Conclusion
In conclusion, the combination of thalidomide and celecoxib together with an effort to maintain synbiosis with berberine are all important factors that may help mitigate the SARS-CoV-2-induced cytokine storm. In mild cases, one can focus on maintaining a healthy immune response via the administration of synbiotics. In moderate-to-severe cases, immunomodulatory agents and synbiotics, including berberine, may help to prevent the lethal cytokine storm60.
1. Thalidomide and Celecoxib
Low molecular weight immunomodulatory agents (<350 Da) can cross the cell membrane and limit activation of NF-kB.
Thalidomide (200 mg/day), Celecoxib (400 mg/day)
2. Symbiotics and Berberine
Function by down-regulating proinflammatory cytokines
Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Conflict of Interests: None
Ethics Approval: This is Review article - Ethics committee approval and informed consent are not needed.