MERS-CoV

Molecular immune pathogenesis and diagnosis of COVID-19

Journal of Pharmaceutical Analysis
5 March 2020

Xiaowei Li, Manman Geng, Yizhao Peng, Liesu Meng, Shemin Lu

Abstract

Coronavirus disease 2019 (COVID-19) is a kind of viral pneumonia with an unusual outbreak in Wuhan, China, in December 2019, which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The emergence of SARS-CoV-2 has been marked as the third introduction of a highly pathogenic coronavirus into the human population after the severe acute respiratory syndrome coronavirus (SARS-CoV) and the Middle East respiratory syndrome coronavirus (MERS-CoV) in the twenty-first century. In this minireview, we provide a brief introduction of the general features of SARS-CoV-2 and discuss current knowledge of molecular immune pathogenesis, diagnosis and treatment of COVID-19 on the base of the present understanding of SARS-CoV and MERS-CoV infections, which may be helpful in offering novel insights and potential therapeutic targets for combating the SARS-CoV-2 infection.

Keywords

Coronavirus, SARS-CoV-2, SARS-CoV, MERS-CoV, Pathogenesis

Climate factors and incidence of Middle East respiratory syndrome coronavirus

Journal of Infection and Public Health
ARTICLE IN PRESS

Asmaa Altamimi, Anwar E. Ahmed

Abstract

Background

Our understanding of climate factors and their links to the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) outbreaks is incomplete. This study aimed to estimate the monthly incidence of MERS-CoV cases and to investigate their correlation to climate factors.

Methods

The study used aggregated monthly MERS-CoV cases that reported to the Saudi Center for Disease Prevention and Control from the Riyadh Region between November 1, 2012 and December 31, 2018. Data on the meteorological situation throughout the study period was calculated based on Google reports on the Riyadh Region (24.7136 °N, 46.6753 °E). The Poisson regression was used to estimate the incidence rate ratio (IRR) and its 95% confidence intervals (CI) for each climate factor.

Results

A total of 712 MERS-CoV cases were included in the analysis (mean age 54.2 ± 9.9 years), and more than half (404) (56.1%) MERS-CoV cases were diagnosed during a five-month period from April to August. The highest peak timing positioned in August 2015, followed by April 2014, June 2017, March 2015, and June 2016. High temperatures (IRR = 1.054, 95% CI: 1.043–1.065) and a high ultraviolet index (IRR = 1.401, 95% CI: 1.331–1.475) were correlated with a higher incidence of MERS-CoV cases. However, low relative humidity (IRR = 0.956, 95% CI: 0.948–0.964) and low wind speed (IRR = 0.945, 95% CI: 0.912–0.979) were correlated with a lower incidence of MERS-CoV cases.

Conclusion

The novel coronavirus, MERS-CoV, is influenced by climate conditions with increasing incidence between April and August. High temperature, high ultraviolet index, low wind speed, and low relative humidity are contributors to increased MERS-CoV cases. The climate factors must be evaluated in hospitals and community settings and integrated into guidelines to serve as source of control measures to prevent and eliminate the risk of infection.

Keywords

Weather conditions, Meteorological factors, MERS-CoV

Some One Health based control strategies for the Middle East respiratory syndrome coronavirus

One Health
Volume 8, December 2019, 100102

Maged Gomaa Hemida, Abdelmohsen Alnaeem

Abstract

The Middle East respiratory syndrome coronavirus (MERS-CoV) presents an ideal example for developing One Health concepts. Dromedary camels are the principal reservoir for the virus. Infected camels shed the virus in body secretions, particularly nasal discharges. MERS-CoV has the potential to remain active in the environment for some time under optimum conditions of temperature and humidity. This shedding sustains the virus in endemic communities and thus contact with camels is considered a major risk factor for human infection. Reducing virus shedding from camels will have a great positive impact on reducing the human risk of infection. Our main objective is to highlight the potential aspects of reducing virus shedding from camels to the environment, thereby reducing the possibility of human infection. We will focus on the potential roles of camel markets, camel shows, importation, transportation and grazing in the amplification and shedding of the virus, providing some novel concepts for the control approaches for the MERS-CoV.

