新型冠状病毒肺炎相关心血管疾病风险及其治疗中的药学监护

新型冠状病毒肺炎(COVID-19)是一种由新型冠状病毒(SARS-CoV-2)引起的传染性疾病.多项研究显示,SARS-CoV-2感染除了导致病毒性肺炎,还可能产生潜在的心血管危害,增加已有心血管疾病患者潜在的并发症和死亡风险.其发生机制尚不清楚,可能由于SARS-CoV-2通过血管紧张素转化酶2(ACE2)途径侵入...     

系统性红斑狼疮患者接种新型冠状病毒疫苗的建议及依据

在新型冠状病毒肺炎(COVID-19)疫情持续的当下,自身免疫性疾病导致的免疫异常和应用免疫抑制剂治疗导致的免疫功能低下,使得系统性红斑狼疮(SLE)患者对新型冠状病毒(SARS-CoV-2)的易感性更高.同时,感染是SLE患者死亡的重要危险因素,也可导致SLE患者病情活跃、恶化进而使预后更差.但是,目前SLE患者接种...     

《新型冠状病毒感染诊疗方案(试行第十版)》解读

随着对新型冠状病毒(SARS-CoV-2)认识的深入，为做好后续诊疗工作，SARS-CoV-2感染诊疗方案不断更新。该文对《新型冠状病毒感染诊疗方案(试行第十版)》进行解读，并与《新型冠状病毒肺炎诊疗方案》(试行第九版)比较，重点介绍新版诊疗方案的更新要点，以便更好地应用于临床实践。     

二级中医院药学科应对新型冠状病毒疫情的药事管理与药学服务模式探索

目的 探讨新型冠状病毒肺炎(COVID-19)疫情期间二级中医院药学科的应对模式.方法 根据《新型冠状病毒感染的肺炎诊疗方案(试行第七版)》等国家文件要求,天津市滨海新区中医医院药学科结合实际工作情况,从药事管理和药学服务两方面构筑应对模式.结果 在药事管理方面,该院药学科及时成立药学工作领导小组,建立应急预案,加强了对药师新型冠状病毒(SARS-CoV-2)防护知识的培训,并做好了新型冠状病毒药品储备和管理工作.在药学服务方面,该院充分发挥中医药优势,采用传统汤药及香佩疗法,同时为病人提供药品配送、网络宣传及慢病长期取药等优质药学服务.结论 疫情期间,医院药学科积极应对,构筑了药事管理和药学服务的工作模式,以期为其他中医院药学科工作提供参考.     

抗新型冠状病毒肺炎药物靶点的研究进展

自2019年12月以来,新型冠状病毒(SARS-CoV-2)在国内爆发,并且目前已在日本和韩国等地进入高发态势,该病毒导致的新型冠状病毒肺炎(COVID-19)已造成多人感染并有2500余人死亡,世界卫生组织于2020年1月31日宣布疫情为"国际关注的突发公共卫生事件"。抗新型冠状病毒药物是阻止病毒传播以及在宿主体内复制从而引起肺炎的有力武器。综述了抗COVID-19药物靶点以及相应的药物和候选物的研究进展。     

儿童新型冠状病毒肺炎药物治疗研究进展

新型冠状病毒(severe acute respiratory syndrome corona virus,SARS-CoV)-2感染在全球暴发,目前尚无明确有效的抗病毒药物治疗SARS-CoV-2感染.结合以往临床一线治疗新型冠状病毒肺炎(corona virus disease 2019,COVID-19)的经验,...     

