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Dvorkin J, De Luca J, Alvarez-Paggi D, Caballero MT. Responding to Higher-Than-Expected Infant Mortality Rates from Respiratory Syncytial Virus (RSV): Improving Treatment and Reporting Strategies. Infect Drug Resist 2023; 16:595-605. [PMID: 36733921 PMCID: PMC9888399 DOI: 10.2147/idr.s373584] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 01/16/2023] [Indexed: 01/28/2023] Open
Abstract
Respiratory syncytial virus (RSV) has a major role in respiratory infections in young infants around the world. However, substantial progress has been made in recent years in the field of RSV. A wide variety of observational studies and clinical trials published in the past decade provide a thorough idea of the health and economic burden of RSV disease in the developing world. In this review, we discuss the impact of RSV burden of disease, major gaps in disease estimations, and challenges in generating new therapeutic options and an immune response against the virus, and briefly describe next generation technologies that are being evaluated.
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Affiliation(s)
- Julia Dvorkin
- Fundación INFANT, Buenos Aires, Argentina,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | | | - Damian Alvarez-Paggi
- Fundación INFANT, Buenos Aires, Argentina,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Mauricio T Caballero
- Fundación INFANT, Buenos Aires, Argentina,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina,Correspondence: Mauricio T Caballero, Fundación INFANT, Gavilán 94, Buenos Aires, Argentina, Email
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2
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ElSawy KM, Alminderej FM, Caves LSD. Disruption of 3CLpro protease self-association by short peptides as a potential route to broad spectrum coronavirus inhibitors. J Biomol Struct Dyn 2022; 40:13901-13911. [PMID: 34720051 DOI: 10.1080/07391102.2021.1996462] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Coronaviruses have posed a persistent threat to human health over the last two decades. Despite the accumulated knowledge about coronavirus-related pathogens, development of an effective treatment for its new variant COVID-19 is highly challenging. For the highly-conserved and main coronavirus protease 3CLpro, dimerization is known to be essential for its catalytic activity and thereby for virus proliferation. Here, we assess the potential of short peptide segments to disrupt dimerization of the 3CLpro protease as a route to block COVID-19 proliferation. Based on the X-ray structure of the 3CLpro dimer, we identified the SPSGVY126QCAMRP dodecapeptide segment as overlapping the hotspot regions on the 3CLpro dimer interface. Using computational blind docking of the peptide to the 3CLpro monomer, we found that the SPSGVY126QCAMRP peptide has favourable thermodynamic binding (ΔG= -5.93 kcal/mol) to the hotspot regions at the 3CLpro dimer interface. Importantly, the peptide was also found to preferentially bind to the hotspot regions compared to other potential binding sites lying away from the dimer interface (ΔΔG=-1.31 kcal/mol). Docking of peptides corresponding to systematic mutation of the V125 and Y126 residues led to the identification of seven peptides, SPSGHAQCAMRP, SPSGVTQCAMRP, SPSGKPQCAMRP, SPSGATQCAMRP, SPSGWLQCAMRP, SPSGAPQCAMRP and SPSGHPQCAMRP, that outperform the wild-type SPSGVY126QCAMRP peptide in terms of preferential binding to the 3CLpro dimer interface. These peptides have the potential to disrupt 3CLpro dimerization and therefore could provide lead structures for the development of broad spectrum COVID-19 inhibitors.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Karim M ElSawy
- Department of Chemistry, College of Science, Qassim University, Buraydah, Saudi Arabia.,York Cross-Disciplinary Centre for Systems Analysis (YCCSA), University of York, York, UK
| | - Fahad M Alminderej
- Department of Chemistry, College of Science, Qassim University, Buraydah, Saudi Arabia
| | - Leo S D Caves
- York Cross-Disciplinary Centre for Systems Analysis (YCCSA), University of York, York, UK.,Independent Researcher, São Felix da Marinha, Portugal
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3
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Srinivasan K, Pandey AK, Livingston A, Venkatesh S. Roles of host mitochondria in the development of COVID-19 pathology: Could mitochondria be a potential therapeutic target? MOLECULAR BIOMEDICINE 2021; 2:38. [PMID: 34841263 PMCID: PMC8608434 DOI: 10.1186/s43556-021-00060-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 11/04/2021] [Indexed: 02/07/2023] Open
Abstract
The recent emergence of severe acute respiratory syndrome-Corona Virus 2 (SARS-CoV-2) in late 2019 and its spread worldwide caused an acute pandemic of Coronavirus disease 19 (COVID-19). Since then, COVID-19 has been under intense scrutiny as its outbreak led to significant changes in healthcare, social activities, and economic settings worldwide. Although angiotensin-converting enzyme-2 (ACE-2) receptor is shown to be the primary port of SARS-CoV-2 entry in cells, the mechanisms behind the establishment and pathologies of COVID-19 are poorly understood. As recent studies have shown that host mitochondria play an essential role in virus-mediated innate immune response, pathologies, and infection, in this review, we will discuss in detail the entry and progression of SARS-CoV-2 and how mitochondria could play roles in COVID-19 disease. We will also review the potential interactions between SARS-CoV-2 and mitochondria and discuss possible treatments, including whether mitochondria as a potential therapeutic target in COVID-19. Understanding SARS-CoV-2 and mitochondrial interactions mediated virus establishment, inflammation, and other consequences may provide a unique mechanism and conceptual advancement in finding a novel treatment for COVID-19.
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Affiliation(s)
- Kavya Srinivasan
- Department of Microbiology, Biochemistry and Molecular Genetics, Rutgers -New Jersey Medical School, The State University of New Jersey, Newark, NJ USA
- New York Institute of Technology, Old Westbury, NY USA
| | - Ashutosh Kumar Pandey
- Department of Pharmacology, Physiology and Neuroscience, Rutgers -New Jersey Medical School, The State University of New Jersey, Newark, NJ USA
| | | | - Sundararajan Venkatesh
- Department of Microbiology, Biochemistry and Molecular Genetics, Rutgers -New Jersey Medical School, The State University of New Jersey, Newark, NJ USA
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von Hentig N. Repositioning HIV protease inhibitors and nucleos(t)ide RNA polymerase inhibitors for the treatment of SARS-CoV-2 infection and COVID-19. Eur J Clin Pharmacol 2021; 77:1297-1307. [PMID: 33660020 PMCID: PMC7929896 DOI: 10.1007/s00228-021-03108-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 02/05/2021] [Indexed: 12/13/2022]
Abstract
AIMS SARS-CoV-2 is a single-stranded RNA virus which is part of the ß-coronavirus family (like SARS 2002 and MERS 2012). The high prevalence of hospitalization and mortality, in addition to the lack of vaccines and therapeutics, forces scientists and clinicians around the world to evaluate new therapeutic options. One strategy is the repositioning of already known drugs, which were approved drugs for other indications. SUBJECT AND METHOD SARS-CoV-2 entry inhibitors, RNA polymerase inhibitors, and protease inhibitors seem to be valuable targets of research. At the beginning of the pandemic, the ClinicalTrials.gov webpage listed n=479 clinical trials related to the antiviral treatment of SARS-CoV-2 (01.04.2020, "SARS-CoV-2," "COVID-19," "antivirals," "therapy"), of which n=376 are still accessible online in January 2021 (10.01.2021). Taking into account further studies not listed in the CTG webpage, this narrative review appraises HIV protease inhibitors and nucleos(t)ide RNA polymerase inhibitors as promising candidates for the treatment of COVID-19. RESULTS Lopinavir/ritonavir, darunavir/cobicistat, remdesivir, tenofovir-disoproxilfumarate, favipriravir, and sofosbuvir are evaluated in clinical studies worldwide. Study designs show a high variability and results often are contradictory. Remdesivir is the drug, which is deployed in nearly 70% of the reviewed clinical trials, followed by lopinavir/ritonavir, favipiravir, ribavirine, and sofosbuvir. DISCUSSION This review discusses the pharmacological/clinical background and questions the rationale and study design of clinical trials with already approved HIV protease inhibitors and nucleos(t)ide RNA polymerase inhibitors which are repositioned during the SARS-CoV-2 pandemic worldwide. Proposals are made for future study design and drug repositioning of approved antiretroviral compounds.
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Affiliation(s)
- Nils von Hentig
- Sachsenhausen Practice of General Medicine, HIV-Focus, Frankfurt am Main, Germany.
- HIVCENTER, Internal Medicine II, Goethe University Hospital, Frankfurt am Main, Germany.
- Institute of Clinical Pharmacology, Goethe University, Frankfurt am Main, Germany.
- Section Pharmacology, German AIDS Society, Frankfurt am Main, Germany.
- Praxis für Allgemeinmedizin / HIV-Schwerpunkt, Ziegelhüttenweg 1-3, 60598, Frankfurt am Main, Germany.
- HIVCENTER, Johann Wolfgang Goethe Universität, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
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Tian L, Qiang T, Liang C, Ren X, Jia M, Zhang J, Li J, Wan M, YuWen X, Li H, Cao W, Liu H. RNA-dependent RNA polymerase (RdRp) inhibitors: The current landscape and repurposing for the COVID-19 pandemic. Eur J Med Chem 2021; 213:113201. [PMID: 33524687 PMCID: PMC7826122 DOI: 10.1016/j.ejmech.2021.113201] [Citation(s) in RCA: 123] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/14/2020] [Accepted: 01/12/2021] [Indexed: 02/06/2023]
Abstract
The widespread nature of several viruses is greatly credited to their rapidly altering RNA genomes that enable the infection to persist despite challenges presented by host cells. Within the RNA genome of infections is RNA-dependent RNA polymerase (RdRp), which is an essential enzyme that helps in RNA synthesis by catalysing the RNA template-dependent development of phosphodiester bonds. Therefore, RdRp is an important therapeutic target in RNA virus-caused diseases, including SARS-CoV-2. In this review, we describe the promising RdRp inhibitors that have been launched or are currently in clinical studies for the treatment of RNA virus infections. Structurally, nucleoside inhibitors (NIs) bind to the RdRp protein at the enzyme active site, and nonnucleoside inhibitors (NNIs) bind to the RdRp protein at allosteric sites. By reviewing these inhibitors, more precise guidelines for the development of more promising anti-RNA virus drugs should be set, and due to the current health emergency, they will eventually be used for COVID-19 treatment.
