COVID-19 future or investigational therapies

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Future or Investigational Therapies

Immune Targets

• The B cell and T cell epitopes derived from the spike (S) and nucleocapsid (N) proteins are currently under investigation as immune targets for development of vaccine.
• Phylogenetic similarity between SARS-CoV and COVID-19 at the level of structural proteins S, E, M, and N is providing guidance for development of a possible vaccine.

Prior Work

The following table depicts major vaccine products that have been developed against SARS-CoV and MERS-CoV:

Vaccine Base	Antigen	Clinical Testing	Pros	Cons
DNA	Spike protein S1	Phase I, II (NCT03721718)	Reduced production time Easy design and manipulation Stimulates B and T cells responses
Viral Vector	Spike protein S1; Chimpanzee adenovirus vector, Modified Vaccinia Ankara
Conjugated subunit	Spike protein S1 Receptor binding domain Nucleocapsid Membrane protein Envelope protein Delta Inulin Adjuvant and/or fusion with Fc
Virion	Spike protein S1 Receptor binding domain Membrane protein Envelope protein Prepared in baculovirus
Inactivated	Whole virus Formaldehyde or gamma irradiation inactivation
Live attenuated	Mutant MERS-CoV and SARS-CoV or recombination with other live attenuated virus