Vaccinations against the SARS-CoV-2 virus are in full swing in all countries. Many people hope for more normality and a way back to old life.
So we know that vaccination is the right way, but not everyone is open for this solution. What if a drug treatment of coronavirus disease would also work? We raise the question here and thus look at the state of research.
This article does not claim to be complete, but rather we would like to take a look at ongoing medication research.
Different types of meds
For the treatment of corona virus infections, different types of medications can be considered:
- Drugs with an antiviral active ingredient, so-called virostatics: These drugs are intended to prevent viruses from entering the body and stop them from multiplying
- Cardiovascular drugs: These drugs protect blood vessels, the heart and other organs
- Medication with immunosuppression: If the disease has already progressed, these drugs should keep the body’s defensive reactions in check so that no more damage occurs
Medication against SARS-CoV-2 is uncharted territory, but there are drugs that are already on the market to treat other viral diseases. Basically, this is the group of viral drugs. Drugs against HIV, hepatitis, malaria, Ebola and influenza have already been researched and are also being investigated for the use of a SARS CoV-2 infection. Their further development is less complex than the complete new development of a drug.
It is important that a corona disease goes through different phases and that active substances are used depending on the course of the disease and the phase of the disease. Otherwise, the drugs can even be counterproductive. They are intended to prevent the virus from reproducing or entering the body.
Virostatics that inhibit the docking of the SARS-CoV-2 virus to the body cell
Several companies are testing nasal sprays with an antiviral agent, the theory is to kill the virus before it reaches the lungs. Some companies are already advanced with the tests and are planning to get approval. The active substance iota carrageenan, originating from Argentina, is under discussion to minimize the risk of infection with SARS-CoV-2. The active ingredient originates from the red algae and is already available for the prevention of colds. A clinical study on the efficacy of coronavirus infection is currently underway.
A different approach is pursued by research with the underlying theory that coronaviruses can only dock on certain molecules. These are the molecules ACE2 and TMPRSS2. Based on this, an active ingredient has been developed in Vienna that contains a large amount of ACE2 molecules and binds the viruses, virtually adhesives them and prevents further penetration into the organism. Initial successes have already been achieved with the active substance. Thus, the result of a phase II study with seriously ill patients was that the respiration time could be shortened and the viral load lowered.
Importance of blood plasma
The blood plasma of corona patients who have recovered plays a major role in research. This blood plasma contains antibodies that are selectively extracted and modulated so that, for example, they survive longer in the body. Research is being carried out all over the world with such genetically engineered antiviral antibodies and various variants of them. A list of all clinical studies can be found at antibody society. The antibody society is an international non-profit organization that supports research and development in the field of antibodies.
Two research institutions from the USA and Switzerland are pursuing a new approach: they want to launch drugs that trigger the release of corresponding antibodies in the body using genes. Therefore, pills containing synthetically produced SARS-CoV-2 antibodies are not taken; rather, the drugs contain the genes for production in the body itself. This has the advantage that many antibodies can be produced quickly, while the production of these in a biotechnical laboratory is time-consuming. This type of drug is not yet on the market.
Furthermore, research is conducted with synthetic molecules, which are often more stable than their natural origin. In animal experiments, these agents were used to prevent corona deaths. Phase II and III studies for this type of viral drugs are starting this year.
Antiviral drugs that inhibit the proliferation of the virus in the cell
Small, synthetically produced molecules are used in this approach. The procedure is well known and the already approved drug Remdesivir was originally developed for another viral infection: Ebola. However, it turned out not to be effective. The multiplication of coronaviruses can be inhibited by the drug under certain conditions.
In addition, there are several products that were originally developed against the flu virus, which are tested in clinical studies for their applicability to a corona infection. None of them are on the market yet. Both Pfizer and the University of Lübeck are researching a new antiviral agents which also inhibit the proliferation of the SARS-CoV-2 virus in the cell. Also in research, Veru-111 is a compound that complicates the transport of coronavirus to the nucleus, thus hindering the proliferation of the virus.
An already approved active substance niclosamide, which was originally used against tapeworm infestation, is being further researched. It has been shown that the agent strengthens the cell’s own purification process and thus weakens virus multiplication. The drug is in phase II of ist clinical trial. The approach of the research groups of the Universities of Mainz, Giessen and Würzburg is also interesting: Here, an active substance has been newly developed that silences an enzyme of SARS-CoV-2 and thus counteracts replication of the virus.
Meds to support the cardiovascular system
A severe corona disease affects not only the lungs, but also the heart, kidneys and other organs. Anticoagulant drugs, which were originally used after surgery and have already been approved, have shown initial success with SARS CoV-2 therapy. Active substances include heparin and bivalirudine.
In addition, a study will examine whether the active substance dapagliflozin can prevent organ failure and severe complications. This drug has been approved as a diabetes-2 drug and is also used for heart failure. Furthermore, the use of antihypertensive agents, mainly from the class of sartans, is being tested.
Attenuating immunomodulators for severe disease
With a severe SARS-CoV-2 course, the body’s immune response is so strong that it threatens its own organism. In order to curb this overreaction, attenuating immunomodulators are used, as is the case with rheumatism or multiple sclerosis. In a study with seriously ill COVID patients, the drug dexamethasone has been able to reduce mortality and is being further researched.
Furthermore, interferons, genetically engineered variants of endogenous messenger substances, are tested for use in SARS-CoV-2 infections.
Conclusion
It is unlikely that there will be a single drug for SARS-CoV-2. SARS-CoV-2 disease can act differently and has different stages of the disease. When using an active substance, it is therefore important to determine which phase of the disease the patient is in. Drugs that show good results in one phase of the disease can have the opposite effect in another phase of the disease. If necessary, individual active substances can be combined and the medication can be built up on top of each other.
Antiviral drugs are the first step of the medication. They’re trying to stop the virus from docking to the human cell and multiplying. In the second step, cardiovascular drugs can be used to prevent severe thrombosis and strokes. If the disease is already far advanced, immunosuppressors can be used to curb the body’s excessive immune system.
Research in all areas is conducted on a large scale and internationally. In order to ensure the efficacy and safety of any drugs for the use of SARS-CoV-2, all clinical trial phases will be completed. A large number of drug projects are currently in phase II trials. In this phase, the therapy concept is examined and positive effects of the therapy should be recognizable. The production of a drug often takes years.
„An active ingredient is by no means a drug” as Rolf Hilgenfeld, Director of the Institute of Biochemistry at the University of Lübeck, emphasized.
