Although the COVID-19 pandemic primarily impairs respiratory function, epidemiological studies show that multiple systems may be affected. The severe complications of a SARS-CoV-2 infection appear to be induced by inflammatory dysregulation (“cytokine storm”), which also causes immunosuppression. Several studies underscore the positive effects of osteopathic medicine on inflammation and immune regulation. A careful review of the evidence-based literature highlights significant improvements with osteopathic manipulative treatment (OMT) as an adjunct to conventional treatment. OMT can improve the condition of infected patients by reducing symptoms and increasing the effectiveness of conventional treatments. OMT may also benefit patients who have recovered by reducing the long-term consequences of the infection and by improving their quality of life during convalescence. This review argues for multidisciplinary care to ensure the potential positive contributions of adjunctive osteopathic medicine to conventional care in the fight against pandemics such as COVID-19.
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Pathophysiology of SARS virusesAngiotensin-converting enzyme 2 (ACE2) is a surface protein present in the cells of essentially all tissues; its activity has been shown to be very high in the colon, kidney, gallbladder, myocardium, and breast, as well as in the ovary, lung, etc. It hydrolyses angiotensin II (Ang II) to Ang-(1-7). By binding to its specific receptors (AT1R), Ang II induces the production of cytokines, leading to local inflammation, fibrosis, oxidative stress, and vasoconstriction. The binding of Ang-(1-7) to its specific receptors (MAS-R) produces opposite effects. SARS viruses enter host cells by binding specifically to ACE2 and inducing its downregulation. This leads to a compensatory overproduction of Ang II by ACE, as well as a very low rate of hydrolysis of Ang II into Ang-(1-7). Therefore, the main process that helps explain SARS (and the resulting high mortality rate) is the apparently resulting viral hyperinflammation. OMT modulation of inflammatory and immune diseasesIt is known that lymph suppresses inflammation, mainly by regulating cytokines; it also increases endothelial cell permeability, distributes new leukocytes, and in vitro studies have shown that lymph can inhibit macrophage activity and slow neutrophil apoptosis. A specific category of OMT techniques, commonly referred to as the “pump technique”, is used to promote lymph circulation. With pump techniques, lymph flow as well as the total number of leukocytes (neutrophils, monocytes, CD4+ T, CD8+ T, IgG, IgA1) in the lymph of the thoracic and mesenteric ducts is increased. Pump techniques also increase the mobilisation of leukocytes into the lymphatic circulation from the gut-associated lymphoid tissues (GALT (Gut-Associated Lymphoid Tissues) is “the largest mass of lymphatic tissue in the body” and produces 60% of the total daily Ig, which is then secreted into the gastrointestinal tract).
