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Denholm JT, Venkatesh B, Davis J, Bowen AC, Hammond NE, Jha V, McPhee G, McQuilten Z, O’Sullivan MVN, Paterson D, Price D, Rees M, Roberts J, Jones M, Totterdell J, Snelling T, Trask N, Morpeth S, Tong SYC. ASCOT ADAPT study of COVID-19 therapeutics in hospitalised patients: an international multicentre adaptive platform trial. Trials 2022; 23:1014. [PMID: 36514143 PMCID: PMC9747535 DOI: 10.1186/s13063-022-06929-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 11/15/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND SARS-CoV-2 infection is associated with a significant risk of hospitalisation, death, and prolonged impact on quality of life. Evaluation of new treatment options and optimising therapeutic management of people hospitalised with SARS-CoV-2 infection remains essential, but rapid changes in pandemic conditions and potential therapies have limited the utility of traditional approaches to randomised controlled trials. METHODS ASCOT ADAPT is an international, investigator-initiated, adaptive platform, randomised controlled trial of therapeutics for non-critically ill patients hospitalised with COVID-19. The study design is open label and pragmatic. Potential participants are hospitalised adults with PCR confirmed, symptomatic, SARS-CoV-2 infection, within 14 days of symptom onset. Domains include antiviral, antibody and anticoagulant interventions, with a composite primary outcome of 28-day mortality or progression to intensive-care level respiratory or haemodynamic support. Initial interventions include intravenous nafamostat and variable dose anticoagulation. A range of secondary endpoints, and substudies for specific domains and interventions are outlined. DISCUSSION This paper presents the trial protocol and management structure, including international governance, remote site monitoring and biobanking activities and provides commentary on ethical and pragmatic considerations in establishing the ASCOT ADAPT trial under pandemic conditions. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry (ACTRN12620000445976) and ClinicalTrials.gov (NCT04483960).
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Affiliation(s)
- Justin T. Denholm
- grid.416153.40000 0004 0624 1200Victorian Infectious Diseases Service, The Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia ,grid.1008.90000 0001 2179 088XDepartment of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000 Australia
| | - Balasubramanian Venkatesh
- grid.415508.d0000 0001 1964 6010The George Institute for Global Health, Sydney, Australia ,grid.464831.c0000 0004 8496 8261The George Institute for Global Health, New Delhi, India ,grid.1005.40000 0004 4902 0432Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Joshua Davis
- grid.1043.60000 0001 2157 559XMenzies School of Health Research, Charles Darwin University, Darwin, Australia ,grid.414724.00000 0004 0577 6676Department of Infectious Diseases, John Hunter Hospital, Newcastle, NSW Australia
| | - Asha C. Bowen
- grid.1043.60000 0001 2157 559XMenzies School of Health Research, Charles Darwin University, Darwin, Australia ,grid.410667.20000 0004 0625 8600Department of Infectious Diseases, Perth Children’s Hospital, Perth, Australia ,grid.1012.20000 0004 1936 7910Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Naomi E. Hammond
- grid.415508.d0000 0001 1964 6010The George Institute for Global Health, Sydney, Australia ,grid.1005.40000 0004 4902 0432Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Vivekanand Jha
- grid.464831.c0000 0004 8496 8261The George Institute for Global Health, New Delhi, India ,grid.1005.40000 0004 4902 0432Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Grace McPhee
- grid.1008.90000 0001 2179 088XDepartment of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000 Australia
| | - Zoe McQuilten
- grid.1002.30000 0004 1936 7857Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Monash University, Melbourne, Australia ,grid.1002.30000 0004 1936 7857Transfusion Research Unit, Monash University, Melbourne, Australia
| | - Matthew V. N. O’Sullivan
- grid.413252.30000 0001 0180 6477Department of Infectious Diseases Westmead Hospital, Westmead, Australia ,grid.416088.30000 0001 0753 1056NSW Health Pathology, Institute for Clinical Pathology and Medical Research, Westmead, Australia ,grid.1013.30000 0004 1936 834XSydney Institute for Infectious Diseases, University of Sydney, Sydney, Australia
| | - David Paterson
