Ivermectin Review from June 2020
Ivermectin proposes many potentials effects to treat a range of diseases, with its antimicrobial, antiviral, and anti-cancer properties as a wonder drug. It is highly effective against many microorganisms including some viruses. In this comprehensive systematic review, antiviral effects of...
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Ivermectin: a systematic review from antiviral effects to COVID-19 complementary regimen
The Journal of Antibiotics volume 73, pages593–602(2020)
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Abstract
Ivermectin proposes many potentials effects to treat a range of diseases, with its antimicrobial, antiviral, and anti-cancer properties as a wonder drug. It is highly effective against many microorganisms including some viruses. In this comprehensive systematic review, antiviral effects of ivermectin are summarized including in vitro and in vivo studies over the past 50 years. Several studies reported antiviral effects of ivermectin on RNA viruses such as Zika, dengue, yellow fever, West Nile, Hendra, Newcastle, Venezuelan equine encephalitis, chikungunya, Semliki Forest, Sindbis, Avian influenza A, Porcine Reproductive and Respiratory Syndrome, Human immunodeficiency virus type 1, and severe acute respiratory syndrome coronavirus 2. Furthermore, there are some studies showing antiviral effects of ivermectin against DNA viruses such as Equine herpes type 1, BK polyomavirus, pseudorabies, porcine circovirus 2, and bovine herpesvirus 1. Ivermectin plays a role in several biological mechanisms, therefore it could serve as a potential candidate in the treatment of a wide range of viruses including COVID-19 as well as other types of positive-sense single-stranded RNA viruses. In vivo studies of animal models revealed a broad range of antiviral effects of ivermectin, however, clinical trials are necessary to appraise the potential efficacy of ivermectin in clinical setting.
Introduction
Ivermectin: a multifaced medication
Ivermectin has been used for several years to treat many infectious diseases in mammals. It has a good safety profile with low adverse effects when orally prescribed. Ivermectin was identified in late 1970s and first approved for animal use in 1981. Its potential use in humans was confirmed a few years later. Subsequently, William C. Campbell and Satoshi Ōmura who discovered and developed this medication received the 2015 Nobel Prize in Physiology or Medicine [
1,
2,
3].
Studies revealed that ivermectin as a broad-spectrum drug with high lipid solubility possesses numerous effects on parasites, [
1,
3] nematodes, arthropods, flavivirus, mycobacteria, and mammals through a variety of mechanisms. In addition to having antiparasitic and antiviral effects, this drug also causes immunomodulation in the host. Studies have shown its effect on inhibiting the proliferation of cancer cells, as well as regulating glucose and cholesterol in animals. Despite diverse effects of this medication, many of its underlying mechanisms are not yet known [
4]. Of note, some of these effects may be secondary to toxic effects on cells (Fig.
1).
Fig. 1
The molecular structure of avermectin, which then underwent chemical alteration to make ivermectin [
45]
Full size image
COVID-19: a global heath issue
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a single-stranded RNA virus that causes a severe acute respiratory syndrome. The virus was originally called SARS-CoV-2 named officially by World Health Organization as COVID-19 and a global health emergency. The first known case of infection was recorded in early December 2019 and subsequently spread to various continents, including Europe and the United States [
5,
6], while the actual behavior of the virus and its pathogenicity are not yet fully understood.
Although there has been a history of studies on the virus since few years ago [
7,
8], as many types of coronaviruses cause simple respiratory tract infections, but SARS-CoV-1 and MERS caused severe respiratory tract illness in infected humans. The decrease in the threat from SARS and MERS led to decreased research activities against this class of viruses which has led to a lack of preparedness for the new SARS-CoV-2 pandemic.
However, the clinical management guidelines have been revised several times and various antiviral and immunomodulatory agents have been suggested. Herbal medicines in China and other countries have been proposed with doubtful outcomes. Hundreds of clinical trials are currently underway [
9,
10]. On the other hand, several hypotheses have been proposed about the effect of cost-effective and available antibiotics [
11,
12], but the effectiveness of those medications has not yet been conclusively proven.
This novel virus has paralyzed not only the world’s health care system but also the political and economic relations [
13]. As a new chapter in human life opens up [
14], the world seems to be divided into two parts pre- and post-COVID-19 era.
Although a few medications have received Emergency Use Authorization for COVID-19 treatment, no proven treatment has been found as yet. A recent in vitro study showed that ivermectin was active against COVID-19-infected cell lines [
15].
In this study, we summarized the antiviral effects of ivermectin by reviewing available in vivo and in vitro studies over the past 50 years.
(pull the article from the above given reference if you want all the gory details)
