Tackling Immune Pathogenesis of COVID-19 through Molecular Pharmaceutics

Abstract

An increasing number of clinical studies worldwide are investigating the repurposing of antiviral, immune-modulatory, and anti-inflammatory agents to face the coronavirus disease-19 (COVID-19) pandemic. Nevertheless, few effective therapies exist to prevent or treat COVID-19, which demands increased drug discovery and repurposing efforts. In fact, many currently tested drugs show unknown efficacy and unpredictable drug interactions, such that interventions are needed to guarantee access to effective and safe medicines. Anti-inflammatory therapy has proven to be effective in preventing further injury in COVID-19 patients, but the benefit comes at a cost, as targeting inflammatory pathways can imply an increased risk of infection. Thus, optimization of the risk/benefit ratio is required in the anti-inflammatory strategy against COVID-19, which accounts for drug formulations and delivery towards regionalization and personalization of treatment approaches. In this perspective, we discuss how better knowledge of endogenous immunomodulatory pathways may optimize the clinical use of novel and repurposed drugs against COVID-19 in inpatient, outpatient, and home settings through innovative drug discovery, appropriate drug delivery systems and dedicated molecular pharmaceutics.

Diverse Immunological Factors Influencing Pathogenesis in Patients with COVID-19: A Review on Viral Dissemination, Immunotherapeutic Options to Counter Cytokine Storm and Inflammatory Responses

“…Several therapeutic candidates with various chemical natures and mechanisms of action are being investigated and reported to regulate the uncontrolled and hyperinflammatory response. Tocilizumab, sarilumab, ruxolitinib, anakinra, and baricitinib, combined with dexamethasone, can be considered extremely effective and reliable therapies for controlling an uncontrolled immune response and hyperinflammatory response [153][154][155].…”

Current treatment strategies for COVID‑19 (Review)

“…The efficacy of corticosteroids was supported for the treatment of patients with severe COVID-19, although certain studies suggested that treatment with corticosteroid may not have an effect in hospitalized patients. A systematic analysis of several clinical trials that included 1,703 critically ill patients determined that corticosteroid treatment resulted in lower mortality among COVID-19 cases compared to standard care or a placebo (the WHO Rapid Evidence Appraisal for COVID-19 Therapies 2020) (88)(89)(90). In a recent clinical trial, 2,014 patients with COVID-19 were treated with dexamethasone; 22.9% of patients in the dexamethasone group and 25.7% of patients in the usual care group died within 28 days after treatment, suggesting antiviral efficacy of dexamethasone.…”