- grid.1003.20000 0000 9320 7537University of Queensland Centre for Clinical Research, Faculty of Medicine & Centre for Translational Anti-infective Pharmacodynamics, School of Pharmacy, The University of Queensland, Brisbane, Australia ,grid.416100.20000 0001 0688 4634Department of Infectious Diseases, Royal Brisbane and Women’s Hospital, Brisbane, Queensland Australia
| | - David Price
- grid.1008.90000 0001 2179 088XDepartment of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000 Australia
| | - Megan Rees
- grid.1008.90000 0001 2179 088XDepartment of Respiratory Medicine, The Royal Melbourne Hospital and Department of Medicine, University of Melbourne, Melbourne, Victoria Australia
| | - Jason Roberts
- grid.1003.20000 0000 9320 7537University of Queensland Centre for Clinical Research, Faculty of Medicine & Centre for Translational Anti-infective Pharmacodynamics, School of Pharmacy, The University of Queensland, Brisbane, Australia ,grid.416100.20000 0001 0688 4634Department of Infectious Diseases, Royal Brisbane and Women’s Hospital, Brisbane, Queensland Australia ,grid.416100.20000 0001 0688 4634Departments of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women’s Hospital, Brisbane, Australia ,grid.411165.60000 0004 0593 8241Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Mark Jones
- grid.1013.30000 0004 1936 834XSchool of Public Health, University of Sydney, Camperdown, Australia
| | - James Totterdell
- grid.1013.30000 0004 1936 834XSchool of Public Health, University of Sydney, Camperdown, Australia
| | - Thomas Snelling
- grid.414724.00000 0004 0577 6676Department of Infectious Diseases, John Hunter Hospital, Newcastle, NSW Australia ,grid.410667.20000 0004 0625 8600Department of Infectious Diseases, Perth Children’s Hospital, Perth, Australia ,grid.1013.30000 0004 1936 834XSchool of Public Health, University of Sydney, Camperdown, Australia
| | | | - Susan Morpeth
- grid.415534.20000 0004 0372 0644Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | - Steven YC Tong
- grid.416153.40000 0004 0624 1200Victorian Infectious Diseases Service, The Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia ,grid.1008.90000 0001 2179 088XDepartment of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000 Australia
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Lang Y, Zheng Y, Qi B, Zheng W, Wei J, Zhao C, Gao W, Li T. Anticoagulation with nafamostat mesilate during extracorporeal life support. Int J Cardiol 2022; 366:71-79. [PMID: 35850387 DOI: 10.1016/j.ijcard.2022.07.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 11/15/2022]
Abstract
Nafamostat mesylate (NM) affects coagulation and fibrinolysis and impedes obesity-associated protein demethylase activity, which regulates Na+/K+ transport properties and the NF-κB signaling pathway. NM significantly decreases macrophage, neutrophil, and T lymphocyte infiltration, thereby reducing inflammation and apoptosis after reperfusion and promoting recovery in patients with severe conditions such as near-fatal asthma and cardiac arrest. Extracorporeal life support (ECLS) devices are used for cardiac and/or pulmonary support as a bridge to recovery, decision, surgery, or transplant in patients with refractory cardio-circulatory or respiratory diseases and provide essential opportunities for organ support and patient survival. However, they can lead to some potential adverse events such as hemorrhage and thrombosis. NM provides a sustained innate immune response of coagulation and anti-inflammation in extracorporeal circuits, principally due to its activation of the contact and complement systems. Heparin is the main anticoagulant used in extracorporeal circuits; however, it may cause massive bleeding and heparin-induced thrombocytopenia. Although no antidote is available, NM has a very short half-life of approximately 8-10 min and might have positive effects on patients who require coagulation and anti-inflammation. NM has been used for anticoagulation in continuous renal replacement therapy, extracorporeal membrane oxygenation, hemodialysis, and left ventricular assist devices. In this review, we focused on the pharmacology, monitoring parameters, and considerations for the special use of NM in patients receiving ECLS. Our findings suggest that systemic anticoagulation with NM during ECLS might be a feasible and safe alternative with several advantages for critically ill patients with high-risk bleeding and might improve their prognosis.