Keywords

MERS-CoV, One Health, Dromedary camel, Human, Transmission, Shedding

A high-throughput inhibition assay to study MERS-CoV antibody interactions using image cytometry

Journal of Virological Methods
Volume 265, March 2019, Pages 77-83

Osnat Rosen, Leo Li-Ying Chan, Olubukola M. Abiona, Portia Gough, Lingshu Wang, Wei Shi, Yi Zhang, Nianshuang Wang, Wing-Pui Kong, Jason S. McLellan, Barney S. Graham, Kizzmekia S. Corbett

Abstract

The emergence of new pathogens, such as Middle East respiratory syndrome coronavirus (MERS-CoV), poses serious challenges to global public health and highlights the urgent need for methods to rapidly identify and characterize potential therapeutic or prevention options, such as neutralizing antibodies. Spike (S) proteins are present on the surface of MERS-CoV virions and mediate viral entry. S is the primary target for MERS-CoV vaccine and antibody development, and it has become increasingly important to understand MERS-CoV antibody binding specificity and function. Commonly used serological methods like ELISA, biolayer interferometry, and flow cytometry are informative, but limited. Here, we demonstrate a high-throughput protein binding inhibition assay using image cytometry. The image cytometry-based high-throughput screening method was developed by selecting a cell type with high DPP4 expression and defining optimal seeding density and protein binding conditions. The ability of monoclonal antibodies to inhibit MERS-CoV S binding was then tested. Binding inhibition results were comparable with those described in previous literature for MERS-CoV spike monomer and showed similar patterns as neutralization results. The coefficient of variation (CV) of our cell-based assay was <10%. The proposed image cytometry method provides an efficient approach for characterizing potential therapeutic antibodies for combating MERS-CoV that compares favorably with current methods. The ability to rapidly determine direct antibody binding to host cells in a high-throughput manner can be applied to study other pathogen-antibody interactions and thus can impact future research on viral pathogens.

Keywords

MERS-CoV, Antibody binding, Inhibition assay, Antibody neutralization, Image cytometry, Celigo

Adaptive evolution influences the infectious dose of MERS-CoV necessary to achieve severe respiratory disease

Virology
Volume 517, April 2018, Pages 98-107

Madeline G. Douglas, Jacob F. Kocher, Trevor Scobey, Ralph S. Baric, Adam S. Cockrell

Abstract

We recently established a mouse model (288–330+/+) that developed acute respiratory disease resembling human pathology following infection with a high dose (5 × 106 PFU) of mouse-adapted MERS-CoV (icMERSma1). Although this high dose conferred fatal respiratory disease in mice, achieving similar pathology at lower viral doses may more closely reflect naturally acquired infections. Through continued adaptive evolution of icMERSma1 we generated a novel mouse-adapted MERS-CoV (maM35c4) capable of achieving severe respiratory disease at doses between 103 and 105 PFU. Novel mutations were identified in the maM35c4 genome that may be responsible for eliciting etiologies of acute respiratory distress syndrome at 10–1000 fold lower viral doses. Importantly, comparative genetics of the two mouse-adapted MERS strains allowed us to identify specific mutations that remained fixed through an additional 20 cycles of adaptive evolution. Our data indicate that the extent of MERS-CoV adaptation determines the minimal infectious dose required to achieve severe respiratory disease.

Keywords

Coronavirus, MERS-CoV, Middle East respiratory syndrome, Respiratory disease, Acute respiratory distress syndrome, Spike protein

Current treatment options and the role of peptides as potential therapeutic components for Middle East Respiratory Syndrome (MERS): A review

Journal of Infection and Public Health
Volume 11, Issue 1, January–February 2018, Pages 9-17

Sabeena Mustafa, Hanan Balkhy, Musa N. Gabere

Abstract

Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is a highly pathogenic respiratory virus with mechanisms that may be driven by innate immune responses. Despite the effort of scientific studies related to this virus, Middle East Respiratory Syndrome (MERS) is still a public health concern. MERS-CoV infection has a high mortality rate, and to date, no therapeutic or vaccine has been discovered, that is effective in treating or preventing the disease. In this review, we summarize our understanding of the molecular and biological events of compounds acting as MERS-CoV inhibitors, the outcomes of existing therapeutic options and the various drugs undergoing clinical trials. Currently, several therapeutic options have been employed, such as convalescent plasma (CP), intravenous immunoglobulin (IVIG), monoclonal antibodies and repurposing of existing clinically approved drugs. However, these therapeutic options have drawbacks, thus the need for an alternative approach. The requirement for effective therapeutic treatment has brought the necessity for additional MERS treatments. We suggest that antimicrobial peptides (AMPs) may be used as alternative therapeutic agents against MERS-CoV infection. In addition, we propose the feasibility of developing effective agents by repurposing the existing and clinically approved anti-coronavirus and anti-viral peptide drugs.

