Treatment Strategies For COVID-19 Research Articles

Exploring the binding dynamics of covalent inhibitors within active site of PLpro in SARS-CoV-2

In the global fight against the COVID-19 pandemic caused by the highly transmissible SARS-CoV-2 virus, the search for potent medications is paramount. With a focused investigation on the SARS-CoV-2 papain-like protease (PLpro) as a promising therapeutic target due to its pivotal role in viral replication and immune modulation, the catalytic triad of PLpro comprising Cys111, His272, and Asp286, highlights Cys111 as an intriguing nucleophilic center for potential covalent bonds with ligands. The detailed analysis of the binding site unveils crucial interactions with both hydrophobic and polar residues, demonstrating the structural insights of the cavity and deepening our understanding of its molecular landscape. The sequence of PLpro among variants of concern (Alpha, Beta, Gamma, Delta and Omicron) and the recent variant of interest, JN.1, remains conserved with no mutations at the active site. Moreover, a thorough exploration of apo, non-covalently bound, and covalently bound PLpro conformations exposes significant conformational changes in loop regions, offering invaluable insights into the intricate dynamics of ligand-protein complex formation. Employing strategic in silico medication repurposing, this study swiftly identifies potential molecules for target inhibition. Within the domain of covalent docking studies and molecular dynamics, using reported inhibitors and clinically tested molecules elucidate the formation of stable covalent bonds with the cysteine residue, laying a robust foundation for potential therapeutic applications. These details not only deepen our comprehension of PLpro inhibition but also play a pivotal role in shaping the dynamic landscape of COVID-19 treatment strategies.

#1567 Risk factors for COVID-19 hospitalization and death in kidney transplant recipients: a retrospective nationwide study in Sweden

Abstract Background and Aims Kidney transplant recipients (KTRs) are particularly susceptible to infections due to their continuous immunosuppressive treatment, the presence of other comorbidities, and, in some cases, impaired kidney function. While previous research has identified certain risk factors for severe COVID-19 in KTRs, comprehensive data at a national level—minimizing regional or center-specific influences—remains scarce. Our study aimed to fill this gap by examining risk factors for severe COVID-19 at a national level. Thus, we conducted a retrospective analysis of COVID-19 outcomes, alongside demographic, clinical, and medication-related risk factors associated with hospitalization and mortality due to COVID-19, within a comprehensive national cohort of Swedish KTRs over the initial two years of the pandemic. Method We assessed the outcomes and identified risk factors associated with hospitalization and mortality from COVID-19 among all kidney transplant recipients in Sweden who were alive as of January 1, 2020 during the first two years of the pandemic (2020-2021). We utilized data from the Swedish Renal Registry (SRR) and other interconnected healthcare registries. The SRR is a nationwide registry, with almost complete coverage (>97%) of patients with kidney replacement therapy in Sweden, including KTRs. Through multivariable adjusted logistic regression models, we systematically analyzed this data to pinpoint risk factors contributing to severe COVID-19 cases in this specific patient population. Results There were 5,824 KTRs in Sweden on January 1, 2020 with a mean age 58 years, 64% men. An increased risk of severe COVID-19 was observed for patients aged between 49 to 68 years, with the highest point estimate for patients aged 49-58 years (OR 2.26, 95% CI 1.50-3.45) and those who underwent a prolonged duration of dialysis before their transplantation (aOR 1.04, CI 95% 1.01-1.07 [per one year increase]). Conversely, KTRs with a longer elapsed time since the transplantation and those who had received a kidney from a living donor had a lower risk of severe COVID-19. Compared to KTRs who were transplanted less than a year ago, those who had received their transplant 6-10 years ago or >10 years ago had an about 50% lower risk of being hospitalized or die from COVID-19 (aOR 0.49, CI 95% 0.35-0.68 and aOR 0.55, CI 95% 0.40-0.74, respectively). While no significant correlation was observed directly between hypertension and severe COVID-19, a significant association was identified with the increasing number of antihypertensive medications prescribed to a patient (P-value <.0001). Furthermore, treatment with mycophenolate mofetil and the use of a higher number of immunosuppressive drugs were associated with a higher risk of severe COVID-19. The use of proton pump inhibitors was also linked to an increased risk of severe COVID-19 (aOR 1.66, 95% CI 1.33-2.07). Conclusion Our study reveals several critical insights into the risk factors associated with severe COVID-19 among KTRs in Sweden. A key finding is the increased risk observed in individuals of working age, potentially due to higher exposure to the virus. Additionally, our findings suggest that the severity of comorbidities, rather than the presence of comorbidities themselves, may play a more significant role in increasing the risk of severe COVID-19. Importantly, our research sheds light on the potential impact of proton pump inhibitor (PPI) therapy, as a modifiable risk factor in the management of COVID-19. In general, our findings are instrumental in developing more targeted prevention and treatment strategies for COVID-19 in KTRs, aiming to improve care for this particularly vulnerable group.

