As the international race for a viable vaccine or treatment rages on, all number of Covid-19 prevention strategies have been proposed in the meantime, some wiser than others (looking at you Trump). One of the more unorthox (yet undoubtedly still wiser than the President’s) suggests a long-term drug cocktail for our older population.
Since its emergence in Wuhan, back in December, it quickly became apparent that the novel coronavirus disproportionately affects and kills those over 60 years of age. And whilst we’re seeing progress daily in drug and vaccine development, it’s quite likely that these treatments will be less effective in the patient populations that need them most. The reason being that immunosenescene, or age-associated immune deterioration, plays a major role in both disease severity and vaccination response. This leaves over one billion people vulnerable to a return of the virus.
In a review article published in the journal, Aging, CEO of Insilico Medicine, Alex Zhavoronkov, proposes that we consider Covid-19 a gerolavic disease (from the Greek, géros meaning “old man” and epilavís, “harmful”) and pursue further study of geroprotective therapies to reduce the burden of this, and potentially future coronavirus outbreaks.
Zhavoronkov discusses speculative geroprotective strategies including administration of rapalogs (rapamycin derivates), NAD+ boosters, senolytics and stem cell treatments, that in albeit, very limited literature showed a reduction in viral burden of other gerolavic infections. He goes on to advocate that clinical trials and meta-analysis should be conducted to investigate the use of these treatments either in isolation or as adjuvant therapies with vaccines and antivirals.
The most promising of these potential geroprotectors is Sirolimus (rapamycin), shown to slow ageing in many species including mice, and delay age-related disease in humans. The immunostimulatory effects of the rapalog, everolimus, have previously been demonstrated in patients administered influenza vaccine, where a 20% enhancement in immune response was recorded under well tolerated doses.
Dr Zhavoronkov here suggests a weekly low-dose rapamycin, in combination with metformin and other relatively cheap and already confirmed geroprotectors for prevention of SARS-CoV-2 infection. Additionally, he postulates that the immunomodulatory properties of rapamycin, may help to prevent Covid-19 induced lung damage and therefore serve secondarily as an effective treatment option.
Zhavoronkov who also sits as chief scientist of the Biogenerontology Research Foundation, the UK’s leading non-profit longevity and ageing research body, has an impressive publishing record of late. In this review he cites the topic of his 2019 paper; deep ageing clocks as a potential method – pending clinical validation – of measuring the efficacy of geroprotective treatments, and as biomarkers of biological age more broadly in anti-ageing clinical research.
Whilst the literature examined by Zhavorokov, makes for an interesting discussion on the use of preventative strategies for enhancing immunological resilience in our elderly populations, the author himself notes that the data is preliminary and the treatments speculative. Beyond a moral obligation to reduce the burden of age-associated diseases, economically, increasing the collective productive age would be incredibly advantageous. Though likely too late to affect the forthcoming recession resulting from this outbreak, protecting our older people prior to the next pandemic could potentially be the way to help us out of it financially.