Current use of existing antiviral drugs for COVID-19 [56].
\\n\\n
Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\\n\\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\\n"}]',published:!0,mainMedia:{caption:"Highly Cited",originalUrl:"/media/original/117"}},components:[{type:"htmlEditorComponent",content:'IntechOpen is proud to announce that 191 of our authors have made the Clarivate™ Highly Cited Researchers List for 2020, ranking them among the top 1% most-cited.
\n\nThroughout the years, the list has named a total of 261 IntechOpen authors as Highly Cited. Of those researchers, 69 have been featured on the list multiple times.
\n\n\n\nReleased this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\n\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\n'}],latestNews:[{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"},{slug:"introducing-intechopen-book-series-a-new-publishing-format-for-oa-books-20210915",title:"Introducing IntechOpen Book Series - A New Publishing Format for OA Books"}]},book:{item:{type:"book",id:"8427",leadTitle:null,fullTitle:"Antimicrobials, Antibiotic Resistance, Antibiofilm Strategies and Activity Methods",title:"Antimicrobials, Antibiotic Resistance, Antibiofilm Strategies and Activity Methods",subtitle:null,reviewType:"peer-reviewed",abstract:"To prevent bacterial adherence, invasion and infection, antimicrobials such as antibiotics are being used and vastly researched nowdays. Several factors such as natural selection, mutations in genes, the presence of efflux pumps, impermeability of the cell wall, structural changes in enzymes and receptors, biofilm formation, and quorum sensing cause microorganisms to develop resistance against antimicrobials. Isolates that synthesize extended spectrum-β-lactamases (ESBL), induced β-lactamases (IBL), carbapenamases, metallo-β-lactamases (MBLs), and New Delhi metallo-β-lactamases (NDM) have emerged. Determining virulence factors such as biofilms and the level of antimicrobial activities of antimicrobial agents alone and in combination with appropriate doses against microorganisms is very important for the diagnosis, inhibition, and prevention of microbial infection. The goal of this book is to provide information on all these topics.",isbn:"978-1-78985-790-0",printIsbn:"978-1-78985-789-4",pdfIsbn:"978-1-83962-103-1",doi:"10.5772/intechopen.78751",price:119,priceEur:129,priceUsd:155,slug:"antimicrobials-antibiotic-resistance-antibiofilm-strategies-and-activity-methods",numberOfPages:152,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"0fdedc9bf6c23241235a0ae011c0304c",bookSignature:"Sahra Kırmusaoğlu",publishedDate:"April 3rd 2019",coverURL:"https://cdn.intechopen.com/books/images_new/8427.jpg",numberOfDownloads:21058,numberOfWosCitations:39,numberOfCrossrefCitations:35,numberOfCrossrefCitationsByBook:6,numberOfDimensionsCitations:68,numberOfDimensionsCitationsByBook:6,hasAltmetrics:1,numberOfTotalCitations:142,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"May 28th 2018",dateEndSecondStepPublish:"June 18th 2018",dateEndThirdStepPublish:"August 17th 2018",dateEndFourthStepPublish:"November 5th 2018",dateEndFifthStepPublish:"January 4th 2019",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"179460",title:"Associate Prof.",name:"Sahra",middleName:null,surname:"Kırmusaoğlu",slug:"sahra-kirmusaoglu",fullName:"Sahra Kırmusaoğlu",profilePictureURL:"https://mts.intechopen.com/storage/users/179460/images/system/179460.jpeg",biography:"Dr. Kırmusaoğlu, PhD, is an assistant professor of Microbiology\nat the Department of Molecular Biology and Genetics, T.C. Haliç\nUniversity. She specialized in Microbiology at Abant Izzet Baysal\nUniversity (Biology Department), Turkey. Her previous experience\nincludes laboratory manager at microbiology laboratories in several\nresearch and private hospitals. Throughout her career, she collaborated\nwith academicians/researchers from Abant Izzate Baysal University (AIBU), Middle East Technical University (METU), and Istanbul\nUniversity Cerrahpaşa Faculty of Medicine, and has participated in various research projects.\nDr. Kırmusaoğlu’s research interests include medical microbiology, pathogenic bacteria, bacterial biofilms, antibiofilm and antibacterial activity, bacterial drug resistance, pathogen–host interactions, pathogenesis, molecular microbiology, and microbiota. She has published several international research articles, books, book chapters, and congress proceedings.\nShe is also the editor of Disinfection, Bacterial Pathogenesis and Antibacterial Control,\nand Antimicrobials, Antibiotic Resistance, Antibiofilm Strategies and Activity Methods\npublished by IntechOpen. In addition to these, she wrote the book Genel Biyoloji Laboratuvar\nKılavuzu (General Biology Laboratory Manual) published by Hipokrat Publisher.\nShe has contributed to a chapter translation of the book Sherris Medical Microbiology\nby Ryan et al. as one of the translation authors of Sherris Tıbbi Mikrobiyoloji, which is a\nTurkish translated book edited by Prof. Dr. Dürdal Us and Prof. Dr. Ahmet Başustaoğlu.",institutionString:"Haliç University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"6",totalChapterViews:"0",totalEditedBooks:"5",institution:{name:"Haliç University",institutionURL:null,country:{name:"Turkey"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"897",title:"Pharmaceutical Microbiology",slug:"pharmaceutical-microbiology"}],chapters:[{id:"65914",title:"Introductory Chapter: The Action Mechanisms of Antibiotics and Antibiotic Resistance",doi:"10.5772/intechopen.85211",slug:"introductory-chapter-the-action-mechanisms-of-antibiotics-and-antibiotic-resistance",totalDownloads:4366,totalCrossrefCites:6,totalDimensionsCites:9,hasAltmetrics:1,abstract:null,signatures:"Sahra Kırmusaoğlu, Nesrin Gareayaghi and Bekir S. Kocazeybek",downloadPdfUrl:"/chapter/pdf-download/65914",previewPdfUrl:"/chapter/pdf-preview/65914",authors:[{id:"179460",title:"Associate Prof.",name:"Sahra",surname:"Kırmusaoğlu",slug:"sahra-kirmusaoglu",fullName:"Sahra Kırmusaoğlu"},{id:"248288",title:"Prof.",name:"Bekir",surname:"Kocazeybek",slug:"bekir-kocazeybek",fullName:"Bekir Kocazeybek"},{id:"406463",title:"Dr.",name:"Nesrin",surname:"Gareayaghi",slug:"nesrin-gareayaghi",fullName:"Nesrin Gareayaghi"}],corrections:null},{id:"64597",title:"Antimicrobial Resistance",doi:"10.5772/intechopen.82303",slug:"antimicrobial-resistance",totalDownloads:1229,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Klebsiella pneumoniae (K. pneumoniae) pose an emerging threat to public health sector worldwide. They are one of the potent nosocomial pathogens and cause variety of infections including pneumonia, septicaemia, wound infections, urinary tract infections and catheter-associated infections. From the last two decades, these pathogens are becoming more powerful due to the acquisition of resistomes on different types of plasmids and transposons. There are four main mechanisms of antibacterial resistance such as efflux pump, target alteration, membrane permeability and notably enzymes hydrolysis. K. pneumoniae produce different types of enzymes but most importantly extended spectrum-β-lactamase (ESBL), carbapenemase and metallo-β-lactamase (MBL). K. pneumoniae carbapenemases (KPCs) and New Delhi metallo-β-lactamase (NDM) producing isolates displayed resistance not only against the β-lactam drugs (penicillins, cephalosporins and carbapenems) but also to other classes of antibiotics (aminoglycosides and quinolones). Therapeutic options available to treat serious infections caused by these extensively drug-resistant pathogens are limited to colistin, tigecycline and fosfomycin. Hence, combination therapy has also been recommended to treat such bacteria with clinical side effects, therefore, new treatment regime must be required. Moreover, we are relying on conventional diagnostic tools, however, novel techniques must be required for robust identification of multi-drug-resistant bacteria.",signatures:"Muhammad Usman Qamar, Muhammad Hidayat Rasool, Shah Jahan,\nMuhammad Shafique and Bilal Aslam",downloadPdfUrl:"/chapter/pdf-download/64597",previewPdfUrl:"/chapter/pdf-preview/64597",authors:[{id:"201590",title:"Dr.",name:"Bilal",surname:"Aslam",slug:"bilal-aslam",fullName:"Bilal Aslam"},{id:"229169",title:"Dr.",name:"Muhammad",surname:"Shafique",slug:"muhammad-shafique",fullName:"Muhammad Shafique"},{id:"247821",title:"Dr.",name:"Muhammad Usman",surname:"Qamar",slug:"muhammad-usman-qamar",fullName:"Muhammad Usman Qamar"},{id:"261133",title:"Dr.",name:"Muhammad Hidayat",surname:"Rasool",slug:"muhammad-hidayat-rasool",fullName:"Muhammad Hidayat Rasool"},{id:"261134",title:"Dr.",name:"Shah",surname:"Jahan",slug:"shah-jahan",fullName:"Shah Jahan"}],corrections:null},{id:"64267",title:"Alternative Approaches to Combat Medicinally Important Biofilm-Forming Pathogens",doi:"10.5772/intechopen.80341",slug:"alternative-approaches-to-combat-medicinally-important-biofilm-forming-pathogens",totalDownloads:1161,totalCrossrefCites:1,totalDimensionsCites:5,hasAltmetrics:0,abstract:"Bacteria have developed the capability to produce structured communities (or cluster of cells) via adherence to surface to form biofilms that facilitate or prolong their survival under extreme environmental condition. Bacterial biomass adheres to inanimate and biotic surfaces in the hospital setting as well as in the environment. In the healthcare system, the biofilm formation on medical devices allows bacteria to sustain as a reservoir and becomes more resistant to antimicrobial agents. However, biofilm formation facilitates pathogens to sabotage the host defenses that are linked to long-term retention within the host cell. Therefore, in this review, we provide some steps leading to the formation of biofilm within the host and on inanimate surfaces, also emphasizing various medically significant pathogens and debate current developments on novel approaches that aimed to prevent biofilm formations and its dispersion to patients.",signatures:"Mansab Ali Saleemi, Navindra Kumari Palanisamy and Eng Hwa Wong",downloadPdfUrl:"/chapter/pdf-download/64267",previewPdfUrl:"/chapter/pdf-preview/64267",authors:[{id:"256712",title:"Ph.D.",name:"Eng Hwa",surname:"Wong",slug:"eng-hwa-wong",fullName:"Eng Hwa Wong"},{id:"264554",title:"Ph.D. Student",name:"Mansab",surname:"Saleemi",slug:"mansab-saleemi",fullName:"Mansab Saleemi"},{id:"264555",title:"Dr.",name:"Navindra Kumari",surname:"Palanisamy",slug:"navindra-kumari-palanisamy",fullName:"Navindra Kumari Palanisamy"}],corrections:null},{id:"62795",title:"Origin and Control Strategies of Biofilms in the Cultural Heritage",doi:"10.5772/intechopen.79617",slug:"origin-and-control-strategies-of-biofilms-in-the-cultural-heritage",totalDownloads:1566,totalCrossrefCites:6,totalDimensionsCites:9,hasAltmetrics:0,abstract:"Biodeterioration