Toward an Improved Electrocatalytic Determination of Immunomodulator COVID Medication Baricitinib Using Multiwalled Carbon Nanotube Nickel Hybrid.

The study presents a first electrochemical method for the determination of the immunomodulator drug Baricitinib (BARI), crucial in managing COVID-19 patients requiring oxygen support. A unique electrode was developed by modifying graphite carbon nickel nanoparticles (NiNPs) with functionalized multiwalled carbon nanotubes (f.MWCNTs), resulting in nanohybrids tailored for highly sensitive BARI detection. Comparative analysis revealed the superior electrocatalytic performance of the nanohybrid-modified electrode over unmodified counterparts and other modifications, attributed to synergistic interactions between f.MWCNTs and nickel nanoparticles. Under optimized conditions, the sensors exhibited linear detection within a concentration range from 4.00 × 10-8 to 5.56 × 10-5 M, with a remarkably low detection limit of 9.65 × 10-9 M. Notably, the modified electrode displayed minimal interference from common substances and demonstrated high precision in detecting BARI in plasma and medicinal formulations, underscoring its clinical relevance and potential impact on COVID-19 treatment strategies.

Precision Detection of Fungal Co-Infections for Enhanced COVID-19 Treatment Strategies Using FESEM Imaging

Precision Detection of Fungal Co-Infections for Enhanced COVID-19 Treatment Strategies Using FESEM Imaging

Augmented Reality Visualization and Quantification of COVID-19 Infections in the Lungs

The ongoing COVID-19 pandemic has had a significant impact globally, and the understanding of the disease’s clinical features and impacts remains insufficient. An important metric to evaluate the severity of pneumonia in COVID-19 is the CT Involvement Score (CTIS), which is determined by assessing the proportion of infections in the lung field region using computed tomography (CT) images. Interactive augmented reality visualization and quantification of COVID-19 infection from CT allow us to augment the traditional diagnostic techniques and current COVID-19 treatment strategies. Thus, in this paper, we present a system that combines augmented reality (AR) hardware, specifically the Microsoft HoloLens, with deep learning algorithms in a user-oriented pipeline to provide medical staff with an intuitive 3D augmented reality visualization of COVID-19 infections in the lungs. The proposed system includes a graph-based pyramid global context reasoning module to segment COVID-19-infected lung regions, which can then be visualized using the HoloLens AR headset. Through segmentation, we can quantitatively evaluate and intuitively visualize which part of the lung is infected. In addition, by evaluating the infection status in each lobe quantitatively, it is possible to assess the infection severity. We also implemented Spectator View and Sharing a Scene functions into the proposed system, which enable medical staff to present the AR content to a wider audience, e.g., radiologists. By providing a 3D perception of the complexity of COVID-19, the augmented reality visualization generated by the proposed system offers an immersive experience in an interactive and cooperative 3D approach. We expect that this will facilitate a better understanding of CT-guided COVID-19 diagnosis and treatment, as well as improved patient outcomes.

