COVID-19: The Immune Responses and Clinical Therapy Candidates

Abstract

The pandemic of coronavirus disease 2019 (COVID-19), with rising numbers of patients worldwide, presents an urgent need for effective treatments. To date, there are no therapies or vaccines that are proven to be effective against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Several potential candidates or repurposed drugs are under investigation, including drugs that inhibit SARS-CoV-2 replication and block infection. The most promising therapy to date is remdesivir, which is US Food and Drug Administration (FDA) approved for emergency use in adults and children hospitalized with severe suspected or laboratory-confirmed COVID-19. Herein we summarize the general features of SARS-CoV-2’s molecular and immune pathogenesis and discuss available pharmacological strategies, based on our present understanding of SARS-CoV and Middle East respiratory syndrome coronavirus (MERS-CoV) infections. Finally, we outline clinical trials currently in progress to investigate the efficacy of potential therapies for COVID-19.

Arrhythmia in COVID-19

“…Specifically, infection with SARS and MERS, close relatives of the current COVID-19 virus, has demonstrated a propensity to cause arrhythmias including sinus bradycardia [8,21]. In COVID-19, arrhythmias could be secondary to medication side effects [35], hypoxia and pulmonary disease, activated protein kinase C, direct oxidized Ca2+/calmodulin-dependent protein kinase II activity [36], and myocarditis [2,37]. Sinus bradycardia is one of the most common arrhythmias seen in COVID-19 patients, and it can be persistent for up to 2 weeks [22,23].…”

“…Moreover, atrial arrhythmias were more common among COVID-19 patients requiring mechanical ventilation [24]. Since an exaggerated inflammatory response plays a major role in the complications of COVID-19, anti-inflammatory medications have been proposed as potential therapeutic agents against cardiovascular complications of COVID-19 [35,40]. Despite the growing number of case reports demonstrating arrhythmias in COVID-19 patients, evidence establishing COVID-19 as the direct cause is lacking.…”

The use of convalescent plasma for pediatric patients with SARS-CoV-2: A systematic literature review

“…The U.S. Food and Drug Administration (FDA) approved remdesivir for emergency use in children hospitalized with severe suspected or laboratory-confirmed COVID-19 [ 41 ]. Parenteral remdesivir has been approved by the European Medicines Agency for pediatric and adolescent patients (≥12 years, body weight ≥40 kg), and has shown potential benefits [ 42 ].…”

Immunological strategies against spike protein: Neutralizing antibodies and vaccine development for COVID‐19

“…Recent transcriptional analysis revealed that there was an imbalanced response with minimal levels of interferons and a remarkable increase of chemotactic and inflammatory response characterized by expression of IL‐1β, IL‐6, TNF, CXCL1 as shown in Figure 1 1 . The excessive formation of proinflammatory cytokines, such as IL‐6 and IL‐1β, may result in a higher risk of vascular hyperpermeability and respiratory failure 1,2 . Recent research progress on mechanistic studies of SARS‐CoV‐2 and clinical trials of neutralizing antibodies and vaccine development is one giant leap.…”