2019-nCoV: Yes, of course "host-directed therapies" should be a priority!
Updated: Feb 26, 2020
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Reducing mortality from 2019-nCoV: host-directed therapies should be an option (Lancet 2020 Feb): Given the current absence of 2019-nCoV-specific drugs, the authors support the repurposing of various drugs such as “metformin, glitazones, fibrates, sartans, and atorvastin, as well as nutrient supplements and biologics” to “reduce immunopathology, boost immune responses, and prevent or curb ARDS.” Regarding nutritional supplements, the authors state, “Zinc and other metal-containing formulations appear to have anti-viral activity, are safe, cheap, and readily available. These formulations could be used as adjuncts to monotherapy or as combinational therapies with cyclosporine, lopinavir–ritonavir, interferon beta‑1b, ribavirin, remdesivir, monoclonal antibodies, and anti-viral peptides targeting 2019-nCoV.”
Perspective from DrV: Of course, I found great irony in the subtitle of this article; that “host-directed therapies should be an option” is thus far the understatement of the year and should have been written more assertively as “multiple host-directed therapies should be the foundation for this infectious disease that otherwise has no specific treatment.” Whether they knew it or not, the authors were attempting to cross a great paradigmatic chasm between current medical practice which seeks a “microbe-specific intervention for each viral infection” versus treating the hosts’ physiology which is 1) responsible for the reproduction of the virus, and 2) responsible for mounting an effective and at times excessive immune/inflammatory response to the virus. Addressing host physiology should be an obvious first and foundational intervention, but instead the authors reveal the relative radicalness of such an idea. Interestingly and further, the authors note that “Interleukin 17 blockade [with drugs/biologics] might benefit those patients who have a 2019-nCoV infection and increased plasma concentration of interleukin 17,” but they make no mention of using nutrients such as vitamin D3, vitamin A, and acetylcysteine which have been shown to counteract elevations in IL-17 in various other diseases. Furthermore, note the sloppiness in the mention of “Zinc and other metal-containing formulations” which should have been more definitive as “zinc supplementation” with specific dosage recommendations and “other metal-containing formulations” should have been clarified to mention specifically selenium and to clarify that iron should be avoided except in cases of iron deficiency.
Zumla et al. Reducing mortality from 2019-nCoV: host-directed therapies should be an option. Lancet. 2020 Feb 22;395(10224):e35-e36. doi: 10.1016/S0140-6736(20)30305-6
Amani et al. Vitamin D3 Induced Decrease in IL-17 and Malondialdehyde, and Increase in IL-10 and Total Antioxidant Capacity Levels in Patients with Irritable Bowel Syndrome. Iran J Immunol. 2018 Sep;15(3):186-196. doi: 10.22034/IJI.2018.39388
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