EFFECTS OF ANTIVIRAL THERAPEUTIC DRUGS FOR SARS-COV-2 ON TREATMENT OUTCOMES AND CLINICAL PARAMETERS

The emergence of SARS-CoV-2, the virus responsible for the COVID-19 pandemic, has prompted extensive research into antiviral therapeutic interventions aimed at improving treatment outcomes and clinical parameters. It provides a concise overview of the research conducted in this field, focusing on the impact and significance of various antiviral drugs. By analyzing key studies and trials, it aims to elucidate the efficacy and safety profiles of drugs such as remdesivir, favipiravir, molnupiravir, and Paxlovid in managing COVID-19. The scientific and practical significance of this research lies in its contribution to understanding the role of antiviral drugs in combating SARS-CoV-2 infection. This knowledge is crucial for optimizing treatment strategies and improving patient outcomes during the ongoing pandemic. Methodologically, this research involves reviewing and synthesizing data from reputable studies published in peer-reviewed journals. Key outcomes and clinical parameters assessed include viral clearance, mortality rates, hospitalization duration, and adverse effects associated with antiviral drug administration. The main results and analysis highlight the varying impacts of different antiviral drugs on SARS-CoV-2 treatment outcomes. For instance, remdesivir shows promise in reducing recovery time and mortality, while favipiravir demonstrates enhanced viral clearance but may cause transient liver enzyme elevations. In conclusion, this research underscores the value of antiviral therapeutic drugs in mitigating SARS-CoV-2 infection. The findings contribute to the evolving understanding of COVID-19 treatment strategies and offer insights into optimizing clinical care protocols. The practical significance of these results lies in informing healthcare professionals and policymakers about effective therapeutic options for managing COVID-19 cases, ultimately improving patient care and outcomes. This abstract encapsulates the essential aspects of research on antiviral drugs for SARS-CoV-2, emphasizing its scientific, practical, and methodological significance in advancing our response to the global pandemic.

Targeting epidermal growth factor receptor signalling pathway: A promising therapeutic option for COVID-19.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is continuously producing new variants, necessitating effective therapeutics. Patients are not only confronted by the immediate symptoms of infection but also by the long-term health issues linked to long COVID-19. Activation of epidermal growth factor receptor (EGFR) signalling during SARS-CoV-2 infection promotes virus propagation, mucus hyperproduction, and pulmonary fibrosis, and suppresses the host's antiviral response. Over the long term, EGFR activation in COVID-19, particularly in COVID-19-induced pulmonary fibrosis, may be linked to the development of lung cancer. In this review, we have summarised the significance of EGFR signalling in the context of SARS-CoV-2 infection. We also discussed the targeting of EGFR signalling as a promising strategy for COVID-19 treatment and highlighted erlotinib as a superior option among EGFR inhibitors. Erlotinib effectively blocks EGFR and AAK1, thereby preventing SARS-CoV-2 replication, reducing mucus hyperproduction, TNF-α expression, and enhancing the host's antiviral response. Nevertheless, to evaluate the antiviral efficacy of erlotinib, relevant clinical trials involving an appropriate patient population should be designed.

A pandemic by novel corona virus, seventh member of human coronavirus

Human coronavirus (HCoVs) pathogens are the cause of multiple respiratory epidemics since last 18 years, now has one more outbreak with novel evolution recognized in Wuhan, China in early December 2019. The novel corona virus 2019 is the most dangerous evolution of species SARS (severe acute respiratory syndrome) and MERS (Middle East respiratory syndrome) spread on 2003 and 2012 respectively, named “coronavirus disease 2019” (COVID-19) by the World health organization. The HCoVs have remarkably huge RNA genome, and an inimitable replication tactic. The current evolution COVID-19 has very high morbidity and mortality rate and has created world’s biggest health emergency ever. The outbreak is now declared pandemic by WHO. In this review we highlight history of HCoVs, epidemiology, possible genetic evolution, pathogenesis, diagnosis and current prevention and treatment strategies for COVID-19.

