5 | CONCLUSION AND
PERSPECTIVES
The interaction of nervous system and immune system is essential for
regulating innate immune response and controlling inflammation. CAP has
broad development prospects in the treatment of inflammatory diseases.
With the in-depth study of CAP pathway, its relationship with various
inflammatory diseases has not been fully elucidated, so the
pharmacological effect of drugs through CAP has accounted for a large
share of disease treatment, which is still unknown. Inflammatory
diseases also include depression, shock, allergic asthma, colitis,
cancer, and other diseases with high incidence rates. Many CHM that
treats inflammatory diseases has not yet been studied whether they are
related to CAP. It may become a potential treatment for such diseases.
Therefore, it is necessary to thoroughly study the relationship among
CAP, pathways, and diseases. Studying the mechanism of CHM in CAP is
also more conducive to understanding its mechanism from a new entry
point and promoting the clinical application of CHM. In the drug studies
compiled in this review, most of them focused on the activation of
α7nAChR and the regulation of ACh level in CAP. The mechanism researches
of most drugs are still needing to be explored for further applications.
Characteristics of the multicomponent-multitarget-multipathway of CHM,
more therapeutic drugs can be developed from CHM prescriptions or active
ingredients. It has better clinical application value as an alternative
therapy for CAP activation through secondary advance research.
Some researchers have suggested that COVID-19 may be a cholinergic
system disease in the late stage of development. It has clinical
manifestations of cytokine storm, insomnia, and thromboembolic
complications, indicating that it is related to cholinergic dysfunction
(Farsalinos et al., 2020). ACE-2 is the main receptor used by SARS-CoV-2
to enter the host cell and nicotine upregulates ACE-2 through α7nAChR
(Leung, Yang, & Sin, 2020; Russo et al., 2020). So that it has become a
possible treatment that changes the expression of ACE-2 through α7nAChR
antagonist to prevent SARS-CoV-2 from entering the cells. The present
review found that Chinese medicines such as Liang-Ge-San, Huanglian
Jiedu Decoction, Shenfu Injection, Scutellariae Radix, Coptidis Rhizoma,
and total flavonoids of litchi have the effect of treating ALI and
sepsis. In the COVID-19 epidemic, Huanglian Jiedu Decoction, Shenfu
Injection, and other drugs have also been recommended for clinical
using, which have achieved remarkable results. In the SARS epidemic, it
has also been revealed that in the treatment of such major coronavirus
infections, glucocorticoid drugs, ribavirin, alpha-interferon,
lopinavir/ritonavir after long-term application, it will produce a
certain degree of sequelae such as liver damage, pulmonary fibrosis, and
femoral head necrosis. In the treatment of CHM, more emphasis is placed
on increasing efficacy and reducing toxicity, improving the security of
medication, enhancing self-immunity, and improving the ability to clear
viruses. Therefore, CHM based on CAP exerting anti-inflammatory effect
is also one of the treatment methods in COVID-19, which can reduce
dosage or use of hormone drugs to a greater extent, reduce liver damage
and sequelae, and the combination of Chinese and Western medicine is
more conducive to overcoming such problems at an early date. The
mechanism and clinical application need to be further explored.
Although there are no clinical drugs that have clinical side effects
with α7nAChR as the target, due to the limitations of cholinergic drugs,
they have side effects on the organs under the parasympathetic nervous
system. For instance, when acting on M2 mAChR may cause bradycardia,
when acting on M3 mAChR may cause blood pressure drop, abdominal cramps
caused by smooth muscle contraction and bronchial asthma, etc., and
cholinergic drugs entering the brain may also affect nerves.
Consequently, purely safe drugs do not exist, the usage and dosage of
drug are crucial. In clinical applications, CHM emphasizes dialectical
medicine to avoid contraindications (such as bronchial asthma,
arrhythmia, intestinal resection, urinary tract obstruction, etc.). It
is reasonably matched with medicines to enhance the therapeutic effect
and reduce toxicity, and exert the advantage of the anti-inflammatory
effect of CHM with accurate curative effect and small side effects. In
summary, CAP is an important mechanism for inflammatory disease
treatment with CHM. There are still a lot of research that needs to be
explored in-depth, which can be utilized as a new perspective for
clinical application.