Saudi Pharmaceutical Journal

Saudi Pharmaceutical Journal

Volume 28, Issue 11, November 2020, Pages 1333-1352
Saudi Pharmaceutical Journal

Review
Current approaches used in treating COVID-19 from a molecular mechanisms and immune response perspective

https://doi.org/10.1016/j.jsps.2020.08.024Get rights and content
Under a Creative Commons license
open access

Abstract

Coronavirus disease 2019 (COVID-19), which is caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was declared by the World Health Organization (WHO) as a global pandemic on March 11, 2020. SARS-CoV-2 targets the respiratory system, resulting in symptoms such as fever, headache, dry cough, dyspnea, and dizziness. These symptoms vary from person to person, ranging from mild to hypoxia with acute respiratory distress syndrome (ARDS) and sometimes death. Although not confirmed, phylogenetic analysis suggests that SARS-CoV-2 may have originated from bats; the intermediary facilitating its transfer from bats to humans is unknown. Owing to the rapid spread of infection and high number of deaths caused by SARS-CoV-2, most countries have enacted strict curfews and the practice of social distancing while awaiting the availability of effective U.S. Food and Drug Administration (FDA)-approved medications and/or vaccines. This review offers an overview of the various types of coronaviruses (CoVs), their targeted hosts and cellular receptors, a timeline of their emergence, and the roles of key elements of the immune system in fighting pathogen attacks, while focusing on SARS-CoV-2 and its genomic structure and pathogenesis. Furthermore, we review drugs targeting COVID-19 that are under investigation and in clinical trials, in addition to progress using mesenchymal stem cells to treat COVID-19. We conclude by reviewing the latest updates on COVID-19 vaccine development. Understanding the molecular mechanisms of how SARS-CoV-2 interacts with host cells and stimulates the immune response is extremely important, especially as scientists look for new strategies to guide their development of specific COVID-19 therapies and vaccines.

Keywords

Coronavirus
SARS-CoV-2
Investigational medications
Pandemic
Pathophysiology
Viral immune response

Abbreviations

ACE2
angiotensin-converting enzyme 2
AHFS
American Hospital Formula Service
ANGII
angiotensin II
APCs
antigen presenting cells
ARDS
acute respiratory distress syndrome
COVID-19
coronavirus disease
CoVs
coronaviruses
GVHD
graft versus host disease
HCoVs
human coronoaviruses
IBV
infectious bronchitis coronavirus
IFN-γ
interferon-gamma
ILCs
innate lymphoid cells
MERS-CoV
Middle East respiratory syndrome
nsps
nonstructural proteins
NKs
natural killer cells
ORFs
open reading frames
PAMPs
pathogen-associated molecular patterns
RdRp
RNA-dependent RNA polymerase
SARS-CoV-2
severe acute respiratory syndrome coronavirus 2
SLE
systemic lupus erythematosus
TMPRSS2
transmembrane serine protease 2
WHO
World Health Organization

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Peer review under responsibility of King Saud University.