Clinical Rationale for SARS-CoV-2 Base Spike Protein
Detoxification in Post COVID-19 and Vaccine
A. McCullough, M.D., M.P.H.
Brian C. Procter, M.D.
Injury Syndromes Peter
Cade Wynn
SARS-CoV-2 Spike Protein as a Therapeutic Target

Proteolytic Degradation of Spike Protein

The majority of the global population has contracted
COVID-19 and/or taken one of the many COVID-19 vaccines.
As a result, the injurious SARS-CoV-2 spike protein has been
an antigenic exposure to most in the world. Provided theinfection was treated early and limited to the nasopharynx
without invasive disease, the infection was self-limited
without sequelae. Mucosal immunity with IgA, T-cells, B-cells,
and natural killer cells handles the coronavirus and defends
the body against systemic illness.1 However, in the setting ofinvasive disease with COVID-19 pneumonia, viremia, cytokine
storm, thrombosis, and end-organ injury, there is evidenceof widespread residual replicating SARS-CoV-2 spike protein
in tissues for months, and the S1 segment within CD16
monocytes for more than one year.2
Repeated administrations of COVID-19 vaccines,
particularly the mRNA or adenoviral DNA products, deliver
the genetic code for the spike protein, which is produced bya wide array of cells in tissues, resulting in an uncontrolled
duration and cumulative doses of spike protein. The risein IgG against the spike protein is many fold greater after
vaccination than from the natural infection. This is a proxyfor considerably greater exposure to the spike protein after
immunization than after infection. Anti-spike IgG levels areassociated with post-COVID-19 symptoms.3 Yonker et al.
have recently shown that some individuals do not develop
neutralizing antibodies against the spike protein, and as
a result develop organ injury, particularly myocarditis inchildren and young adults.4 Free circulating soluble andextracellular vesicle-linked spike protein is associated withpersistent symptoms.5
The spike protein is responsible for the pathogenicityof the SARS-CoV-2 infection and drives the developmentof adverse events, injuries, disabilities, and death after
vaccination through immunologic and thrombotic
mechanisms. The spike protein has been found in the brain,heart, liver, kidneys, ovaries, testicles and other vital organs
at autopsy in cases of death after vaccination.6-9 In the caseof vaccine-induced thrombotic injury, the spike protein has
been found within the blood clot itself.10
Thus, there is strong rationale for considering residual
SARS-CoV-2 spike protein as a treatment target in post
COVID-19 and vaccine injury syndromes. The spike protein
participates directly in pathophysiology, incites inflammation,and propels thrombosis. Thus, overlapping coverage for these
domains would be desirable in a combination approach. Whilespecific syndromes (cardiovascular, neurological, endocrine,
thrombotic, immunological) will require additional therapies,
we will focus the remaining discussion on degrading the spike
protein and antagonizing its effects in tissues and organs.

Nattokinase
The spike protein has been found free, bound by
antibodies, and also encased within lysosomes or exosomes
both inside and outside of cells. Patterson et al. have foundthese, both after infection and after vaccination, likely
worsened by repeated exposures (Figure 1). This shows thatthe spike protein can persist in the human body for a very
long time (months to years), probably because it is resistantto proteolytic cleavage and disposal.11
Proteolytic cleavage of spike appears to be an
important mechanism to initiate clearance of the proteinby the reticuloendothelial system. Nattokinase is anaturally occurring proteolytic enzyme with thrombolytic
properties derived from the fermentation of soy beans
by Bacillus subtilis natto.12 The organism is a probiotic
gram-positive spore-forming bacterium with veterinaryand human applications.13 Nattokinase has been widelyused as a cardiovascular supplement in Japan for its antiatherosclerotic and antithrombotic properties.14 It has
undergone safety testing in doses up to 80,000 fibrinolytic
units (FU) daily. Kurosawa and colleagues have shown inhumans that D-dimer concentrations at six and eight 8 hours,
and blood fibrin/fibrinogen degradation products at fourhours after administration of a single oral dose of 2,000 FU(100 mg) were elevated significantly (p < 0.05, respectively).
Thus, an empiric starting dose could be 2,000 FU twice a day.
Full pharmacokinetic and pharmacodynamic studies havenot been completed, but several years of market use as anover-the-counter supplement suggests that nattokinase issafe, with the main caveat being excessive bleeding. Caution
is needed with concurrent antiplatelet and anticoagulant
drugs.15
Oba and colleagues performed a series of experimentswith various concentrations of nattokinase in preclinicalmodels. They found that nattokinase effectively stopped
SARS-CoV-2 and bovine herpes virus type 1 infection of humancells in culture, and that the proteolytic effect of nattokinase
was heat sensitive.16 Tanikawa et al. examined the effect of
nattokinase on the spike protein of SARS-CoV-2. In the firstexperiment they demonstrated that spike was degraded in atime and dose-dependent manner in a cell lysate preparationthat could be analogous to a vaccine recipient. The second
experiment demonstrated that nattokinase degraded the
spike protein in SARS-CoV-2-infected cells. This reproduced
a similar study done by Oba and colleagues.17 Because of therisk of bleeding, patients must be strongly cautioned to seek
medical supervision with combining this nutraceutical withconcurrent antiplatelet and anticoagulant drugs. Additionally,
allergic reactions can occur, especially in patients who have