Keywords

MERS-CoV, Ribavirin, Interferon, Peptide therapeutics, Convalescent plasma, Intravenous immunoglobin, Antimicrobial peptides


Dynamics of scientific publications on the MERS-CoV outbreaks in Saudi Arabia

Journal of Infection and Public Health
Volume 10, Issue 6, November–December 2017, Pages 702-710

Ali A. Rabaan, Shamsah H. Al-Ahmed, Ali M.Bazzi, and Jaffar A. Al-Tawfiq

Abstract

Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is an emerging disease with a relatively high case fatality rate. Most cases have been reported from Saudi Arabia, and the disease epidemic potential is considered to be limited. However, human–human transmission has occurred, usually in the context of healthcare facility-associated outbreaks. The scientific and medical community depends on timely publication of epidemiological information on emerging diseases during outbreaks to appropriately target public health responses. In this review, we considered the academic response to four MERS CoV outbreaks that occurred in Al-Hasa in 2013, Jeddah in 2014 and Riyadh in 2014 and 2015. We analysed 68 relevant epidemiology articles. For articles for which submission dates were available, six articles were submitted during the course of an outbreak. One article was published within a month of the Al-Hasa outbreak, and one each was accepted during the Jeddah and Riyadh outbreaks. MERS-CoV epidemiology articles were cited more frequently than articles on other subjects in the same journal issues. Thus, most epidemiology articles on MERS-CoV were published with no preferential advantage over other articles. Collaboration of the research community and the scientific publishing industry is needed to facilitate timely publication of emerging infectious diseases.

Keywords

Middle East Respiratory Syndrome Coronavirus, Outbreak, Epidemiology, Publication, Saudi Arabia, MERS-CoV

MERS-CoV infection: Mind the public knowledge gap

Journal of Infection and Public Health
Volume 11, Issue 1, January–February 2018, Pages 89-93

Amen Bawazir, Eman Al-Mazroo, Hoda Jradi, Anwar Ahmed, and Motasim Badria

Abstract

In August 2015, the Corona outbreak caused by Middle East respiratory syndrome coronavirus (MERS-CoV) was the 9th episode since June 2012 in Saudi Arabia. Little is known about the public awareness toward the nature or prevention of the disease. The aim of this work was to assess the knowledge of the adult population in Riyadh toward the MERS-CoV.

In this cross-sectional survey, a self-administrated questionnaire was distributed to randomly selected participants visiting malls in Riyadh. The questionnaire contained measurable epidemiological and clinical MERS-CoV knowledge level variables and relevant source of information.

The study included 676 participants. Mean age was 32.5 (±SD 8.6) years and 353 (47.8%) were males. Almost all participants heard about the corona disease and causative agent. The study showed a fair overall knowledge (66.0%), less knowledge on epidemiological features of the disease (58.3%), and good knowledge (90.7%) on the clinical manifestation of the MERS-CoV. Internet was the major (89.0%) source of disease information, and other sources including health care providers, SMS, television, magazines and books were low rated (all <25%). In a multivariate logistic regression analysis age ≤30 years (Odds Ratio (OR) = 1.647, 95%CI 1.048–2.584, P = 0.030), male gender (OR = 1.536, 95%CI 1.105–2.134, P = 0.01), and no tertiary education (OR = 1.957, 95%CI 1.264–3.030, P = 0.003) were independent significant predictors of poor epidemiological knowledge.

This study concludes that there was inadequate epidemiological knowledge received by the public and the reliance mostly on the clinical manifestations to recognizing the MERS-CoV disease. Comprehensive public health education programs is important to increase awareness of simple epidemiological determinants of the disease is warranted.