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Affiliation(s)
- Yuheng Lang
- The Third Central Clinical College of Tianjin Medical University, Tianjin 300170, China; Department of Heart Center, The Third Central Hospital of Tianjin, 83 Jintang Road, Hedong District, Tianjin 300170, China; Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China; Artificial Cell Engineering Technology Research Center, Tianjin, China
| | - Yue Zheng
- School of Medicine, Nankai University, Tianjin 300071, China; Department of Heart Center, The Third Central Hospital of Tianjin, 83 Jintang Road, Hedong District, Tianjin 300170, China; Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China; Artificial Cell Engineering Technology Research Center, Tianjin, China
| | - Bingcai Qi
- The Third Central Clinical College of Tianjin Medical University, Tianjin 300170, China; Department of Heart Center, The Third Central Hospital of Tianjin, 83 Jintang Road, Hedong District, Tianjin 300170, China; Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China; Artificial Cell Engineering Technology Research Center, Tianjin, China
| | - Weifeng Zheng
- Department of Heart Center, The Third Central Hospital of Tianjin, 83 Jintang Road, Hedong District, Tianjin 300170, China; Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China; Artificial Cell Engineering Technology Research Center, Tianjin, China
| | - Jin Wei
- Department of General practice, The Third Central Hospital of Tianjin, 83 Jintang Road, Hedong District, Tianjin 300170, China
| | - Chengxiu Zhao
- Department of Anesthesiology,Handan First Hospital,24Congtai Road,Handan 056002, China
| | - Wenqing Gao
- Department of Heart Center, The Third Central Hospital of Tianjin, 83 Jintang Road, Hedong District, Tianjin 300170, China; Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China; Artificial Cell Engineering Technology Research Center, Tianjin, China
| | - Tong Li
- The Third Central Clinical College of Tianjin Medical University, Tianjin 300170, China; School of Medicine, Nankai University, Tianjin 300071, China; Department of Heart Center, The Third Central Hospital of Tianjin, 83 Jintang Road, Hedong District, Tianjin 300170, China; Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China; Artificial Cell Engineering Technology Research Center, Tianjin, China.
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3
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Kodama K, Imai T, Asai Y, Kozu Y, Hayashi K, Shimizu T, Gon Y, Ootsuka S. Incidence and risk factors for hyperkalaemia in patients treated for COVID-19 with nafamostat mesylate. J Clin Pharm Ther 2022; 47:1070-1078. [PMID: 35313385 PMCID: PMC9114925 DOI: 10.1111/jcpt.13646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 02/10/2022] [Accepted: 02/24/2022] [Indexed: 12/15/2022]
Abstract
What is known and objective Nafamostat mesylate (NM) is used clinically in combination with antiviral drugs to treat coronavirus disease (COVID‐19). One of the adverse events of NM is hyperkalaemia due to inhibition of the amiloride‐sensitive sodium channels (ENaC). The incidence and risk factors for hyperkalaemia due to NM have been studied in patients with pancreatitis but not in COVID‐19. COVID‐19 can be associated with hypokalaemia or hyperkalaemia, and SARS‐CoV‐2 is thought to inhibit ENaC. Therefore, frequency and risk factors for hyperkalaemia due to NM may differ between COVID‐19 and pancreatitis. Hyperkalaemia may worsen the respiratory condition of patients. The objective of this study was to determine the incidence and risk factors for hyperkalaemia in COVID‐19 patients treated with favipiravir, dexamethasone and NM. Methods This retrospective study reviewed the records of hospitalized COVID‐19 patients treated with favipiravir and dexamethasone, with or without NM, between March 2020 and January 2021. Multivariable logistic regression analysis was performed to identify the risk factors for hyperkalaemia. Results and Discussion Of 45 patients who received favipiravir and dexamethasone with NM for the treatment of COVID‐19, 21 (47%) experienced hyperkalaemia. The duration of NM administration was a significant predictor of hyperkalaemia (odds ratio: 1.55, 95% confidence interval: 1.04–2.31, p = 0.031). The receiver‐operating characteristic curve analysis determined that the cut‐off value for predicting the number of days until the onset of hyperkalaemia was 6 days and the area under the curve was 0.707. What is new and conclusion This study revealed that the incidence of hyperkalaemia is high in patients treated for COVID‐19 with NM, and that the duration of NM administration is a key risk factor. When NM is administered for the treatment of COVID‐19, it should be discontinued within 6 days to minimize the risk of hyperkalaemia.
