COVID-19 in Elderly Adults: Clinical Features, Molecular Mechanisms, and Proposed Strategies
Yang Ya, Zhao Yalei, Zhang Fen, Zhang Lingjian, Li Lanjuan
Table 1 Potential strategies for the treatment of COVID-19.
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