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known soy allergies. There is insufficient information for
the use of nattokinase in children or pregnant or lactating
women.
Bromelain
Bromelain is a family of cysteine proteases, isolated fromthe pineapple stem (Ananas comosus).18 Traditionally, it has
been used for its antiinflammatory and healing effects incases of arthritis and injury, while it has been approved inEurope for the debridement of burn wounds. Experimental
studies have demonstrated that bromelain presents unique
immunomodulatory actions: 1) downregulation of theproinflammatory prostaglandin PGE-2 through inhibition
of NF-kB and cyclooxygenase 2 (COX-2); 2) upregulationof the antiinflammatory PGE-1 (Figure 1); 3) activation of
inflammatory mediators (interleukin 1b, interleukin-6, tumor
necrosis factor-a, and interferon-g) as an acute response tocellular stress, but also inhibition of inflammatory mediators
in states of overt cytokine production; 4) modulation of T-cell
responses in vitro and in vivo; and 5) enhancement of T-celldependent antigen-specific B-cell antibody responses.
Importantly,
bromelainexertsdose-dependent
anticoagulant effects: 1) downregulation of PGE-2 andthromboxane A2 (TXA2), thus leading to relative excess of
prostacyclin in platelets, and 2) promotion of fibrinolysis bystimulating the conversion of plasminogen to plasmin andprevention of platelet aggregation (Figure 1).

Figure 1. Venn Diagram of Mechanisms of Action of Proposed
Agents that Target the SARS-CoV-2 Spike Protein
Bromelain also hydrolyzes bradykinin and reduceskininogen and bradykinin levels in serum and tissues,
improving inflammation and edema as shown in animalstudies.19 Notably, the latter action supports a potential
role of bromelain in alleviating COVID-19 symptoms suchas cough, fever, and pain, and the more serious implicationsof inflammation, thrombosis, and edema. The effect ofJournal of American Physicians and Surgeons Volume 28 Number 3

Fall 2023

bromelain on PGE-2 inhibition exceeds that of prednisone
and aspirin, presenting very low toxicity and no major side
effects.
Additionally, a recent experimental study demonstrated
that bromelain inhibits infection of VeroE6 cells by SARSCoV-2 through blocking the virus binding and entry into cellsby downregulation of ACE-2 and TMPRSS2 expression, andcleavage of the SARS-CoV-2 spike protein, presenting a noveland promising therapeutic option, which warrants further
investigation.20
Bromelain increases the prothrombin time and partial
thromboplastin time and can thus increase bleeding risk. It
can cause gastrointestinal upset. Severe allergic reactions
can occur.21 Bromelain may increase the absorption of
medications—including antibiotics (such as tetracycline andamoxicillin), chemotherapeutic agents (such as 5-fluorouracil
and vincristine), ACE inhibitors (such as captopril andlisinopril), benzodiazepines, certain antidepressants, opioids,
and barbiturates. Physician supervision is advised. A standard
dose of bromelain for human use is 500 mg orally per day.
Inhibition of Spike and Its Fragments in Tissues
CurcuminCurcumin (diferuloylmethane) is derived from turmeric(Curcuma longa), a member of the ginger family of plants.
Curcumin is a polyphenol and modulates inflammation in thesetting of viral infections via inhibition of cytokines throughmultiple transcription factors. Additionally, curcumin
inhibits angiotensin converting enzyme (ACE), modulating
angiotensin II synthesis, and promotes fibrinolysis and theanticoagulation process (see Figures 1 and 2).
The antiviral actions of curcumin against multiple viruses(influenza and hepatitis viruses, herpes viruses, humanpapilloma virus, human immunodeficiency virus, severe acuterespiratory syndrome coronavirus and other coronaviruses),bacteria, and fungi have been suggested in prior mechanistic
studies.22 In silico studies have demonstrated that curcumin
prevents SARS-CoV-2 entry into cells by blocking the spike
protein binding sites and the cell ligands (ACE-2 receptors
and TMPRSS-2), and by that mechanism reduces viral
replication.23
The minimal absorption of curcumin following oral
administration has been overcome with nanoparticle
technology. Randomized trials have consistently showed
reductions in hs-CRP and other inflammatory markers inthe setting of spike protein mediated infection/injury.24,25
The World Health Organization (WHO) has determined 0–3
mg per kilogram of body weight to be an acceptable daily
dietary intake, about 250 mg. At higher therapeutic doses
there can be gastrointestinal adverse events including peptic
ulcer disease. Nano or liposomal curcumin is available as anoral supplement with better absorption dosed at 500 mg
twice a day and has been shown to be safe without liver or
serious gastrointestinal toxicity.26 Alternatively, curcumin
can be combined with piperine (black pepper extract), at
about 10 mg/1000 mg, to significantly increase absorption.
There are, however, published studies showing that curcumin
supplements decrease effectiveness of prescription hormones
thyroid and estradiol, so patients on these prescription91

medicines need to be monitored by their physicians to avoid
being destabilized by the addition of curcumin. The samecaution applies to turmeric supplements.

