A Precision Medicine Approach to SARS-CoV-2 Pandemic Management

Abstract

Purpose of review: Precision medicine (PM) represents a new paradigm in disease diagnosis, prevention, and treatment. To apply PM premises in an emerging coronavirus pandemic acquires potentially greater relevance in order to allow the selection of specific preventive measures as well as biomarkers that will be useful in disease management.

Recent findings: The identification of the new coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as the responsible for the coronavirus disease 2019 (COVID-19) pandemic had led to a plethora of strategies to contain viral dissemination, affecting life styles and personal behaviors. Viral genomic sequencing has shown that SARS-CoV-2 spike protein utilizes angiotensin-converting enzyme 2 (ACE2) found on ciliated epithelial cells of the human lungs as its specific receptor. Neutralizing antibodies to the receptor-binding domain of the spike protein were detected in patients recovered from COVID-19; however, both T cells and NK cells were reduced in severe cases. Excessive and uncontrolled releases of pro-inflammatory cytokines such as IL-1B, IL-1RA, IL-7, IL-8, IL-9, IL-10, fibroblast growth factor (FGF), granulocyte-macrophage colony-stimulating factor (GM-CSF), and tumor necrosis factor (TNFα) were increased in severe patients. These cytokines might be useful biomarkers of disease worsening and potential targets for new biological therapies currently under investigation.

Summary: Present knowledge and recent developments in PM approach to COVID-19 disease prevention, evaluation, and management are pointed out. Better understanding of pathogenic pathways together with an accurate phenotype classification of patients presented with SARS-CoV-2 infection and symptoms might contribute to a more accurate definition of biomarkers and other diagnostic tools, which may lead to more precise mitigation strategies, personalized pharmacologic options, as well as new biological therapy developments.

Keywords: Biomarkers; COVID-19; Coronavirus management algorithm; Precision medicine.

Fig. 1

A precision medicine approach to SARS-CoV-2 pandemic management. Following Siddiqu and Mehra [41], they proposed a 3-stage classification model for COVID-19 illness. COPD chronic obstructive pulmonary disease, AHT arterial hypertension, CV disease cardiovascular disease, CRP C-reactive protein, LDH lactate dehydrogenase, CPAP continuous positive airway pressure, ECMO extracorporeal membrane oxygenation, Low MW heparin low molecular weight heparin, PAI-1 plasminogen activator inhibitor 1, IL interleukin, GM-CSF granulocyte–macrophage colony-stimulating factor, MIP macrophage inflammatory protein, TNF tumor necrosis factor, JAK Janus kinase.