新型冠状病毒检测方法的研究进展

2019年12月,一种新型冠状病毒(SARS-CoV-2)在国内爆发,并迅速蔓延至全球多个国家,对全球公共卫生安全构成了巨大威胁。为应对新型冠状病毒肺炎(COVID-19)疫情造成的对病毒检测的需求,国内外企业和科研单位陆续研发出众多病毒检测方法和产品。综述了目前用于新型冠状病毒检测方法的研究进展,介绍了这些检测技术的原理,阐明了其优势和限制,并例举了一些有代表性的研究成果。     

评估新冠病毒疫苗临床效力的挑战

新型冠状病毒,即严重急性呼吸综合征冠状病毒2(SARS-CoV-2)所引起的新型冠状病毒肺炎(COVID-19)在疫情暴发后已导致全球超过264万人死亡,造成了巨大的经济损失和社会动荡.有效的疫苗对于阻止发病率和死亡率进一步攀升至关重要.尽管部分国家可能会仅凭安全性和免疫原性数据来部署使用COVID-19疫苗,但疫苗的...     

ACE2与新型冠状病毒肺炎的心肾损伤

由新型冠状病毒(Severe acute respiratory syndrome coronavirus 2,SARS-CoV-2)感染引起的新型冠状病毒肺炎(Coronavirus disease 2019,COVID-19)不仅可以诱发典型的呼吸系统疾病,也能导致心肾系统等相关疾病。SARS-CoV-2的受体为血管紧张素转换酶2(Angiotensin-converting enzyme 2,ACE2)。本文通过阐述ACE2在心脏和肾脏中的作用,分析SARS-CoV-2感染引起患者心肾损伤的可能机制,为临床治疗COVID-19及研发抗SARS-CoV-2药物提供参考依据。     

天然产物来源的抗SARS-CoV-2药物研究进展

广谱高效的小分子药物是应对新型冠状病毒感染(COVID-19)及未来可能爆发疫情的重要武器。天然产物是药物先导化合物的重要来源,在抗COVID-19的药物研发中得到了广泛关注。本文综述了抗新型冠状病毒(SARS-CoV-2)药物的关键靶点和具有抗SARS-CoV-2活性的天然产物的研究进展,以期为抗SARS-CoV-2药物的研发提供参考。     

新型冠状病毒治疗靶点及药物研究进展

目的探索SARS-CoV-2的治疗靶点,治疗药物和疫苗研发的近况,为其后期的研究提供思路。方法通过检索国内外的专业数据库,对SARS-CoV-2的最新文献进行解读,获取相关数据。结果目前研究出2个抗病毒药物靶点,一个抗体和疫苗的靶点及一个开发检测试剂的靶点,可能的有效药物和疫苗也已经开始临床研究。结论目前SARS-CoV-2的针对性靶点已清楚,候选药物和疫苗的疗效尚待确认。     

新型冠状病毒肺炎治疗药物研发现状

目的 探讨新型冠状病毒肺炎(简称新冠肺炎)治疗药物研发现状、成效和存在的问题,并提出改进建议。方法 以国家卫生健康委员会《新型冠状病毒肺炎诊疗方案》中药物治疗的演变为切入点,结合临床治疗现状,总结各种治疗新型冠状病毒感染药物的特点,分析新冠肺炎疫情暴发以来登记注册拟开展的药物临床试验研究情况及存在的问题。结果 对于新冠肺炎,目前尚无特效抗病毒治疗方法,国家卫生健康委员会《新型冠状病毒肺炎诊疗方案》中所推荐的药物治疗也是基于突发疫情条件下的试用建议,且需严格监控。针对新冠肺炎疫情下登记注册拟开展的药物临床试验项目整体上普遍存在立题依据、研究基础和研究条件不充分,缺乏必要的临床前试验数据和质量保证体系等问题。结论 针对新冠肺炎,药物选择都是基于既往的严重急性呼吸综合征(SARS)、中东呼吸综合征(MERS)或其他新型流感病毒的治疗经验,积极的对症支持治疗仍是治疗的关键。针对新型冠状病毒的新药研发应回归到认真做好基于药物作用靶点、作用机制的活性筛选的基础工作。     