Figure 2. Sites of Possible Suppression of Spike-Protein
Sequelae Including Degradation and Inhibition of Thrombosis
and Inflammation
Other Compounds
There is a host of other compounds that have supportive
mechanistic and clinical data that could additionally playroles in a multidrug regimen. A notable supplement isaugmented N-acetylcysteine, which can be given in a dose
range of 400 to 1,000 mg per day. Other hopeful products ina long list include: ivermectin, hydroxychloroquine, selenium,
Irish sea moss, green tea extract (Camillia sinensis), Nigellasativa (black cumin), dandelion extract (Taraxacum officinale),glutathione, and many more. We have chosen to focus on
nattokinase, bromelain, and curcumin as a manageable triad
that has a well-characterized safety profile and sufficient
information on dosing in clinical practice.
Laboratory and Clinical Monitoring
Laboratory monitoring can be helpful in guiding the
response to treatment. A reasonable battery of commerciallyavailable assays above and beyond routine testing can include:
hs-CRP, D-dimer, antinuclear antibody (ANA), qualitative
antibodies for the SARS-CoV-2 nucleocapsid, and quantitative
antibodies for the spike protein. Advanced panels at baseline
and after treatment can be extended to reflect cytokines
including: cytokines TNF-alpha, IL-4, IL-13, IL-2, GM-CSF, sCD40L,
CCL5 (RANTES), CCL3 (MIP-1alpha), IL-6, IL-10, IFN-gamma,
VEGF, IL-8, CCL4(MIP-1beta). Cellular measurements include
WBC CD4%, CD8%, and CD4/CD8 ratio, and quantification of
SARS-CoV-2 S1 spike protein-containing monocytes, available
from Radiance Diagnostics, Naperville, Ill.27
Discussion
Triple therapy with nattokinase, bromelain, and curcumin issuggested as a generally safe detoxification foundation upon92

which other drug and nutraceutical treatment strategies can be
developed for the amelioration of SARS-CoV-2 spike proteindriven syndromes affecting those who have recovered fromCOVID-19 and/or received one or more injections of a COVID
vaccine (Figure 2). Unfortunately, most individuals around theglobe have had both exposures and with multiple occurrences.
The duration of therapy and the impact on clinical outcomessuch as quality of life, symptom scores, hospitalization, anddeath are unknown. Thus, no therapeutic claims can be madeuntil large prospective randomized double-blind placebocontrolled trials are completed. A check of clinicaltrials.gov
indicates that no such trials yet have been registered. In
the meantime, based on signals of benefit and acceptablesafety, the triad of nattokinase 2,000 FU (100 mg) twice daily,bromelain 500 mg a day, and nano-curcumin 500 mg twice
daily for at least 3 months with continuation for a year or
more, as a base detoxification regimen upon which additional
agents can be added, is a reasonable empiric strategy for those
suffering with post COVID-19 or vaccine-associated symptoms.
Clinicians should recognize this combination has significant
anticoagulant effects that will be potentially counterbalancedby the pro-coagulant effects of spike protein. Patients should becounseled and monitored for bleeding complications including
easy bruising, nasal mucosal bleeding, and gastrointestinal
hemorrhage.
Conclusion
Chronic disabling symptoms from “long COVID” andfollowing mRNA injections are an increasingly prevalent
problem. The symptomatic presentation has many common
features, which might be explained by the spike protein of
the virus, which is also manufactured by the vaccinee’s own
cells. There is no accepted protocol for treatment. Based on
their mechanisms of action, a combination of nattokinase,bromelain, and curcumin should be considered. Patients needclose monitoring because of anticoagulant effects. Formal
clinical trials are urgently needed.
Peter A. McCullough, M.D., M.P.H., an internist and cardiologist, is president of
the McCullough Foundation; Cade Wynn works as an assistant with McKinney
Family Medicine; Brian C. Procter, M.D., founder of McKinney Family Medicine,is a family physician practicing in McKinney, Texas. Contact: peteramccullough@gmail.com.
Disclosures: Dr. McCullough receives partial salary support and holds an equity
position in The Wellness Company, Boca Raton, Fla. The Wellness Company
markets dietary supplements, including Spike Support, which contains
nattokinase among multiple ingredients.

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