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Aging and disease    2020, Vol. 11 Issue (6) : 1481-1495     DOI: 10.14336/AD.2020.0903
Review Article |
COVID-19 in Elderly Adults: Clinical Features, Molecular Mechanisms, and Proposed Strategies
Ya Yang, Yalei Zhao, Fen Zhang, Lingjian Zhang, Lanjuan Li*
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
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Abstract  

Coronavirus disease 2019 (COVID-19) is causing problems worldwide. Most people are susceptible to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but elderly populations are more susceptible. Elevated susceptibility and death rates in elderly COVID-19 patients, especially those with age-related complications, are challenges for pandemic prevention and control. In this paper, we review the clinical features of elderly patients with COVID-19 and explore the related molecular mechanisms that are essential for the exploration of preventive and therapeutic strategies in the current pandemic. Furthermore, we analyze the feasibility of currently recommended potential novel methods against COVID-19 among elderly populations.

Keywords COVID-19      elderly      clinical feature      molecular mechanism      strategy     
Corresponding Authors: Li Lanjuan   
About author:

These authors contrinuted equally to this work.

Just Accepted Date: 10 September 2020   Issue Date: 19 November 2020
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Yang Ya
Zhao Yalei
Zhang Fen
Zhang Lingjian
Li Lanjuan
Cite this article:   
Yang Ya,Zhao Yalei,Zhang Fen, et al. COVID-19 in Elderly Adults: Clinical Features, Molecular Mechanisms, and Proposed Strategies[J]. Aging and disease, 2020, 11(6): 1481-1495.
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http://www.aginganddisease.org/EN/10.14336/AD.2020.0903     OR
Figure1.  Interaction of SARS-CoV-2 with ACE2 and CD26. To enter the host cells, SARS-CoV-2 binds to membrane-bound ACE2 with the assistance of Furin and TMPRSS2. SARS-CoV-2 infections could create positive feedback loops that increase ACE2 expression and promote viral dissemination. On the other hand, SARS-CoV-2 infections may induce ACE2 shedding. ACE2 downregulation could lead to accumulation of Ang II, therefore inducing cytokine storm and ARDS. Activation of CD26 on T lymphocytes may partially contribute to the high expression of IL-6 in COVID-19 patients.
TreatmentAgentRelated Target/PathwaysPotential efficacy in COVID-19
Antiviral drugsRemdesivir
LPV/RTV Favipiravir Arbidol
Reduces the production of viral RNA
Inhibits antiretroviral protease Targets RNA-dependent RNA polymerase Perturbs the virus membrane structure
Shortens the recovery time in COVID-19 patients
Shortens the viral shedding duration in patients Induces a shorter viral clearance time and greater improvement rate in chest imaging Shorter duration of positive RNA test compared to those treated with LPV/RTV
Antisenescence drugsAzithromycin
Chloroquine; hydroxychloroquine Rapamycin
Targets and removes senescent cells; inhibits IL-6 and IL-1β expression; extends the lifespan of myofibroblasts
Prevents the induction and accumulation of β-Gal; inhibits the replication of SARS-CoV in vitro Downregulates the IL-6 pathway; reduces the number of senescent T-cells through the mTOR-NLRP3-IL-1β axis
Reduces airway inflammation; antifibrosis
Reduces the viral load in COVID-19 patients Prevents and treats the severity of COVID-19 patients
ACE2-related therapyACE2 activator
ACE2 inhibitor Human recombinant soluble ACE2
Avoids binding of S protein of SARS-CoV-2 to ACE2
Inhibits ACE2 expression Directly binds to SARS-CoV-2 in the circulation
Requires scientific and clinical evidence
Still under debate Blocks SARS-CoV-2 infection; prevents lung injury
CD26 inhibitorLinagliptinAttenuates DM-induced activation of NLRP3 inflammatory bodiesDecreases the concentration of cytokines, especially TNF-α and IL-6
Immunosuppressive TherapyTocilizumab; sarilumab; siltuximab
cyclosporine-cyclophilin A complex Corticosteroids
Directly targets IL-6 receptors
Halts the expression of TNF-α and IL-2; blocks the replication of coronaviruses Inhibits innate and adaptive immune responses as well as immune cells
Improves clinical outcomes in severe cases
Anti-inflammatory and antiviral properties in COVID-19 Improves clinical outcomes in COVID-19 patients with ARDS
MSC transplantation/Advantages in anti-inflammation, antifibrosis and injury repairImproves pulmonary function and symptoms of patients
Artificial liver system/Attenuates the cytokine stormReduces the mortality of severe patients exhibiting rapid disease progression
Table 1  Potential strategies for the treatment of COVID-19.
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