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Affiliation(s)
- Lei Tian
- College of Bioresources Chemical and Materials Engineering, Shaanxi University of Science & Technology, Xi'an, 710021, PR China; Faculty of Pharmacy, Shaanxi University of Science & Technology, Xi'an, 710021, PR China
| | - Taotao Qiang
- College of Bioresources Chemical and Materials Engineering, Shaanxi University of Science & Technology, Xi'an, 710021, PR China
| | - Chengyuan Liang
- Faculty of Pharmacy, Shaanxi University of Science & Technology, Xi'an, 710021, PR China.
| | - Xiaodong Ren
- Medical College, Guizhou University, Guiyang, 550025, PR China.
| | - Minyi Jia
- Faculty of Pharmacy, Shaanxi University of Science & Technology, Xi'an, 710021, PR China
| | - Jiayun Zhang
- Faculty of Pharmacy, Shaanxi University of Science & Technology, Xi'an, 710021, PR China
| | - Jingyi Li
- Faculty of Pharmacy, Shaanxi University of Science & Technology, Xi'an, 710021, PR China
| | - Minge Wan
- School of Medicine and Pharmacy, Shaanxi University of Business & Commerce, Xi'an, 712046, PR China
| | - Xin YuWen
- Faculty of Pharmacy, Shaanxi University of Science & Technology, Xi'an, 710021, PR China
| | - Han Li
- Faculty of Pharmacy, Shaanxi University of Science & Technology, Xi'an, 710021, PR China
| | - Wenqiang Cao
- Zhuhai Jinan Selenium Source Nanotechnology Co., Ltd., Hengqin New Area, Zhuhai, 519030, PR China.
| | - Hong Liu
- Zhuhai Jinan Selenium Source Nanotechnology Co., Ltd., Hengqin New Area, Zhuhai, 519030, PR China.
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Konwar M, Sarma D. Advances in developing small molecule SARS 3CL pro inhibitors as potential remedy for corona virus infection. Tetrahedron 2021; 77:131761. [PMID: 33230349 PMCID: PMC7674993 DOI: 10.1016/j.tet.2020.131761] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 10/06/2020] [Accepted: 11/09/2020] [Indexed: 01/08/2023]
Abstract
Originated in China, coronavirus disease 2019 (COVID-19)- the highly contagious and fatal respiratory disease caused by SARS-CoV-2 has already infected more than 29 million people worldwide with a mortality rate of 3.15% (according to World Health Organization's (WHO's) report, September 2020) and the number is exponentially increasing with no remedy whatsoever discovered till date. But it is not the first time this infectious viral disease has appeared, in 2002 SARS-CoV infected more than 8000 individuals of which 9.6% patients died and in 2012 approximately 35% of MERS-CoV infected patients have died. Literature reports indicate that a chymotripsin-like cystein protease (3CLpro) is responsible for the replication of the virus inside the host cell. Therefore, design and synthesis of 3CLpro inhibitor molecules play a great impact in drug development against this COVID-19 pandemic. In this review, we are discussing the anti-SARS effect of some small molecule 3CLpro inhibitors with their various binding modes of interactions to the target protein.
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Affiliation(s)
- Manashjyoti Konwar
- Department of Chemistry, Dibrugarh University, Dibrugarh, 786004, Assam, India
- Department of Chemistry, Dibru College, Dibrugarh, 786003, Assam, India
| | - Diganta Sarma
- Department of Chemistry, Dibrugarh University, Dibrugarh, 786004, Assam, India
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7
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Endothelial Cell Contributions to COVID-19. Pathogens 2020; 9:pathogens9100785. [PMID: 32992810 PMCID: PMC7600722 DOI: 10.3390/pathogens9100785] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/21/2020] [Accepted: 09/22/2020] [Indexed: 01/08/2023] Open
Abstract
Understanding of the clinical, histological and molecular features of the novel coronavirus 2019 (Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)) has remained elusive. Coronavirus disease 2019 (COVID-19) caused by this virus has unusual clinical presentation with regard to other related coronaviruses. Recent reports suggest that SARS-CoV-2, unlike other related viruses, infects and replicates within endothelial cells, which may explain a significant portion of the observed clinical pathology. Likewise, mounting evidence associates vascular and endothelial cell dysfunction with increased mortality. This review focuses on understanding how endothelial cell pathology is caused by SARS-CoV-2 at the molecular and cellular levels and how these events relate to COVID-19. A detailed examination of current knowledge regarding canonical inflammatory reaction pathways as well as alteration of endothelial cell-derived exosomes and transdifferentiation by SARS-CoV-2 is included in this assessment. Additionally, given an understanding of endothelial contributions to COVID-19, potential therapeutic aims are discussed, particularly as would affect endothelial function and pathology.
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Andrade KRCD, Carvalho VKDS, Farinasso CM, Lima AAD, Silva RB, Wachira VK, Capucho HC, Souza PMD, Vanni T, Sachetti CG, Rêgo DF. Terapia medicamentosa para infecções por coronavírus em humanos: revisão sistemática rápida. CIENCIA & SAUDE COLETIVA 2020; 25:3517-3554. [DOI: 10.1590/1413-81232020259.14242020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 01/08/2023] Open
Abstract
Resumo O objetivo deste trabalho foi avaliar efeitos de tratamentos medicamentosos para infecções por coronavírus. Revisão sistemática rápida com buscas nas bases MEDLINE, EMBASE, Cochrane, BVS, Global Index Medicus, Medrix, bioRxiv, Clinicaltrials.gov e International Clinical Trials Registry Platform. Foram incluídos 36 estudos avaliando alternativas medicamentosas contra SARS, SARS-CoV-2 e MERS. A maioria dos estudos incluídos foi conduzida na China com delineamento observacional para tratamento da COVID-19. Os tratamentos mais estudados foram antimaláricos e antivirais. Nos antimaláricos, a metanálise de dois estudos com 180 participantes não identificou benefício da hidroxicloroquina em relação à negativação da carga viral via reação em cadeia de polimerase em tempo real e o uso de antivirais comparado ao cuidado padrão foi similar em relação aos desfechos. As evidências científicas disponíveis são preliminares e de baixa qualidade metodológica, o que sugere cautela na interpretação dos dados. Pesquisas que avaliem a eficácia comparativa em ensaios clínicos randomizados, controlados, com tempo de acompanhamento adequado e com os métodos devidamente divulgados e sujeitos à revisão científica por pares são necessárias. Recomenda-se atualização periódica da presente revisão.
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Kalergis AM, Soto JA, Gálvez NMS, Andrade CA, Fernandez A, Bohmwald K, Bueno SM. Pharmacological management of human respiratory syncytial virus infection. Expert Opin Pharmacother 2020; 21:2293-2303. [PMID: 32808830 DOI: 10.1080/14656566.2020.1806821] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Human respiratory syncytial virus (hRSV) is the primary viral cause of respiratory diseases, leading to bronchiolitis and pneumonia in vulnerable populations. The only current treatment against this virus is palliative, and no efficient and specific vaccine against this pathogen is available. AREAS COVERED The authors describe the disease symptoms caused by hRSV, the economic and social impact of this infection worldwide, and how this infection can be modulated using pharmacological treatments, preventing and limiting its dissemination. The authors discuss the use of antibodies as prophylactic tools -such as palivizumab- and the use of nonspecific drugs to decrease the symptoms associated with the infection -such as bronchodilators, corticoids, and antivirals. They also discuss current vaccine candidates, new prophylactic treatments, and new antivirals options, which are currently being tested. EXPERT OPINION Today, many researchers are focused on developing different strategies to modulate the symptoms induced by hRSV. However, to achieve this, understanding how current treatments are working and their shortcomings needs to be further elucidated.
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Affiliation(s)
- Alexis M Kalergis
- Millennium Institute on Immunology and Immunotherapy, Departamento De Genética Molecular Y Microbiología, Facultad De Ciencias Biológicas, Pontificia Universidad Católica De Chile , Santiago, Chile.,Departamento De Endocrinología, Facultad De Medicina, Pontificia Universidad Católica De Chile , Santiago, Chile
| | - Jorge A Soto
- Millennium Institute on Immunology and Immunotherapy, Departamento De Genética Molecular Y Microbiología, Facultad De Ciencias Biológicas, Pontificia Universidad Católica De Chile , Santiago, Chile
| | - Nicolás M S Gálvez
- Millennium Institute on Immunology and Immunotherapy, Departamento De Genética Molecular Y Microbiología, Facultad De Ciencias Biológicas, Pontificia Universidad Católica De Chile , Santiago, Chile
| | - Catalina A Andrade
- Millennium Institute on Immunology and Immunotherapy, Departamento De Genética Molecular Y Microbiología, Facultad De Ciencias Biológicas, Pontificia Universidad Católica De Chile , Santiago, Chile
| | - Ayleen Fernandez
- Millennium Institute on Immunology and Immunotherapy, Departamento De Genética Molecular Y Microbiología, Facultad De Ciencias Biológicas, Pontificia Universidad Católica De Chile , Santiago, Chile
| | - Karen Bohmwald
- Millennium Institute on Immunology and Immunotherapy, Departamento De Genética Molecular Y Microbiología, Facultad De Ciencias Biológicas, Pontificia Universidad Católica De Chile , Santiago, Chile
| | - Susan M Bueno
- Millennium Institute on Immunology and Immunotherapy, Departamento De Genética Molecular Y Microbiología, Facultad De Ciencias Biológicas, Pontificia Universidad Católica De Chile , Santiago, Chile
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Das G, Ghosh S, Garg S, Ghosh S, Jana A, Samat R, Mukherjee N, Roy R, Ghosh S. An overview of key potential therapeutic strategies for combat in the COVID-19 battle. RSC Adv 2020; 10:28243-28266. [PMID: 35685027 PMCID: PMC9127683 DOI: 10.1039/d0ra05434h] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 07/09/2020] [Indexed: 12/27/2022] Open
Abstract
The sudden ravaging outbreak of a novel coronavirus, or SARS-CoV-2, in terms of virulence, severity, and casualties has already overtaken previous versions of coronaviruses, like SARS CoV and MERS CoV. Originating from its epicenter in Wuhan, China, this mutated version of the influenza virus with its associated pandemic effects has engulfed the whole world with awful speed. In the midst of this bewildering situation, medical and scientific communities are on their toes to produce the potential vaccine-mediated eradication of this virus. Though the chances are really high, to date no such panacea has been reported. The time requirements for the onerous procedures of human trials for the successful clinical translation of any vaccine or potential therapeutics are also a major concern. In order to build some resistance against this massive pandemic, the repurposing of some earlier antiviral drugs has been done, along with the refurbishment of some immune-responsive alternative avenues, like monoclonal antibody mediated neutralization, interferon treatment, and plasma therapy. New drugs developed from the RBD domain of the virus spike protein and drugs targeting viral proteases are also undergoing further research and have shown potential from preliminary results. The sole purpose of this review article is to provide a brief collective overview of the recent status of therapeutics advances and approaches, and their current state of implementation for the management of COVID-19.