Keywords

Corona virus, Attitude, Riyadh, Saudi Arabia, MERS-CoV

T-cell immunity of SARS-CoV: Implications for vaccine development against MERS-CoV

Antiviral Research
Volume 137, January 2017, Pages 82-92

William J .Liu, Min Zhao,Kefang Liu, Kun Xud, Gary Wong, Wenjie Tan, George F. Gao

Abstract

Over 12 years have elapsed since severe acute respiratory syndrome (SARS) triggered the first global alert for coronavirus infections. Virus transmission in humans was quickly halted by public health measures and human infections of SARS coronavirus (SARS-CoV) have not been observed since. However, other coronaviruses still pose a continuous threat to human health, as exemplified by the recent emergence of Middle East respiratory syndrome (MERS) in humans. The work on SARS-CoV widens our knowledge on the epidemiology, pathophysiology and immunology of coronaviruses and may shed light on MERS coronavirus (MERS-CoV). It has been confirmed that T-cell immunity plays an important role in recovery from SARS-CoV infection. Herein, we summarize T-cell immunological studies of SARS-CoV and discuss the potential cross-reactivity of the SARS-CoV-specific immunity against MERS-CoV, which may provide useful recommendations for the development of broad-spectrum vaccines against coronavirus infections.

Keywords

SARS-CoV, MERS-CoV, Vaccine, T-cell, Epitope, Cross-reactivity

Use of the Human Coronavirus 2012 (MERS) GeneSig kit for MERS-CoV detection

Gene Reports
Volume 4, September 2016, Pages 67-69

Rouba Hoteit, Dina Shammaa, Rami Mahfouz

Abstract

Introduction

Mortality due to MERS-CoV infection is common especially among immunocompromised patients. The pathogenesis and the transmission mode of this virus are still not well understood. The name of the virus is derived from the area of its appearance and the genomic sequence that was used in the development of qRT-PCR assays for MERS-CoV detection was retrieved from the first detected case isolate. The employed assays target various regions including the area upstream of the envelope gene (upE) that is used for screening and the open reading frames (ORF) 1a and 1b used for confirmation.

Aim

This study assesses the use of a MERS-CoV specific assay for screening of respiratory samples in anticipation of the possible spread of the virus in the region.

Methods

46 respiratory specimens were tested using the qualitative one-step qRT-PCR GeneSig Human Coronavirus 2012 (MERS) kit (PrimerDesign™).

Results

Out of the 46 tested samples, 45 were negative for MERS-CoV and one sample was found MERS-CoV positive.

Conclusion

The GeneSig Human Coronavirus 2012 (MERS) kit is very useful for the screening of suspected respiratory cases in the Middle East area as well as other regions.

Keywords

MERS-CoV, Lebanon, GeneSig kit


MERS-CoV spike protein: Targets for vaccines and therapeutics

Antiviral Research
Volume 133, September 2016, Pages 165-177

Qihui Wang, Gary Wong, Guangwen Lu, Jinghua Yan, George F. Gao

Abstract

The disease outbreak caused by Middle East respiratory syndrome coronavirus (MERS-CoV) is still ongoing in the Middle East. Over 1700 people have been infected since it was first reported in September 2012. Despite great efforts, licensed vaccines or therapeutics against MERS-CoV remain unavailable. The MERS-CoV spike (S) protein is an important viral antigen known to mediate host-receptor binding and virus entry, as well as induce robust humoral and cell-mediated responses in humans during infection. In this review, we highlight the importance of the S protein in the MERS-CoV life cycle, summarize recent advances in the development of vaccines and therapeutics based on the S protein, and discuss strategies that can be explored to develop new medical countermeasures against MERS-CoV.

Keywords

Coronavirus, MERS-CoV, Spike protein, Vaccines, Therapeutics, Animal models

Identification, synthesis and evaluation of SARS-CoV and MERS-CoV 3C-like protease inhibitors

Bioorganic & Medicinal Chemistry
Volume 24, Issue 13, 1 July 2016, Pages 3035-3042

Vathan Kumar, Kian-Pin Tan, Ying-Ming Wang, Sheng-Wei Lin, Po-Huang Liang

Abstract

Severe acute respiratory syndrome (SARS) led to a life-threatening form of atypical pneumonia in late 2002. Following that, Middle East Respiratory Syndrome (MERS-CoV) has recently emerged, killing about 36% of patients infected globally, mainly in Saudi Arabia and South Korea. Based on a scaffold we reported for inhibiting neuraminidase (NA), we synthesized the analogues and identified compounds with low micromolar inhibitory activity against 3CLpro of SARS-CoV and MERS-CoV. Docking studies show that a carboxylate present at either R1 or R4 destabilizes the oxyanion hole in the 3CLpro. Interestingly, 3f, 3g and 3m could inhibit both NA and 3CLpro and serve as a starting point to develop broad-spectrum antiviral agents.

