taila against C. bertholletiae was manifested as microstructural alterations of the spores and their delayed germination. Anu Taila reduced the germination-promoting reactive oxygen species (ROS) levels in both the pathogen, C. bertholletiae, and the human host lung epithelial A549 cells. Expressions of structural (chitin synthase, trehalose synthase) and functional (cAMP-PKA) markers of spore germination were regulated by Anu Taila. cAMP-PKA expression and ROS generation are well-correlated, implicating the role of Anu Taila in delaying C. bertholletiae spore germination by targeting cAMP-PKA-mediated ROS generation. In conclusion, this study demonstrates that Anu Taila can create an opportunity for the host immune system to tackle the onset of C. bertholletiae infection by delaying its pathogenesis. This can be further leveraged to reinforce the host immune system through combinatorial treatment to prevent the establishment of the mucormycosis infection.

Effect of Ayurvedic Intervention as an adjunct therapy in Post COVID-19 Mucormycosis (PCM): A non-randomized parallel group study

Background

The Ayurveda therapy is often used as an adjunct to conventional allopathic treatments for management of chronic disorders including life threatening infections such as post COVID-19 Mucormycosis (PCM).

Aims/objectives

The aim of the current study is to evaluate the role of adjunct Ayurveda therapy (AAT + CAT) over conventional Allopathic therapy (CAT) in the prevention of progression of oral/orbital/neural extension of PCM.

Material and methods

A non-randomised parallel group interventional study was on a sample of 92 cases of PCM, sorted into two groups i.e. group A (n = 46; AAT + CAT) and group B (n = 46; CAT/controls). The group A received AAT (lab-tested standardised regimen) while simultaneously receiving conventional antifungal measures (or CAT). The outcomes assessed were clinical symptomatic grading score, Nasal endoscopic examination for patency of sinuses, Progression or extension of disease from sinuses to maxilla, orbit and brain, need of additional surgical interventions and antifungal medication after study period, adverse drug reactions and mortality.

Results

The group A (AAT + CAT)) had shown extension free PCM in 86.96% (n = 40) as opposed to 41.3% (n = 19) in group B (CAT), No surgical interventions were needed in 89.13% (n = 41) in group A vs. 60.87% (n = 28) in group B. Around 69.5% (n = 32) in group A vs. 4.37% (n = 2) in group B did not need antifungal medication. The safety of both arms of the therapy has been determined by liver function and renal profile which are with in normal range in both groups.

Conclusion

Adjunct Ayurveda therapy (given along with routine medical therapy) for PCM showed a better cure and reduced disease progression after a trial period of 45 days and in the extended observational period of three months. AAT + CAT regimen is not only therapeutically effective, but also safe and economical option to consider for PCM.