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Affiliation(s)
- Gaurav Das
- Organic and Medicinal Chemistry and Structural Biology and Bioinformatics Division, CSIR-Indian Institute of Chemical Biology 4, Raja S. C. Mullick Road, Jadavpur Kolkata 700 032 WB India +91-33-2473-5197 ext. 0284 +91-33-2499-5872
- Academy of Scientific and Innovative Research (AcSIR) Ghaziabad 201002 India
| | - Surojit Ghosh
- Department of Bioscience & Bioengineering, Indian Institute of Technology Jodhpur NH 65, Surpura Bypass Road Karwar Rajasthan 342037 India +91-291-280-1212
| | - Shubham Garg
- Department of Bioscience & Bioengineering, Indian Institute of Technology Jodhpur NH 65, Surpura Bypass Road Karwar Rajasthan 342037 India +91-291-280-1212
| | - Satyajit Ghosh
- Department of Bioscience & Bioengineering, Indian Institute of Technology Jodhpur NH 65, Surpura Bypass Road Karwar Rajasthan 342037 India +91-291-280-1212
| | - Aniket Jana
- Department of Bioscience & Bioengineering, Indian Institute of Technology Jodhpur NH 65, Surpura Bypass Road Karwar Rajasthan 342037 India +91-291-280-1212
| | - Ramkamal Samat
- Department of Bioscience & Bioengineering, Indian Institute of Technology Jodhpur NH 65, Surpura Bypass Road Karwar Rajasthan 342037 India +91-291-280-1212
| | - Nabanita Mukherjee
- Department of Bioscience & Bioengineering, Indian Institute of Technology Jodhpur NH 65, Surpura Bypass Road Karwar Rajasthan 342037 India +91-291-280-1212
| | - Rajsekhar Roy
- Department of Bioscience & Bioengineering, Indian Institute of Technology Jodhpur NH 65, Surpura Bypass Road Karwar Rajasthan 342037 India +91-291-280-1212
| | - Surajit Ghosh
- Department of Bioscience & Bioengineering, Indian Institute of Technology Jodhpur NH 65, Surpura Bypass Road Karwar Rajasthan 342037 India +91-291-280-1212
- Organic and Medicinal Chemistry and Structural Biology and Bioinformatics Division, CSIR-Indian Institute of Chemical Biology 4, Raja S. C. Mullick Road, Jadavpur Kolkata 700 032 WB India +91-33-2473-5197 ext. 0284 +91-33-2499-5872
- Academy of Scientific and Innovative Research (AcSIR) Ghaziabad 201002 India
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Kim SB, Huh K, Heo JY, Joo EJ, Kim YJ, Choi WS, Kim YJ, Seo YB, Yoon YK, Ku NS, Jeong SJ, Kim SH, Peck KR, Yeom JS. Interim Guidelines on Antiviral Therapy for COVID-19. Infect Chemother 2020; 52:281-304. [PMID: 32342676 PMCID: PMC7335642 DOI: 10.3947/ic.2020.52.2.281] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Indexed: 12/15/2022] Open
Abstract
Since the first case was reported in Wuhan, Hubei Province, China on December 12, 2019, Coronavirus disease 2019 (COVID-19) has spread widely to other countries since January 2020. As of April 16, 2020, 10635 confirmed cases have been reported, with 230 deaths in Korea. COVID-19 patients may be asymptomatic or show various clinical manifestations, including acute symptoms such as fever, fatigue, sore throat; pneumonia presenting as acute respiratory distress syndrome; and multiple organ failure. As COVID-19 has such varied clinical manifestations and case fatality rates, no standard antiviral therapy regimen has been established other than supportive therapy. In the present guideline, we aim to introduce potentially helpful antiviral and other drug therapies based on in vivo and in vitro research and clinical experiences from many countries.
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Affiliation(s)
- Sun Bean Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Kyungmin Huh
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Yeon Heo
- Department of Infectious Diseases, Ajou University school of Medicine, Suwon, Korea
| | - Eun Jeong Joo
- Division of Infectious Diseases, Department of Internal Medicine, Sungkyunkwan University School of Medicine, Kangbuk Samsung hospital, Seoul, Korea
| | - Youn Jeong Kim
- Division of Infectious Diseases, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Won Suk Choi
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Yae Jean Kim
- Division of Infectious Diseases and Immunodeficiency, Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yu Bin Seo
- Division of Infectious Diseases, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Young Kyung Yoon
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Nam Su Ku
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Su Jin Jeong
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Han Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyong Ran Peck
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joon Sup Yeom
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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XU Y, LYU D, YING K. [Coagulation dysfunction in COVID-19]. Zhejiang Da Xue Xue Bao Yi Xue Ban 2020; 49:340-346. [PMID: 32762158 PMCID: PMC8800697 DOI: 10.3785/j.issn.1008-9292.2020.05.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/30/2020] [Indexed: 11/15/2022]
Abstract
In addition to common clinical features, patients with coronavirus disease 2019 (COVID-19) have varying degree of coagulation dysfunction with the risk of thrombosis and/or bleeding. COVID-19 related coagulation dysfunction is a dynamic process, which may be accompanied by the formation of disseminated intravascular coagulation and is related to the severity of the disease. The imbalance of the body's immune and inflammatory response caused by coronavirus infection is an important cause of coagulation dysfunction. Dynamic monitoring as well as early prevention and treatment are of great significance for improving the prognosis of patients. This article reviews the research progress of COVID-19 related coagulation dysfunction, to provide reference for clinical research and management.
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13
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Stawicki SP, Jeanmonod R, Miller AC, Paladino L, Gaieski DF, Yaffee AQ, De Wulf A, Grover J, Papadimos TJ, Bloem C, Galwankar SC, Chauhan V, Firstenberg MS, Di Somma S, Jeanmonod D, Garg SM, Tucci V, Anderson HL, Fatimah L, Worlton TJ, Dubhashi SP, Glaze KS, Sinha S, Opara IN, Yellapu V, Kelkar D, El-Menyar A, Krishnan V, Venkataramanaiah S, Leyfman Y, Saoud Al Thani HA, WB Nanayakkara P, Nanda S, Cioè-Peña E, Sardesai I, Chandra S, Munasinghe A, Dutta V, Dal Ponte ST, Izurieta R, Asensio JA, Garg M. The 2019-2020 Novel Coronavirus (Severe Acute Respiratory Syndrome Coronavirus 2) Pandemic: A Joint American College of Academic International Medicine-World Academic Council of Emergency Medicine Multidisciplinary COVID-19 Working Group Consensus Paper. J Glob Infect Dis 2020; 12:47-93. [PMID: 32773996 PMCID: PMC7384689 DOI: 10.4103/jgid.jgid_86_20] [Citation(s) in RCA: 186] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 04/25/2020] [Accepted: 05/04/2020] [Indexed: 02/06/2023] Open
Abstract
What started as a cluster of patients with a mysterious respiratory illness in Wuhan, China, in December 2019, was later determined to be coronavirus disease 2019 (COVID-19). The pathogen severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel Betacoronavirus, was subsequently isolated as the causative agent. SARS-CoV-2 is transmitted by respiratory droplets and fomites and presents clinically with fever, fatigue, myalgias, conjunctivitis, anosmia, dysgeusia, sore throat, nasal congestion, cough, dyspnea, nausea, vomiting, and/or diarrhea. In most critical cases, symptoms can escalate into acute respiratory distress syndrome accompanied by a runaway inflammatory cytokine response and multiorgan failure. As of this article's publication date, COVID-19 has spread to approximately 200 countries and territories, with over 4.3 million infections and more than 290,000 deaths as it has escalated into a global pandemic. Public health concerns mount as the situation evolves with an increasing number of infection hotspots around the globe. New information about the virus is emerging just as rapidly. This has led to the prompt development of clinical patient risk stratification tools to aid in determining the need for testing, isolation, monitoring, ventilator support, and disposition. COVID-19 spread is rapid, including imported cases in travelers, cases among close contacts of known infected individuals, and community-acquired cases without a readily identifiable source of infection. Critical shortages of personal protective equipment and ventilators are compounding the stress on overburdened healthcare systems. The continued challenges of social distancing, containment, isolation, and surge capacity in already stressed hospitals, clinics, and emergency departments have led to a swell in technologically-assisted care delivery strategies, such as telemedicine and web-based triage. As the race to develop an effective vaccine intensifies, several clinical trials of antivirals and immune modulators are underway, though no reliable COVID-19-specific therapeutics (inclusive of some potentially effective single and multi-drug regimens) have been identified as of yet. With many nations and regions declaring a state of emergency, unprecedented quarantine, social distancing, and border closing efforts are underway. Implementation of social and physical isolation measures has caused sudden and profound economic hardship, with marked decreases in global trade and local small business activity alike, and full ramifications likely yet to be felt. Current state-of-science, mitigation strategies, possible therapies, ethical considerations for healthcare workers and policymakers, as well as lessons learned for this evolving global threat and the eventual return to a "new normal" are discussed in this article.
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Affiliation(s)
- Stanislaw P Stawicki
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA,COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA,Address for correspondence: Dr. Stanislaw P Stawicki, Department of Research and Innovation, St. Luke's University Health Network, 801 Ostrum Street, Bethlehem, Pennsylvania, USA. E-mail:
| | - Rebecca Jeanmonod
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA,COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Andrew C Miller
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Lorenzo Paladino
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA,COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - David F Gaieski
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Anna Q Yaffee
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Annelies De Wulf
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Joydeep Grover
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Thomas J. Papadimos
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Christina Bloem
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Sagar C Galwankar
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA,COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Vivek Chauhan
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Michael S. Firstenberg
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA,COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Salvatore Di Somma
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Donald Jeanmonod
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA,COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Sona M Garg
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Veronica Tucci
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Harry L Anderson
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA,COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Lateef Fatimah
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Tamara J Worlton
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | | | - Krystal S Glaze
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Sagar Sinha
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Ijeoma Nnodim Opara
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Vikas Yellapu
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Dhanashree Kelkar
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Ayman El-Menyar
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Vimal Krishnan
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - S Venkataramanaiah
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Yan Leyfman
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | | | | | - Sudip Nanda
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Eric Cioè-Peña
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Indrani Sardesai
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Shruti Chandra
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Aruna Munasinghe
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Vibha Dutta
- COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Silvana Teixeira Dal Ponte
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Ricardo Izurieta
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA
| | - Juan A Asensio
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA,COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
| | - Manish Garg
- Working Group on International Health Security, The American College of Academic International Academic Medicine, USA,COVID-19 Pandemic Taskforce, World Academic Council of Emergency Medicine, USA
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14
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Shi Q, Zhou Q, Wang X, Liao J, Yu Y, Wang Z, Lu S, Ma Y, Xun Y, Luo X, Li W, Fukuoka T, Ahn HS, Lee MS, Luo Z, Liu E, Chen Y, Li Q, Yang K, Guan Q. Potential effectiveness and safety of antiviral agents in children with coronavirus disease 2019: a rapid review and meta-analysis. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:624. [PMID: 32566561 PMCID: PMC7290634 DOI: 10.21037/atm-20-3301] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/26/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND The COVID-19 outbreak presents a new, life-threatening disease. Our aim was to assess the potential effectiveness and safety of antiviral agents for COVID-19 in children. METHODS Electronic databases (MEDLINE, Embase, Web of Science, the Cochrane library, CBM, CNKI, and Wanfang Data) from their inception to March 31, 2020 were searched for randomized controlled trials (RCTs), clinical controlled trials and cohort studies of interventions with antiviral agents for children (less than 18 years of age) with COVID-19. RESULTS A total of 23 studies with 6,008 patients were included. There was no direct evidence and all of evidence were indirect. The risks of bias in all studies were moderate to high in general. The effectiveness and safety of antiviral agents for children with COVID-19 is uncertain: For adults with COVID-19, lopinavir/ritonavir had no effect on mortality [risk ratio (RR) =0.77; 95% confidence interval (CI), 0.45 to 1.30]. Arbidol and hydroxychloroquine (HCQ) had no benefit on probability of negative PCR test (RR =1.27; 95% CI, 0.93 to 1.73; RR =0.93; 95% CI, 0.73 to 1.18) respectively. For adults with SARS, interferon was associated with reduced corticosteroid dose [weighted mean difference (WMD) = -0.14 g; 95% CI, -0.21 to -0.07] but had no effect on mortality (RR =0.72; 95% CI, 0.28 to 1.88); ribavirin did not reduce mortality (RR =0.68; 95% CI, 0.43 to 1.06) and was associated with high risk of severe adverse reactions; and oseltamivir had no effect on mortality (RR =0.87; 95% CI, 0.55 to 1.38). Ribavirin combined with interferon was also not effective in adults with MERS and associated with adverse reactions. CONCLUSIONS There is no evidence showing the effectiveness of antiviral agents for children with COVID-19, and the clinical efficacy of existing antiviral agents is still uncertain. We do not suggest clinical routine use of antivirals for COVID-19 in children, with the exception of clinical trials.
