A Perspective on Emerging Therapeutic Interventions for COVID-19

Abstract

Coronaviruses are enveloped positive-sense RNA viruses with an unusual large RNA genome and a unique replication mechanism, which are characterized by club-like spikes that protrude from their surface. An outbreak of a novel coronavirus 2019 infection has posed significant threat to the health and economies in the whole world. This article reviewed the viral replication, pathogenicity, prevention and treatment strategies. With a lack of approved treatment options for this virus, alternative approaches to control the spread of disease is in urgent need. This article also covers some management strategies which may be applied to this virus outbreak. Ongoing clinical studies related to possible treatments for COVID-19, potential vaccines, and alternative medication such as natural compounds are also discussed.

Keywords: COVID-19 pandemic; SARS-CoV-2; control; public health; therapeutics.

Figure 1

Probable sources of SARS-CoV-2 leading to symptoms, and prevention tips.

Figure 2

The systemic and respiratory disorders caused by SARS-COV-2 infection. The incubation period of SARS-COV-2 infection is ~5.2 days. There are general similarities in the symptoms between SARS-COV-2 and previous β-coronavirus. However, SARS-COV-2 shows some unique clinical features that include the targeting of the lower airway as evident by upper respiratory tract symptoms like rhinorrhea, sneezing, and sore throat. ACE2, angiotensin-converting enzyme 2; ssRNA virus, single-stranded RNA virus; RDRP, RNA-Dependent RNA Polymerase Gene; IL-1, interleukin 1; IL-6, interleukin-6; TNF-α, tumor necrosis alpha; PO2, partial pressure of oxygen; SNS, sympathetic nervous system; HR, heart rate; SIRS, systemic inflammatory response syndrome.

Figure 3

Some important diagnostic and therapeutic targets for SARS-CoV-2 infection. ACE2, angiotensin-converting enzyme 2; R, receptor; IL, interleukin; GCSF, granulocyte colony-stimulating factor; IP-10, interferon gamma-induced protein 10; TNF-α, tumor necrosis factor alpha; MIP1, Macrophage Inflammatory Protein 1; MCP-1, monocyte chemotactic protein-1; ALT, alanine transaminase; AST, aspartate transaminase; CRP, C-reactive protein.

Figure 4

Summarized scheme with proposed acting targets of anti-SARS-CoV-2 in the replication cycle of the virus. Inhibitors of cell entry: inhibitors of angiotensin-converting enzyme 2 (ACE2Is) and antimalarial drugs: chloroquine, hydroxychloroquine; inhibitors of transmembrane protease/serine subfamily member 2 (TMPRSS2): camostate; Inhibitors of replication, membrane fusion, and assembly of SARS-CoV-2: remdesivir, lopinavir/ritonavir combination, umifenovir; humanized monoclonal antibody IgG1 anti-human receptor for interleukin-6 (IL-6): tocilizumab.