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Affiliation(s)
- Kentaro Kodama
- Department of Pharmacy, Nihon University Itabashi Hospital, Itabashi-ku, Japan
| | - Toru Imai
- Department of Pharmacy, Nihon University Itabashi Hospital, Itabashi-ku, Japan
| | - Yasuo Asai
- Division of Respiratory Medicine, Department of Internal Medicine, Nihon University School of Medicine, Itabashi-ku, Japan
| | - Yutaka Kozu
- Division of Respiratory Medicine, Department of Internal Medicine, Nihon University School of Medicine, Itabashi-ku, Japan
| | - Kentaro Hayashi
- Division of Respiratory Medicine, Department of Internal Medicine, Nihon University School of Medicine, Itabashi-ku, Japan
| | - Tetsuo Shimizu
- Division of Respiratory Medicine, Department of Internal Medicine, Nihon University School of Medicine, Itabashi-ku, Japan
| | - Yasuhiro Gon
- Division of Respiratory Medicine, Department of Internal Medicine, Nihon University School of Medicine, Itabashi-ku, Japan
| | - Susumu Ootsuka
- Department of Pharmacy, Nihon University Itabashi Hospital, Itabashi-ku, Japan
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Yang Q, Zhang S, Wu S, Yao B, Wang L, Li Y, Peng H, Huang M, Bi Q, Xiong P, Li L, Deng Y, Deng Y. Identification of nafamostat mesylate as a selective stimulator of NK cell IFN-γ production via metabolism-related compound library screening. Immunol Res 2022; 70:354-364. [PMID: 35167033 PMCID: PMC8852993 DOI: 10.1007/s12026-022-09266-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 01/27/2022] [Indexed: 12/11/2022]
Abstract
Natural killer (NK) cells play important roles in controlling virus-infected and malignant cells. The identification of new molecules that can activate NK cells may effectively improve the antiviral and antitumour activities of these cells. In this study, by using a commercially available metabolism-related compound library, we initially screened the capacity of compounds to activate NK cells by determining the ratio of interferon-gamma (IFN-γ)+ NK cells by flow cytometry after the incubation of peripheral blood mononuclear cells (PBMCs) with IL-12 or IL-15 for 18 h. Our data showed that eight compounds (nafamostat mesylate (NM), loganin, fluvastatin sodium, atorvastatin calcium, lovastatin, simvastatin, rosuvastatin calcium, and pitavastatin calcium) and three compounds (NM, elesclomol, and simvastatin) increased the proportions of NK cells and CD3+ T cells that expressed IFN-γ among PBMCs cultured with IL-12 and IL-15, respectively. When incubated with enriched NK cells (purity ≥ 80.0%), only NM enhanced NK cell IFN-γ production in the presence of IL-12 or IL-15. When incubated with purified NK cells (purity ≥ 99.0%), NM promoted NK cell IFN-γ secretion in the presence or absence of IL-18. However, NM showed no effect on NK cell cytotoxicity. Collectively, our study identifies NM as a selective stimulator of IFN-γ production by NK cells, providing a new strategy for the prevention and treatment of infection or cancer in select populations.