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Affiliation(s)
- Qianling Shi
- The First School of Clinical Medicine, Lanzhou University, Lanzhou 730000, China
| | - Qi Zhou
- The First School of Clinical Medicine, Lanzhou University, Lanzhou 730000, China
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
| | - Xia Wang
- Department of Respiratory Medicine, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Jing Liao
- Department of Respiratory Medicine, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Yang Yu
- The Second School of Clinical Medicine, Lanzhou University, Lanzhou 730000, China
| | - Zijun Wang
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
| | - Shuya Lu
- Department of Pediatric, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu 610072, China
| | - Yanfang Ma
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
| | - Yangqin Xun
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
| | - Xufei Luo
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
- School of Public Health, Lanzhou University, Lanzhou 730000, China
| | - Weiguo Li
- Department of Respiratory Medicine, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Toshio Fukuoka
- Emergency and Critical Care Center, Department of General Medicine, Department of Research and Medical Education at Kurashiki Central Hospital, Kurashiki, Japan
- Advisory Committee in Cochrane Japan, Tokyo, Japan
| | - Hyeong Sik Ahn
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
- Korea Cochrane Centre, Seoul, Korea
| | - Myeong Soo Lee
- Korea Institute of Oriental Medicine, Daejeon, Korea
- University of Science and Technology, Daejeon, Korea
| | - Zhengxiu Luo
- Department of Respiratory Medicine, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Enmei Liu
- Department of Respiratory Medicine, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Yaolong Chen
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
- Lanzhou University, An Affiliate of the Cochrane China Network, Lanzhou 730000, China
- Chinese GRADE Center, Lanzhou 730000, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou University, Lanzhou 730000, China
| | - Qubei Li
- Department of Respiratory Medicine, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Kehu Yang
- The First School of Clinical Medicine, Lanzhou University, Lanzhou 730000, China
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou University, Lanzhou 730000, China
| | - Quanlin Guan
- The First School of Clinical Medicine, Lanzhou University, Lanzhou 730000, China
- Department of Oncology Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, China
| | - on behalf of COVID-19 Evidence and Recommendations Working Group
- The First School of Clinical Medicine, Lanzhou University, Lanzhou 730000, China
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
- Department of Respiratory Medicine, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
- The Second School of Clinical Medicine, Lanzhou University, Lanzhou 730000, China
- Department of Pediatric, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu 610072, China
- School of Public Health, Lanzhou University, Lanzhou 730000, China
- Emergency and Critical Care Center, Department of General Medicine, Department of Research and Medical Education at Kurashiki Central Hospital, Kurashiki, Japan
- Advisory Committee in Cochrane Japan, Tokyo, Japan
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
- Korea Cochrane Centre, Seoul, Korea
- Korea Institute of Oriental Medicine, Daejeon, Korea
- University of Science and Technology, Daejeon, Korea
- Lanzhou University, An Affiliate of the Cochrane China Network, Lanzhou 730000, China
- Chinese GRADE Center, Lanzhou 730000, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou University, Lanzhou 730000, China
- Department of Oncology Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, China
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15
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Saxena SK, Kumar S, Bhatt MLB, Saxena SK. Therapeutic Development and Drugs for the Treatment of COVID-19. CORONAVIRUS DISEASE 2019 (COVID-19) 2020. [PMCID: PMC7189400 DOI: 10.1007/978-981-15-4814-7_10] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
SARS-CoV-2/novel coronavirus (2019-nCoV) is a new strain that has recently been confirmed in Wuhan City, Hubei Province of China, and spreads to more than 165 countries of the world including India. The virus infection leads to 245,922 confirmed cases and 10,048 deaths worldwide as of March 20, 2020. Coronaviruses (CoVs) are lethal zoonotic viruses, highly pathogenic in nature, and responsible for diseases ranging from common cold to severe illness such as Middle East respiratory syndrome (MERS) and severe acute respiratory syndrome (SARS) in humans for the past 15 years. Considering the severity of the current and previous outbreaks, no approved antiviral agent or effective vaccines are present for the prevention and treatment of infection during the epidemics. Although, various molecules have been shown to be effective against coronaviruses both in vitro and in vivo, but the antiviral activities of these molecules are not well established in humans. Therefore, this chapter is planned to provide information about available treatment and preventive measures for the coronavirus infections during outbreaks. This chapter also discusses the possible role of supportive therapy, repurposing drugs, and complementary and alternative medicines for the management of coronaviruses including COVID-19.
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Affiliation(s)
- Shailendra K. Saxena
- grid.411275.40000 0004 0645 6578Centre for Advanced Research, King George’s Medical University, Lucknow, India
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16
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Sharma M, Surani S. Searching an Effective Therapy for the Coronavirus Pandemic: Do We See Light at the End of the Tunnel? Cureus 2020; 12:e7415. [PMID: 32337139 PMCID: PMC7182165 DOI: 10.7759/cureus.7415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 03/25/2020] [Indexed: 11/28/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is an emerging infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). First reported at the end of December 2019 as a cause for clusters of pneumonia cases in Wuhan city in China, the rapid spread of this condition was declared a pandemic on March 11, 2020, by the World Health Organization (WHO). Apart from the mortality and morbidity associated with COVID-19, the massive social and financial havoc inflicted by this pandemic has left the entire world pondering if medical science can innovate and curtail the ongoing damage due to SARS-CoV-2. Recent findings of an open-label study that investigated the use of hydroxychloroquine and azithromycin in COVID-19 patients in Marseille, France, has garnered some optimism in scientific quarters and the general public alike in terms of finding a treatment regimen to control the rampant rise of COVID-19. We will discuss the potential off-label therapy and studies as it pertains to COVID-19.
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Affiliation(s)
- Munish Sharma
- Internal Medicine, Corpus Christi Medical Center, Corpus Christi, USA
| | - Salim Surani
- Internal Medicine, Texas A&M Health Science Center, Bryan, USA
- Internal Medicine, Corpus Christi Medical Center, Corpus Christi, USA
- Internal Medicine, University of North Texas, Dallas, USA
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17
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Morse JS, Lalonde T, Xu S, Liu WR. Learning from the Past: Possible Urgent Prevention and Treatment Options for Severe Acute Respiratory Infections Caused by 2019-nCoV. Chembiochem 2020; 21:730-738. [PMID: 32022370 PMCID: PMC7162020 DOI: 10.1002/cbic.202000047] [Citation(s) in RCA: 515] [Impact Index Per Article: 128.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Indexed: 11/08/2022]
Abstract
With the current trajectory of the 2019-nCoV outbreak unknown, public health and medicinal measures will both be needed to contain spreading of the virus and to optimize patient outcomes. Although little is known about the virus, an examination of the genome sequence shows strong homology with its better-studied cousin, SARS-CoV. The spike protein used for host cell infection shows key nonsynonymous mutations that might hamper the efficacy of previously developed therapeutics but remains a viable target for the development of biologics and macrocyclic peptides. Other key drug targets, including RNA-dependent RNA polymerase and coronavirus main proteinase (3CLpro), share a strikingly high (>95 %) homology to SARS-CoV. Herein, we suggest four potential drug candidates (an ACE2-based peptide, remdesivir, 3CLpro-1 and a novel vinylsulfone protease inhibitor) that could be used to treat patients suffering with the 2019-nCoV. We also summarize previous efforts into drugging these targets and hope to help in the development of broad-spectrum anti-coronaviral agents for future epidemics.
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Affiliation(s)
- Jared S. Morse
- The Texas A&M Drug Discovery LaboratoryDepartment of ChemistryTexas A&M UniversityCollege StationTX77843USA
| | - Tyler Lalonde
- The Texas A&M Drug Discovery LaboratoryDepartment of ChemistryTexas A&M UniversityCollege StationTX77843USA
| | - Shiqing Xu
- The Texas A&M Drug Discovery LaboratoryDepartment of ChemistryTexas A&M UniversityCollege StationTX77843USA
| | - Wenshe Ray Liu
- The Texas A&M Drug Discovery LaboratoryDepartment of ChemistryTexas A&M UniversityCollege StationTX77843USA
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18
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Aijazi I, Al Shama FMA, Shandala Y, Varghese RM. Crimean-Congo haemorrhagic fever presenting with acute compartment syndrome of the extremities (think beyond normal infections). BMJ Case Rep 2020; 13:13/2/e232323. [PMID: 32033997 DOI: 10.1136/bcr-2019-232323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Crimean-Congo haemorrhagic fever (CCHF) is a viral zoonosis transmitted to humans and animals (which act as a reservoir) through the bite of a 'Hyalomma' tick. CCHF virus belongs to the genus Nairovirus Humans are infected when they come in direct contact with the blood or secretions of infected livestock or other infected humans. This disease initially presents with non-specific febrile symptoms common to many viral illnesses and later progresses to disseminated intravascular coagulation (DIC) with haemorrhagic manifestations.We present the case of a middle-aged man with CCHF. He presented to the hospital with DIC and acute compartment syndrome in the right forearm, requiring urgent orthopaedic intervention. The diagnosis was delayed because there was no clear history of contact. The patient was started taking ribavirin on the fifth day of hospital admission. He recovered fully.
