**1. Introduction**

The severe acute respiratory syndrome coronavirus 2 SARS-CoV-2 virus is the cause of COVID-19. The World Health Organisation reported that COVID19 became an international global health crisis in January 2020 and that COVID19 has become a global epidemic, causing more than 20 million infections and 7 million deaths by March 2020. COVID-19 clinical signs include arthromyalgia, cough, diarrhoea, fevers, headache, lethargy, multiorgan disorder, severe interstitial pneumonia and septic coagulomas [1]. The severe development of COVID-19 also leads to a cytokine storm and excessively pro-inflammatory cytokine secretion [2]. In 2002–2004 and 2012–2014, epidemics of similar β-caronaviral virus (SARS) and Middle East Respiratory Syndrome (MERS), have previously taken place [3, 4].

## **2. Food supplements to improve immune quality, antioxidants and anti-inflammation**

Today, most states all around globe are working to develop corona vaccines, with a number entering human studies while most of them are being studied and developed in various stages. Furthermore, there are no specialised COVID-19 drugs, nor are there any meaningful statistics on the impacts of nutritional additives on COVID-19 risk or seriousness at both national and international levels. Developing new antiviral medications for COVID-19 is a major challenge that requires significant time and resources in the development and evaluation of this product. Several scores of proof signify, in particular in people with insufficient food resources as well as through their free radical scavenging, anti-inflammatory or viricidal capabilities, that many supplements from various vegetables, fruits, spices, herbs and root sources can decrease the hazard or intensity of a diverse variety of viral infections. These nutrients may be recycled to reduce the disease effects of SARS-CoV-2 infection. Thus the utilisation of natural compounds, together with the treatment for COVID-19, can propose new preventative and treatment support. The positive effects of certain nutrients are discussed in the following section [5].

#### **3. Vitamin B and its biological roles**

Vitamin B complex are the main vitamin of the brain function, eyes, gastrointestinal tract, liver, hair, muscular tone, nervous system, skin, and are critical to the health of the nervous system. These vitamins next to each other help to detoxify the organ, promote good metabolism, release enzymes from the food, stabilise the functions of your nervous system, provide cells with plenty of oxygen, maintain healthy skin and hair, protect faulty vision and have also been utilised in weaknesses [6]. **Table 1** provides an overview of the vitamin B complex with its cellular roles, scientific name, recommended male and female dose.

#### **4. Vitamin B and pandemic**

Due to anti-inflammatory and immunomodulatory properties of vitamin C and vitamin D in this era of pandemic they are getting much attention. Low vitamin D and C levels lead to coagulopathy and suppression of the immune system causing lymphocytopenia. The data showed that in corona virus patients with low levels of vitamin D have high mortality rate. In corona virus patients, the consumption of vitamin C increases the oxygenation index [9]. Accordingly, a lack of vitamin B can seriously alter the function of a cell and immune system that leads to hyperhomocysteinemia inflammation. Vitamin B must be stressed because it plays a key role in proper immune function, energy metabolism and cell function [10]. Vitamin B helps to reduce inflammation, strengthens respiratory functioning, preserves endothelial homogenity, inhibits hypercoagulation, activate innate and adaptive immune responses properly, and can decrease hospitalisation for long periods of time [11]. Thus, the role of B complex in patients with COVID-19 needs to be evaluated and additional non-drug B vitamins can be used in existing treatments.

### **5. Food supplements to counteract COVID-19**

Phase 1 is critical from the point of view of prevention because individuals are carriers and can unintentionally propagate the infection. The organisation and


*Novel Treatment Strategy against COVID-19 through Anti-Inflammatory, Antioxidant… DOI: http://dx.doi.org/10.5772/intechopen.100251*

> **Table 1.** *Summary of Vitamin B complex [7, 8].*

mounting of specific adaptive immune responses in persons and the utilisation of antivirals in phase 1 is vital for preventing entry of virus, disease progression and replication to phase 2. Global strategies can thus include administering external antivirals and food supplements that increase immune levels. In addition to retaining the overall status of the patient, phase 2 of the infection can be adapted for treatment to protect damage and malfunction to tissue in the course of the treatment by using nutritional supplements that can repress continuing oxidative stress, acute inflammation and cytokine storms. In short, in order to improve the immune response in phase one and eliminating it in the second phase, approaches to counter SARS-CoV-2 are effective, in addition to symptomatic treatment [5, 12].