is defined as the undesirable change in the properties of materials caused by the activity of biological agents. This process is complex and involves alterations in the physicochemical and mechanical properties by the action of organisms and depends on the microorganisms involved, type of substrate, and environmental conditions. The biodeterioration of cultural heritage is the physical or chemical damage caused by microorganisms on objects, monuments, or buildings that belong to the cultural heritage. Among the main materials that can be affected are: stone, metal, ceramic, polymers, and other materials. Among the main undesirable effects to these materials are: discoloration, dissolution, rupture, and efflorescence among others. Biofilms represent the usual form of growth of bacteria and consist of communities of microorganisms that grow attached to an inert surface or a living tissue, surrounded by an extracellular matrix that they themselves synthesize. The importance of biodeterioration by biofilms is mainly related to changes in pH values, ionic concentrations, oxide-reduction reactions in the biofilm thickness, and in the interface with the substrate and enzymatic degradation. This chapter presents evidence of the participation of biofilms and associated mechanisms in biodeterioration as well as the main prevention and control strategies.",signatures:"Laura E. Castrillón Rivera, Alejandro Palma Ramos,\nJorge I. Castañeda Sánchez and María Elisa Drago Serrano",downloadPdfUrl:"/chapter/pdf-download/62795",previewPdfUrl:"/chapter/pdf-preview/62795",authors:[{id:"59716",title:"Dr.",name:"Maria Elisa",surname:"Drago-Serrano",slug:"maria-elisa-drago-serrano",fullName:"Maria Elisa Drago-Serrano"},{id:"74103",title:"Dr.",name:"Laura",surname:"Castrillon Rivera",slug:"laura-castrillon-rivera",fullName:"Laura Castrillon Rivera"},{id:"208136",title:"Dr.",name:"Jorge Ismael",surname:"Castañeda-Sánchez",slug:"jorge-ismael-castaneda-sanchez",fullName:"Jorge Ismael Castañeda-Sánchez"},{id:"253064",title:"Prof.",name:"Alejandro",surname:"Palma Ramos",slug:"alejandro-palma-ramos",fullName:"Alejandro Palma Ramos"}],corrections:null},{id:"65644",title:"Antimicrobial Agents: Antibacterial Agents, Anti-biofilm Agents, Antibacterial Natural Compounds, and Antibacterial Chemicals",doi:"10.5772/intechopen.82560",slug:"antimicrobial-agents-antibacterial-agents-anti-biofilm-agents-antibacterial-natural-compounds-and-an",totalDownloads:1915,totalCrossrefCites:1,totalDimensionsCites:7,hasAltmetrics:0,abstract:"The surge in antimicrobial resistance coupled with the decline in the antimicrobial drug pipeline calls for the discovery and development of new agents to tackle antibiotic resistance and prevent a return to a post-antibiotic era. Several factors account for resistance of microbes; some are natural and others are acquired. Natural selection, presence of efflux pumps, impermeable cell wall, biofilm formation and quorum sensing are some of the factors. Though it is difficult to outwit the pathogens, the discovery and development of compounds with pleiotropic modes or mechanisms of action different from the conventional drugs currently being used can help us tackle antimicrobial resistance. Natural products have been known to be a rich source of bioactive compounds with diverse structures and functional group chirality. Various reports indicate medicinal plants with antibacterial, anti-biofilm, efflux pump inhibition, wound healing effects or properties and others used for upper respiratory and urinary tract infections. There is an urgent need to research into natural products particularly plants for antimicrobial agents including antibacterial agents, anti-biofilm agents, antibacterial natural compounds and antibacterial chemicals. This chapter throws more light on such antimicrobials.",signatures:"Yaw Duah Boakye, Newman Osafo, Cynthia Amaning Danquah,\nFrancis Adu and Christian Agyare",downloadPdfUrl:"/chapter/pdf-download/65644",previewPdfUrl:"/chapter/pdf-preview/65644",authors:[{id:"182058",title:"Dr.",name:"Christian",surname:"Agyare",slug:"christian-agyare",fullName:"Christian Agyare"},{id:"196452",title:"Dr.",name:"Newman",surname:"Osafo",slug:"newman-osafo",fullName:"Newman Osafo"},{id:"252789",title:"Dr.",name:"Yaw Duah",surname:"Boakye",slug:"yaw-duah-boakye",fullName:"Yaw Duah Boakye"},{id:"262750",title:"Dr.",name:"Cynthia",surname:"Amaning Danquah",slug:"cynthia-amaning-danquah",fullName:"Cynthia Amaning Danquah"},{id:"262752",title:"Dr.",name:"Francis",surname:"Adu",slug:"francis-adu",fullName:"Francis Adu"}],corrections:null},{id:"65613",title:"The Methods for Detection of Biofilm and Screening Antibiofilm Activity of Agents",doi:"10.5772/intechopen.84411",slug:"the-methods-for-detection-of-biofilm-and-screening-antibiofilm-activity-of-agents",totalDownloads:9179,totalCrossrefCites:14,totalDimensionsCites:22,hasAltmetrics:0,abstract:"Biofilm producer microorganisms cause nosocomial and recurrent infections. Biofilm that is a sticky exopolysaccharide is the main virulence factor causing biofilm-related infections. Biofilm formation begins with attachment of bacteria to biotic surface such as host cell or abiotic surface such as prosthetic devices. After attachment, aggregation of bacteria is started by cell-cell adhesion. Aggregation continues with the maturation of biofilm. Dispersion is started by certain conditions such as phenol-soluble modulins (PSMs). By this way, sessile bacteria turn back into planktonic form. Bacteria embedded in biofilm (sessile form) are more resistant to antimicrobials than planktonic bacteria. So it is hard to treat biofilm-embedded bacteria than planktonic forms. For this reason, it is important to detect biofilm. There are a few biofilm detection and biofilm production methods on prosthetics, methods for screening antibacterial effect of agents against biofilm-embedded microorganism and antibiofilm effect of agents against biofilm production and mature biofilm. The aim of this chapter is to overview direct and indirect methods such as microscopy, fluorescent in situ hybridization, and Congo red agar, tube method, microtiter plate assay, checkerboard assay, plate counting, polymerase chain reaction, mass spectrometry, MALDI-TOF, and biological assays used by antibiofilm researches.",signatures:"Sahra Kırmusaoğlu",downloadPdfUrl:"/chapter/pdf-download/65613",previewPdfUrl:"/chapter/pdf-preview/65613",authors:[{id:"179460",title:"Associate Prof.",name:"Sahra",surname:"Kırmusaoğlu",slug:"sahra-kirmusaoglu",fullName:"Sahra Kırmusaoğlu"}],corrections:null},{id:"64272",title:"Streptomyces as a Source of Antimicrobials: Novel Approaches to Activate Cryptic Secondary Metabolite Pathways",doi:"10.5772/intechopen.81812",slug:"streptomyces-as-a-source-of-antimicrobials-novel-approaches-to-activate-cryptic-secondary-metabolite",totalDownloads:1642,totalCrossrefCites:7,totalDimensionsCites:16,hasAltmetrics:0,abstract:"Streptomyces is the most important bacterial genus for bioactive compound production. These soil bacteria are characterized by a complex differentiation cycle. Streptomyces is extremely important in biotechnology, producing approximately two thirds of all antibiotics, as well as many compounds of medical and agricultural interest. Drug discovery from streptomycetes became challenging once the most common compounds were discovered, and the system was basically abandoned by industry. Simultaneously, antibiotic resistance is increasing dramatically, and new antibiotics are required. Screening from nature is being resumed (exploring new environments, looking for elicitors, metagenome, etc.). Secondary metabolism is conditioned by differentiation; although the relationship between both has long remained elusive, differentiation as a trigger for antibiotic production remains basically unexplored. Most cultures used in screening campaigns for new bioactive molecules have been performed empirically, and workflow was extremely productive during the so-called golden age of antibiotics; however, currently there is a bottleneck. Streptomyces is still the most important natural source of antibiotics, and it also harbors many cryptic secondary metabolite pathways not expressed under laboratory conditions. In this chapter, we review strategies based on differentiation, one of the keys improving secondary metabolite production and activating cryptic pathways to face the challenges of drug discovery.",signatures:"Ángel Manteca and Paula Yagüe",downloadPdfUrl:"/chapter/pdf-download/64272",previewPdfUrl:"/chapter/pdf-preview/64272",authors:[{id:"269991",title:"Dr.",name:"Angel",surname:"Manteca",slug:"angel-manteca",fullName:"Angel Manteca"},{id:"272633",title:"Dr.",name:"Paula",surname:"Yagüe",slug:"paula-yague",fullName:"Paula Yagüe"}],corrections:null}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},subseries:null,tags:[{id:"23",label:"women in science book program"}]},relatedBooks:[{type:"book",id:"6148",title:"Bacterial Pathogenesis and Antibacterial Control",subtitle:null,isOpenForSubmission:!1,hash:"92128a5094670f6b0c9321640f60d3a3",slug:"bacterial-pathogenesis-and-antibacterial-control",bookSignature:"Sahra",coverURL:"https://cdn.intechopen.com/books/images_new/6148.jpg",editedByType:"Edited by",editors:[{id:"179460",title:"Associate Prof.",name:"Sahra",surname:"Kırmusaoğlu",slug:"sahra-kirmusaoglu",fullName:"Sahra Kırmusaoğlu"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8133",title:"Pathogenic Bacteria",subtitle:null,isOpenForSubmission:!1,hash:"b26e69f94525a38ead8ac88e3c68631a",slug:"pathogenic-bacteria",bookSignature:"Sahra Kırmusaoğlu and Sonia Bhonchal Bhardwaj",coverURL:"https://cdn.intechopen.com/books/images_new/8133.jpg",editedByType:"Edited by",editors:[{id:"179460",title:"Associate Prof.",name:"Sahra",surname:"Kırmusaoğlu",slug:"sahra-kirmusaoglu",fullName:"Sahra Kırmusaoğlu"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"8032",title:"Staphylococcus and Streptococcus",subtitle:null,isOpenForSubmission:!1,hash:"b9ddbf132ac8ea9d2a7613836e5a27ca",slug:"staphylococcus-and-streptococcus",bookSignature:"Sahra Kırmusaoğlu",coverURL:"https://cdn.intechopen.com/books/images_new/8032.jpg",editedByType:"Edited by",editors:[{id:"179460",title:"Associate Prof.",name:"Sahra",surname:"Kırmusaoğlu",slug:"sahra-kirmusaoglu",fullName:"Sahra Kırmusaoğlu"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"6601",title:"Disinfection",subtitle:null,isOpenForSubmission:!1,hash:"ea121cf9b26d006bc6d7c7f92195852d",slug:"disinfection",bookSignature:"Sahra Kırmusaoğlu",coverURL:"https://cdn.intechopen.com/books/images_new/6601.jpg",editedByType:"Edited by",editors:[{id:"179460",title:"Associate