European Journal of Cardiovascular Medicine

Since the first reports of a novel Coronavirus Disease 2019 (COVID-19), caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), emerged from the province of Wuhan, China in December 2019 [1], it has brought the entire worldwide to a standstill and impacted every single individual on the planet. In this age of globalization, as expected, the eyes of the world have been vehemently focused on the medical fraternity in hopes of a so far elusive cure. In spite of hundreds of clinical trials, anecdotal reports and off-label attempts, no therapy has proven to be effective in improving outcomes nor provide effective prophylaxis. Intense social, political and media scrutiny, along with the sheer scale of the pandemic, have presented a unique challenge to the medical and scientific fraternity to be able to develop effective remedies in an extremely limited amount of time, and at times, with limited resources as well. Unfortunately, the discovery and licensing of a nascent molecule as an effective drug involves a prolonged gestational period, creating an unacceptable lag between therapeutic need and availability. Drug repurposing, a novel approach which involves identification of new indications for pre-existing drugs, is an economic and time saving endeavor [2], allowing a drug to directly enter phase III or IV clinical trials, thereby saving billions of dollars in production cost [3]. Much like the Middle East Respiratory Syndrome virus (MERS), the SARS-CoV-2 spreads through the respiratory route; however, unlike the former which utilizes Dipeptidyl Peptidase 4 (DPP4), it utilizes Angiotensin Converting Enzyme 2 (ACE 2) as a receptor to enter cells [4,5]. Fusion, is followed by endocytosis of the virion, which is facilitated by an acidic environment, wherein comes in to play diprotic bases such as hydroxychloroquine and chloroquine [6]. Activation of the main RNA Dependent RNA Polymerase (RDRP) enzyme requires proteolysis by a viral protease. Inhibition of the latter by anti-retroviral agents such as lopinavir, ritonavir and darunavir hold therapeutic promise [6]. Agents targeting RDRP such as remdesivir, favipiravir and arbidol have demonstrated some degree of in vitro and in vivo activity against SARS-CoV-2.