新型冠状病毒肺炎与血管紧张素转化酶2的研究现状

自2019年底起，新型冠状病毒肺炎（Coronavirus disease 2019，COVID-19）病例席卷全球。该病毒为β属冠状病毒，基因特征与严重急性呼吸综合征冠状病毒（Severe Acute Respiratory Syndrome Coronavirus，SARS-CoV）有较高相似性，被命名为2019新型冠状病毒（2019 Novel Coronavirus，2019-nCoV）或严重急性呼吸综合征冠状病毒-2（SARS-CoV-2），主要通过棘突蛋白介导与宿主血管紧张素转化酶2（angiotensin-converting enzyme 2，ACE2）受体结合侵犯人体。ACE2与COVID-19感染密切相关，既是SARS-CoV-2感染人体的关键靶点，ACE2表达多寡也是影响COVID-19患者疾病严重程度和死亡率的重要因素。因此靶向ACE2和肾素-血管紧张素系统（renin-angiotensin system，RAS）的诸多上市药物和在研药物，如血管紧张素转化酶抑制剂（angiotensin-converting enzyme inhibitor，ACEI）、血管紧张素受体拮抗剂（angiotensin receptor blocker，ARB）、重组人ACE2、Ⅱ型跨膜丝氨酸蛋白酶（type II transmembrane serine proteases，TMSPSS2）抑制剂、特异性中和抗体等都有可能成为治疗COVID-19的可行策略。此外，依据现有证据并不建议合并高血压的轻症COVID-19确诊病例或疑似病例轻易停用ACEI/ARB，以免造成血压波动。     

Neutralization of SARS-CoV-2 pseudovirus using ACE2-engineered extracellular vesicles

The spread of coronavirus disease 2019 (COVID-19) throughout the world has resulted in stressful healthcare burdens and global health crises. Developing an effective measure to protect people from infection is an urgent need. The blockage of interaction between angiotensin-converting enzyme 2 (ACE2) and S protein is considered an essential target for anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) drugs. A full-length ACE2 protein could be a potential drug to block early entry of SARS-CoV-2 into host cells. In this study, a therapeutic strategy was developed by using extracellular vesicles (EVs) with decoy receptor ACE2 for neutralization of SARS-CoV-2. The EVs embedded with engineered ACE2 (EVs-ACE2) were prepared; the EVs-ACE2 were derived from an engineered cell line with stable ACE2 expression. The potential effect of the EVs-ACE2 on anti-SARS-CoV-2 was demonstrated by both in vitro and in vivo neutralization experiments using the pseudovirus with the S protein (S-pseudovirus). EVs-ACE2 can inhibit the infection of S-pseudovirus in various cells, and importantly, the mice treated with intranasal administration of EVs-ACE2 can suppress the entry of S-pseudovirus into the mucosal epithelium. Therefore, the intranasal EVs-ACE2 could be a preventive medicine to protect from SARS-CoV-2 infection. This EVs-based strategy offers a potential route to COVID-19 drug development.     

Difference in the lipid nanoparticle technology employed in three approved siRNA (Patisiran) and mRNA (COVID-19 vaccine) drugs

Nucleic acid therapeutics are developing into precise medicines that can manipulate specific genes. However, the development of safe and effective delivery system for the target cells has remained a challenge. Lipid nanoparticles (LNPs) have provided a revolutionary delivery system that can ensure multiple clinical translation of RNA-based candidates. In 2018, Patisiran (Onpattro) was first approved as an LNP-based siRNA drug. In 2020, during the coronavirus disease 2019 (COVID-19) outbreak, LNPs have enabled the development of two SARS-CoV-2 mRNA vaccines, Tozinameran (Comirnaty or Pfizer-BioNTech COVID-19 vaccine) and Elasomeran (Spikevax or COVID-19 vaccine Moderna) for conditional approval. Here, we reviewed the state-of-the-art LNP technology employed in three approved drugs (one siRNA-based and two mRNA-based drugs) and discussed the differences in their mode of action, formulation design, and biodistribution.     