Prof.",name:"Sahra",surname:"Kırmusaoğlu",slug:"sahra-kirmusaoglu",fullName:"Sahra Kırmusaoğlu"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"4648",title:"Concepts, Compounds and the Alternatives of Antibacterials",subtitle:null,isOpenForSubmission:!1,hash:"ba284c040146d00fdd709cabc4c8cb5a",slug:"concepts-compounds-and-the-alternatives-of-antibacterials",bookSignature:"Varaprasad Bobbarala",coverURL:"https://cdn.intechopen.com/books/images_new/4648.jpg",editedByType:"Edited by",editors:[{id:"90574",title:"Dr.",name:"Varaprasad",surname:"Bobbarala",slug:"varaprasad-bobbarala",fullName:"Varaprasad Bobbarala"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"6978",title:"Antimicrobial Resistance",subtitle:"A Global Threat",isOpenForSubmission:!1,hash:"949e88946357845e5843b4d7fbc1701f",slug:"antimicrobial-resistance-a-global-threat",bookSignature:"Yashwant Kumar",coverURL:"https://cdn.intechopen.com/books/images_new/6978.jpg",editedByType:"Edited by",editors:[{id:"79718",title:"Dr.",name:"Yashwant",surname:"Kumar",slug:"yashwant-kumar",fullName:"Yashwant Kumar"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"4759",title:"Antimicrobial Resistance",subtitle:"An Open Challenge",isOpenForSubmission:!1,hash:"04be7bb9b8da174cdb838a38c75236b4",slug:"antimicrobial-resistance-an-open-challenge",bookSignature:"Maria Cristina Ossiprandi",coverURL:"https://cdn.intechopen.com/books/images_new/4759.jpg",editedByType:"Edited by",editors:[{id:"80691",title:"Prof.",name:"Maria Cristina",surname:"Ossiprandi",slug:"maria-cristina-ossiprandi",fullName:"Maria Cristina Ossiprandi"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9521",title:"Antimicrobial Resistance",subtitle:"A One Health Perspective",isOpenForSubmission:!1,hash:"30949e78832e1afba5606634b52056ab",slug:"antimicrobial-resistance-a-one-health-perspective",bookSignature:"Mihai Mareș, Swee Hua Erin Lim, Kok-Song Lai and Romeo-Teodor Cristina",coverURL:"https://cdn.intechopen.com/books/images_new/9521.jpg",editedByType:"Edited by",editors:[{id:"88785",title:"Prof.",name:"Mihai",surname:"Mares",slug:"mihai-mares",fullName:"Mihai Mares"}],equalEditorOne:{id:"190224",title:"Dr.",name:"Swee Hua Erin",middleName:null,surname:"Lim",slug:"swee-hua-erin-lim",fullName:"Swee Hua Erin Lim",profilePictureURL:"https://mts.intechopen.com/storage/users/190224/images/system/190224.png",biography:"Dr. Erin Lim is presently working as an Assistant Professor in the Division of Health Sciences, Abu Dhabi Women\\'s College, Higher Colleges of Technology in Abu Dhabi, United Arab Emirates and is affiliated as an Associate Professor to Perdana University-Royal College of Surgeons in Ireland, Selangor, Malaysia. She obtained her Ph.D. from Universiti Putra Malaysia in 2010 with a National Science Fellowship awarded from the Ministry of Science, Technology and Innovation Malaysia and has been actively involved in research ever since. Her main research interests include analysis of carriage and transmission of multidrug resistant bacteria in non-conventional settings, besides an interest in natural products for antimicrobial testing. She is heavily involved in the elucidation of mechanisms of reversal of resistance in bacteria in addition to investigating the immunological analyses of diseases, development of vaccination and treatment models in animals. She hopes her work will support the discovery of therapeutics in the clinical setting and assist in the combat against the burden of antibiotic resistance.",institutionString:"Higher Colleges of Technology",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"3",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"Perdana University",institutionURL:null,country:{name:"Malaysia"}}},equalEditorTwo:{id:"221544",title:"Dr.",name:"Kok-Song",middleName:null,surname:"Lai",slug:"kok-song-lai",fullName:"Kok-Song Lai",profilePictureURL:"https://mts.intechopen.com/storage/users/221544/images/system/221544.jpeg",biography:"Dr. Lai Kok Song is an Assistant Professor in the Division of Health Sciences, Abu Dhabi Women\\'s College, Higher Colleges of Technology in Abu Dhabi, United Arab Emirates. He obtained his Ph.D. in Biological Sciences from Nara Institute of Science and Technology, Japan in 2012. Prior to his academic appointment, Dr. Lai worked as a Senior Scientist at the Ministry of Science, Technology and Innovation, Malaysia. His current research areas include antimicrobial resistance and plant-pathogen interaction. His particular interest lies in the study of the antimicrobial mechanism via membrane disruption of essential oils against multi-drug resistance bacteria through various biochemical, molecular and proteomic approaches. 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Clinically, it is characterized by a progressive loss of articular cartilage and remodeling of the underlying bone remodeling due to a combination of an active response of chondrocytes and the inflammatory cells in the surrounding tissues. Recent research place greater emphasis to promotes our understanding of the OA pathophysiology. A variety of risk factors have been identified. These include gender, traumatic injury, obesity, metabolic dysfunction, nutrition, mechanical factors, and environmental and genetic factors. Extensive research over the past 20 years provided a better understanding, diagnosis, and management of OA. The first part of this book deals with the current progress of OA imaging diagnosis and treatments. The second part discusses how exercise could benefit those with OA. The third part explores potential shreds of evidence of medicinal plants in the strategies for disease prevention.
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Stability to storage of a new pharmaceutical product is a key step for medical and commercial success. As with other pharmaceutical products, nanomaterials and nanotechnological drugs (nanomedicines) must be rigorously designed and tested to demonstrate the favorable benefit/risk ratio needed by health authorities to issue marketing authorizations.
Innovative pharmaceutical products, such as micro and nanocarriers, have to face two important aspects for regulatory approval: firstly, the demonstration of efficacy and safety profile is necessary, and secondly suitable storage conditions must be identified for the final product. In the case of colloidal (nanosized) carriers, it is important to obtain nearly unchanged physico-chemical properties during storage [1, 2].
The issue of stability to long-term storage of nanosized drug carriers will be briefly commented in this chapter, since this aspect can become, and often actually is, crucial for the translation of basic researches to clinically valid products. Liposomes, that would often be promising colloidal systems for drug delivery and targeting, are a sound example of how the question of stability strongly influences the translation from lab scale to therapeutics. Apart some few products which were able to reach a clinical significance, a huge number of projects, although promising at the preliminary phases, are unable to undergo industrial and commercial scaling-up, in most cases because of their very limited physico-chemical stability and difficulty to preserve the chemical integrity of liposomal formulations.
Another important aspect is related to the requirement of sterilization, mandatory for products that must come in contact with blood, eye or other damaged or sensitive tissues. Gamma or UV radiation and autoclaving or chemical (ethylene oxide) sterilization techniques are usually applied to sterilize polymer-based products or devices. These processes expose the polymeric materials to a certain degree of physico-chemical stress and thus fundamental to ensure that the sterilized biomaterial retains its characteristics and features.
Of course, for some applications of biomaterials, a robust chemical stability is paradoxically unwanted. For resorbable materials, for instance, such as materials for sutures or fixing screws for bone fractures, a relatively rapid degradation in the body after the healing process is required.
Considering colloidal systems, we should pay attention to three principal properties, such as size and size distribution (homogeneity), surface charge, and shape (the rule of 4S), that should not significantly change during storage and that influence physico-chemical stability (Figure 1) [3].
Venn diagram on properties that influence the physico-chemical stability of colloidal suspensions.
Looking into this matter, we can highlight some important properties that separately influence physico-chemical stability. It is widely known that a mean particle size below 100 nm, correlated with a narrow size distribution (PdI < 0.2), allows increasing the stability of a nanosized system. These experimental evidences are necessary but not sufficient conditions, for instance also zeta potential values (i.e., a surface charge not less than ±35 mV) stabilize the nanoformulation. When this situation is not verified, several instability conditions have been reported.
To improve the stability of colloidal delivery systems upon storage, the removal of solvents, if required during the preparation method, is necessary, to obtain a final aqueous suspension. Storage of aqueous suspensions could determine some changes in the product such as increase of size, due to coalescence or aggregation phenomena, or even a reduction of it, due to degradation of the polymeric matrix, undesirable drug leakage, changes in the surface charge, and so on.
To remove water, freeze-drying (lyophilization) is one of the most efficient techniques used in the pharmaceutical industry and a strategy to reduce and control the instability phenomena [4, 5]. However, several physico-chemical phenomena, such as air adsorption and modification of nanoparticle surface during the various steps of the process may lead difficulty in redispersion of colloidal carriers in aqueous media for the subsequent administration [6, 7]. The addition of inert additives, defined as lyoprotectants or cryoprotectants) at relatively high concentrations (10–30%, but in some instances also up to 50% by weight), could protect the colloidal suspension against stress induced by the freeze-drying process [8–10].
During the last three decades, different studies were performed to select the additives to use during the freeze-dried process to prevent lyophilization stress. Several authors described the protective effect due to the formation of an amorphous vitreous layer on the surface of particles. Carbohydrates and polyalcohols are the most investigated ones [11].
Figure 2 shows how this field is a current topic of interest for scientists, as highlighted by the increased number of papers published in the last two decades (Pubmed source).