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Affiliation(s)
- Ishma Aijazi
- Internal Medicine, Dubai Hospital, Dubai, United Arab Emirates
| | | | - Yaseen Shandala
- Orthopedic Department, Dubai Health Authority, Dubai, United Arab Emirates
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19
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Morse JS, Lalonde T, Xu S, Liu W. Learning from the Past: Possible Urgent Prevention and Treatment Options for Severe Acute Respiratory Infections Caused by 2019-nCoV. CHEMRXIV : THE PREPRINT SERVER FOR CHEMISTRY 2020. [PMID: 32511285 DOI: 10.26434/chemrxiv.11728983.v1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
With the current trajectory of the 2019-nCoV outbreak unknown, public health and medicinal measures will both be needed to contain spreading of the virus and to optimize patient outcomes. While little is known about the virus, an examination of the genome sequence shows strong homology with its more well-studied cousin, SARS-CoV. The spike protein used for host cell infection shows key nonsynonymous mutations which may hamper efficacy of previously developed therapeutics but remains a viable target for the development of biologics and macrocyclic peptides. Other key drug targets, including RdRp and 3CLpro, share a strikingly high (>95%) homology to SARS-CoV. Herein, we suggest 4 potential drug candidates (an ACE2-based peptide, remdesivir, 3CLpro-1 and a novel vinylsulfone protease inhibitor) that can be used to treat patients suffering with the 2019-nCoV. We also summarize previous efforts into drugging these targets and hope to help in the development of broad spectrum anti-coronaviral agents for future epidemics.
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20
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Morse JS, Lalonde T, Xu S, Liu WR. Learning from the Past: Possible Urgent Prevention and Treatment Options for Severe Acute Respiratory Infections Caused by 2019-nCoV. CHEMRXIV : THE PREPRINT SERVER FOR CHEMISTRY 2020:11728983. [PMID: 32511285 PMCID: PMC7251965 DOI: 10.26434/chemrxiv.11728983] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Revised: 01/27/2020] [Indexed: 01/06/2023]
Abstract
With the current trajectory of the 2019-nCoV outbreak unknown, public health and medicinal measures will both be needed to contain spreading of the virus and to optimize patient outcomes. While little is known about the virus, an examination of the genome sequence shows strong homology with its more well-studied cousin, SARS-CoV. The spike protein used for host cell infection shows key nonsynonymous mutations which may hamper efficacy of previously developed therapeutics but remains a viable target for the development of biologics and macrocyclic peptides. Other key drug targets, including RdRp and 3CLpro, share a strikingly high (>95%) homology to SARS-CoV. Herein, we suggest 4 potential drug candidates (an ACE2-based peptide, remdesivir, 3CLpro-1 and a novel vinylsulfone protease inhibitor) that can be used to treat patients suffering with the 2019-nCoV. We also summarize previous efforts into drugging these targets and hope to help in the development of broad spectrum anti-coronaviral agents for future epidemics.
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Affiliation(s)
- Jared S. Morse
- The Texas A&M Drug Discovery Laboratory, Department of
Chemistry, Texas A&M University, College Station, Texas 77843, United
States
| | - Tyler Lalonde
- The Texas A&M Drug Discovery Laboratory, Department of
Chemistry, Texas A&M University, College Station, Texas 77843, United
States
| | - Shiqing Xu
- The Texas A&M Drug Discovery Laboratory, Department of
Chemistry, Texas A&M University, College Station, Texas 77843, United
States
| | - Wenshe R. Liu
- The Texas A&M Drug Discovery Laboratory, Department of
Chemistry, Texas A&M University, College Station, Texas 77843, United
States
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21
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Pandey A, Khan MK, Hamurcu M, Gezgin S. Natural Plant Products: A Less Focused Aspect for the COVID-19 Viral Outbreak. FRONTIERS IN PLANT SCIENCE 2020; 11:568890. [PMID: 33178237 PMCID: PMC7593249 DOI: 10.3389/fpls.2020.568890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/18/2020] [Indexed: 05/08/2023]
Abstract
The sudden emergence of COVID-19 caused by a novel coronavirus (nCoV) led the entire world to search for relevant solutions to fight the pandemic. Although continuous trials are being conducted to develop precise vaccines and therapeutic antibodies, a potential remedy is yet to be developed. Plants have largely contributed to the treatment of several human diseases and different phytoconstituents have been previously described to impede the replication of numerous viruses. Despite the previous positive reports of plant-based medications, no successful clinical trials of phyto-anti-COVID drugs could be conducted to date. In this article, we discuss varying perspectives on why phyto-anti-viral drug clinical trials were not successful in the case of COVID-19. The issue has been discussed in light of the usage of plant-based therapeutics in previous coronavirus outbreaks. Through this article, we aim to identify the disadvantages in this research area and suggest some measures to ensure that phytoconstituents can efficiently contribute to future random viral outbreaks. It is emphasized that if used strategically phyto-inhibitors with pre-established clinical data for other diseases can save the time required for long clinical trials. The scientific community should competently tap into phytoconstituents and take their research up to the final stage of clinical trials so that potential phyto-anti-COVID drugs can be developed.
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22
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Mohammadi Barzelighi H, Daraei B, Dastan F. Approaches for the Treatment of SARS-CoV-2 Infection: A Pharmacologic View and Literature Review. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH : IJPR 2020; 19:258-281. [PMID: 33680028 PMCID: PMC7757982 DOI: 10.22037/ijpr.2020.113821.14506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The emergence of a novel Coronavirus disease (COVID-19) inducing acute respiratory distress syndrome (ARDS) was identified in Hubei province of China in December 2019 and rapidly spread worldwide as pandemic and became a public health concern. COVID-19 disease is caused by a new virus known as SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2), which has recently offered many challenges and efforts to identify effective drugs for its prevention and treatment. Currently, there is no proven effective approach and medication against this virus. Quickly expanding clinical trials and studies on Coronavirus disease 2019 increase our knowledge regarding SARS-CoV-2 virus and introduce several potential drugs targeting virus moiety or host cell elements. Overall, 3 stages were suggested for SARS-CoV-2 infection according to the disease severity, clinical manifestations, and treatment outcomes, including mild, moderate, and severe. This review aimed to classify and summarize several medications and potential therapies according to the disease 3 stages; however, it is worth noting that no medication and therapy has been effective so far.
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Affiliation(s)
| | - Bahram Daraei
- Department of Toxicology and Pharmacology, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Farzaneh Dastan
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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23
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Liu Y, Zhang Y, Zhao W, Liu X, Hu F, Dong B. Pharmacotherapy of Lower Respiratory Tract Infections in Elderly-Focused on Antibiotics. Front Pharmacol 2019; 10:1237. [PMID: 31736751 PMCID: PMC6836807 DOI: 10.3389/fphar.2019.01237] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 09/27/2019] [Indexed: 02/05/2023] Open
Abstract
Lower respiratory tract infections (LRTIs) refer to the inflammation of the trachea, bronchi, bronchioles, and lung tissue. Old people have an increased risk of developing LRTIs compared to young adults. The prevalence of LRTIs in the elderly population is not only related to underlying diseases and aging itself, but also to a variety of clinical issues, such as history of hospitalization, previous antibacterial therapy, mechanical ventilation, antibiotic resistance. These factors mentioned above have led to an increase in the prevalence and mortality of LRTIs in the elderly, and new medical strategies targeting LRTIs in this population are urgently needed. After a systematic review of the current randomized controlled trials and related studies, we recommend novel pharmacotherapies that demonstrate advantages for the management of LRTIs in people over the age of 65. We also briefly reviewed current medications for respiratory communicable diseases in the elderly. Various sources of information were used to ensure all relevant studies were included. We searched Pubmed, MEDLINE (OvidSP), EMBASE (OvidSP), and ClinicalTrials.gov. Strengths and limitations of these drugs were evaluated based on whether they have novelty of mechanism, favorable pharmacokinetic/pharmacodynamic profiles, avoidance of interactions and intolerance, simplicity of dosing, and their ability to cope with challenges which was mainly evaluated by the primary and secondary endpoints. The purpose of this review is to recommend the most promising antibiotics for treatment of LRTIs in the elderly (both in hospital and in the outpatient setting) based on the existing results of clinical studies with the novel antibiotics, and to briefly review current medications for respiratory communicable diseases in the elderly, aiming to a better management of LRTIs in clinical practice.
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Affiliation(s)
- Yang Liu
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
- Geriatric Health Care and Medical Research Center, Sichuan University, Chengdu, China
| | - Yan Zhang
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
- Geriatric Health Care and Medical Research Center, Sichuan University, Chengdu, China
| | - Wanyu Zhao
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
- Geriatric Health Care and Medical Research Center, Sichuan University, Chengdu, China
| | - Xiaolei Liu
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
- Geriatric Health Care and Medical Research Center, Sichuan University, Chengdu, China
| | - Fengjuan Hu
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
- Geriatric Health Care and Medical Research Center, Sichuan University, Chengdu, China
| | - Birong Dong
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
- Geriatric Health Care and Medical Research Center, Sichuan University, Chengdu, China
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24
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Dyall J, Gross R, Kindrachuk J, Johnson RF, Olinger GG, Hensley LE, Frieman MB, Jahrling PB. Middle East Respiratory Syndrome and Severe Acute Respiratory Syndrome: Current Therapeutic Options and Potential Targets for Novel Therapies. Drugs 2017; 77:1935-1966. [PMID: 29143192 PMCID: PMC5733787 DOI: 10.1007/s40265-017-0830-1] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
No specific antivirals are currently available for two emerging infectious diseases, Middle East respiratory syndrome (MERS) and severe acute respiratory syndrome (SARS). A literature search was performed covering pathogenesis, clinical features and therapeutics, clinically developed drugs for repurposing and novel drug targets. This review presents current knowledge on the epidemiology, pathogenesis and clinical features of the SARS and MERS coronaviruses. The rationale for and outcomes with treatments used for SARS and MERS is discussed. The main focus of the review is on drug development and the potential that drugs approved for other indications provide for repurposing. The drugs we discuss belong to a wide range of different drug classes, such as cancer therapeutics, antipsychotics, and antimalarials. In addition to their activity against MERS and SARS coronaviruses, many of these approved drugs have broad-spectrum potential and have already been in clinical use for treating other viral infections. A wealth of knowledge is available for these drugs. However, the information in this review is not meant to guide clinical decisions, and any therapeutic described here should only be used in context of a clinical trial. Potential targets for novel antivirals and antibodies are discussed as well as lessons learned from treatment development for other RNA viruses. The article concludes with a discussion of the gaps in our knowledge and areas for future research on emerging coronaviruses.
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Affiliation(s)
- Julie Dyall
- Integrated Research Facility, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, MD, USA.
| | - Robin Gross
- Integrated Research Facility, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, MD, USA
| | - Jason Kindrachuk
- Department of Medical Microbiology, University of Manitoba, Winnipeg, MN, Canada
| | - Reed F Johnson
- Emerging Viral Pathogens Section, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, MD, USA
| | | | - Lisa E Hensley
- Integrated Research Facility, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, MD, USA
| | - Matthew B Frieman
- Department of Microbiology and Immunology, University of Maryland, School of Medicine, Baltimore, MD, USA
| | - Peter B Jahrling
- Integrated Research Facility, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, MD, USA
- Emerging Viral Pathogens Section, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, MD, USA
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25
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Stobart CC, Moore ML. Development of next-generation respiratory virus vaccines through targeted modifications to viral immunomodulatory genes. Expert Rev Vaccines 2015; 14:1563-72. [PMID: 26434947 DOI: 10.1586/14760584.2015.1095096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Vaccines represent one of the greatest contributions of the scientific community to global health. Yet, many pathogens remain either unchallenged or inadequately hindered by commercially available vaccines. Respiratory viruses pose distinct and difficult challenges due to their ability to rapidly spread, adapt, and modify the host immune response. Considerable research has been directed to understand the role of respiratory virus immunomodulatory proteins and how they influence the host immune response. We review here efforts to develop next-generation vaccines through targeting these key immunomodulatory genes in influenza virus, coronaviruses, respiratory syncytial virus, measles virus, and mumps virus.