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Affiliation(s)
- Qinglan Yang
- Pediatrics Research Institute of Hunan Province, Hunan Children's Hospital, Changsha, 410007, China.,Pediatric Intensive Care Unit, Hunan Children's Hospital, University of South China, Changsha, 410007, China
| | - Shuju Zhang
- Pediatrics Research Institute of Hunan Province, Hunan Children's Hospital, Changsha, 410007, China.,Pediatric Intensive Care Unit, Hunan Children's Hospital, University of South China, Changsha, 410007, China
| | - Shuting Wu
- Pediatrics Research Institute of Hunan Province, Hunan Children's Hospital, Changsha, 410007, China.,Pediatric Intensive Care Unit, Hunan Children's Hospital, University of South China, Changsha, 410007, China
| | - Baige Yao
- Pediatric Intensive Care Unit, Hunan Children's Hospital, University of South China, Changsha, 410007, China.,Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Lili Wang
- Pediatrics Research Institute of Hunan Province, Hunan Children's Hospital, Changsha, 410007, China.,Pediatric Intensive Care Unit, Hunan Children's Hospital, University of South China, Changsha, 410007, China
| | - Yana Li
- Pediatrics Research Institute of Hunan Province, Hunan Children's Hospital, Changsha, 410007, China.,Pediatric Intensive Care Unit, Hunan Children's Hospital, University of South China, Changsha, 410007, China
| | - Hongyan Peng
- Pediatrics Research Institute of Hunan Province, Hunan Children's Hospital, Changsha, 410007, China.,Pediatric Intensive Care Unit, Hunan Children's Hospital, University of South China, Changsha, 410007, China
| | - Minghui Huang
- Pediatrics Research Institute of Hunan Province, Hunan Children's Hospital, Changsha, 410007, China.,Pediatric Intensive Care Unit, Hunan Children's Hospital, University of South China, Changsha, 410007, China
| | - Qinghua Bi
- Institute of Materia Medica, College of Pharmacy, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - Peiwen Xiong
- Pediatrics Research Institute of Hunan Province, Hunan Children's Hospital, Changsha, 410007, China.,Pediatric Intensive Care Unit, Hunan Children's Hospital, University of South China, Changsha, 410007, China
| | - Liping Li
- Pediatrics Research Institute of Hunan Province, Hunan Children's Hospital, Changsha, 410007, China. .,Pediatric Intensive Care Unit, Hunan Children's Hospital, University of South China, Changsha, 410007, China.
| | - Yafei Deng
- Pediatrics Research Institute of Hunan Province, Hunan Children's Hospital, Changsha, 410007, China. .,Pediatric Intensive Care Unit, Hunan Children's Hospital, University of South China, Changsha, 410007, China.
| | - Youcai Deng
- Institute of Materia Medica, College of Pharmacy, Army Medical University (Third Military Medical University), Chongqing, 400038, China.
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Yates AG, Weglinski CM, Ying Y, Dunstan IK, Strekalova T, Anthony DC. Nafamostat reduces systemic inflammation in TLR7-mediated virus-like illness. J Neuroinflammation 2022; 19:8. [PMID: 34991643 PMCID: PMC8734544 DOI: 10.1186/s12974-021-02357-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 12/14/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The serine protease inhibitor nafamostat has been proposed as a treatment for COVID-19, by inhibiting TMPRSS2-mediated viral cell entry. Nafamostat has been shown to have other, immunomodulatory effects, which may be beneficial for treatment, however animal models of ssRNA virus infection are lacking. In this study, we examined the potential of the dual TLR7/8 agonist R848 to mimic the host response to an ssRNA virus infection and the associated behavioural response. In addition, we evaluated the anti-inflammatory effects of nafamostat in this model. METHODS CD-1 mice received an intraperitoneal injection of R848 (200 μg, prepared in DMSO, diluted 1:10 in saline) or diluted DMSO alone, and an intravenous injection of either nafamostat (100 μL, 3 mg/kg in 5% dextrose) or 5% dextrose alone. Sickness behaviour was determined by temperature, food intake, sucrose preference test, open field and forced swim test. Blood and fresh liver, lung and brain were collected 6 h post-challenge to measure markers of peripheral and central inflammation by blood analysis, immunohistochemistry and qPCR. RESULTS R848 induced a robust inflammatory response, as evidenced by increased expression of TNF, IFN-γ, CXCL1 and CXCL10 in the liver, lung and brain, as well as a sickness behaviour phenotype. Exogenous administration of nafamostat suppressed the hepatic inflammatory response, significantly reducing TNF and IFN-γ expression, but had no effect on lung or brain cytokine production. R848 administration depleted circulating leukocytes, which was restored by nafamostat treatment. CONCLUSIONS Our data indicate that R848 administration provides a useful model of ssRNA virus infection, which induces inflammation in the periphery and CNS, and virus infection-like illness. In turn, we show that nafamostat has a systemic anti-inflammatory effect in the presence of the TLR7/8 agonist. Therefore, the results indicate that nafamostat has anti-inflammatory actions, beyond its ability to inhibit TMPRSS2, that might potentiate its anti-viral actions in pathologies such as COVID-19.