COVID-19 treatment by repurposing drugs until the vaccine is in sight

Corona virus disease (COVID-19) has created pandemic in the world as declared by WHO on March 12, 2020. It is a viral disease caused by SARS-CoV 2 virus and has affected large populations in over 120 countries. There is no specific treatment available and management is empirical. Until such time that an effective vaccine is available for COVID-19 viral infection, one can repurpose known therapeutic drug molecules such as angiotensin receptor 2 blocker, a commonly used antihypertensive drug, to control COVID-19 virus from gaining entry into the host cell by blocking the angiotensin receptor. Clinical trials should also be undertaken to use statins, which are lipid-lowering drugs but have anti-inflammatory and immunomodulatory properties to prevent acute lung injury in COVID-19 infection.     

血管紧张素转换酶抑制剂/血管紧张素受体拮抗剂在新型冠状病毒肺炎疫情防控中的应用分析

根据《中国心血管病报告》,中国现患心血管病人数约2.9亿,而大量循证医学证据证实了血管紧张素转换酶抑制剂(ACEI)或血管紧张素受体拮抗剂(ARB)治疗心血管等疾病的价值.ACEI/ARB是肾素-血管紧张素-醛固酮系统(RAAS)的阻滞剂,可上调血管紧张素转换酶2(ACE2)表达水平.而ACE2是新型冠状病毒肺炎(CO...     

The concern about ACE/ARB and COVID-19: Time to hold your horses!

Concern about coronavirus 2019 (COVID-19) morbidity and mortality has drawn attention to the potential role of angiotensin-converting enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) because the SARS-CoV-2 uses the ACE2 receptor as its point of entry into the body. It is not clear if and to what degree the SARS-CoV-2 virus affects the renin-angoiotensin system. Early studies from China which speculated on the role of ACE inhibition and ARBs did not evaluate the drug regimens. A vast body of evidence supports the use of ACE inhibitors and ARBs in hypertensive patients and patients with heart failure, and very little evidence has been acquired about their role in COVID-19. There is good evidence in support of the use of ACE inhibitors and ARBs in indicated patients with hypertension and heart failure, and clinicians should be reticent about abruptly withdrawing these drugs based on a paucity of evidence.     

Baricitinib,a drug with potential effect to prevent SARS-COV-2 from entering target cells and control cytokine storm induced by COVID-19

In December 2019, a novel coronavirus pneumonia (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) suddenly broke out in China and rapidly spread all over the world. Recently, a cell surface protein, known as angiotensin-converting enzyme II (ACE2), has been identified to be involved in receptor-mediated endocytosis for SARS-CoV-2 entry to the cells. Many studies have reported the clinical characteristics of COVID-19: sudden deterioration of disease around 1–2 weeks after onset; much lower level of lymphocytes, especially natural killer (NK) cells in peripheral blood; extremely high pro-inflammatory cytokines and C reactive protein (CRP). About 15.7% of patients develop severe pneumonia, and cytokine storm is an important factor leading to rapid disease progression. Currently, there are no specific drugs for COVID-19 and the cytokine storm it causes. Baricitinib intracellularly inhibits the proinflammatory signal of several cytokines by suppressing Janus kinase (JAK) JAK1/JAK2. It has been demonstrated clinical benefits for the patients with rheumatoid arthritis (RA), active systemic lupus erythematosus and atopic dermatitis with good efficacy and safety records. Baricitinib is expected to interrupt the passage and intracellular assembly of SARS-CoV-2 into the target cells mediated by ACE2 receptor, and treat cytokine storm caused by COVID-19. Several clinical trials are currently investigating the drug, and one of which has been completed with encouraging results. In this paper, we will elaborate the role of cytokine storm mediated by JAK-STAT pathway in severe COVID-19, the possible mechanisms of baricitinib on reducing the viral entry into the target cells and cytokine storm, the key points of pharmaceutical care based on the latest research reports, clinical trials progress and drug instruction from the US FDA, so as to provide reference for the treatment of severe COVID-19.