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Affiliation(s)
- Christopher C Stobart
- a 1 Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA.,b 2 Children's Healthcare of Atlanta, Atlanta, GA 30322, USA
| | - Martin L Moore
- a 1 Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA.,b 2 Children's Healthcare of Atlanta, Atlanta, GA 30322, USA
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26
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Peck KM, Burch CL, Heise MT, Baric RS. Coronavirus Host Range Expansion and Middle East Respiratory Syndrome Coronavirus Emergence: Biochemical Mechanisms and Evolutionary Perspectives. Annu Rev Virol 2015; 2:95-117. [PMID: 26958908 DOI: 10.1146/annurev-virology-100114-055029] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Coronaviruses have frequently expanded their host range in recent history, with two events resulting in severe disease outbreaks in human populations. Severe acute respiratory syndrome coronavirus (SARS-CoV) emerged in 2003 in Southeast Asia and rapidly spread around the world before it was controlled by public health intervention strategies. The 2012 Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak represents another prime example of virus emergence from a zoonotic reservoir. Here, we review the current knowledge of coronavirus cross-species transmission, with particular focus on MERS-CoV. MERS-CoV is still circulating in the human population, and the mechanisms governing its cross-species transmission have been only partially elucidated, highlighting a need for further investigation. We discuss biochemical determinants mediating MERS-CoV host cell permissivity, including virus spike interactions with the MERS-CoV cell surface receptor dipeptidyl peptidase 4 (DPP4), and evolutionary mechanisms that may facilitate host range expansion, including recombination, mutator alleles, and mutational robustness. Understanding these mechanisms can help us better recognize the threat of emergence for currently circulating zoonotic strains.
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Affiliation(s)
| | | | - Mark T Heise
- Genetics.,Microbiology and Immunology, University of North Carolina, Chapel Hill, North Carolina 27599;
| | - Ralph S Baric
- Epidemiology, and.,Microbiology and Immunology, University of North Carolina, Chapel Hill, North Carolina 27599;
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27
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Abstract
BACKGROUND Crimean-Congo hemorrhagic fever (CCHF) is endemic in some regions of our country. It is seen in all age groups; however, its prevalance is low in children. The studies on CCHF have been mostly in adults. The aim of this study was to evaluate the epidemiologic, demographic, clinical and laboratory findings of children with CCHF. METHODS Between May 2008 and September 2011, the medical records of patients who were admitted to the Children Infectious Diseases Service of Ondokuz Mayis University School of Medicine with positive blood IgM by enzyme-linked immunosorbent assay or polymerase chain reaction positive for CCHF were retrospectively evaluated. Epidemiologic and demographic features, clinical and laboratory data and therapy were recorded. RESULTS Fifty-four patients with the diagnosis of CCHF were recorded between May 2008 and September 2011. Main symptoms during hospital admission were fever (98%), vomiting (59%), headache (39%), nausea (39%), diarrhea (22%), abdominal pain (22%), bleeding (22%) and rash (20%). During admission, thrombocytopenia was found in 74%, elevated aspartate aminotransferase in 61%, leucopenia in 57%, elevated creatine kinase (33%) and alanine aminotransaminase (29%), and prolonged prothrombin time and partial thromboplastine time in 28% were noted. Thirty-nine patients received ribavirin treatment. During clinical follow up, bradycardia was recorded in 18 patients (33%) all of whom received ribavirin treatment. One patient died. CONCLUSIONS This study reports the largest series of children with CCHF and the first to describe bradycardia associated with ribavirin therapy.
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28
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Chen W, Liu B, Wang LQ, Ren J, Liu JP. Chinese patent medicines for the treatment of the common cold: a systematic review of randomized clinical trials. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 14:273. [PMID: 25074623 PMCID: PMC4129119 DOI: 10.1186/1472-6882-14-273] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 07/18/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Many Chinese patent medicines (CPMs) have been authorized by the Chinese State of Food and Drug Administration for the treatment of the common cold. A number of clinical trials have been conducted and published. However, there is no systematic review or meta-analysis on their efficacy and safety for the common cold to justify their clinical use. METHODS We searched CENTRAL, MEDLINE, EMBASE, SinoMed, CNKI, VIP, China Important Conference Papers Database, China Dissertation Database, and online clinical trial registry websites for published and unpublished randomized clinical trials (RCTs) of CPMs for the common cold till 31 March 2013. Revman 5.2 software was used for data analysis with effect estimate presented as relative risk (RR) and mean difference (MD) with a 95% confidence interval (CI). RESULTS A total of five RCTs were identified. All of the RCTs were of high risk of bias with flawed study design and poor methodological quality. All RCTs included children aged between 6 months to 14 years. Results of individual trials showed that Shuanghuanglian oral liquid (RR 4.00; 95% CI: 2.26 to 7.08), and Xiaoer Resuqing oral liquid (RR 1.43; 95% CI: 1.15 to 1.77) had higher cure rates compared with antivirus drugs. Most of the trials did not report adverse events, and the safety of CPMs was still uncertain. CONCLUSIONS Some CPMs showed a potential positive effect for the common cold on cure rate. However, due to the poor methodology quality and the defects in the clinical design of the included RCTs, such as the lack of placebo controlled trials, the inappropriate comparison intervention and outcome measurement, the confirmative conclusions on the beneficial effect of CPMs for the common cold could not be drawn.
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Affiliation(s)
- Wei Chen
- />Centre For Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Bo Liu
- />Medical Care Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Li-qiong Wang
- />Centre For Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Jun Ren
- />Centre For Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Jian-ping Liu
- />Centre For Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
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29
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Cheng VC, Chan JF, To KK, Yuen K. Clinical management and infection control of SARS: lessons learned. Antiviral Res 2013; 100:407-19. [PMID: 23994190 PMCID: PMC7132413 DOI: 10.1016/j.antiviral.2013.08.016] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 07/27/2013] [Accepted: 08/18/2013] [Indexed: 02/08/2023]
Abstract
The outbreak of severe acute respiratory syndrome (SARS) in 2003 was the first emergence of an important human pathogen in the 21st century. Responding to the epidemic provided clinicians with extensive experience in diagnosing and treating a novel respiratory viral disease. In this article, we review the experience of the SARS epidemic, focusing on measures taken to identify and isolate patients, prevent the transmission of infection to healthcare workers and develop effective therapies. Lessons learned from the SARS epidemic will be especially important in responding to the current emergence of another highly pathogenic human coronavirus, the agent of Middle East respiratory syndrome (MERS), and to the recently emerging H7N9 influenza A virus in China. This paper forms part of a symposium in Antiviral Research on "From SARS to MERS: 10years of research on highly pathogenic human coronaviruses."
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Affiliation(s)
- Vincent C.C. Cheng
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region
- Infection Control Team, Queen Mary Hospital, Hong Kong Special Administrative Region
| | - Jasper F.W. Chan
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region
- Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Kelvin K.W. To
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region
- Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong Special Administrative Region
| | - K.Y. Yuen
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region
- Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong Special Administrative Region
- Corresponding author. Tel.: +86 852 22553206; fax: +86 852 28724555.
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30
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Smith EC, Blanc H, Vignuzzi M, Denison MR. Coronaviruses lacking exoribonuclease activity are susceptible to lethal mutagenesis: evidence for proofreading and potential therapeutics. PLoS Pathog 2013; 9:e1003565. [PMID: 23966862 PMCID: PMC3744431 DOI: 10.1371/journal.ppat.1003565] [Citation(s) in RCA: 324] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 07/03/2013] [Indexed: 12/14/2022] Open
Abstract
No therapeutics or vaccines currently exist for human coronaviruses (HCoVs). The Severe Acute Respiratory Syndrome-associated coronavirus (SARS-CoV) epidemic in 2002–2003, and the recent emergence of Middle East Respiratory Syndrome coronavirus (MERS-CoV) in April 2012, emphasize the high probability of future zoonotic HCoV emergence causing severe and lethal human disease. Additionally, the resistance of SARS-CoV to ribavirin (RBV) demonstrates the need to define new targets for inhibition of CoV replication. CoVs express a 3′-to-5′ exoribonuclease in nonstructural protein 14 (nsp14-ExoN) that is required for high-fidelity replication and is conserved across the CoV family. All genetic and biochemical data support the hypothesis that nsp14-ExoN has an RNA proofreading function. Thus, we hypothesized that ExoN is responsible for CoV resistance to RNA mutagens. We demonstrate that while wild-type (ExoN+) CoVs were resistant to RBV and 5-fluorouracil (5-FU), CoVs lacking ExoN activity (ExoN−) were up to 300-fold more sensitive. While the primary antiviral activity of RBV against CoVs was not mutagenesis, ExoN− CoVs treated with 5-FU demonstrated both enhanced sensitivity during multi-cycle replication, as well as decreased specific infectivity, consistent with 5-FU functioning as a mutagen. Comparison of full-genome next-generation sequencing of 5-FU treated SARS-CoV populations revealed a 16-fold increase in the number of mutations within the ExoN− population as compared to ExoN+. Ninety percent of these mutations represented A:G and U:C transitions, consistent with 5-FU incorporation during RNA synthesis. Together our results constitute direct evidence that CoV ExoN activity provides a critical proofreading function during virus replication. Furthermore, these studies identify ExoN as the first viral protein distinct from the RdRp that determines the sensitivity of RNA viruses to mutagens. Finally, our results show the importance of ExoN as a target for inhibition, and suggest that small-molecule inhibitors of ExoN activity could be potential pan-CoV therapeutics in combination with RBV or RNA mutagens. RNA viruses have high mutation rates (10−3 to 10−5 mutations/nucleotide/round of replication), allowing for rapid viral adaptation in response to selective pressure. While RNA viruses have long been considered unable to correct mistakes during replication, CoVs such as SARS-CoV and the recently emerged MERS-CoV are important exceptions to this paradigm. All CoVs encode an exoribonuclease activity in nonstructural protein 14 (nsp14-ExoN) that is proposed to prevent and/or remove misincorporated nucleotides. Because of the demonstrated resistance of SARS-CoV to the antiviral drug ribavirin (RBV), we hypothesized that ExoN is responsible for CoV resistance to RNA mutagens. Using RBV and the RNA mutagen 5-fluorouracil (5-FU), we show that CoVs lacking ExoN activity (ExoN−) are highly susceptible to RBV and 5-FU, in contrast to wild-type (ExoN+) CoVs. The inhibitory activity of 5-FU against ExoN− viruses resulted specifically from 5-FU incorporation during viral RNA synthesis that lead to extensive mutagenesis within the viral population, and was associated with a profound decrease in virus specific infectivity. These results demonstrate the proofreading activity of ExoN during virus replication and suggest that inhibitors of ExoN activity could be broadly useful inhibitors of CoV replication in combination with RBV or RNA mutagens.
