Current Knowledge on the Pathogenesis of and Therapeutic Options against SARS-CoV-2: An Extensive Review of the Available Evidence

Abstract

Background: By May 16, 2020, the SARS-CoV-2 virus had spread to 188 countries, infecting over 4.6 million people and causing 310,520 fatalities. A major factor responsible for the voracious spread of the virus is the lack of specific therapeutics for treatment. Current efforts have focused on repurposing existing agents with proven antiviral properties for the treatment of SARS-CoV-2. In this review, we discuss the pathogenesis of the virus; the current standard of care and state of knowledge on the antiviral effect of some of the therapeutic options, including Chloroquine/Hydroxychloroquine, Remdesivir, Lopinavir/Ritonavir combination and Convalescent Plasma; and examine the efforts so far towards the development of a vaccine candidate against SARS-CoV-2. Main Body: The current standard of care which includes supportive treatment and oxygen therapy are crucial in the treatment of SARS-CoV-2 infection. Convalescent plasma has a strong immunotherapeutic potential for the treatment of both MERS- CoV and SARS-CoV infections, which many clinical studies have shown to be applicable for treating SARS-CoV-2. Remdesivir (GS-5734), an experimental Ebola virus drug effectively inhibited SARS-CoV-2 in-vitro and in-vivo, and has recently been given emergency use authorization by the United States Food and Drug Administration (FDA) following early signs of success in human clinical trials. The therapeutic potential of the Lopinavir/Ritonavir combination has been extensively explored, and though promising; it had no significant effect on viral clearance and has been associated with severe adverse reactions. Chloroquine & Hydroxychloroquine have been shown to effectively inhibit the infection in-vitro and in animal models, and had a significant viral clearance. Most vaccine development efforts remain in Phase I stage of development. Conclusion: The current state of knowledge about the therapeutic options against SARS-CoV-2 shows great promise, however, more structured clinical studies are needed to provided much needed evidence to support the establishment of proper guidelines of therapy to curb the pandemic.