Coronaviruses: Options for Treatment

Abstract

The persistent Middle East respiratory syndrome (MERS) epidemic calls for immediately available and effective treatment options. Robotic screening of commercially available drugs has identified various agents with anti-MERS coronavirus (CoV) activities including mycophenolic acid and β-interferon which have better pharmacokinetics than ribavirin and α-interferon. Cyclosporine protects cells against MERS-CoV but its clinically achievable level is often below the IC50 demonstrated in cell lines. 3CL-protease and helicase inhibitors have not reached the stage for clinical evaluation. Anti-DPP4 antibodies block virus attachment to host cell receptor but may induce immunopathology. Host factors essential for cell entry like airway proteases can be targeted by camostat. Convalescent plasma with neutralizing antibodies may be effective despite the theoretical risk of immune enhancement. Potent inhibition of MERS-CoV can be achieved by neutralizing human monoclonal antibodies against RBD and antiviral peptides against HR2 of the MERS-CoV Spike glycoprotein. Better animal models and randomized controlled trials are necessary for further evaluation of these antiviral strategies.