Antisense oligonucleotide: A promising therapeutic option to beat COVID-19.

The COVID-19 crisis and the development of the first approved mRNA vaccine have highlighted the power of RNA-based therapeutic strategies for the development of new medicines. Aside from RNA-vaccines, antisense oligonucleotides (ASOs) represent a new and very promising class of RNA-targeted therapy. Few drugs have already received approval from the Food and Drug Administration. Here, we underscored why and how ASOs hold the potential to change the therapeutic landscape to beat SARS-CoV-2 viral infections. This article is categorized under: RNA Interactions with Proteins and Other Molecules > Small Molecule-RNA Interactions.

Does the use of cysteine-rich whey protein supplements (Inmunocal (R)) improve the health well-being of COVID-19 patients? A qualitative study

Introduction: In the context of SARS-CoV-2 infection, it has been proposed that oxidative stress may contribute to the management of COVID-19 severity. The impact on the well-being of patients with COVID-19 using cysteine-providing supplements has not yet been evaluated and there is a need to understand the benefits and limitations they may offer.Aim: The aim of this study is to understand the experiences of improved well-being with cysteine-rich whey protein supplementation (Immunocal (R)) in patients with COVID-19.Methods: A qualitative study was conducted by conducting semi-structured interviews with four participants taking Immunocal (R) while they had COVID-19. Participants were randomly recruited through internet networking. Ethical approval was obtained from the University ethics committee. Participants were informed of the study objectives two days in advance and consent was obtained before interviews began. We used the 16-item "Use of Immunocal supplement for COVID-19" (USIC-19) questionnaire to inquire about COVID-19 behavior (time of illness, symptoms, and severity of illness) and the experience of using the supplement during illness. Confidentiality was maintained throughout this study.Results: All participants presented mild discomfort such as headache, weakness, and tiredness when they had COVID-19 impacting most of them emotionally. The use of Immunocal (R) produced a partial improvement in all patients as only two continued to experience fatigue. Immunocal (R) improved the mood (50%) and physical health of the participants. In addition, participants reported that the supplement was recommended and dosed primarily by a consultant and that they did not feel hesitant to use it because of previous experiences of friends and family. The daily dosage of half of the participants was two sachets and all felt the need to consume the supplement which resulted in daily use.Conclusion: Following the daily dosage indications of the consultants, the participants who have consumed Inmunocal (R) have presented a partial improvement of the symptoms related to COVID-19, however, they feel the need to consume the supplement daily to improve their quality of life.

Systematic Review on the Therapeutic Options for COVID-19: Clinical Evidence of Drug Efficacy and Implications.

A novel coronavirus-2 (SARS-CoV-2) was first identified in Wuhan, China, and quickly spread globally. Several treatments have been proposed, many of which have proven ineffective. Consequently, there is a need to review the published evidence of drug clinical trials to guide future prescribing. A systematic review of published clinical trials and retrospective observational studies was carried out. The search was made using PubMed, Embase, MEDLINE, and China National Knowledge Infrastructure (CNKI) databases. Articles published between January 2020 and October 2020 and written in the English language were retrieved and included in the study. Researches that used traditional medicine, in-vitro and in-vivo animal studies, as well as reviews were excluded. Seventy-three relevant articles that fulfilled the inclusion criteria were finally selected and reviewed. Hydroxychloroquine, chloroquine, and azithromycin produced no clinical evidence of efficacy in randomized controlled clinical trials (RCT). However, retrospective observational studies reported the efficacy of remdesivir and lopinavir/ritonavir in reducing viral load, although there have been concerns with lopinavir/ritonavir and, more recently, remdesivir. Recently, tocilizumab, dexamethasone, and methylprednisolone significantly relieved lung inflammation and decreased mortality in patients with severe COVID-19. In addition, convalescent plasma was effective in boosting strong immunity among patients with mild COVID-19. There is currently no single worldwide approved therapeutic option for patients with COVID-19 despite the initial hype with medicines, including hydroxychloroquine. Nonetheless, dexamethasone has shown promise in symptomatic treatment and convalescent plasma in boosting immunity. New treatments are currently being researched, and the findings will be reported accordingly to provide evidence-based guidance for prescribers and policymakers.

COVID-19: Consider IL-6 receptor antagonist for the therapy of cytokine storm syndrome in SARS-CoV-2 infected patients.

COVID-19 leads to mortality of several patients and the cytokine storm is reportedly critical in the patients. To reduce the cytokine storm, we would like to propose the interleukin (IL) 6 receptor (IL-6R) antagonist therapy for the COVID-19 patients. Two humanized monoclonal antibodies are in clinical trial following IL-6R antagonist therapies namely tocilizumab and sarilumab. However, researchers and physicians should look for more IL-6R antagonists for the therapy of cytokine storm syndrome severe acute respiratory syndrome coronavirus 2 infected persons to enhance the therapeutic options for cytokine storm.

Coronavirus Disease 2019 Treatment: It is Time for Stewardship!

How to cite this article: Nasa P. Coronavirus Disease 2019 Treatment: It is Time for Stewardship! Indian J Crit Care Med 2020;24(10):895-896.

Tocilizumab: A Therapeutic Option for the Treatment of Cytokine Storm Syndrome in COVID-19.

Presently, we need more therapeutic molecules for this COVID-19 outbreak. The severity and mortality of the disease is associated with a high level of release of cytokine in the patients which is known as CRS (cytokine release syndrome) or cytokine storm syndrome. IL-6 is a type of pro-inflammatory cytokine which release in the severe COVID-19 patients. This cytokine initiates CRS the JAK-STAT or MAPK/NF-κB-IL-6 pathway. Tocilizumab, a humanized monoclonal antibody, is designed to bind both mIL-6R (membrane bound receptor for IL-6) and sIL-6R (soluble receptor for IL-6) and inhibit the JAK-STAT or MAPK/NF-κB-IL-6 signaling pathway. It finally stops the cytokine storm syndrome. However, we need to understand that how tocilizumab is bound with mIL-6R or sIL-6R. Similarly, we also need to understand more about the real molecular mechanism of activity of tocilizumab.