A review published in Inflammopharmacology indicated that a small to moderate dose of Boswellia serrata (B. serrata) extract might enhance the adaptive immune response in mild to moderate symptoms of coronavirus disease. Adel A. Gomaa et al. undertook the study for highlighting the currently published investigations that have demonstrated promising treatment benefits of boswellic acids and B. serrata extract against SARS-CoV-2 and the associated conditions.

A review of the published information up to March 2021 was done. Online electronic databases like Egyptian Knowledge Bank, PubMed, Web of Science, and Scopus were searched for collecting the studies. Recently conducted studies have stated that boswellic acids and B. serrata extract are safe and exhibit favorable effects to treat similar symptoms witnessed by coronavirus-infected people.

Compared to oral use, traditional usage by chewing B. serrata gum appears to be highly advantageous (due to improvement of buccal cavity or oral cavity hygiene and low oral bioavailability). For many poor people, it is the cheapest alternative. The potential advantages of boswellic acids and B. serrata are due to their cardioprotective, anti-inflammatory, immunomodulatory, anti-platelet aggregation, antifungal, antioxidant, antibacterial, and wide antiviral effect.

Boswellic acids and B. serrata and act via multiple mechanisms. One common mechanism might be through directly interacting with IκB kinases and suppressing nuclear factor-κB-regulated gene expressions. But, the most recent mechanism suggested that boswellic acids not only suppressed creation of classical 5-lipoxygenase products but also generated anti-inflammatory lipoxygenase-isoform-selective modulators.

But, large doses of boswellic acids might be helpful to suppress the uncontrolled activation of innate immune response. There is a requisition of more clinical results for determining with certainty if there is adequate evidence of benefits against SARS-CoV-2, concluded the study authors.