Trend of article publication in the field ‘freeze-dried and nanoparticles’ (Pubmed database; update: February 2018).
The protective action of cryoprotectants is principally a surface phenomenon, for which the proper amount of this component should also be evaluated. The concentration should be established as a function of total superficial area correlated to the size and the presence or not of the adsorbed drug onto the surface that could change the disposition of cryoprotectant at a molecular level on the surface. In the case of sugars, it was showed a reduction in the suitable amount to be used going from monosaccharides and disaccharides to oligosaccharides, therefore as a function of the type [9].
To better understand what happens during the freeze-drying process, the involved steps are recalled below. Scientists do not often distinguish between cooling and freezing steps and they consider as a single process. Conversely, cooling is related to the decrease of temperature of the chamber and the product inside it, while freezing corresponds to the modification of the physical state of the formulation from liquid (water) to solid (ice). During this step, water starts to nucleate and ice crystals are formed. Supercooling occurs if the formulation is cooled below its freezing point.
Lyophilization of nanosystems would however deserve a peculiar discussion. The first question is whether it is better a slow or fast freezing speed to obtain redispersible nanoformulations? The answer should consider some aspects: first of all, the state of excipient (e.g., the cryoprotectant) during freezing. For instance, mannitol crystallizes during slow freezing, while it is made more amorphous upon a fast freezing that makes mannitol to be able to protect nanoparticles. Another aspect is the concentration; several authors reported an enhanced protective action with increasing the amount of cryoprotectant. In summary, fast freezing rate and high concentration of cryoprotectant should produce a dry nanoformulation that preserve its better initial physico-chemical properties upon redispersion with an aqueous medium. However, a critical concentration for each cryoprotector seems to exist, above which an additional amount is prejudicial in many cases [12].
During primary drying, it is appropriate to obtain a non-collapsed cake, whose consequence would be a long time necessary for the redispersion of the freeze-dried nanoparticles. If primary drying occurs below the Tc of the nanoformulation, it is possible to avoid this phenomenon and the product will preserve the initial macroscopic structure.
Also the secondary drying is very important to be considered. Several authors sometimes underestimate the evaluation and standardization of operative conditions during this step. Currently, the drying time and shelf temperature can be optimized using simulation softwares, thus reducing experimental errors [13].
Raw materials used for the preparation of the colloidal carriers should be considered in the design and in the selection of the cryoprotectant. Liposomes are more sensitive to the freezing step, while polymers used to realize micro and nanocarriers are resistant to the low temperatures, but could suffer in the dehydration process, with a difficulty to restore the initial particle morphology and size (e.g., because of aggregation).
Polymer- and lipid-based nanomedicines are checked during stability assays for physico-chemical, chemical, and microbiological aspects, such as macroscopic and microscopic physical appearance, particle mean size and size homogeneity, zeta potential (surface charge), morphology and surface chemistry, drug loading/content and release profile, and
For formulations that contain or encapsulate biotechnological products, like monoclonal antibodies, peptides, proteins, and gene material, the procedures described in ICH guideline Q5C for stability testing of these compounds must be considered [16].
Moreover, for medical devices and especially for sterile devices, apart an extrapolation from the above ICH guidelines, the ISO 13485:2016 rules are useful to manage the quality and stability requirements of these products, with the aim of demonstrating their ability to meet customer needs and regulatory requisites.
In April 2014 in London, during the “SME workshop for micro-, small- and medium-sized enterprises: focus on quality for medicines containing chemical entities”, organized by EMA, Dolores Hernán Pérez de la Ossa presented a report entitled “Quality aspects of nano-based medicines” [17].
The report identifies the challenges that a nanomedicine product should overcome to pass the regulatory process and safely reach the market. Such document fixes not only the physico-chemical aspects of the proposed nanomedicine, but also any complex supramolecular structure, for example the presence of ligands on the surface. These molecules determine the interactions with biological substrates and influence the physical stability of the so-called third generation nanoformulations. The presence of these substances often limits the effects of others additives added to stabilize the colloidal carriers. Cryoprotectant agents could not cover the surface and not preserve from aggregation during a freeze-dried process. The ligands could significantly modify the zeta potential value, a predictable parameter of colloidal carrier stability.
Another important aspect worthy of note is that only a small number of scientists, during the planning of an experimental work, taken into account the regulatory aspects, which instead must be considered before the development of a project. The biggest threshold is the scalable, controlled, and reproducible manufacturing of nanomedicines under good manufacturing practice (GMP) and, in many cases, under sterile conditions.
Why it is important to control physico-chemical properties of nanocarriers? Safety and efficacy of nanomedicines upon biological substrates are strictly correlated with these properties (Figure 3).
The main properties of nanomedicines that influence both long-term storage stability and biological interactions.
For this reason, there is a growing interest in quality-by-design approach (QbD): it is in fact very important to establish which critical quality attributes (CQA) govern the quality, safety, and efficacy of nanomedicines, also considering their specific route of administration or application. Applying this or a similar approach in preclinical studies helps to obtain reproducible drug batches [18–20].
Coronaviruses (CoVs) belong to the subfamily Orthocoronavirinae in the family of Coronaviridae. In this family, there are four types of viruses: α-coronavirus, β-coronavirus, γ-coronavirus, δ-coronavirus [1]. The CoV genome is an enveloped, positive-sense, and single-stranded RNA, and it has the largest genome of known RNA viruses. It is known that α- and β-CoV types cause infections in mammals as δ- and γ-CoVs infect birds [2]. Severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome (MERS) belonging to β-CoVs are the most aggressive strains of coronaviruses and cause viral pneumonia outbreaks [3, 4]. SARS-CoV disease is a kind of pneumonia and caused by novel CoV whose genome structure was more than 82% identical to those of SARS-CoV, named coronavirus disease 2019 (COVID-19) [5, 6]. SARS-Cov-2 is a beta gene virus genetically very close to bat-CoVRaTG13, and bat-SL-CoVZC45 Covs can cause severe illness. As the COVID-19 outbreak turned into a global threat, the World Health Organization (WHO) announced it as a global pandemic on 12 March 2020. The COVID-19 pandemic has changed the scenario of the entire world. COVID-19 outbreak started in Wuhan, China, has globally spread to 219 countries and territories [7]. Currently, there are few vaccines for COVID-19. Their acceptance and efficacy are an issue of debate across the whole world. Therefore, there is an urgent need to find drugs or vaccines for the treatment of COVID-19 infections effectively. However, there are some studies related to the use of known drugs such as remdesivir and chloroquine that have proved efficacy on COVID-19 infection. We summarize some antiviral drugs as therapeutic options for the treatment of COVID-19 [8].
COVID-19 mainly attacks the respiratory-tract-associated organs. Additionally, the virus has shown impact various to other organs or systems such as the gastrointestinal system, nervous system, etc. [9]. The most common symptoms in COVID-19 patients are fever, dry cough, loss of taste, lethargy, shortness of breath, dyspnea, chest pain, fatigue, myalgia, whereas headache, dizziness, abdominal pain, diarrhea, nausea, and vomiting are less commonly observed [10, 11]. Anosmia is also one of the most critical symptoms in COVID-19 patients [12]. COVID-19 is more contagious than other coronaviruses, and its transmission rate is higher than the closely related strain, SARS-CoV-10 [13]. Currently, new variants of COVID-19 are reported from different regions of the world. Coronavirus interacts with cell surface receptors such as angiotensin-converting enzyme-2 (ACE-2) and neuropilin to gain entry inside the cell. The receptor-binding domain of viral spike protein is essential in SARS-CoV-2 entry into the host cell via surface ACE-2 [14]. Recently, another cell receptor Neuropilin-1 was found to be involved in SARS-CoV-2 entry. After binding to the receptor, the conformational change in the spike protein leads to virus fusion with the host cell membrane. The virus may transfer the RNA directly inside the cells or may proceed through the endosomal pathway [15]. Upon translation of viral RNA, the viral replicase polyprotein PP1a and PP1ab are produced and cleaved into small products by viral endopeptidase [16]. RNA-dependent RNA polymerase (RdRp) produces subgenomic RNAs by discontinuous transcription [16, 17]. This further gets translated into respective viral proteins. After processing through the endoplasmic reticulum (ER), ER-Golgi intermediate compartment (ERGIC), and Golgi complex, the viral RNA and proteins are assembled into virions. These virions are transported through vesicles and exocytosed for transmission. These steps of the viral life cycle are beneficial virus inhibition targets for different drugs. The coronaviruses are ribonucleic acid (RNA) viruses, which have a positive single-strand RNA [14, 18]. When SARS-CoV-2 enters the body and comes in contact with the host cell membrane, some changes occur in the structure of the virus. The human TMPRSS2 protein alters the conformation of the spike glycoprotein in the virus. Two substantial protease enzymes, 3-chymotrypsin-like protease (3CLpro) and papain-like protease (PLPro), have essential roles in its viral replication process after it enters the host cell via ACE2 receptors [19]. The expression of several genes, such as AHCYL2, ZNF385B, etc., appears to have a strong correlation with the expression of ACE2 and TMPRSS2 protein receptors in human healthy and normal lung cells [20].
However, repurposing drugs could prove to be beneficial tactics for finding COVID-19 treatment, including cost-effectiveness, elimination of some clinical trial steps, faster on-field availability, combining the drugs with other possible drugs, and the invention of information about the mechanisms of the existing drug. Researchers were able to develop the possible COVID-19 medications using information from previous CoVs therapies, genetic sequences, and protein modeling studies. Antimalarials, antivirals, antibiotics, and corticosteroids are among the most often studied medications, and they have been repurposed based on their ability to neutralize viruses, reduce lung inflammation, or alleviate other illness symptoms. Chloroquine (CQ), hydroxychloroquine (HCQ), and azithromycin (AZM) are the most often utilized antiviral drugs against COVID-19, since they have already demonstrated reasonable antiviral efficacy against SARS-CoV, MERS-CoV, and SARS-CoV-2. Anti-HIV medications lopinavir/ritonavir (LPV/RTV) are being studied for COVID-19 since they were successful in previous CoV epidemics. Furthermore, the anti-Ebola medicine remdesivir (RDV) was evaluated for COVID-19 and garnered further attention.