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Affiliation(s)
- Everett Clinton Smith
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- The Elizabeth B. Lamb Center for Pediatric Research, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Hervé Blanc
- Institut Pasteur, Centre National de la Recherche Scientifique Unité de Recherche Associée 3015, Paris, France
| | - Marco Vignuzzi
- Institut Pasteur, Centre National de la Recherche Scientifique Unité de Recherche Associée 3015, Paris, France
| | - Mark R. Denison
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- The Elizabeth B. Lamb Center for Pediatric Research, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- * E-mail:
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31
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Ribavirin is not effective against Crimean-Congo hemorrhagic fever: observations from the Turkish experience. Int J Infect Dis 2013; 17:e799-801. [PMID: 23773242 PMCID: PMC7110843 DOI: 10.1016/j.ijid.2013.02.030] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Revised: 02/25/2013] [Accepted: 02/26/2013] [Indexed: 11/25/2022] Open
Abstract
Crimean–Congo hemorrhagic fever (CCHF) is a viral infection associated with a high mortality rate. Ribavirin is the only drug used in the treatment of this disease. Studies investigating the effectiveness of ribavirin in CCHF have been retrospective and to date have included only a small number of cases. In recent years, due to climate changes, the number of cases of CCHF in Turkey has increased, and experience in the treatment of CCHF has improved. Several studies have evaluated the efficacy of ribavirin in Turkey, including one randomized controlled trial and two studies with a large number of cases. In these studies, ribavirin therapy was not shown to decrease mortality rates; the mortality rate was 2–9% in patients treated with ribavirin and 5.6–11% in those who were not treated with this drug. These findings suggest that patients with CCHF should be followed with supportive care only until randomized controlled trials with larger groups have been conducted.
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32
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Duygu F, Kaya T, Baysan P. Re-Evaluation of 400 Crimean-Congo Hemorrhagic Fever Cases in an Endemic Area: Is Ribavirin Treatment Suitable? Vector Borne Zoonotic Dis 2012; 12:812-6. [DOI: 10.1089/vbz.2011.0694] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Fazilet Duygu
- Department of Infectious Disease and Clinic Microbiology, Tokat State Hospital, Tokat, Turkey
| | - Turan Kaya
- Department of Infectious Disease and Clinic Microbiology, Tokat State Hospital, Tokat, Turkey
| | - Pinar Baysan
- Department of Public Health, The Provincial Health Directorate, Tokat, Turkey
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33
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Tezer H, Tavil B, Sucaklı IA, Korukluoğlu G, Uyar Y, Dinçer E, Tunç B, Özkul A. Concurrent Crimean-Congo Hemorrhagic Fever and Visceral Leishmaniasis in a Turkish Girl. Vector Borne Zoonotic Dis 2011; 11:743-5. [DOI: 10.1089/vbz.2010.0092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
- Hasan Tezer
- Department of Pediatric Infectious Diseases, Republic of Turkey Ministry of Health, Ankara Diskapi Children's Training and Research Hospital, Ankara, Turkey
| | - Betül Tavil
- Department of Hematology, Republic of Turkey Ministry of Health, Ankara Diskapi Children's Training and Research Hospital, Ankara, Turkey
| | - Iclal Ayrancı Sucaklı
- Department of Pediatric Infectious Diseases, Republic of Turkey Ministry of Health, Ankara Diskapi Children's Training and Research Hospital, Ankara, Turkey
| | | | - Yavuz Uyar
- Department of Virology, Refik Saydam Hygiene Center, Ankara, Turkey
| | - Ender Dinçer
- Departmant of Virology, Ankara University Faculty of Veterinary Medicine, Ankara, Turkey
| | - Bahattin Tunç
- Department of Hematology, Republic of Turkey Ministry of Health, Ankara Diskapi Children's Training and Research Hospital, Ankara, Turkey
| | - Aykut Özkul
- Departmant of Virology, Ankara University Faculty of Veterinary Medicine, Ankara, Turkey
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34
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Denison MR, Graham RL, Donaldson EF, Eckerle LD, Baric RS. Coronaviruses: an RNA proofreading machine regulates replication fidelity and diversity. RNA Biol 2011; 8:270-9. [PMID: 21593585 PMCID: PMC3127101 DOI: 10.4161/rna.8.2.15013] [Citation(s) in RCA: 364] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Revised: 01/27/2011] [Accepted: 01/28/2011] [Indexed: 12/18/2022] Open
Abstract
In order to survive and propagate, RNA viruses must achieve a balance between the capacity for adaptation to new environmental conditions or host cells with the need to maintain an intact and replication competent genome. Several virus families in the order Nidovirales, such as the coronaviruses (CoVs) must achieve these objectives with the largest and most complex replicating RNA genomes known, up to 32 kb of positive-sense RNA. The CoVs encode sixteen nonstructural proteins (nsp 1-16) with known or predicted RNA synthesis and modification activities, and it has been proposed that they are also responsible for the evolution of large genomes. The CoVs, including murine hepatitis virus (MHV) and SARS-CoV, encode a 3'-to-5' exoribonuclease activity (ExoN) in nsp14. Genetic inactivation of ExoN activity in engineered SARS-CoV and MHV genomes by alanine substitution at conserved DE-D-D active site residues results in viable mutants that demonstrate 15- to 20-fold increases in mutation rates, up to 18 times greater than those tolerated for fidelity mutants of other RNA viruses. Thus nsp14-ExoN is essential for replication fidelity, and likely serves either as a direct mediator or regulator of a more complex RNA proofreading machine, a process previously unprecedented in RNA virus biology. Elucidation of the mechanisms of nsp14-mediated proofreading will have major implications for our understanding of the evolution of RNA viruses, and also will provide a robust model to investigate the balance between fidelity, diversity and pathogenesis. The discovery of a protein distinct from a viral RdRp that regulates replication fidelity also raises the possibility that RNA genome replication fidelity may be adaptable to differing replication environments and selective pressures, rather than being a fixed determinant.
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Affiliation(s)
- Mark R Denison
- Department of Pediatrics and Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
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Kumar D, Humar A. Respiratory viral infections in transplant and oncology patients. Infect Dis Clin North Am 2010; 24:395-412. [PMID: 20466276 PMCID: PMC7135290 DOI: 10.1016/j.idc.2010.01.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Deepali Kumar
- Department of Medicine, Transplant Infectious Diseases, University of Alberta, 6-030 Katz-Rexall Center for Health Research, Edmonton, Alberta T6G 2E1, Canada.
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Cleri DJ, Ricketti AJ, Vernaleo JR. Severe acute respiratory syndrome (SARS). Infect Dis Clin North Am 2010; 24:175-202. [PMID: 20171552 PMCID: PMC7135483 DOI: 10.1016/j.idc.2009.10.005] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
This article reviews the virology, history, pathology, epidemiology, clinical presentations, complications, radiology, laboratory testing, diagnosis, treatment, and prevention of severe respiratory distress syndrome, with reference to documented outbreaks of the disease.
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Affiliation(s)
- Dennis J Cleri
- Internal Medicine Residency Program, St Francis Medical Center, 601 Hamilton Avenue, Trenton, NJ 08629, USA.
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Tezer H, Sucakli IA, Sayli TR, Celikel E, Yakut I, Kara A, Tunc B, Ergonul O. Crimean-Congo hemorrhagic fever in children. J Clin Virol 2010; 48:184-6. [PMID: 20444644 PMCID: PMC7108219 DOI: 10.1016/j.jcv.2010.04.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2009] [Revised: 03/26/2010] [Accepted: 04/01/2010] [Indexed: 11/16/2022]
Abstract
Background Crimean-Congo hemorrhagic fever (CCHF) virus causes a severe disease in humans with a mortality up to 30%. In Turkey there has been an increase in the number of cases during years since 2002. Humans of all ages living in endemic areas,especially those who are working as shepherds and toddlers, have high risk of acquiring CCHF. Objectives The epidemiological, clinical, and laboratory characteristics of the children, who were diagnosed as Crimean-Congo hemorrhagic fever (CCHF) were described. Study design The children infected with CCHF virus between April 2008 and October 2009, and hospitalised in Ankara Dışkapı Children's and Research Hospital were included. Results Laboratory diagnosis was set by detection of CCHF IgM antibodies and/or genetic detection of CCHF virus. Thirtyone cases included to the study, and all were from the northeastern Anatolia and the southern parts of Black sea region. The mean age was 9.45 ± 4.9 years, the proportion of females was 38.7%. The majority (87%) of the cases had the history of tick bite. There was no fatal case. All the patients had the history of fever. Malaise,tonsillopharyngitis, nausea-vomiting, headache, diarrhea, myalgia and rash were the most common symptoms. The mean AST and ALT levels on the admission were 116 (range 25–389) and 61 (range 8–180) U/L respectively. The mean platelet count on admission was 125,000/mm3, and the lowest was 23,000/mm3. The mean of the lowest white blood cell count was 2353/mm3 and the mean of the highest lactate dehydrogenase was 861 IU/L. Conclusions The clinical course of CCHF among children seems to be milder than in adults. Tonsillopharyngitis is a common symptom among children with CCHF.
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Affiliation(s)
- Hasan Tezer
- Department of Pediatrics, Republic of Turkey Ministry of Health Ankara Diskapi Children's and Research Hospital, Diskapi, and Hacettepe University Faculty of Medicine, Ankara, Turkey.
