Current treatment options and the role of peptides as potential therapeutic components for Middle East Respiratory Syndrome (MERS): A review

Abstract

Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is a highly pathogenic respiratory virus with mechanisms that may be driven by innate immune responses. Despite the effort of scientific studies related to this virus, Middle East Respiratory Syndrome (MERS) is still a public health concern. MERS-CoV infection has a high mortality rate, and to date, no therapeutic or vaccine has been discovered, that is effective in treating or preventing the disease. In this review, we summarize our understanding of the molecular and biological events of compounds acting as MERS-CoV inhibitors, the outcomes of existing therapeutic options and the various drugs undergoing clinical trials. Currently, several therapeutic options have been employed, such as convalescent plasma (CP), intravenous immunoglobulin (IVIG), monoclonal antibodies and repurposing of existing clinically approved drugs. However, these therapeutic options have drawbacks, thus the need for an alternative approach. The requirement for effective therapeutic treatment has brought the necessity for additional MERS treatments. We suggest that antimicrobial peptides (AMPs) may be used as alternative therapeutic agents against MERS-CoV infection. In addition, we propose the feasibility of developing effective agents by repurposing the existing and clinically approved anti-coronavirus and anti-viral peptide drugs.

Keywords: Antimicrobial peptides; Convalescent plasma; Interferon; Intravenous immunoglobin; MERS-CoV; Peptide therapeutics; Ribavirin.

Fig. 1

A Schematic representation of the MERS-CoV structural proteins: spike (S), envelope (E), membrane (M), and nucleocapsid (N). B shows spike (S) protein and its subunits S1 and S2 form a fusion core, where SP is signal peptide, FP is fusion peptide, HR1 and HR2 are the heptad repeats 1 and 2, TM is transmembrane domain, and CP is cytoplasmic domain. C shows HR1 and HR2 with the linker. D shows the MERS-CoV structure complexed with human DPP4 with PDB ID: 4L72 visualised in Biovia DS Visualizer , and E shows structure of MERS-CoV nsp5 protease bound with a designed inhibitor, PDB ID: 4RSP visualised in Biovia DS Visualizer .