Similarly, favipiravir (FPV), ribavirin (RBV), umifenovir (UFV), and oseltamivir (OTV) have broad-spectrum antiviral activities and clinically tested against COVID-19. The effective uses of HCQ, RDV, LPV/RTV, or LPV/RTV in combination with Interferon (IFN) β-1a against COVID-19 [21], all these drugs had little or no effect on overall mortality, initiation of ventilation, and duration of hospital stay in hospitalized patients. So far, to treat severe and critical COVID-19, only corticosteroids have proven effective [21]. Other drugs, such as Angiotensin-Converting-Enzyme inhibitors (ACEi), have also been used to treat COVID-19. However, no clear correlation was reported between mortality rate and ACEi drugs in hypertension patients with COVID-19 [22]. Due to the possibility of secondary infection in these patients, antibiotics have been used as various protocols [23].
Umifenovir (UFV) may interact with SARS-CoV-2 surface glycoproteins and lipids and obstruct the interaction with the entry receptor ACE-2. Antibodies against SARS-CoV-2 may prevent the virus from entering the body and causing illness. Chloroquine (CQ), hydroxychloroquine (HCQ), and azithromycin (AZM) can raise endosomal pH, making viral entrance and RNA release more difficult. CQ, HCQ, and AZM all have immunomodulatory properties. RDV, FPV, and RBV are nucleoside inhibitors that impede RNA replication and reduce RNA-dependent RNA polymerase activity. Fraternization of LPV with viral protease may change proteolysis. OTV may interact with components involved in exocytosis, preventing the virus from leaving the cell. Antibodies against cytokine receptors and corticosteroids have been shown to have anti-inflammatory properties in the face of excessive immune responses. Drugs such as CQ are wide-spectrum inhibitors of viral cell entry, and RDV is a wide-spectrum RNA polymerase inhibitor. SARS-CoV-2 infection concurrently triggers the host immune system and an inflammatory cascade response (cytokine storm). These are being targeted in the treatment of COVID-19 patients [23].
So far, no fully effective drug has been discovered against this virus. The antiviral drugs, usually nucleoside analogs or intracellular proteases, block the virus by preventing its entry into the cell or by interfering with its replication inside the cell. Protease inhibitors target certain proteases, whereas fusion inhibitors block the fusion phase of viral entrance. Transcription inhibitors impede viral replication by inhibiting RNA-dependent RNA polymerase during the reverse transcription process. Nucleoside reverse transcriptases are some of the transcriptase inhibitors. M2 channel protein is a target for certain antivirals. In this chapter, we have provided information about repurposed drugs that are used against COVID-19, the mechanism of activity, therapeutic regimens, pharmacokinetics, and drug-drug interactions [7, 8].
The rationale major biochemical events and components in the replication cycle of coronavirus are considered as targets for currently developed drugs. These include the spike protein, proteolytic enzymes, and RNA-dependent RNA polymerase [24]. SARS-CoV-2 is transmitted mainly via respiratory droplets. The virus enters the host cells through two pathways, either via endosomes or plasma membrane fusion. In both mechanisms, the viral S protein mediates attachment to the membrane of the host cell and engages ACE2 as the entry receptor [25]. A host protease termed transmembrane serine protease 2 (TMPRSS2) activates the connection between S protein and ACE-2 [26]. S protein is used by the virus to destroy antibodies and make it simpler for it to attach to host receptors [27]. Beta-coronaviruses generally employ hemagglutinin-esterase (HE) to bind to sialic acid on the glycoprotein surface, despite the fact that the fusion machinery of SARS-CoV-2 remains unknown [28]. Fusion inhibitors might be used to prevent these fusion stages.
The envelope is peeled off when fusion is complete, and the SARS-CoV-2 genome, together with its nucleocapsid, penetrates the cytoplasm of the host cell. Its genome comprises the open reading frames 1a and 1b (ORF1a and ORF1b) genes, which create two polyproteins (pp) named pp1a and pp1b, which aid in the viral translation process by hijacking host ribosomes [29]. Main protease (Mpro) and papain-like protease (Ppro) break these polyproteins to create multiple non-structural proteins [30]. Aside from Mpro and Ppro, SARS-CoV-2 has 3C-like cysteine protease (3CLPro), which has a 96% resemblance to SARS-CoV. These proteases are essential for viral replication and transcription, and protease inhibitors inhibiting these proteases are potential antivirals for SARS-CoV-2. The promising clinical outcomes for COVID-19 patients should be obtained by using alpha-interferon, chloroquine phosphate, arabinol, remdesivir, lopinavir/ritonavir, and anti-inflammatory drugs [31, 32, 33, 34]. Moreover, clinical trials with these drugs should be performed on COVID-19 patients to prove their efficacy and safety as proposed for tocilizumab (Figure 1) [35].
Schematic diagram of the life cycle of SARS-CoV-2.
Highest sequence similarity (~96%) was observed for the bat Coronavirus. So, it has been speculated that COVID-19 was transmitted from bats to humans. The intermediary animal host could be a pangolin or dog. COVID-19 illness is spread via intimate contact with an infected individual, as well as minute respiratory droplets emitted during coughing, sneezing, or talking [36]. Small droplets of saliva or sputum emitted from the mouth might carry large amounts of viruses that can linger in the air for lengthy periods of time and function as infection carriers. Even when a person is not in direct physical touch with the infected individual, inhaling these minute droplets causes viral infection to move from the sick to the healthy. The virus enters the human body via the eyes, nose, and mouth and spreads by encountering the virus on infected surfaces and then touching these bodily areas [37]. Environmental factors such as temperature and humidity influence viral propagation across infected surfaces [38]. The binding of homotrimer spike protein (S) on the virus’s surface to ACE2 on the host’s cell membrane facilitates SARS-CoV-2 entry into host cells [16]. The host cell receptor’s credit is a critical predictor of the virus’s tissue tropism and pathogenicity. The life cycle of SARS-CoV-2 is similar to the SARS-CoV and MERS-CoV [39]. Different strategies have been adopted to fight COVID-19.
COVID-19 diagnosis is a crucial step in tracking the virus and understanding its spread. This aids in the prevention of transmission as well as adequate patient care. COVID-19 is diagnosed in the first instance by observing signs and symptoms such as first loss of smell or taste or both, cough, mild to high fever, myalgia or weariness, and so on [40]. In addition, some people experience gastrointestinal problems such as vomiting, diarrhea, and nausea [41]. However, variations in the development of symptoms ranging from asymptomatic to severe instances, such as septic shock, metabolic acidosis, coagulation malfunction, and acute respiratory pneumonia-like syndrome, have been recorded often [17]. These indications and symptoms should only be used as a starting point for additional testing, not as a diagnostic tool. The recognition of symptoms in clinical conditions is the most important factor in diagnosis. Swabs are used to obtain pathological samples from the upper and lower respiratory areas (throat, oropharyngeal, nasopharyngeal, broncho-alveolar fluid, and sputum). The virus is still absent in the blood and urine of infected people, hence they are not regarded valid clinical specimens. The interlink between the temporal surge of viral load and its bio-distribution in different tissues of the body has a critical implication on the accuracy of various tests for diagnosis, according to reports of inconsistency in RTPCR test results for CoV-SARS-2 in various tissues [42] and temporal variation of test results from the same tissues [43]. SARS-spike CoV-2’s surface glycoprotein binds to the ACE2 receptor and then enters the host cell. Viral particles release their DNA after entering the host cell, which is then translated into protein, and additional viral particles are created, which are then released to infect the next cells. Many assays (molecular and immunological assays) or tools have been used for the diagnosis of COVID-19 and many more are currently in development.
SARS-Cov-2 infections currently have no vaccinations or antiviral therapies available [44]. Because developing safe and stable vaccines takes time and the pandemic is still going on, it’s critical to test and discover current medications that are already effective against SARS and MERS to determine whether they can be effectively applied to SARSCov-2. Various preclinical studies on other CoVs genetically very close to SARS-Cov-2 suggested that promising clinical outcomes for COVID-19 patients should be obtained by using several drugs including alpha-interferon, chloroquine phosphate, arabinol, remdesivir, lopinavir/ritonavir, and anti-inflammatory drugs. In a large-scale drug screening, nelfinavir has potent antiviral activity against SARS-Cov-2 [45]. Besides, praziquantel, pitavastatin, and perampanel might be effective against SARS-CoV-2. The outbreak of COVID-19 infection is related to the unavailability of specific drugs to combat this viral infection. Despite the challenges related to COVID-19 therapy, there are still several approaches being undertaken that show significant outcomes [5]. Discuss the positive impacts of some of the clinically used drugs for the COVID-19. Some drugs are in clinical trials, and some have shown significant promise in COVID-19 patients [46]. To find the solutions for COVID-19, great efforts have been made and are continued to develop vaccines, small-molecule drugs, or monoclonal antibodies that can prevent the infection [47]. In addition to drugs under clinical trials, some vaccines are expected to play a significant role in controlling the COVID-19 pandemic (Figure 2).
Common inhibitory action of antiviral drugs.
In 2009, Gilead Sciences, Inc. (USA) developed an antiviral drug called Remdesivir (RDV) to treat hepatitis B [48]. It did not indicate a desirable act against hepatitis. However, it is effective against other viruses, such as the Nipah virus, hepatitis C, and Marburg [49]. RDV is a broad-spectrum antiviral nucleoside analog, and now it is used as a treatment option for COVID-19 [50]. It is the class of polymerase inhibitors and showed activity against different RNA viruses, including SARS-CoV, MERS-CoV, Lassa fever virus, Junin virus, respiratory syncytial virus, Nipah virus, Hendra viruses, filoviruses, and Ebola viruses. RDV is a prodrug of its parent adenosine triphosphate analog, (2R,3R,4S,5R)-2-(4-aminopyrrolo(2,1-f)(1,2,4)triazin-7-yl)-3,4-dihydroxy-5-(hydroxymethyl)oxolane-2-carbonitrile (GS-441524), and has similarity to the adenine nucleic acid structurally. Both of these drugs are metabolized into the active component as nucleoside triphosphate (GS-443902) after ingestion and show antiviral activity against SARS-CoV [51]. RDV targets the viral genome replication process by acting as an RdRp inhibitor [52], RDV was used to block the RNA-dependent RNA polymerase of SARS-CoV-2. On metabolization of RDV into active nucleoside triphosphate (NTP), which competes with ATP for incorporation into nascent RNA strands, premature RNA synthesis occurs, resulting in RNA strand termination and cessation of growth [51]. RDV when tested through in vitro studies using the Vero E6 cells showed an EC50 value of 1.76 μM that showed its activity against SARS-CoV-2 [53]. Intravenous remdesivir treatment showed significant improvement for COVID-19. RDV and chloroquine are highly effective in the control of SARS-CoV-2 infection. In severe COVID-19 treated with RDV, improvements in the clinical finding were observed in 68% of patients [54]. However, in October 2020, the WHO removed it from the list of effective drugs in the treatment procedure of COVID-19 patients because it failed in the first trials for the treatment of COVID-19 [42]. There are still controversies regarding the results, no benefit in COVID-19 treatment using RDV; whereas, the company claims it as a promising drug for the same. After penetrating the cell, RDV as a prodrug (GS-5734) and like Favipiravir, binds to the triphosphate group under esterase, kinase, and phosphatase enzymatic reactions. These enzymes modify the structure of RDV and convert it to the active form, RDV-triphosphate (RDV-TP or GS-441524) [55]. After virus entry into the cell cytoplasm, this prodrug gets activated and loses its ability to diffuse to the intercellular space [53]. However, the primary mechanism of action of RDV against SARS-CoV-2 is unclear, and more research is necessary to understand it [56]. In an in vitro study, the combination of RDV and chloroquine (antimalarial drug) effectively inhibited SARS-CoV-2 growth in Vero E6 cells [19]. RDV is used to treat COVID-19 cases.