Determinants of passive antibody efficacy in SARS-CoV-2 infection: a systematic review and meta-analysis

Randomised controlled trials of passive antibodies as treatment and prophylaxis for COVID-19 have reported variable efficacy. However, the determinants of efficacy have not been identified. We aimed to assess how the dose and timing of administration affect treatment outcome. In this systematic review and meta-analysis, we extracted data from published studies of passive antibody treatment from Jan 1, 2019, to Jan 31, 2023, that were identified by searching multiple databases, including MEDLINE, PubMed, and ClinicalTrials.gov. We included only randomised controlled trials of passive antibody administration for the prevention or treatment of COVID-19. To compare administered antibody dose between different treatments, we used data on in-vitro neutralisation titres to normalise dose by antibody potency. We used mixed-effects regression and model fitting to analyse the relationship between timing, dose and efficacy. We found 58 randomised controlled trials that investigated passive antibody therapies for the treatment or prevention of COVID-19. Earlier clinical stage at treatment initiation was highly predictive of the efficacy of both monoclonal antibodies (p<0·0001) and convalescent plasma therapy (p=0·030) in preventing progression to subsequent stages, with either prophylaxis or treatment in outpatients showing the greatest effects. For the treatment of outpatients with COVID-19, we found a significant association between the dose administered and efficacy in preventing hospitalisation (relative risk 0·77; p<0·0001). Using this relationship, we predicted that no approved monoclonal antibody was expected to provide more than 30% efficacy against some omicron (B.1.1.529) subvariants, such as BQ.1.1. Early administration before hospitalisation and sufficient doses of passive antibody therapy are crucial to achieving high efficacy in preventing clinical progression. The relationship between dose and efficacy provides a framework for the rational assessment of future passive antibody prophylaxis and treatment strategies for COVID-19. The Australian Government Department of Health, Medical Research Future Fund, National Health and Medical Research Council, the University of New South Wales, Monash University, Haematology Society of Australia and New Zealand, Leukaemia Foundation, and the Victorian Government.

Hysteresis and Hopf bifurcation: Deciphering the dynamics of an in-host model of SARS-CoV-2 with logistic target cell growth and sigmoidal immune response

Mathematical models of in-host dynamics of SARS-CoV-2 may reveal the intricate underlying dynamics of host-pathogen interaction and guide crucial steps to curtail progression of COVID-19 and other similar infectious diseases. While the existing models on SARS-CoV-2 have considered a wide range of host-pathogen interactions, at their core, these models are remarkably similar, particularly in the choice of mathematical functions used in modeling the interactions. Specifically, these models have employed mass action kinetics while modeling target-cell interaction with virus particles and immune response to virus, thus overlooking the role of saturated evolution of target epithelial cells as well as immune cells. Here we fill this gap by developing a more comprehensive model of in-host dynamics of SARS-CoV-2 that concurrently models target epithelial cell growth using a logistic equation and virus-immune interaction using Michaelis–Menten kinetics. We identify a feasible disease-free equilibrium whose local stability depends on ”reproduction number” and global stability on the replenishment rate as well as the removal rate of immune cells. We also obtain multiple endemic equilibria and perform their local and global stability analysis. Our detailed numerical investigation demonstrates that the infection rate and reproduction number govern several interesting dynamical behaviors such as forward bifurcation with and without hysteresis, Hopf bifurcation, and multiple endemic equilibria. To analyze the impact of parameters on the model system and disease dynamics, we investigate several sensitive parameters and compute their sensitivity indices. Finally, to understand the impact of anti-viral therapy on viral load, we identify a novel threshold of replication rate that must be crossed to enable virus proliferation. Our results thus provide novel insights into the in-host dynamics of SARS-CoV-2 and we expect this model will help in the development of better treatment strategies for COVID-19 and other such infectious diseases.

