Developing therapeutic approaches for twenty-first-century emerging infectious viral diseases

• Published in: Nature medicine Vol. 27; no. 3; pp. 401 - 410
• Main Authors: Meganck, Rita M., Baric, Ralph S.
• Format: Journal Article
• Language: English
• Published: New York Nature Publishing Group US 01-03-2021; Nature Publishing Group
• Subjects: 631/154; 692/308/174; 692/699/255; Antibodies; Antiviral agents; Antiviral Agents - therapeutic use; Biomedical and Life Sciences; Biomedicine; Cancer Research; Communicable Diseases, Emerging - therapy; Computer viruses; Control; Coronaviruses; COVID-19; COVID-19 - epidemiology; COVID-19 Drug Treatment; Drug Development - methods; Drug Development - trends; Drug Repositioning; Drug resistance; Drug therapy; Drugs; Epidemics; History, 21st Century; Humans; Immunosuppressive agents; Infectious Diseases; Inventions - trends; Metabolic Diseases; Molecular Medicine; Neurosciences; Outbreaks; Pandemics; Pharmaceutical research; Review Article; SARS-CoV-2; Therapies, Investigational - methods; Therapies, Investigational - trends; Viral diseases; Virus diseases; Virus Diseases - therapy; United States
• ISSN: 1078-8956; 1546-170X
• DOI: 10.1038/s41591-021-01282-0

The twenty-first century has already recorded more than ten major epidemic or pandemic virus emergence events, including the ongoing and devastating coronavirus disease 2019 (COVID-19) pandemic. As viral disease emergence is expected to accelerate, these data dictate a need for proactive approaches to develop broadly active family-specific and cross-family therapeutics for use in future disease outbreaks. Emphasis should focus not only on the development of broad-spectrum small-molecule and antibody direct-acting antivirals, but also on host-factor therapeutics, including repurposing previously approved or in-pipeline drugs. Another new class of therapeutics with great antiviral therapeutic potential is RNA-based therapeutics. Rather than only focusing on known risks, dedicated efforts must be made toward pre-emptive research focused on outbreak-prone virus families, ultimately offering a strategy to shorten the gap between outbreak and response. Emphasis should also focus on orally available drugs for outpatient use, if possible, and on identifying combination therapies that combat viral and immune-mediated pathologies, extend the effectiveness of therapeutic windows and reduce drug resistance. While such an undertaking will require new vision, dedicated funding and private, federal and academic partnerships, this approach offers hope that global populations need never experience future pandemics such as COVID-19.
As the emergence of viral diseases is expected to accelerate, proactive programs to develop broadly active family-specific and cross-family antiviral therapeutics will be key to prepare for future disease outbreaks.