The rationale for a multi-step therapeutic approach based on antivirals, drugs and nutrients with immunomodulatory activity in patients with coronavirus-SARS2-induced disease of different severities

Br J Nutr. 2021 Feb 14;125(3):275-293. doi: 10.1017/S0007114520002913. Epub 2020 Jul 24.

Abstract

In December 2019, a novel human-infecting coronavirus, named Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2), was recognised to cause a pneumonia epidemic outbreak with different degrees of severity in Wuhan, Hubei Province in China. Since then, this epidemic has spread worldwide; in Europe, Italy has been involved. Effective preventive and therapeutic strategies are absolutely required to block this serious public health concern. Unfortunately, few studies about SARS-CoV-2 concerning its immunopathogenesis and treatment are available. On the basis of the assumption that the SARS-CoV-2 is genetically related to SARS-CoV (about 82 % of genome homology) and that its characteristics, like the modality of transmission or the type of the immune response it may stimulate, are still poorly known, a literature search was performed to identify the reports assessing these elements in patients with SARS-CoV-induced infection. Therefore, we have analysed: (1) the structure of SARS-CoV-2 and SARS-CoV; (2) the clinical signs and symptoms and pathogenic mechanisms observed during the development of acute respiratory syndrome and the cytokine release syndrome; (3) the modification of the cell microRNome and of the immune response in patients with SARS infection; and (4) the possible role of some fat-soluble compounds (such as vitamins A, D and E) in modulating directly or indirectly the replication ability of SARS-CoV-2 and host immune response.

Keywords: COVID-19; SARS; Therapy; Vitamins.

MeSH terms

  • Antiviral Agents / therapeutic use*
  • COVID-19 / therapy*
  • COVID-19 / virology*
  • Gene Expression Regulation, Viral / drug effects
  • Gene Expression Regulation, Viral / physiology
  • Genome, Viral
  • Humans
  • Immunologic Factors / therapeutic use*
  • SARS-CoV-2*
  • Severe Acute Malnutrition / drug therapy
  • Severe Acute Malnutrition / etiology
  • Severity of Illness Index
  • Viral Proteins
  • Vitamins / administration & dosage
  • Vitamins / therapeutic use

Substances

  • Antiviral Agents
  • Immunologic Factors
  • Viral Proteins
  • Vitamins