Based on the genetic make-up of SARS-CoV-2, which of the following drug classes is most likely to prove effective?
a. Angiotensin converting enzyme inhibitors
b. Protease inhibitors
c. Nucleoside analogues
d. Neuraminidase inhibitors
e. Calcium channel blockers
Answer: (b). The SARS-CoV-2 RNA codes for a pair of protease enzymes that are essential to production of viable virions upon release. Since protease inhibitors have been highly effective for treating patients with infections of human immunodeficiency virus and hepatitis C virus, that is the best choice.
Use of neuraminidase inhibitors (e.g., oseltamivir, peramivir, zanamivir) is not logical, since coronaviruses do not have a gene for neuraminidase.
Nucleoside analogues (e.g., acyclovir, ganciclovir, ribavirin) would be expected to exert effects only at high levels since the coronavirus has an exonuclease that would recognize and remove the analogues when incorporated into the viral genome.
It is currently unknown as to whether angiotensin converting enzyme (ACE) inhibitors or angiotensin-2 receptor blockers (ARBs) are beneficial or harmful based on changes in the ACE2 protein involved in viral entry in lung tissue.