Abstract
In January 2020, Chinese health agencies reported an outbreak of a novel coronavirus-2 (CoV-2) which can lead to severe acute respiratory syndrome (SARS). The virus, which belongs to the coronavirus family (SARS-CoV-2), was named coronavirus disease 2019 (COVID-19) and declared a pandemic by the World Health Organization (WHO). Full-length genome sequences of SARS-CoV-2 showed 79.6% sequence identity to SARS-CoV, with 96% identity to a bat coronavirus at the whole-genome level. COVID-19 has caused over 133,000 deaths and there are over 2 million total confirmed cases as of 15 April 2020. Current treatment plans are still under investigation due to a lack of understanding of COVID-19. One potential mechanism to slow disease progression is the use of antiviral drugs to either block the entry of the virus or interfere with viral replication and maturation. Currently, antiviral drugs, including chloroquine/hydroxychloroquine, remdesivir, and lopinavir/ritonavir, have shown effective inhibition of SARS-CoV-2 in vitro. Due to the high dose needed and narrow therapeutic window, many patients are experiencing severe side effects with the above drugs. Hence, repurposing these drugs with a proper formulation is needed to improve the safety and efficacy for COVID-19 treatment. Extracellular vesicles (EVs) are a family of natural carriers in the human body. They play a critical role in cell-to-cell communications. EVs can be used as unique drug carriers to deliver protease inhibitors to treat COVID-19. EVs may provide targeted delivery of protease inhibitors, with fewer systemic side effects. More importantly, EVs are eligible for major aseptic processing and can be upscaled for mass production. Currently, the FDA is facilitating applications to treat COVID-19, which provides a very good chance to use EVs to contribute in this combat.
Highlights
Coronavirus disease 2019 (COVID-19) is a current, emerging infectious disease; it has been declared a pandemic by the World Health Organization (WHO)
East Respiratory Syndrome (MERS), and Swine Acute Diarrhea Syndrome (SADS), two of which originated from China through bats, researchers in China in early 2019 speculated that severe acute respiratory syndrome (SARS)- or MiddleEast Respiratory Syndrome (MERS)-like coronaviruses are likely to originate from bats in China [3,4]
The SARS-CoV-2 spike protein binds to a receptor on the human cell surface called angiotensin-converting enzyme 2 (ACE2), which is most abundant in the type II alveolar cells of the lungs [24,25]
Summary
Coronavirus disease 2019 (COVID-19) is a current, emerging infectious disease; it has been declared a pandemic by the World Health Organization (WHO). The previous two zoonotic coronaviruses that caused a worldwide pandemic are MERS and SADS, which appeared in 2012 and 2017, respectively [5] Compared to these coronaviruses and other related viruses like Ebola (2003) and H1N1 (2009), SARS-CoV-2 has emerged as the most resilient, with a perfect combination of ease of transmission, late incubation period, symptomatic nature, and morbidity and mortality [6]. Until we find drugs and/or vaccines for COVID-19, repurposing existing drugs is likely to play a significant role in reducing symptoms or treating the disease in patients It is, important to note that social distancing and taking extra precautions are the principle ways one can mitigate the worldwide spread and morbidity and mortality caused by SARS-CoV-2 infection [14]. The main theme of this review, is the repurposing of protease inhibitor (PI) drugs, which are currently used to treat Human Immunodeficiency Virus (HIV), Hepatitis C Virus (HCV), and other RNA viruses, in the treatment of COVID-19
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