Keywords

MERS-CoV, SARS-Cov, 3CLpro, Coronavirus, Pyrazolone

MERS-CoV: Middle East respiratory syndrome corona virus: Can radiology be of help? Initial single center experience

The Egyptian Journal of Radiology and Nuclear Medicine
Volume 47, Issue 1, March 2016, Pages 95-106

Ahmed Hamimi

Abstract

Human infection with a novel coronavirus named Middle East respiratory syndrome coronavirus (MERS-CoV) was first identified in Saudi Arabia and the Middle East in September, 2012. The aim of this study was to establish the most pathognomonic radiological sign(s) to diagnose MERS CoV.

Patients and methods

This is a retrospective descriptive study. All patients were subjected to serial X-ray. High resolution non-contrast CT chest was also obtained for 10 patients. The scans were reviewed for findings including consolidation, ground-glass opacities, nodules, reticular opacities and hilar and mediastinal adenopathy.

Results

A total of 12 patients were included in our study with prevalence of males (2:1) with ages ranging between 18 and 76 years having an average age of 36 ± 2 years. The outcome of these patients was as follows: 6 were treated with average hospital stay ranging between 21 and 35 days, one case died after 14 days, and 5 cases were transferred to Central Governmental hospital according the local authority rules.

Conclusions

MERS CoV virus may have a specific pattern in chest X-ray and CT developing a single or multiple opacities progressing into a widespread multifocal bilateral patches of ground glass opacities or confluent consolidation resembling organizing pneumonia.

Keywords

MERS-CoV, CT, Chest X-ray, Ground glass, Organizing pneumonia

Bat-to-human: spike features determining ‘host jump’ of coronaviruses SARS-CoV, MERS-CoV, and beyond

Trends in Microbiology
Volume 23, Issue 8, August 2015, Pages 468-478

Guangwen Lu, Qihui Wang, George F. Gao

Abstract

Both severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV) are zoonotic pathogens that crossed the species barriers to infect humans. The mechanism of viral interspecies transmission is an important scientific question to be addressed. These coronaviruses contain a surface-located spike (S) protein that initiates infection by mediating receptor-recognition and membrane fusion and is therefore a key factor in host specificity. In addition, the S protein needs to be cleaved by host proteases before executing fusion, making these proteases a second determinant of coronavirus interspecies infection. Here, we summarize the progress made in the past decade in understanding the cross-species transmission of SARS-CoV and MERS-CoV by focusing on the features of the S protein, its receptor-binding characteristics, and the cleavage process involved in priming.

Keywords

coronavirus, interspecies transmission, viral and host determinants, spike (S), SARS-CoV, MERS-CoV

Middle East Respiratory Syndrome Coronavirus “MERS-CoV”: Current Knowledge Gaps

Paediatric Respiratory Reviews
Volume 16, Issue 3, June 2015, Pages 197-202

G. R. Banik, G. Khandaker, H. Rashid

Abstract

The Middle East respiratory syndrome coronavirus (MERS-CoV) that causes a severe lower respiratory tract infection in humans is now considered a pandemic threat to the Gulf region. Since its discovery in 2012, MERS-CoV has reached 23 countries affecting about 1100 people, including a dozen children, and claiming over 400 lives. Compared to SARS (severe acute respiratory syndrome), MERS-CoV appears to kill more people (40% versus 10%), more quickly, and is especially more severe in those with pre-existing medical conditions. Most MERS-CoV cases (>85%) reported thus far have a history of residence in, or travel to the Middle East. The current epidemiology is characterised by slow and sustained transmission with occasional sparks. The dromedary camel is the intermediate host of MERS-CoV, but the transmission cycle is not fully understood. In this current review, we have briefly summarised the latest information on the epidemiology, clinical features, diagnosis, treatment and prevention of MERS-CoV especially highlighting the knowledge gaps in its transmission dynamics, diagnosis and preventive strategy.