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Ascioglu S, Leblebicioglu H, Elaldi N, Bodur H, Vahaboglu H. Response to Ergonul: Scientific Evidence Versus Personal Beliefs In Crimean-Congo Haemorrhagic Fever Treatment. J Infect 2009. [DOI: 10.1016/j.jinf.2009.08.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Efficacy of oral ribavirin treatment in Crimean-Congo haemorrhagic fever: A quasi-experimental study from Turkey. J Infect 2009; 58:238-44. [DOI: 10.1016/j.jinf.2009.01.014] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Revised: 01/28/2009] [Accepted: 01/29/2009] [Indexed: 10/21/2022]
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INFLUENZA AND VIRAL RESPIRATORY INFECTIONS. PHARMACOLOGY AND THERAPEUTICS 2009. [PMCID: PMC7332234 DOI: 10.1016/b978-1-4160-3291-5.50081-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rusnak JM, Byrne WR, Chung KN, Gibbs PH, Kim TT, Boudreau EF, Cosgriff T, Pittman P, Kim KY, Erlichman MS, Rezvani DF, Huggins JW. Experience with intravenous ribavirin in the treatment of hemorrhagic fever with renal syndrome in Korea. Antiviral Res 2009; 81:68-76. [PMID: 18977392 PMCID: PMC7127354 DOI: 10.1016/j.antiviral.2008.09.007] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2008] [Revised: 09/24/2008] [Accepted: 09/25/2008] [Indexed: 10/25/2022]
Abstract
Results of a clinical study using intravenous (IV) ribavirin for treating Department of Defense personnel with hemorrhagic fever with renal syndrome (HFRS) acquired in Korea from 1987 to 2005 were reviewed to determine the clinical course of HFRS treated with IV ribavirin. A total of 38 individuals enrolled in the study had subsequent serological confirmation of HFRS. Four of the 38 individuals received three or fewer doses of ribavirin and were excluded from treatment analysis. Of the remaining 34 individuals, oliguria was present in one individual at treatment initiation; none of the remaining 33 subjects developed oliguria or required dialysis. The mean peak serum creatinine was 3.46 mg/dl and occurred on day 2 of ribavirin therapy. Both the peak serum creatinine and the onset of polyuria occurred on mean day 6.8 of illness. Reversible hemolytic anemia was the main adverse event of ribavirin, with a >or=25% decrease in hematocrit observed in 26/34 (76.5%) individuals. While inability to adjust for all baseline variables prevents comparison to historical cohorts in Korea where oliguria has been reported in 39-69% cases and dialysis required in approximately 40% HFRS cases caused by Hantaan virus, the occurrence of 3% oliguria and 0% dialysis requirement in the treatment cohort is supportive of a previous placebo-controlled HFRS trial in China where IV ribavirin given early resulted in decreased occurrence of oliguria and decreased severity of renal insufficiency.
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Affiliation(s)
- Janice M Rusnak
- Division of Medicine, U.S. Army Medical Research Institute of Infectious Diseases, Fort Detrick, MD 21702, USA.
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Muller MP, Dresser L, Raboud J, McGeer A, Rea E, Richardson SE, Mazzulli T, Loeb M, Louie M. Adverse events associated with high-dose ribavirin: evidence from the Toronto outbreak of severe acute respiratory syndrome. Pharmacotherapy 2007; 27:494-503. [PMID: 17381375 PMCID: PMC7168122 DOI: 10.1592/phco.27.4.494] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Study Objectives. To distinguish adverse events related to ribavirin therapy from those attributable to severe acute respiratory syndrome (SARS), and to determine the rate of potential ribavirin‐related adverse events. Design. Retrospective cohort study. Setting. Hospitals in Toronto, Ontario, Canada. Patients. A cohort of 306 patients with confirmed or probable SARS, 183 of whom received ribavirin and 123 of whom did not, between February 23, 2003, and July 1, 2003. Of the 183 treated patients, 155 (85%) received very high‐dose ribavirin; the other 28 treated patients received lower‐dose regimens. Measurements and Main Results. Data on all patients with SARS admitted to hospitals in Toronto were abstracted from charts and electronic databases onto a standardized form by trained research nurses. Logistic regression was used to evaluate the association between ribavirin use and each adverse event (progressive anemia, hypomagnesemia, hypocalcemia, bradycardia, transaminitis, and hyperamylasemia) after adjusting for SARS‐related prognostic factors and corticosteroid use. In the primary logistic regression analysis, ribavirin use was strongly associated with anemia (odds ratio [OR] 3.0, 99% confidence interval [CI] 1.5–6.1, p<0.0001), hypomagnesemia (OR 21, 99% CI 5.8–73, p<0.0001), and bradycardia (OR 2.3, 99% CI 1.0–5.1, p=0.007). Hypocalcemia, transaminitis, and hyperamylasemia were not associated with ribavirin use. The risk of anemia, hypomagnesemia, and bradycardia attributable to ribavirin use was 27%, 45%, and 17%, respectively. Conclusions. High‐dose ribavirin is associated with a high rate of adverse events. The use of high‐dose ribavirin is appropriate only for the treatment of infectious diseases for which ribavirin has proven clinical efficacy, or in the context of a clinical trial. Ribavirin should not be used empirically for the treatment of viral syndromes of unknown origin.
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Affiliation(s)
- Matthew P Muller
- Department of Microbiology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
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Tai DYH. Pharmacologic Treatment of SARS: Current Knowledge and Recommendations. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2007. [DOI: 10.47102/annals-acadmedsg.v36n6p438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
The severe acute respiratory syndrome (SARS) pandemic caught the world by surprise in 2003 and spread rapidly within a relatively short period of time. Hence, randomised placebocontrolled clinical trials on the treatment of SARS were not possible. Our understanding was obtained from observational, cohort studies, case series and reports. Nevertheless, such information is useful in providing clinical management guidelines and directing future research in case SARS recurs. Early in the pandemic, a combination of ribavirin and corticosteroids was adopted as the standard treatment in Hong Kong, Canada and elsewhere because of the apparent good results of the first few patients. Subsequent reports showed that ribavirin was associated with a high rate of toxicity and lacked in vitro antiviral effect on SARS-coronavirus (SAR-CoV). The timing and dosage regimens of steroid in the treatment of SARS are controversial. Pulse methylprednisolone 250 to 500 mg/day for 3 to 6 days has been reported to have some efficacy in a subset of patients with “critical SARS,” i.e., critically ill SARS patients with deteriorating radiographic consolidation, increasing oxygen requirement with PaO2 <10 kPa or SpO2 <90% on air, and respiratory distress (rate of 30/min). Prolonged therapy with high-dose steroids, in the absence of an effective antimicrobial agent, could predispose patients to complications such as disseminated fungal infection, and avascular necrosis. Kaletra (400 mg ritonavir and 100 mg lopinavir), a protease inhibitor used in the treatment of human immunodeficiency virus infection, may be considered for early treatment of SARS patients, preferably in a randomised double-blind placebocontrolled clinical trial setting. Interferon (IFN) is not recommended as standard therapy in SARS. However, there are enough data on in vitro activity of IFN preparations and a few clinical studies for these products to support a controlled trial if SARS recurs. Many other experimental treatments have been tried in an uncontrolled manner, and they should not be recommended as standard therapy.
Key words: Corticosteroid, Interferon, Protease inhibitor, Ribavirin, SARS
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Treatment of Crimean-Congo Hemorrhagic Fever. CRIMEAN-CONGO HEMORRHAGIC FEVER 2007. [PMCID: PMC7119965 DOI: 10.1007/978-1-4020-6106-6_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Barnard DL, Day CW, Bailey K, Heiner M, Montgomery R, Lauridsen L, Winslow S, Hoopes J, Li JKK, Lee J, Carson DA, Cottam HB, Sidwell RW. Enhancement of the infectivity of SARS-CoV in BALB/c mice by IMP dehydrogenase inhibitors, including ribavirin. Antiviral Res 2006; 71:53-63. [PMID: 16621037 PMCID: PMC7114261 DOI: 10.1016/j.antiviral.2006.03.001] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2005] [Revised: 02/28/2006] [Accepted: 03/01/2006] [Indexed: 01/11/2023]
Abstract
Because of the conflicting data concerning the SARS-CoV inhibitory efficacy of ribavirin, an inosine monophosphate (IMP) dehydrogenase inhibitor, studies were done to evaluate the efficacy of ribavirin and other IMP dehydrogenase inhibitors (5-ethynyl-1-beta-D-ribofuranosylimidazole-4-carboxamide (EICAR), mizoribine, and mycophenolic acid) in preventing viral replication in the lungs of BALB/c mice, a replication model for severe acute respiratory syndrome (SARS) infections (Subbarao, K., McAuliffe, J., Vogel, L., Fahle, G., Fischer, S., Tatti, K., Packard, M., Shieh, W.J., Zaki, S., Murphy, B., 2004. Prior infection and passive transfer of neutralizing antibody prevent replication of severe acute respiratory syndrome coronavirus (SARS-CoV) in the respiratory tract of mice. J. Virol. 78, 3572-3577). Ribavirin given at 75 mg/kg 4 h prior to virus exposure and then given twice daily for 3 days beginning at day 0 was found to increase virus lung titers and extend the length of time that virus could be detected in the lungs of mice. Other IMP dehydrogenase inhibitors administered near maximum tolerated doses using the same dosing regimen as for ribavirin were found to slightly enhance virus replication in the lungs. In addition, ribavirin treatment seemed also to promote the production of pro-inflammatory cytokines 4 days after cessation of treatment, although after 3 days of treatment ribavirin inhibited pro-inflammatory cytokine production in infected mice, significantly reducing the levels of the cytokines IL-1alpha, interleukin-5 (IL-5), monocyte chemotactic protein-1 (MCP-1), and granulocyte-macrophage colony stimulating factor (GM-CSF). These findings suggest that ribavirin may actually contribute to the pathogenesis of SARS-CoV by prolonging and/or enhancing viral replication in the lungs. By not inhibiting viral replication in the lungs of infected mice, ribavirin treatment may have provided a continual source of stimulation for the inflammatory response thought to contribute to the pathogenesis of the infection. Our data do not support the use of ribavirin or other IMP dehydrogenase inhibitors for treating SARS infections in humans.
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Affiliation(s)
- Dale L Barnard
- Institute for Antiviral Research, Utah State University, Logan, 84322-5600, USA.
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Abstract
Crimean-Congo haemorrhagic fever (CCHF) is an often fatal viral infection described in about 30 countries, and it has the most extensive geographic distribution of the medically important tickborne viral diseases, closely approximating the known global distribution of Hyalomma spp ticks. Human beings become infected through tick bites, by crushing infected ticks, after contact with a patient with CCHF during the acute phase of infection, or by contact with blood or tissues from viraemic livestock. Clinical features commonly show a dramatic progression characterised by haemorrhage, myalgia, and fever. The levels of liver enzymes, creatinine phosphokinase, and lactate dehydrogenase are raised, and bleeding markers are prolonged. Infection of the endothelium has a major pathogenic role. Besides direct infection of the endothelium, indirect damage by viral factors or virus-mediated host-derived soluble factors that cause endothelial activations and dysfunction are thought to occur. In diagnosis, enzyme-linked immunoassay and real-time reverse transcriptase PCR are used. Early diagnosis is critical for patient therapy and prevention of potential nosocomial infections. Supportive therapy is the most essential part of case management. Recent studies suggest that ribavirin is effective against CCHF, although definitive studies are not available. Health-care workers have a serious risk of infection, particularly during care of patients with haemorrhages from the nose, mouth, gums, vagina, and injection sites. Simple barrier precautions have been reported to be effective.
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Affiliation(s)
- Onder Ergönül
- Ankara Numune Education and Research Hospital, Infectious Diseases and Clinical Microbiology Clinic, Ankara, Turkey.
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2006. [DOI: 10.1002/pds.1174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Chu CM, Chan KS. Ribavarin Should Be Tested in Clinical Trials in Combination With Other Antiviral Agents for Severe Acute Respiratory Syndrome. Chest 2005. [PMID: 16354884 PMCID: PMC7130147 DOI: 10.1016/s0012-3692(15)49656-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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