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Affiliation(s)
- Abi G Yates
- Department of Pharmacology, The University of Oxford, Mansfield Road, Oxford, UK
- School of Biomedical Sciences, The University of Queensland, Brisbane, Australia
| | - Caroline M Weglinski
- Department of Pharmacology, The University of Oxford, Mansfield Road, Oxford, UK
| | - Yuxin Ying
- Department of Pharmacology, The University of Oxford, Mansfield Road, Oxford, UK
| | - Isobel K Dunstan
- Department of Pharmacology, The University of Oxford, Mansfield Road, Oxford, UK
| | - Tatyana Strekalova
- Sechenov First Moscow State Medical University, Moscow, Russia
- Institute of General Pathology and Pathophysiology, Moscow, Russia
| | - Daniel C Anthony
- Department of Pharmacology, The University of Oxford, Mansfield Road, Oxford, UK.
- Sechenov First Moscow State Medical University, Moscow, Russia.
- University of Southern Denmark, Odense, Denmark.
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Felsenstein S, Reiff AO. A hitchhiker's guide through the COVID-19 galaxy. Clin Immunol 2021; 232:108849. [PMID: 34563684 PMCID: PMC8461017 DOI: 10.1016/j.clim.2021.108849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 09/04/2021] [Indexed: 01/08/2023]
Abstract
Numerous reviews have summarized the epidemiology, pathophysiology and the various therapeutic aspects of Coronavirus disease 2019 (COVID-19), but a practical guide on "how to treat whom with what and when" based on an understanding of the immunological background of the disease stages remains missing. This review attempts to combine the current knowledge about the immunopathology of COVID-19 with published evidence of available and emerging treatment options. We recognize that the information about COVID-19 and its treatment is rapidly changing, but hope that this guide offers those on the frontline of this pandemic an understanding of the host response in COVID-19 patients and supports their ongoing efforts to select the best treatments tailored to their patient's clinical status.
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Affiliation(s)
- Susanna Felsenstein
- University of Liverpool, Faculty of Health and Life Sciences, Brownlow Hill, Liverpool, L69 3GB, United Kingdom.
| | - Andreas Otto Reiff
- Arthritis & Rheumatic Diseases, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, United States.
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Ji HL, Wagener BM, Ness TJ, Zhao R. Fibrinolytic or anti-plasmin (nafamostat) therapy for COVID-19: A timing challenge for clinicians. Pulm Pharmacol Ther 2021; 70:102055. [PMID: 34271164 PMCID: PMC8276553 DOI: 10.1016/j.pupt.2021.102055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/08/2021] [Accepted: 07/11/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Hong-Long Ji
- Department of Cellular and Molecular Biology, University of Texas Health Science Centre at Tyler, Tyler, TX 75708, USA; Texas Lung Injury Institute, The University of Texas Health Science Centre at Tyler, Tyler, TX 75708, USA.
| | - Brant M Wagener
- Division of Molecular and Translational Biomedicine, USA; Division of Critical Care Medicine, Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Timothy J Ness
- Division of Molecular and Translational Biomedicine, USA.
| | - Runzhen Zhao
- Department of Cellular and Molecular Biology, University of Texas Health Science Centre at Tyler, Tyler, TX 75708, USA.
