The most severe cases of COVID-19, and the highest rates of death, are among the elderly. There is an urgent need to search for an agent to treat the disease and control its progression. Boswellia serrata is traditionally used to treat chronic inflammatory diseases of the lung. This review aims to highlight currently published research that has shown evidence of potential therapeutic effects of boswellic acids (BA) and B. serrata extract against COVID-19 and associated conditions. We reviewed the published information up to March 2021. Studies were collected through a search of online electronic databases (academic libraries such as PubMed, Scopus, Web of Science, and Egyptian Knowledge Bank). Several recent studies reported that BAs and B. serrata extract are safe agents and have multiple beneficial activities in treating similar symptoms experienced by patients with COVID-19. Because of the low oral bioavailability and improvement of buccal/oral cavity hygiene, traditional use by chewing B. serrata gum may be more beneficial than oral use. It is the cheapest option for a lot of poorer people. The promising effect of B. serrata and BA can be attributed to its antioxidant, anti-inflammatory, immunomodulatory, cardioprotective, anti-platelet aggregation, antibacterial, antifungal, and broad antiviral activity. B. serrata and BA act by multiple mechanisms. The most common mechanism may be through direct interaction with IκB kinases and inhibiting nuclear factor-κB-regulated gene expression. However, the most recent mechanism proposed that BA not only inhibited the formation of classical 5-lipoxygenase products but also produced anti-inflammatory LOX-isoform-selective modulators. In conclusion a small to moderate dose B. serrata extract may be useful in the enhancing adaptive immune response in mild to moderate symptoms of COVID-19. However, large doses of BA may be beneficial in suppressing uncontrolled activation of the innate immune response. More clinical results are required to determine with certainty whether there is sufficient evidence of the benefits against COVID-19.

COVID-19 病例最严重、死亡率最高的是老年人。迫切需要寻找治疗该疾病并控制其进展的药物。齿叶 乳香传统上用于治疗肺部慢性炎症性疾病。本综述旨在重点介绍目前已发表的研究，这些研究已证明乳香酸 (BA) 和锯缘乳香提取物对 COVID-19 及相关病症具有潜在治疗作用。我们审查了截至 2021 年 3 月已发布的信息。研究是通过搜索在线电子数据库（PubMed、Scopus、Web of Science 和埃及知识库等学术图书馆）收集的。最近的几项研究报告称，BA 和锯缘B. serrata提取物是安全的药物，并且在治疗 COVID-19 患者经历的类似症状方面具有多种有益活性。由于口服生物利用度较低且需要改善颊/口腔卫生，传统咀嚼锯齿状锯齿状杆菌口香糖可能比口服使用更有益。对于许多穷人来说，这是最便宜的选择。B. serrata和 BA的良好作用可归因于其抗氧化、抗炎、免疫调节、心脏保护、抗血小板聚集、抗菌、抗真菌和广泛的抗病毒活性。B. serrata和 BA 通过多种机制发挥作用。最常见的机制可能是通过与 IκB 激酶直接相互作用并抑制核因子 κB 调节的基因表达。然而，最新的机制提出，BA 不仅抑制经典 5-脂氧合酶产物的形成，而且还产生抗炎 LOX-亚型选择性调节剂。总之，小至中等剂量的锯齿状芽孢杆菌提取物可能有助于增强轻度至中度 COVID-19 症状的适应性免疫反应。然而，大剂量的 BA 可能有利于抑制先天免疫反应不受控制的激活。需要更多的临床结果来确定是否有足够的证据证明对 COVID-19 的益处。