Multisystem inflammatory syndrome in children (MIS-C): Implications for long COVID.

The COVID-19 pandemic caused by the coronavirus 2 of the severe acute respiratory syndrome (SARS-CoV-2) has significantly affected people around the world, leading to substantial morbidity and mortality. Although the pandemic has affected people of all ages, there is increasing evidence that children are less susceptible to SARS-CoV-2 infection and are more likely to experience milder symptoms than adults. However, children with COVID-19 can still develop serious complications, such as multisystem inflammatory syndrome in children (MIS-C). This narrative review of the literature provides an overview of the epidemiology and immune pathology of SARS-CoV-2 infection and MIS-C in children. The review also examines the genetics of COVID-19 and MIS-C in children, including the genetic factors that can influence the susceptibility and severity of the diseases and their implications for personalized medicine and vaccination strategies. By examining current evidence and insights from the literature, this review aims to contribute to the development of effective prevention and treatment strategies for COVID-19, MIS-C, and long COVID syndromes in children.

Dicoumarol is an effective post-exposure prophylactic for SARS-CoV-2 Omicron infection in human airway epithelium

Repurposing existing drugs to inhibit SARS-CoV-2 infection in airway epithelial cells (AECs) is a quick way to find novel treatments for COVID-19. Computational screening has found dicoumarol (DCM), a natural anticoagulant, to be a potential SARS-CoV-2 inhibitor, but its inhibitory effects and possible working mechanisms remain unknown. Using air-liquid interface culture of primary human AECs, we demonstrated that DCM has potent antiviral activity against the infection of multiple Omicron variants (including BA.1, BQ.1 and XBB.1). Time-of-addition and drug withdrawal assays revealed that early treatment (continuously incubated after viral absorption) of DCM could markedly inhibit Omicron replication in AECs, but DCM did not affect the absorption, exocytosis and spread of viruses or directly eliminate viruses. Mechanistically, we performed single-cell sequencing analysis (a database of 77,969 cells from different airway locations from 10 healthy volunteers) and immunofluorescence staining, and showed that the expression of NAD(P)H quinone oxidoreductase 1 (NQO1), one of the known DCM targets, was predominantly localised in ciliated AECs. We further found that the NQO1 expression level was positively correlated with both the disease severity of COVID-19 patients and virus copy levels in cultured AECs. In addition, DCM treatment downregulated NQO1 expression and disrupted signalling pathways associated with SARS-CoV-2 disease outcomes (e.g., Endocytosis and COVID-19 signalling pathways) in cultured AECs. Collectively, we demonstrated that DCM is an effective post-exposure prophylactic for SARS-CoV-2 infection in the human AECs, and these findings could help physicians formulate novel treatment strategies for COVID-19.

Computational Protein Design for COVID-19 Research and Emerging Therapeutics.

As the world struggles with the ongoing COVID-19 pandemic, unprecedented obstacles have continuously been traversed as new SARS-CoV-2 variants continually emerge. Infectious disease outbreaks are unavoidable, but the knowledge gained from the successes and failures will help create a robust health management system to deal with such pandemics. Previously, scientists required years to develop diagnostics, therapeutics, or vaccines; however, we have seen that, with the rapid deployment of high-throughput technologies and unprecedented scientific collaboration worldwide, breakthrough discoveries can be accelerated and insights broadened. Computational protein design (CPD) is a game-changing new technology that has provided alternative therapeutic strategies for pandemic management. In addition to the development of peptide-based inhibitors, miniprotein binders, decoys, biosensors, nanobodies, and monoclonal antibodies, CPD has also been used to redesign native SARS-CoV-2 proteins and human ACE2 receptors. We discuss how novel CPD strategies have been exploited to develop rationally designed and robust COVID-19 treatment strategies.

Cancer, more than a "COVID-19 co-morbidity".

