A Review of the Currently Available Antibody Therapy for the Treatment of Coronavirus Disease 2019 (COVID-19)

Abstract

Monoclonal antibodies are a promising treatment for COVID-19. However, the emergence of SARS-CoV-2 variants raised concerns about these therapies' efficacy and long-term viability. Studies reported several antibodies, that received authorization for COVID-19 treatment, are not effective against new variants or subvariants of SARS-CoV-2, hence their distribution has to be paused. Here, the authors reviewed the status of the currently available monoclonal antibodies for COVID-19 treatment, their potential as a therapeutic agent, and the challenges ahead. To address these issues, the authors presented general information on SARS-CoV-2 and how monoclonal antibodies work against SARS-CoV-2. The authors then focus on the antibodies that have been deployed for COVID-19 treatment and their current status, as well as the evidence supporting their potential as an early intervention against COVID-19. Lastly, the authors discussed some leading obstacles that hinder the development and administration of monoclonal antibodies for the treatment of COVID-19.

Keywords: COVID-19; SARS-CoV-2; human coronavirus; monoclonal antibody; therapy.

Figure 1

Diagram depicting the genome organization of SARS-CoV-2. The genome of SARS-CoV-2, with a size of ~30 Kb, encodes 4 structural proteins, 16 non-structural proteins (nsps), and 6 accessory proteins. The structural proteins, including spike glycoprotein (S), nucleocapsid (N), membrane (M), and envelope (E) proteins, are important for virus assembly and infection and are the target for the development of vaccines and therapeutics for COVID-19.

Figure 2

Diagram representing the structure of the monoclonal antibody, and the neutralizing mechanism. In (A), the monoclonal antibody is comprised of chains that are connected by disulfide linkage to form a “Y” shape. The region that binds to the target antigen is indicated. In (B), the RBD binds to hACE, which facilitates viral entry into the cells (left). Monoclonal antibodies disrupt the RBD–hACE interaction by targeting the RBD (antigen), thus hindering viral entry into the cells (right).