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2019冠状病毒病抗病毒治疗的心血管不良反应:证据与可能机制

Cardiovascular adverse effects of antiviral therapies for COVID-19: Evidence and plausible mechanisms.

作者信息

Chen Eileen, Xi Lei

机构信息

Virginia Commonwealth University School of Medicine (M.D. Class 2027), Richmond, VA, 23298, USA.

Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, 23298-0204, USA.

出版信息

Acta Pharmacol Sin. 2025 Mar;46(3):554-564. doi: 10.1038/s41401-024-01382-w. Epub 2024 Sep 9.

Abstract

Antiviral therapeutics have made a critical contribution in mitigating the symptoms and clinical outcomes of the coronavirus disease of 2019 (COVID-19), in which a single-stranded RNA viral pathogen, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causes multi-organ injuries. Several antivirals were widely prescribed to treat COVID-19, either through the emergency use authorization (EUA) by the governmental regulatory agencies (i.e., remdesivir, paxlovid, molnupiravir, and the SARS-CoV-2-targeted monoclonal antibodies - tixagevimab and cilgavimab), as well as the repurposed use of the existing antiviral or antimalarial drugs (e.g., hydroxychloroquine, chloroquine, and ivermectin). Despite their efficacy in ameliorating COVID-19 symptoms, some adverse side-effects of the antivirals were also reported during the COVID-19 pandemic. Our current review has aimed to gather and extrapolate the recently published information concerning cardiovascular adverse effects caused by each of the antivirals. We also provide further discussion on the potential cellular mechanisms underlying the cardiovascular adverse effects of the selected antiviral drugs, which should be carefully considered when evaluating risk factors in managing patients with COVID-19 or similar infectious diseases. It is foreseeable that future antiviral drug development assisted with the newest artificial intelligence platform may improve the accuracy to predict the structures of biomolecules of antivirals and therefore to mitigate their associated cardiovascular adversities.

摘要

抗病毒疗法在减轻2019冠状病毒病(COVID-19)的症状和临床结局方面发挥了关键作用,该病由单链RNA病毒病原体严重急性呼吸综合征冠状病毒2(SARS-CoV-2)引起多器官损伤。几种抗病毒药物被广泛用于治疗COVID-19,要么是通过政府监管机构的紧急使用授权(EUA)(即瑞德西韦、帕罗韦德、莫努匹拉韦以及靶向SARS-CoV-2的单克隆抗体——替沙格韦单抗和西加韦单抗),以及现有抗病毒或抗疟疾药物的重新利用(例如羟氯喹、氯喹和伊维菌素)。尽管它们在改善COVID-19症状方面有效,但在COVID-19大流行期间也报告了一些抗病毒药物的不良副作用。我们当前的综述旨在收集和推断最近发表的有关每种抗病毒药物引起的心血管不良反应的信息。我们还进一步讨论了所选抗病毒药物心血管不良反应潜在的细胞机制,在评估COVID-19或类似传染病患者管理中的风险因素时应仔细考虑这些机制。可以预见,未来借助最新人工智能平台的抗病毒药物研发可能会提高预测抗病毒药物生物分子结构的准确性,从而减轻其相关的心血管不良反应。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9446/11845466/27bb3bae5a60/41401_2024_1382_Fig1_HTML.jpg

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