Patients with cancer represent a particularly vulnerable population at risk of adverse outcomes related to COVID-19. Collectively, the initial studies, including patients with and without cancer, confirmed that patients with cancer had a higher risk of complications and death related to COVID-19. Subsequent studies on patients with COVID-19 and cancer investigated patient and disease-related factors associated with COVID-19 severity and morality. Multiple interconnected factors include demographics, comorbidities, cancer-associated variables, treatment side effects, and other parameters. However, there is a lack of clarity on the contributions of any one factor. In this commentary, we deconvolute the data of specific risk factors associated with worse outcomes due to COVID-19 in cancer patients and focus on understanding the recommended guidelines to mitigate COVID-19 risk in this vulnerable population. In the first section, we highlight the key parameters, including age and race, cancer status, type of malignancy, cancer therapy, smoking status and comorbidities that impact outcomes for cancer patients with COVID-19. Next, we discuss efforts made at the patient, health system, and population levels to mitigate the effects of the ongoing outbreak for patients with cancer, including (1) screening, barrier and isolation strategies (2), Masking/PPE (3), vaccination, and (4) systemic therapies (e.g., evusheld) to prevent disease onset in patients. In the last section, we discuss optimal treatment strategies for COVID-19, including additional therapies for patients with COVID-19 and cancer. Overall, this commentary focuses on articles with high yield and impact on understanding the evolving evidence of risk factors and management guidelines in detail. We also emphasize the ongoing collaboration between clinicians, researchers, health system administrators and policymakers and how its role will be important in optimizing care delivery strategies for patients with cancer. Creative patient-centered solutions will be critical in the coming years, post the pandemic.

The efficacy of traditional Chinese medicine in the treatment of the COVID-19 pandemic in Henan Province: a retrospective study

BackgroundSince 2020, novel coronavirus disease (COVID-19) has posed serious threats to health systems and led to tremendous economic decline worldwide. Traditional Chinese medicine (TCM) is considered a promising treatment strategy for COVID-19 in China and is increasingly recognized as a key participant in the battle against COVID-19. Clinicians also need accurate evidence regarding the effectiveness of TCM treatments for COVID-19.MethodsWe retrospectively analyzed patients diagnosed with COVID-19 by collected from the electronic medical records of the hospitals in Henan Province from January 19, 2020, to March 2, 2020. Demographic characteristics, clinical data, frequency analysis of Chinese patent medicines (CPMs), Chinese medicine injections (CMIs), evaluation of baseline symptom scores, nucleic acid negative conversion, length of hospitalization, and mortality rates were studied.ResultsBetween 15 January 2020 and 2 March 2020, 131 hospitals with 1245 patients were included. Survey response Chinese herbal decoction, CPMs, and CMIs combined with conventional Western medicine (CWM) used for the treatment of COVID-19. The top 8 CPMs were Lianhua Qingwen capsules, Shuanghuanglian oral liquid, Pudilan Xiaoyan oral liquid, Banlangen granules, Lanqin oral liquid, compound licorice tablets, Bailing capsules, montmorillonite powder. The most frequently used CMIs were Xuebijing, Tanreqing, Reduning, Xiyanping and Yanhuning. TCM combined with CWM improved the patients’ symptom scores for fever, cough, chest tightness, shortness of breath, and fatigue. Nucleic acid negative conversion occurred at11.55 ± 5.91 d and the average length of hospitalization was 14.92 ± 6.15 d. The mortality rate was approximately 1.76%, which is a reduction in patient mortality.ConclusionsTCM combined with CWM improved clinical symptoms and reduced hospitalization and mortality rates.