### **6. Pathogenesis of COVID-19**

The information provided shows that infection pathogenesis can be divided into two components. Phase 1: an asymptomatic phase of detectable viruses or not. Phase 2: High viral load symptomatic phase [13]. After binding the S protein into the ACE2 receptors and then initiating cellular transmembrane protease, serine 2 (TMPRSS2) and then the virus enters the airway epithelium. After the virus enters the host, innate interferon (IFN) immune response will be inhibited or delayed [14]. Ubiquitation and breakdown of RNA sensor molecules interrupts with downstream signalling [5, 15]. After an impairment of the IFN viral replication system, activation is generated of the granulocytes macrophages and monocytes that lead to the description of the "cytokine storm." The activation of proinflammatory cytokines, which involves interleukin IL-12, IL-8, IL-6 and IL-1 are described, involves massive secretions of the tumour necrosis factor (TNF-α). Tissue fibrosis, pneumonia and hyperinflammation of tissues is associated with this [16]. Research has suggested that oxidative stress is involved in COVID-19 pathogenesis. The evidence seems to indicate that SARS-CoV-2 actually causes oxidative stress by improving reactive oxygen species (ROS) production and indirectly suppressing host defence [17]. Moreover, granulocytosis also contributes to superoxide ions, a kind of of ROS

#### **Figure 1.**

*Schematic representation of pathogenesis of COVID-19. Phase 1 which is asymptomatic includes dysregulation of host innate immune system, elevation of oxidative stress and phase 2 is acute inflammatory harmful phase [12, 24].*

*Novel Treatment Strategy against COVID-19 through Anti-Inflammatory, Antioxidant… DOI: http://dx.doi.org/10.5772/intechopen.100251*

and an extra development of proinflammatory cytokines in response to SARSCoV-2 infections [16, 18, 19]. High levels of cytokines also cause HA-synthase-2 (HAS2) endothelial inductions in alveolar and fibroblast epithelial cell (Type 2) [20–23]. Lungs of patients with corona virus have increased cytokine (IL-1, TNF-α) inflammatory levels. This is related to higher HAS2 activity and successive corona virus lung pathophysiology. The clinical and scientific study results above therefore recommend that corona virus pathogenesis consists of two stages: Stage 1, dysregulation of host innate immune system, elevation of oxidative stress and phase 2 is acute inflammatory harmful phase (**Figure 1**).

### **7. Cross-discussion of immunity, inflammation and oxidative stress with vitamin B complex**

In 1936 R.R. Williams and his coworkers defined their chemical structure and were able to synthesise the Vitamin B1 (thiamin) as the oldest vitamin. Vitamin B1 has an impact on anti-inflammatory characteristics, cytochrome C release, mitochondrial membranes, oxidative stress-induced, NF-kappaβ and protein kinases, P38-MAPK. Over expression of proinflammation cytokines like TNF, IL-1, IL-6, and arachidonic acid products, nervous system malfunction, T-cycle infiltration, neuroinflammation, expression CD40 by the microglia and CD40L, causing the loss of astrocytes, beriberi, CL2 chemokine over expression all are the outcomes of deficient vitamin B1 [25].

Therapies with vitamin B complex reduced proinflammatory expression and enhanced anti - proliferative cytokine activity, thereby making a contribution to neuroinflammatory resolution. Macrophages are usually grouped into two major subtypes: (i) macrophages (M1) that are involved as principal phagocytic cells in the inflammatory sites; and (ii) macrophages (M2) which carry out the process of tissue reshaping following inflammatory cellular activity. At the same time, B vitamins reduced the macrophage count for M1 and improved the macrophage count of M2. Thus, B vitamins have the potency for neuroinflammatory and neuroregenerational treatments and could be an excellent remedy for human peripheral nerve injury (PNI) [26].

Vitamin B-6 played an important role during the last decades in the mechanism for inflammatory and antioxidant activities [27]. PLP may interact with peroxy radicals and sequester free radicals and, through its group of hydroxyls, prevent lipid peroxidation on the pyridine ring [28]. PLP plays the role as a coenzyme in the manufacturing, throughout inflammation, of cytokines as well as other multipeptide intermediaries [29]. Therefore insufficient vitamin B-6 may diminish its antioxidant potential directly or interfere with inflammatory reactions [30].

### **8. COVID-19 patients: thiamine in hypoxia**

Thiamine inadequacy impairs inflammatory profile through neuroinflammation by affecting cardiovascular system [31]. As the corona virus needs antibodies, mainly T cells, thiamine deficiencies can result in insufficient antibody responses and consequently in more serious symptoms. Thus, the correct immune responses to corona virus infection are effective to assist with sufficient thiamine levels. Moreover, COVID-19 symptoms seem to be much related to the disease of altitude and pulmonary edema of high altitude. By inhibiting carbonic anhydrase enzymes and consequently increasing oxygen level, for prevention of high altitude sickness and pulmonary edema acetazolamide is commonly prescribed. Thiamine also works as

an inhibitor of the carbon anhydrase enzyme, hence the potential of hypoxia limitation and lowered hospitalisation at high concentrations of thiamine administered in early COVID-19 people. Research is still needed on the possibility of helping to heal COVID-19 patients by administering of increased thiamine doses [11].
