Treatment options and Vaccines updates of COVID-19

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Current Therapies of COVID-19

• Currently, no specific antiviral treatment has been confirmed to be effective against COVID-19.
• Regarding patients infected with COVID-19, it has been recommended to apply appropriate symptomatic treatment and supportive care.
• Many of the patients have accepted oxygen therapy, and the WHO has recommended extracorporeal membrane oxygenation (ECMO) to patients with refractory hypoxemia.
• Rescue treatment involving convalescent plasma and immunoglobulin G are also delivered to some critical cases according to their conditions.

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Treatments options for COVID-19

• The only option available is using broad-spectrum antiviral drugs like Nucleoside analogs and also HIV-protease inhibitors that could alleviate virus infection until the specific antiviral becomes available.
• Furthermore, several other compounds are in development.
• These include the clinical candidate EIDD-2801 compound that has shown high therapeutic potential against seasonal and pandemic influenza virus infections and this represents another potential drug to be considered for the treatment of COVID-19 infection.

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Remdesivir

• Remdesivir has been reported to be used for the treatment of a few cases of COVID-19 successfully.
• Remdesivir is a 1′-cyano-substituted adenosine nucleotide analog prodrug and shows broad-spectrum antiviral activity against several RNA viruses.

Chloroquine (Hydroxychloroquine)

• Chloroquine (Hydroxychloroquine) is another repurposed drug that shows great potential for the treatment of COVID-19.
• Chloroquine has been in use for many years for the treatment of malaria, with a mechanism not well understood against some viral infections.
• It has been assumed that chloroquine can inhibit pH-dependent steps of the replication of several viruses, with a potent effect on infection and the spread of SARS-CoV-2.
• Moreover, chloroquine has immunomodulatory effects, suppressing the production/release of TNF-α and IL-6 and also works as a novel class of autophagy inhibitor, which may interfere with viral infection and replication.
• Several studies have found that chloroquine interfered with the glycosylation of cellular receptors of SARS-CoV and functioned at both entry and post-entry stages of the COVID-19 infection in Vero E6 cells.
• A combination of remdesivir and chloroquine was proven to inhibit the recently emerged SARS-CoV-2 in vitro effectively.
• The protease inhibitors, lopinavir, and ritonavir used to treat the infection with human immunodeficiency virus (HIV), MERS-CoV and SARS-CoV patients have been reported to significantly reduce the β-coronavirus viral loads of COVID-19 patients after treatment with these drugs.

Update: FDA Revokes Emergency Use Authorization for Chloroquine and Hydroxychloroquine

Ivermectin

• Ivermectin is an FDA-approved broad-spectrum anti-parasitic agent that has shown to have antiviral activity against a broad range of viruses in vitro.
• Ivermectin is an inhibitor of the causative virus (SARS-CoV-2) able to effect ∼a 5000-fold reduction in viral RNA at 48 hours.
• Ivermectin has been confirmed to inhibit nuclear import and HIV-1 replication.
• It has been shown to inhibit the nuclear import of host and viral proteins in many RNA viruses like dengue virus (DENV), West Nile Virus, and Venezuelan equine encephalitis virus (VEEV).
• This broad-spectrum activity is believed to be due to the involvement of IMPα/β1 during infection in the case of many different RNA viruses.
• It has been assumed that ivermectin acts through inhibiting IMPα/β1-mediated nuclear import of viral proteins, as shown for other RNA viruses.
• The confirmation of this mechanism in the case of SARS-CoV-2 and the identification of the specific SARS-CoV-2 and host components impacted is yet to be done.
• Ivermectin has an established safety profile for human use, and is FDA-approved for several parasitic infections and thus is worthy of further consideration as a possible SARS-CoV-2 antiviral.

Vaccines Update for COVID-19

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• Currently, there is no vaccine available for this disease.
• However, as of April 6, 2020, there are 61 ongoing research efforts across the globe to develop a COVID-19 vaccine.
• Five vaccine candidates, for instance, have already started human testing in record timing.
• But it is believed to take at least a year to determine if any vaccine works against this virus.

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References

1. Caly L, Druce J, Catton M, Jans D and Wagstaff K. The FDA-approved Drug Ivermectin inhibits the replication of SARS-CoV-2 in vitro. Antiviral Research. 2020. 104787. ISSN 0166-3542, https://doi.org/10.1016/j.antiviral.2020.104787. (http://www.sciencedirect.com/science/article/pii/S0166354220302011)
2. Guo Y, Cae Q, Hong Z, et al. The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak – an update on the status. Millitary Medical Reasearch. (2020) 7:11. https://doi.org/10.1186/s40779-020-00240-0
3. Rothan HA and Byrareddy SN. (2020). Journal of Autoimmunity, https://doi.org/10.1016/j.jaut.2020.102433
4. Adhikari et al. Epidemiology, causes, clinical manifestation and diagnosis, prevention and control of coronavirus disease (COVID-19) during the early outbreak period: a scoping review. Infectious Diseases of Poverty. (2020) 9:29.
5. Liu, C., Zhou, Q., Li, Y., Garner, L. V., Watkins, S. P., Carter, L. J., Smoot, J., Gregg, A. C., Daniels, A. D., Jervey, S., & Albaiu, D. (2020). Research and Development on Therapeutic Agents and Vaccines for COVID-19 and Related Human Coronavirus Diseases. ACS central science, 6(3), 315–331. https://doi.org/10.1021/acscentsci.0c00272

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