Multimodal single-cell analyses of peripheral blood mononuclear cells of COVID-19 patients in Japan

SARS-CoV-2 continues to spread worldwide. Patients with COVID-19 show distinct clinical symptoms. Although many studies have reported various causes for the diversity of symptoms, the underlying mechanisms are not fully understood. Peripheral blood mononuclear cells from COVID-19 patients were collected longitudinally, and single-cell transcriptome and T cell receptor repertoire analysis was performed. Comparison of molecular features and patients’ clinical information revealed that the proportions of cells present, and gene expression profiles differed significantly between mild and severe cases; although even among severe cases, substantial differences were observed among the patients. In one severely-infected elderly patient, an effective antibody response seemed to have failed, which may have caused prolonged viral clearance. Naïve T cell depletion, low T cell receptor repertoire diversity, and aberrant hyperactivation of most immune cell subsets were observed during the acute phase in this patient. Through this study, we provided a better understanding of the diversity of immune landscapes and responses. The information obtained from this study can help medical professionals develop personalized optimal clinical treatment strategies for COVID-19.

Essential oils and extracts of commonly used medicinal plants to fight against emerging and re-emerging infectious diseases including COVID-19

Introduction: In recent years, many infectious diseases are emerging as a pandemic. COVID-19 is one of the major challenges for mankind at present. The third wave of SARS-CoV-2 outbreak has already started hitting the world and new variants has also started spreading. At present, patients with severe COVID-19 are treated with antiviral drugs for controlling viral infection and supportive treatment with anti-inflammatory and antibacterial drugs to control hyper inflammatory response and secondary infection respectively. Antioxidant drugs are also gaining importance in COVID-19 patient’s supportive care. Many herbal preparations are known and have been proven for their health benefits such as immune-modulatory, anti-viral, anti-inflammatory, anti-microbial and Antioxidant roles.Methods: Four herbal plants of household use were selected for the study namely garlic, cloves, cinnamon and eucalypts. Research data was collected for all the plants for their immune-modulatory, anti-viral, anti-inflammatory, anti-microbial and Antioxidant roles and presented comprehensively in the preparation of this manuscript. Results: Essential oils and extracts of medicinal plants such as garlic, cloves, cinnamon and eucalypts have all those characteristics required to prevent as well as control infection and supportive care which is important in the fight against COVID-19.Discussion: There is relevance in the treatment strategy for COVID-19 and medicinal properties of plant extracts which make these medicinal plants as a potential alternative to pharmacological agents for immunity boost up, treatment and management of viral pandemics including COVID-19 outbreak.

COVID-19 treatment strategies with drugs centrally procured by the German Federal Ministry of Health in a representative tertiary care hospital: a temporal analysis.

To ensure the fastest and earliest possible treatment, the German Federal Ministry of Health (BMG) initiated central procurement and nationwide distribution of new drugs against COVID-19. A single centre was used for a retrospective temporal analysis of this procedure. A descriptive analysis of hospitalization and treatment of COVID-19 patients with drugs centrally procured by the BMG at St. Georg Hospital, Leipzig, Germany, for the period from 1 March 2020 to 28 February 2023 was employed considering the approval status, evolving guidelines and recommendations of medical societies. In total, 3,412 patients ≥18 years (54.9% men) with PCR-confirmed SARS-CoV-2 infection were admitted. The mean age was 64 years during the reporting period and 66.1/70.6 years during the first and second COVID-19 waves, respectively. 964 patients (28.2%) received COVID-19 therapy with drugs procured centrally by the BMG. Remdesivir was the most commonly used (63%). SARS-CoV-2 neutralizing monoclonal antibodies represented 23% of the therapies. Peroral antivirals (nirmatrelvir/ritonavir and molnupiravir) were used in 14% of COVID-19 patients, with molnupiravir being insignificant (five prescriptions). Specific therapeutic approaches were mainly based on antiviral therapy in the early phase of COVID-19 to prevent severe disease progression in vulnerable patient groups. Most drugs had not been approved at the time of central procurement; therefore, prescriptions were given on a case-by-case basis after careful risk-benefit assessments. All available neutralizing monoclonal SARS-CoV-2 antibodies lost efficacy during the pandemic due to different circulating immune escape variants. Remdesivir and nirmatrelvir/ritonavir remained effective therapies in the early phase of COVID-19.