Keywords

Dromedary, MERS-CoV, Middle East, Respiratory tract infection, SARS, Transmission chain

Development of animal models against emerging coronaviruses: From SARS to MERS coronavirus

Virology
Volumes 479–480, May 2015, Pages 247-258

Troy C. Sutton, Kanta Subbarao

Abstract

Two novel coronaviruses have emerged to cause severe disease in humans. While bats may be the primary reservoir for both viruses, SARS coronavirus (SARS-CoV) likely crossed into humans from civets in China, and MERS coronavirus (MERS-CoV) has been transmitted from camels in the Middle East. Unlike SARS-CoV that resolved within a year, continued introductions of MERS-CoV present an on-going public health threat. Animal models are needed to evaluate countermeasures against emerging viruses. With SARS-CoV, several animal species were permissive to infection. In contrast, most laboratory animals are refractory or only semi-permissive to infection with MERS-CoV. This host-range restriction is largely determined by sequence heterogeneity in the MERS-CoV receptor. We describe animal models developed to study coronaviruses, with a focus on host-range restriction at the level of the viral receptor and discuss approaches to consider in developing a model to evaluate countermeasures against MERS-CoV.

Keywords

Coronaviruses, SARS-CoV, MERS-CoV, Animal models, Receptor

Receptor-binding domain-based subunit vaccines against MERS-CoV

Virus Research
Volume 202, 16 April 2015, Pages 151-159

Naru Zhang, Jian Tang, Lu Lu, Shibo Jiang, Lanying Du

Abstract

Development of effective vaccines, in particular, subunit-based vaccines, against emerging Middle East respiratory syndrome (MERS) caused by the MERS coronavirus (MERS-CoV) will provide the safest means of preventing the continuous spread of MERS in humans and camels. This review briefly describes the structure of the MERS-CoV spike (S) protein and its receptor-binding domain (RBD), discusses the current status of MERS vaccine development and illustrates the strategies used to develop RBD-based subunit vaccines against MERS. It also summarizes currently available animal models for MERS-CoV and proposes a future direction for MERS vaccines. Taken together, this review will assist researchers working to develop effective and safe subunit vaccines against MERS-CoV and any other emerging coronaviruses that might cause future pandemics.

Keywords

Middle East respiratory syndrome coronavirus, MERS-CoV, Receptor-binding domain, Subunit vaccines

Development of human neutralizing monoclonal antibodies for prevention and therapy of MERS-CoV infections

Microbes and Infection
Volume 17, Issue 2, February 2015, Pages 142-148

Tianlei Ying, Haoyang Li, Lu Lu, Dimiter S. Dimitrov, Shibo Jiang

Abstract

The recent Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak poses a serious threat to public health. Here, we summarize recent advances in identifying human neutralizing monoclonal antibodies (mAbs) against MERS-CoV, describe their mechanisms of action, and analyze their potential for treatment of MERS-CoV infections.

Keywords

Coronavirus, MERS-CoV, mAbs, Receptor binding domain (RBD)

Middle East respiratory syndrome coronavirus (MERS-CoV) entry inhibitors targeting spike protein

Virus Research
Volume 194, 19 December 2014, Pages 200-210

Shuai Xia, Qi Liu, Qian Wang, Zhiwu Sun, Shan Su, Lanying Du, Tianlei Ying, Lu Lu, Shibo Jiang

Abstract

The recent outbreak of Middle East respiratory syndrome (MERS) coronavirus (MERS-CoV) infection has led to more than 800 laboratory-confirmed MERS cases with a high case fatality rate (∼35%), posing a serious threat to global public health and calling for the development of effective and safe therapeutic and prophylactic strategies to treat and prevent MERS-CoV infection. Here we discuss the most recent studies on the structure of the MERS-CoV spike protein and its role in virus binding and entry, and the development of MERS-CoV entry/fusion inhibitors targeting the S1 subunit, particularly the receptor-binding domain (RBD), and the S2 subunit, especially the HR1 region, of the MERS-CoV spike protein. We then look ahead to future applications of these viral entry/fusion inhibitors, either alone or in combination with specific and nonspecific MERS-CoV replication inhibitors, for the treatment and prevention of MERS-CoV infection.

Keywords

Middle East respiratory syndrome coronavirus, MERS-CoV, Receptor-binding domain, Fusion inhibitor, Entry inhibitor, Six-helix bundle