The combined use of RDV and IFN-β created a higher antiviral activity compared with the lopinavir/ritonavir-IFN-β combination against the MERS-CoV virus. Additionally, RDV could be better pulmonary function, cause fall lung viral loads and severe lung pathology in mice; on the contrary, lopinavir/ritonavir-IFN-β could not [57]. In two clinical studies, the use of RDV has been carried out against severe or mild respiratory infections caused by COVID-19. Recently, RDV for emergency use to treat COVID-19, including five antiviral drugs, ribavirin, RDV, sofosbuvir, galidesivir, and tenofovir, was conducted against SARS-CoV-2 RNA-dependent RNA polymerase (RdRp); these drugs showed promising results against COVID-19. Prominent adverse reactions were an acute respiratory failure, decreased glomerular filtration rate, lymphocytopenia, pyrexia, hyperglycemia, increased anemia, increased creatine, and liver transaminases. RDV given in combination with baricitinib (Janus kinase inhibitor used to hinder intracellular signaling of cytokines) was effective compared with RDV alone in terms of reducing recovery time additionally speeding improvement. RDV’s parent nucleotide GS-441524 is superior and less toxic than its prodrug form and has shown efficacy [58].
Favipiravir (Avigan or T705) is a synthetic antiviral agent that was first marketed as an anti-influenza drug in Japan. It is a derivative of pyrazine carboxamide (6-fluoro-3-hydroxy-2-pyrazine carboxamide) [59]. Due to its similarity to the purine (guanine) nucleotide, it is a type of RNA-dependent RNA-polymerase (RdRp) inhibitor. RdRp uses Favipiravir-RTP in the synthesis of mRNA strands, which can consequently stop viral protein synthesis via suppressing the translation process. Activated Favipiravir-RTP could suppress the SARS-CoV-2 RdRp enzyme and inhibit viral mRNA elongation and protein synthesis [60]. Favipiravir acts against RNA viruses by working on viral genetic copying to prevent its reproduction. A phase 3 clinical trial was involved for the treatment of COVID-19 disease using Favipiravir. For the first day, take 1800 mg twice a day, then 600 mg three times a day from the second day onward for a total of 14 days. Normalization of pyrexia, respiratory rate, and cough alleviation for at least 72 h are the key objectives [61]. The precursor of this drug known as T1105 has anti-influenza effects [62]. Drug excretion is through renal elimination and is mainly impacted by aldehyde oxidase and xanthine oxidase [62]. Favipiravir is a prodrug that is phosphorylated upon its entry into the cell and converted to an active antiviral form, favipiravir ibufuranosyl-5′-triphosphate (T-705-RTP). Favipiravir was first prescribed in Wuhan, to treat patients with SARS-CoV-2 infection. In June 2020, it was approved for mild-to-moderate COVID-19 cases in India. Favipiravir has been consumed to cure distinct viral diseases. Favipiravir was effective against some RNA viruses, such as yellow fever virus, Lisa virus, West Nile virus, Bunyavirus, arenavirus, flavivirus, filoviruses, and Ebola virus [63]. The exact mechanism of action is not clear against SARS-CoV-2. Favipiravir is considered a potential drug for COVID-19 and is currently used for COVID-19 treatment in Japan and Indonesia. Besides, its anti-influenza virus action, it stops the replication of RNA viruses such as flavi-, alpha-, filo-, bunya-, arena-, noroviruses [64]. Favipiravir showed a more powerful antiviral activity than lopinavir/ritonavir. Adverse reactions are not observed in a favipiravir therapy group. Compared with the lopinavir/ritonavir group, it had considerably fewer adverse effects. In a Japanese study, FPV was also shown to control inflammatory mediators and pneumonia progression in COVID-19 patients [65]. Severe or critical COVID-19 patients showed improvements after treating with FPV and FPV also led to improved lung histology [66].
Lopinavir is an antiviral drug belonging to the family of protease inhibitors. It is commonly used to treat Acquired Immunodeficiency Syndrome (AIDS) and prevent HIV from spreading inside the body. Lopinavir/ritonavir (LPV/RTV) is used in combination with other antiretroviral drugs for the treatment of HIV-1 infection. In the coronavirus pandemic, when no definitive drug was proposed to treat patients, it was used in combination with Ritonavir. This LPV/RTV is branded as Kaletra. Lopinavir has a relatively short half-life in the blood and is affected by the cytochrome p450 enzyme, while Ritonavir is a protease inhibitor and reduces the Lopinavir metabolism by suppressing the function of cytochrome p450. The half-life of Lopinavir is improved, and its circulation period is increased. LPV/RTV acts as a protease inhibitor drug and inhibits the action of 3-CLpro, a chymotrypsin-like protease enzyme, that plays a vital role in the processing and interferes with the process of viral replication and its release from host cells [67, 68, 69]. LPV/RTV use is related to diverse side effects, mainly in the gastrointestinal tract. Diarrhea, impaired hepatic cell function, and pancreatitis are some of these crucial side effects.
The use of lopinavir as an emergency drug in China increased the eosinophil count among COVID-19 patients [70]. In an in silico study, LPV/RTV used as HIV protease inhibitors inhibited the main protease (MPro) of SARS-CoV-2 [71]. The LPV/RTV is being used as an emergency treatment for COVID-19 patients in some countries [72]. LPV/RTV alone or in combination with interferon (INF)-β, an inflammation regulator, has been listed by WHO as options for “solidarity” clinical trial for COVID-19. COVID-19 might benefit from LPV/RTV since it reduces viral load and improves clinical symptoms. Lung damage was also significantly reduced when LPV/RTV and umifenovir were used together [73]. A research found that while LPV/RTV therapy was associated with a better result, it did not significantly speed up the clinical progression of severe COVID-19 infection. Although the efficacy of lopinavir for COVID-19 has yet to be determined, LPV/RTV has been employed in the treatment of COVID-19 patients [57]. Now, LPV/RTV and IFN-β1b are in phase 2 for the MERS therapy. Despite the positive findings, in a recent study performed on patients with SARS-CoV-2 infection, the LPV/RTV did not provide clinical improvement compared with standard care processes [72]. Findings of LPV/RTV clinical efficacy remain limited and primarily anecdotal cases. LPV/RTV in the therapy of COVID-19 is needed as current results contradict. LPV/RTV can ameliorate the outcome of MERS-CoV infection [74]. Moreover, LPV/RTV is assumed as a therapeutic option for COVID-19 pneumonia [72]. Thus, more well-designed clinical studies are necessary to identify their efficacy as therapeutic agents for COVID-19.
Novaferon has potential as an antiviral drug against COVID-19. It is a synthesized protein consisting of 167 amino acids, designed on the technical basis of DNA shuffling technology. The antiviral effects of novaferon are shown alone and in combination with lopinavir/ritonavir (LPV/RTV) for COVID-19 treatment. Novaferon inhibited the viral replication in infected cells (EC50 = 1.02 ng/ml) and protected healthy cells from SARS-CoV-2 infection (EC50 = 0.1 ng/ml). Both novaferon and novaferon plus LPV/RTV groups had significantly higher SARS-CoV-2 clearance rates on day 6 than the LPV/RTV group [8].
Ribavirin (Virazole) is an antiviral drug belonging to the nucleoside analogues, (1-beta-d-ribofuranosyl-1,2,4-triazole-3-carboxamide). It is a synthetic nucleoside analog with a guanosine-like structure. Ribavirin disrupts viral DNA and RNA replication, thereby inhibiting virus proliferation in the cell. Although Ribavirin’s primary mechanism of action is suppressing the virus replication, and can also interfere with viral RNA capping, which depends on the presence of natural guanosine in the RNA structure. The natural guanosine in the viral RNA structure prevents the breakdown of RNA strands. Ribavirin reduces the guanosine synthesis in the cell by inhibiting the activity of the inosine monophosphate dehydrogenase enzyme, which negatively impacts virus replication [75]. Although Virazole does not entirely inhibit viral RNA synthesis, the synthesis of the viral genetic material is severely impaired. It results in significant and persistent mutations in viral RNA, which reduce the viability of the virus in host cells [76]. Besides, the presence of Ribavirin in the patient’s body can reduce viral immune evasion and boost immune maintenance [77]. It is the first broad-spectrum antiviral drug against DNA and RNA viruses [75]. It is used clinically to treat HIV and hepatitis C virus (HCV) patients.
Ribavirin, which has been studied for its antiviral effectiveness against SARS-CoV-2, is used to inhibit viral RNA production and viral mRNA capping with a broad range of antiviral activity. It’s a prodrug that, when metabolized, looks like purine RNA nucleotide, which prevents viral multiplication by interfering with RNA metabolism. It was discovered in a comparison study of SARS-CoV-2 patients treated with lopinavir/ritonavir (LPV/RTV) and ribavirin combination treatment [77]. Ribavirin is one of the medications used to treat COVID-19 in conjunction with either IFN alpha or LPV/RTV [46]. Using ribavirin in combination with sofosbuvir and remdesivir, docking and modeling studies revealed that ribavirin is a viable candidate medication for COVID-19 therapy [78]. Ribavirin and sofosbuvir are currently part of the therapeutic regimen to treat COVID-19 in some countries.
Ribavirin inhibits the function of inosine monophosphate dehydrogenase, which affects the formation of guanosine triphosphate (GTP), preventing RNA and DNA viral replication. During the SARS outbreak in Hong Kong, ribavirin was utilized. With or without steroids, it was occasionally chosen. The combination of ribavirin and interferon-β, which appears to inhibit SARS-CoV replication, has shown significant efficacy in the inhibition of SARS-CoV [79]. The ribavirin triple antiviral treatment was safe and superior compared with lopinavir-ritonavir combined therapy.