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Choudhary V, Gupta A, Sharma R, Parmar HS. Therapeutically effective covalent spike protein inhibitors in treatment of SARS-CoV-2. JOURNAL OF PROTEINS AND PROTEOMICS 2021; 12:257-270. [PMID: 34539131 PMCID: PMC8440732 DOI: 10.1007/s42485-021-00074-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 08/13/2021] [Accepted: 08/16/2021] [Indexed: 02/08/2023]
Abstract
COVID-19 [coronavirus disease 2019] has resulted in over 204,644,849 confirmed cases and over 4,323,139 deaths throughout the world as of 12 August 2021, a total of 4,428,168,759 vaccine doses have been administered. The lack of potentially effective drugs against the virus is making the situation worse and dangerous. Numerous forces are working on finding an effective treatment against the virus but it is believed that a de novo drug would take several months even if huge financial support is provided. The only solution left with is drug repurposing that would not only provide effective therapy with the already used clinical drugs, but also save time and cost of the de novo drug discovery. The initiation of the COVID-19 infection starts with the attachment of spike glycoprotein of SARS-CoV-2 to the host receptor. Hence, the inhibition of the binding of the virus to the host membrane and the entry of the viral particle into the host cell are one of the main therapeutic targets. This paper not only summarizes the structure and the mechanism of spike protein, but the main focus is on the potential covalent spike protein inhibitors.
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Affiliation(s)
- Vikram Choudhary
- School of Pharmacy, Devi Ahilya Vishwavidyalaya, Takshila Campus, Khandwa Road (Ring Road), Indore, 452001 Madhya Pradesh India
| | - Amisha Gupta
- School of Pharmacy, Devi Ahilya Vishwavidyalaya, Takshila Campus, Khandwa Road (Ring Road), Indore, 452001 Madhya Pradesh India
| | - Rajesh Sharma
- School of Pharmacy, Devi Ahilya Vishwavidyalaya, Takshila Campus, Khandwa Road (Ring Road), Indore, 452001 Madhya Pradesh India
| | - Hamendra Singh Parmar
- School of Biotechnology, Devi Ahilya Vishwavidyalaya, Takshila Campus, Khandwa Road, Indore, 452001 Madhya Pradesh India
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9
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Cicka D, Sukhatme VP. Available drugs and supplements for rapid deployment for treatment of COVID-19. J Mol Cell Biol 2021; 13:232-236. [PMID: 33493301 PMCID: PMC7928750 DOI: 10.1093/jmcb/mjab002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 12/09/2020] [Accepted: 01/06/2021] [Indexed: 12/15/2022] Open
Abstract
Abstract
Effective treatment for COVID-19 remains elusive, though urgently needed in the current pandemic. Repurposing marketed therapies may be an effective strategy for finding treatments quickly and, recently, in vitro and clinical testing of such therapies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has skyrocketed. However, not all marketed drugs showing in vitro efficacy could achieve therapeutic concentrations in humans and discernment of drugs that have favorable pharmacokinetic properties can save time and resources for future studies. Here, we compile marketed therapies, including supplements, having anti-viral activity with in vitro, in vivo, and/or clinical data against α and β coronaviruses into tables, alongside their pharmacokinetic properties. We point to several drugs or supplements available for immediate repurposing because they have achievable blood concentrations in humans well above their inhibitory concentrations against coronaviruses. This compilation may contribute to the implementation of rapid future studies by narrowing the vast number of marketed drugs reported for potential efficacy against SARS-CoV-2 on the basis of their pharmacokinetic properties and published coronavirus data.
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Affiliation(s)
- Danielle Cicka
- Department of Pharmacology and Chemical Biology,
Emory University School of Medicine, Atlanta, GA, USA
| | - Vikas P Sukhatme
- Department of Medicine, Department of Hematology and
Medical Oncology, Morningside Center for Innovative and Affordable Medicine,
Emory University School of Medicine, Atlanta, GA, USA
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Heparin/nafamostat. REACTIONS WEEKLY 2021. [PMCID: PMC7880026 DOI: 10.1007/s40278-021-90931-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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