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.

Treatment Agent Related Target/Pathways Potential efficacy in COVID-19 Antiviral drugs Remdesivir 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 drugs Azithromycin 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 therapy ACE2 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 inhibitor Linagliptin Attenuates DM-induced activation of NLRP3 inflammatory bodies Decreases the concentration of cytokines, especially TNF-α and IL-6 Immunosuppressive Therapy Tocilizumab; 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 repair Improves pulmonary function and symptoms of patients Artificial liver system / Attenuates the cytokine storm Reduces the mortality of severe patients exhibiting rapid disease progression