The drug showed antiviral efficacy against canine distemper virus, hepatitis C virus, Enterovirus, Chikungunya virus, and Semliki Forest virus, orthopoxvirus, influenza virus, flavi- and paramyxoviruses [80]. A study observed reduced replication of the MERS-CoV in rhesus macaques upon treatment with IFN-α2b and RBV [81]. RBV in combination with LPV/RTV was used in SARS-CoV and MERS-CoV trials [82]. In the case of SARS-CoV-2 infection, an in vitro study showed the EC50 of RBV as 109.50 uM [31]. A study included RBV along with LPV/RTV and IFN-α in the treatment of hospitalized COVID-19 patients. When compared with those that only received LPV-RTV, the triple treatment was found to be effective in reducing illness symptoms and viral shedding. The RBV dosage was 400 mg bid for 14 days, paired with 400 mg/100 mg of LPV/RTV + IFN-β. A research examined the effectiveness of antivirals sofosbuvir/daclatasvir and RBV in the treatment of COVID-19 patients. COVID-19 patients treated with RBV had a greater death rate (33%) than those treated with sofosbuvir/daclatasvir. A cohort study comparing RBV vs. supportive therapy stated that RBV did not help in reducing the mortality rate in COVID-19 patients [83].
It is an antiviral widely used to treat the influenza virus. Arbidol can prevent SARS-CoV-2 infection
Darunavir, an anti-HIV drug, is recommended for COVID-19 treatment in Italy. It is used in a combined regimen along with cytochrome P-450 inhibitors such as ritonavir or cobicistat and confirmed their replication inhibitory effect against SARS-CoV-2. A clinical trial assessed the effectiveness of darunavir combination with other antivirals and hydroxychloroquine for COVID-19 patients. A combination of darunavir and cobicistat is also being tested [93]. PREZCOBIX®, a fixed-dose combination of darunavir and cobicistat, is also used to treat COVID-19. COVID-19 infection was recently discovered in HIV-positive individuals who were already taking darunavir, raising questions about the effectiveness of this HIV protease inhibitor. The darunavir might not be effective in preventing SARS-CoV-2 infection at the dosage of 800 mg [94]. Darunavir is a second generation of HIV-1 protease inhibitors used to prevent SARS-CoV-2 infection in vitro [17] by inhibiting viral replication at 300 μM, and this inhibition efficiency was 280-fold compared with the untreated groups. Darunavir boosted with ritonavir or cobicistat is used in HIV/AIDS treatment. The efficacy of darunavir or ritonavir is enhanced by cytochrome p450 (CYP3A) inhibition [95]. Cell experiments with darunavir showed that the drug inhibited viral replication of COVID-19 in vitro. The lopinavir/ritonavir used in the treatment of HIV/AIDS has more efficacy and tolerability than darunavir, its use in COVID-19 is limited.
Oseltamivir (Tamiflu) is an antiviral agent that is used for patients with influenza A and B. It is a protease inhibitor, which specifically inhibits the neuraminidase enzyme in the influenza virus. This enzyme has a key role in the binding of the influenza virus to the cell membrane and spread throughout the body. Therefore, Oseltamivir, by targeting neuraminidase, prevents the spread of the influenza virus and its progression inside the body [96]. This drug was used in the treatment of COVID-19 infection, which showed an appropriate effect on patients [41]. Oseltamivir has been applied in concomitant regimens with other drugs such as Hydroxychloroquine or Favipiravirs [97]. In addition to treating influenza A and B patients, this drug may also be used in severe cases. For the treatment of flu patients, Tamiflu is prescribed in a 75 mg dosage twice a day and once a day as prophylaxis. The main side effects of this drug can be nausea and headache [98]. Neuraminidase inhibitors seem beneficial for COVID-19 patients and can reduce their ventilator requirements [99]. The precise mechanism of action of Oseltamivir against COVID-19 infection is still unclear. Oseltamivir is a synthetic derivative prodrug of ethyl ester [100]. It acts as a neuraminidase inhibitor against the influenza virus and is also effective for various avian influenza virus strains [101]. An in vitro oseltamivir study on H5N1 influenza showed that the IC50 was 0.1–4.9 nM [102]. In vivo study involving H5N1 infection required a longer course and higher dosage of Oseltamivir. The COVID-19 originated in China during flu season, and hence earlier, many patients received oseltamivir treatment until the causative agent SARSCoV-2 was discovered. Some current clinical trials have used oseltamivir in combination with other major therapeutic drugs [31, 41].
Sofosbuvir is an antiviral drug and RdRp inhibitor that exerts its effect by suppressing RdRp enzyme activity. A combination of Sofosbuvir with Ledipasvir is used for treating patients with genotype 1 of HCV67. Because of the similarity in the transcription and replication mechanism of the SARS-CoV-2 with HCV in host cells, physicians speculate that this drug may help treat COVID-19 patients [103]. This drug disrupts the activity of RdRp by acting like free nucleotides that are essential for viral mRNA synthesis [104]. Sofosbuvir is a potential option for COVID-19 treatment [105], and extensive clinical studies should be performed to verify the effectiveness of this drug.
Danoprevir, an HCV N53 protease inhibitor, is authorized in China for the treatment of noncirrhotic genotype 1b chronic hepatitis C in combination with other medications. In China, only two clinical studies of danoprevir coupled with ritonavir in the treatment of SARS-CoV-2 infection were completed [8].
In a computer simulation, atazanavir bonded more firmly to the active site of SARS-CoV-2 MPro than lopinavir, and atazanavir suppressed SARS-CoV-2 replication in a test tube. A prior trial on HIV-positive individuals found that combining atazanavir with ritonavir enhanced glucose uptake and lipid parameters while also lowering fasting glucose levels more efficiently than lopinavir-ritonavir. The atazanavir might be an alternative for lopinavir when combined with ritonavir for COVID-19 treatment. This antiviral drug is an option for COVID-19 treatment [8].
SARS-CoV-2 penetrates host cells by receptor-mediated endocytosis, just as other viruses. AP2-related protein kinase 1 controls the process of endocytosis (AAK1). As a result, disrupting AAK1 will prevent not just viral entrance but also intracellular viral assembly. Baricitinib is a Janus kinase (JAK) inhibitor that has a high affinity for AAK1 and can inhibit it. SARS-CoV-2 infection can be treated with baricitinib, which inhibits both viral entry and the inflammatory response [106]. JAK inhibitors such as ruxolitinib and fedratinib, which are linked to baricitinib, decreased clathrin-mediated endocytosis at higher dosages, suggesting that they may not be effective at acceptable concentrations in lowering viral infectivity. Neutropenia, lymphocytopenia, and viral reactivation have all been linked to the use of baricitinib for therapeutic purposes. Because individuals infected with SARSCoV-2 had a lower absolute lymphocyte count, baricitinib may increase the risk of co-infection [107].
Blocking virus-host fusion is a promising target for the novel antiviral agents that inhibit the Abl kinase pathway [41]. In a study, imatinib, an Abl kinase inhibitor, was observed to block the replication of SARS and MERS viruses by blocking viral fusion in 2016 [108]. COVID-19 utilized the SARS-coronavirus receptor ACE2 as well as the cellular protease TMPRSS2 to get access to target cells; therefore, TMPRSS2, transmembrane serine protease 2, inhibiting medicines such imatinib might be evaluated as COVID-19 disease treatment alternatives [37].
Another possible medicine that targets the fusion stage in viruses is camostat mesylate, a serine protease inhibitor. SARS-CoV-2 enters target host cells via ACE-2 receptors and/or TMPRSS2 receptors, with camostat mesylate acting as a TMPRSS2 inhibitor. It inhibits the virus’s cellular entrance by downregulating the production of the SARS-CoV-2 spike (S) protein, which prevents surface fusion. SARS-CoV infection in human bronchial epithelial cells was inhibited by camostat mesylate [109]. In vitro testing revealed that camostat mesylate and E-64d (a cysteine protease inhibitor) effectively blocked SARS-CoV-2 TMPRSS2 binding. Clinical studies are now underway to compare the efficacy of hydroxychloroquine and camostat mesylate vs. hydroxychloroquine alone. Another serine protease inhibitor, nafamostat mesylate, was shown to be 15 times more effective in preventing the SARS-CoV-2 virus from infecting host cells. As a result, nafamostat mesylate can be regarded a preferable option to camostat mesylate due to its more robust antiviral activity and acceptable safety profile [37]. Disseminated intravascular coagulation is also treated with nafamostat mesylate (DIC). It will aid in the management of DIC, as seen by increased fibrinolysis in COVID-19 patients [110].
In an in vitro research utilizing Vero E6 cells, nitazoxanide and its active component, tizoxanide, showed promise against MERS CoV and SARS CoV-2, with EC50 values of 0.92 and 2.12 μM, respectively [111]. In addition to coronaviruses, it exhibited action against norovirus, rotavirus, parainfluenza, respiratory syncytial virus, and influenza virus. This antiviral efficacy is due to the fact that the action mechanism is based on interfering with the virus’s host-regulated reproduction pathways rather than the virus’s particular pathways [112]. Nitazoxanide stimulates innate antiviral systems through amplification of cytoplasmic RNA sensing and type 1 IFN pathways. Nitazoxanide increases the expression of certain host systems that interfere with viral infection, allowing viruses to evade the host’s cellular defenses [113]. The nitazoxanide used against influenza viruses blocks the maturation of viral hemagglutinin at the post-translational stage [112]. Even if the findings aren’t promising, this medicine is used to treat some acute respiratory infections such as influenza. Although the in vitro activity of nitazoxanide against SARS-CoV-2 is promising, additional research is needed to understand its function in the management of COVID-19 (Figure 3).
Chemical structure of antiviral drugs.
Other various antiviral agents have been utilized to determine their impacts against SARS-CoV-2. Galidesivir is a nucleoside analog and a protease inhibitor [114]. This drug mechanism on COVID-19 is hypothesized to be similar to other antivirals, although its exact action mechanism is unknown. Another antiviral agent for COVID-19 is Tenofovir, which is known as an anti-influenza drug. It is an antiretroviral agent that targets DNA polymerase and inhibits virus replication [115, 116]. The action mechanism of this substance against COVID-19 requires further studies.
