Pharmacotherapeutics of SARS-CoV-2 Infections

Abstract

The COVID-19 pandemic has affected more than 38 million people world-wide by person to person transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Therapeutic and preventative strategies for SARS-CoV-2 remains a significant challenge. Within the past several months, effective treatment options have emerged and now include repurposed antivirals, corticosteroids and virus-specific antibodies. The latter has included convalescence plasma and monoclonal antibodies. Complete viral eradication will be achieved through an effective, safe and preventative vaccine. To now provide a comprehensive summary for each of the pharmacotherapeutics and preventative strategies being offered or soon to be developed for SARS-CoV-2.

Keywords: Antibodies; Antivirals; COVID-19 therapeutics; SARS-CoV-2; Vaccine.

Fig. 2

Dexamethasone formulations for COVID-19 patient treatments. Nanoparticles or liposome encased dexamethasone proposed for treatment of COVID-19 patients with various stage of SARS-CoV-2 infections such as account, intermediate and recovery stage. This drug is given through intravenous injection or inhalation to hyper-activated immune cells, by potentiating its anti-edema activity and by exploiting its anti-fibrotic effects (Concept of this figure sourced from(Lammers et al. 2020)

Fig. 3

Current vaccine strategies for SARS-CoV-2. Clockwise from top left: (a), delivery of mRNA encoding viral protein through lipid nanoparticle; (b), direct delivery(electroporation) of plasmid DNA encoding viral protein; (c), human and chimpanzee adenovirus-based delivery of DNA encoding viral protein; (d), injection of inactivated viral vector; (e), injection of genetically modified immune cells

Fig. 4

Convalescent plasma therapy. The use of convalescent plasma to treat COVID-19 requires donor testing of a person who has recovered from disease and has substantial titers of SARS-CoV-2 neutralizing antibodies. The plasma of recovered COVID-19 patients contains SARS-CoV-2 antibodies. These are present in plasma, which are collected then used as therapies. Convalescent plasma is safe, specific and effective. This schematic describes how convalescent plasma therapy is administered. It is as follows: (1) Donor apheresis. Blood is collected from the patient and antibody containing plasma is harvested by apheresis. (2) Plasma infusion. Convalescent plasma is collected from plasma of the donor then administered to the COVID-19 patient intravenously to deliver virus-specific antibodies. The plasma is collected through blood banks and given to blood-type-compatible patients with active SARS-CoV-2 infection. All donors are screened for HIV-1 and for hepatitis viruses and parvovirus B19. There are no other blood components uncovered that could yield secondary complications. The anti-SARS-CoV-2 titer must be at or greater than 1:320. Donors should have no systemic illness for at least 14 days after recovery

Fig. 5

Vaccines for the elderly. Blood samples are collected from elderly are used to test the immunogenicity of small molecule adjuvant conjugated spike protein as vaccine candidates. The lead adjuvants are tested for their ability to induce humoral and cellular immune responses against SARS-CoV-2