Identification of potent COVID-19 main protease inhibitors by loading of favipiravir on Mg12O12 and Zn12O12 nanoclusters: an in silico strategy for COVID-19 treatment

Pandemic new severe acute respiratory syndrome coronavirus (SARS-CoV-2) virus has increased throughout the world. There is no effective treatment against this virus until now. Since its appearance in Wuhan, China in December 2019, SARS-CoV-2 becomes the largest challenge the world is opposite today, including the discovery of an antiviral drug for this virus. Several viral proteins have been prioritized as SARS-CoV-2 antiviral drug targets, among them the papain-like protease (PLpro) and the main protease (Mpro). Inhibition of these proteases would target viral replication, viral maturation and suppression of host innate immune responses. Potential candidates have been identified to show inhibitory effects against Mpro, both in biochemical assays and viral replication in cells. There are different molecules such as lopinavir and favipiravir considerably inhibit the activity of Mpro in vitro. Different studies have shown that structurally improved favipiravir and other similar compounds can inhibit SARS-CoV-2 main protease. In this work, we study the interactions between favipiravir with Mg12O12 and Zn12O12 nanoclusters by density functional theory (DFT) and quantum mechanics atoms in molecules (QMAIM) methods to summarize the ability to load favipiravir onto Mg12O12 and Zn12O12 nanoclusters. Favipiravir-Mg12O12 and favipiravir-Zn12O12 lowest structures complexes were chosen to dock inside the SARS-CoV-2 main protease by molecular docking study. The molecular docking analysis revealed that the binding affinity of Mg12O12 and Zn12O12 nanoclusters inside the Mpro receptor is larger than that of favipiravir. Also, the loading of favipiravir on the surface of Mg12O12 and Zn12O12 nanoclusters increased the binding affinity against the Mpro receptor. Subsequently, 100 ns molecular dynamics simulation of the favipiravir-Mg12O12, and favipiravir-Zn12O12 docked inside the Mpro complexes established that favipiravir-Mg12O12, forms the most stable complex with the Mpro. Further molecular mechanics Poisson Boltzmann surface area (MMPBSA) analyses using the MD trajectories also demonstrated the higher binding affinity of favipiravir-Mg12O12 inside the Mpro. In summary, this study demonstrates a new way to characterize leads for novel anti-viral drugs against SARS-CoV-2, by improving the drug ability of favipiravir via loading it on Mg12O12 and Zn12O12 nanoclusters. Communicated by Ramaswamy H. Sarma

Inhibition of p38 signaling curtails the SARS-CoV-2 induced inflammatory response but retains the IFN-dependent antiviral defense of the lung epithelial barrier

SARS-CoV-2 is the causative agent of the immune response-driven disease COVID-19 for which new antiviral and anti-inflammatory treatments are urgently needed to reduce recovery time, risk of death and long COVID development. Here, we demonstrate that the immunoregulatory kinase p38 MAPK is activated during viral entry, mediated by the viral spike protein, and drives the harmful virus-induced inflammatory responses. Using primary human lung explants and lung epithelial organoids, we demonstrate that targeting p38 signal transduction with the selective and clinically pre-evaluated inhibitors PH-797804 and VX-702 markedly reduced the expression of the pro-inflammatory cytokines IL6, CXCL8, CXCL10 and TNF-α during infection, while viral replication and the interferon-mediated antiviral response of the lung epithelial barrier were largely maintained. Furthermore, our results reveal a high level of drug synergism of both p38 inhibitors in co-treatments with the nucleoside analogs Remdesivir and Molnupiravir to suppress viral replication of the SARS-CoV-2 variants of concern, revealing an exciting and novel mode of synergistic action of p38 inhibition. These results open new avenues for the improvement of the current treatment strategies for COVID-19.