A fusion inhibitor is a group of antivirals that inhibit the fusion process during viral entry into the host cells. Some drugs are available with umifenovir and camostat mesylate representing antiviral activity against SARS-CoV-2 [117].
Some protease inhibitors such as lopinavir, darunavir, and atazanavir are used against COVID-19 [118]. In a computational study, drugs such as carfilzomib, valrubicin, eravacycline, lopinavir, and elbasvir inhibited the main protease in SARS-CoV-2. Further studies are required to confirm the efficacy of these drugs. Saquinavir and other protease inhibitors such as indinavir, amprenavir, and nelfinavir might also show the same effects against COVID-19 like protease inhibitors, due to resemblance between the structures. In a computer simulation, saquinavir and indinavir were found to suppress 3CLPro activity in SARS-CoV-2 [119]. In vitro inhibition of SARS-CoV-2 was shown to be inhibited by saquinavir, indinavir, amprenavir, and nelfinavir, with nelfinavir demonstrating the greatest suppression when compared with the others. In Singapore, saquinavir has been used to treat COVID-19 patients. Two other medications, raltegravir and paritaprevir, were shown to have the ability to block 3CLPro activity in SARS-CoV-2 in a computational investigation (Tables 1 and 2) [120].
Class | Drugs | Application | Emergency use for COVID-19 |
---|---|---|---|
Fusion inhibitor | Umifenovir (Arbidol) | Influenza | Singapore, China |
Protease Inhibitor | Lopinavir | HIV | USA, Japan, Singapore, Italy, China, IPC (Lopinavir-Ritonavir fix dose) |
Darunavir | HIV-1 | Italy (Darunavir-Ritonavir fix dose) | |
Atazanavir | HIV-1 | Singapore | |
Saquinavir | HIV-1 | Singapore | |
Nucleoside reverse transcriptase inhibitor | Emtricitabine | HIV-1 | Singapore (Emtricitabine-Tenofovir fix dose) |
Azvudine | HIV-1 | Singapore | |
Nucleotide reverse transcriptase inhibitor | Remdesivir | Ebola | WHO, IPC, USA, Singapore, Italy |
Favipiravir | (Avigan) Influenza | Singapore, Japan, Indonesia | |
Ribavirin | HCV | Singapore, IPC | |
Sofosbuvir | HCV | Singapore | |
Neuraminidase inhibitor (Virus release inhibitor) | Oseltamivir (Tamiflu) | Influenza A & B | IPC, Singapore, Indonesia |
Current use of existing antiviral drugs for COVID-19 [56].
International Pulmonologists’ Consensus includes the USA, India, Iran, China, Italy, Great Britain, EUA, Colombia, Egypt, Singapore, Romania, Ireland, Malaysia, Saudi Arabia, Sudan, Greece, and Bolivia.
Group | Drugs | Mechanism of action |
---|---|---|
Viral RNA polymerase inhibitors | Remdesivir (GS-5734) | RdRp inhibitor, prodrug, the analog of adenosine nucleotide |
Favipiravir | RdRp inhibitor, prodrug, the analog of guanosine nucleotide | |
Viral protein synthesis inhibitors | Ritonavir/Lopinavir | Inhibitor of protease |
Inhibitors of viral entry | Hydroxychloroquine Chloroquine | Increase in endosomal pH needed for the virus/cell fusion. Interfere with cellular receptor glycosylation of SARS CoV (ACE-2) |
Immunomodulators | Nitazoxanide | Interfere with host regulated pathways of virus replication, amplification of type 1 IFN pathways, and cytoplasmic RNA sensing |
Ivermectin | Inhibition of importin 1 heterodimer to inhibit the nuclear import of host and viral proteins |
Mechanism of action of antiviral drugs used for the treatment of COVID-19.
Another technique for combating SARS-CoV-2 infection is to inhibit RdRp and impede viral replication by targeting the reverse transcription process. Nucleoside reverse transcriptase inhibitors (NRTIs), nucleotide reverse transcriptase inhibitors (NtRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), and nucleoside reverse transcriptase translocation inhibitors are a few examples of possible inhibitors (NRTTIs).
Other NtRTIs with comparable structural properties to remdesivir or ribavirin, such as adefovir, tenofovir alafenamide, tenofovir disoproxil, abacavir, ganciclovir, and didanosine, exhibit antiviral effectiveness against SARS-CoV-2. NRTIs (lamivudine, stavudine, zidovudine, emtricitabine, zalcitabine, and azvudine) and NNRTIs (efavirenz, nevirapine, delavirdine, and rilpivirine) may also have antiviral activity against SARS-CoV-2 [56].
Oseltamivir is a neuraminidase inhibitor used in preventing influenza Neuraminidase inhibitor drugs such as oseltamivir, zanamivir, and peramivir are antiviral drugs that inhibit the viral neuraminidase enzyme and are recommended for influenza and to block the release of viral particles out of host cells. Neuraminidase inhibitors are also used as empirical treatment in MERS-CoV infection [121, 122]. However, a combination of oseltamivir with ganciclovir and lopinavir/ritonavir is used to treat COVID-19 patients [40]. A computational study also supported synergistic effects of oseltamivir-lopinavir-ritonavir combination against SARS-CoV-2 [123]. Oseltamivir is used with ceftriaxone and terbutaline to treat COVID-19 [124]. A study showed that the CT scan of the lungs of a COVID-19 patient showed significant improvement after a three-day course of oseltamivir [19]. Oseltamivir has been used either with or without antibiotics and corticosteroids against COVID-19. In a clinical trial, oseltamivir is tested with chloroquine and favipiravir [93, 125].
Nowadays, the rising SARS-CoV-2 turned into a global threat. COVID-19 targets lung cells by connecting to ACE2 protein. This protein is largely produced in some tissues such as the bile duct, liver, gastrointestinal organs, esophagus, testis, and kidney as well as lung tissue. Thus, COVID-19 may damage these organs and tissues. With the global threatening caused by COVID-19, efficient therapy against COVID-19 is quickly necessary. Nevertheless, the development of new drugs for this disease is still a huge problem for people in the world, and we have none formally approved drugs against COVID-19 now. It is very crucial to cut off the extending of this virus owing to epidemic avoidance and checking techniques. We need to develop novel drugs and to find new therapy methods to prevent this outbreak and to treat COVID-19. The extent of the current pandemic, along with other factors, such as the lack of time to develop novel and effective agents against COVID-19, the high mortality rate, possible mutations in its genetic material and severe economic shocks to societies highlight the value of testing antiviral drugs present in our drug arsenal. Some drugs that have already started with repositioning may be effective against COVId-19 as well. It is essential to address the drug-drug interaction of the drugs in COVID-19 patients with comorbidities. We hope that the continuing studies may provide solutions for the prevention and therapy against the COVID-19.
Despite the fact that specific antiviral medications for COVID-19 have yet to be identified or authorized by the FDA, the usage of some currently existing antiviral agents that target various phases in COVID-19’s life cycle might be an alternate therapeutic strategy for combating the pandemic. Fusion inhibitors, protease inhibitors, and transcription inhibitors are just a few of the interesting antiviral medication classes to investigate. Apart from antiviral medicines, various interesting techniques to treating COVID-19 are being employed, such as convalescent plasma, which has been found to reduce viral load and patient morbidity. The effects of interferon (IFN)-α/β and IL-6R inhibitor1 have also been encouraging [126, 127, 128]. The introduction of several new technologies is likely to yield good benefits. The safety of patients should be prioritized while evaluating new SARS-CoV-2 vaccinations. Nanotechnology offers an effective new route for diagnostics and treatment techniques. The more distinctive nanoparticles operate as excellent antiviral medication delivery vehicles, increasing the procedure’s effectiveness. Finding appropriate diagnostic and therapeutic strategies for the fast and efficient care of severe COVID-19 patients is urgently needed [129, 130]. Different research on different CoV-induced diseases shows that using α-interferon, chloroquine phosphate, arabinol, remdesivir, lopinavir/ritonavir, and anti-inflammatory medications might result in encouraging clinical results for SARS-Cov-2 patients. Tocilizumab should be used as a therapy approach for severe COVID-19 pneumonia to achieve favorable results. Furthermore, further clinical studies with appropriate medications should be conducted on SARS-CoV-2 patients to demonstrate effectiveness and safety.
We are thankful to the Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, 21955, Saudi Arabia, and Glocal School of Pharmacy, Glocal University, Mirzapur Pole, 247121, Saharanpur, Uttar Pradesh, India for providing necessary facilities.
The authors declare no conflicts of interest.
3CLpro | 3-chymotrypsin-like protease |
AAK1 | AP2-associated protein kinase 1 |
ACE2 | angiotensin-converting enzyme 2 |
ACEi | angiotensin-converting-enzyme inhibitors |
ADR | acute respiratory distress syndrome |
AIDS | acquired immunodeficiency syndrome |
Cm | maximum concentration |
CMV | cytomegalovirus |
COVID-19 | coronavirus disease 2019 |
DCGI | drug controller general of India |
DR | drug repurposing |
E | envelope protein |
ER | endoplasmic reticulum |
ERGIC | endoplasmic reticulum-Golgi apparatus compartment |
EVD | Ebola virus disease |
HA | hemagglutinin envelope glycoprotein |
HAV | hepatitis A virus |
HCMV | human cytomegalovirus |
HCV | hepatitis-C virus |
HE | hemagglutinin esterase |
HSV | herpes simplex virus |
ICU | intensive care unit |
INF-β | interferon |
Kb | kilo base pairs |
M | membrane protein |
MERS | Middle-East Respiratory Syndrome |
Mpro | main protease |
N | nucleocapsid |
NNRTI | non-nucleoside reverse-transcriptase inhibitors |
NRTTI | nucleoside reverse transcriptase translocation inhibitors |
NtRTI | nucleotide reverse-transcriptase inhibitor |
PLPro | Papain-like protease |
qRT-PCR | quantitative real-time polymerase chain reaction |
R0 | reproductive number |
RdRp | RNA-dependent RNA polymerase |
RNA | ribonucleic acid |
RVFV | Rift Valley fever virus |
S(P) | Spike protein |
S | glycoprotein spike |
SARS | severe acute respiratory syndrome |
SARS-CoV-2 | Severe acute respiratory syndrome coronavirus 2 |
SPs | spike proteins |
TMPRSS2 | transmembrane serine protease 2 |
US FDA | United States Food and Drug Administration |
WHO | World Health Organization |
Ove Odredbe i uvjeti ističu pravila i regulacije u svezi korištenja IntechOpenove stranice www.intechopen.com i svih poddomena u vlasništvu IntechOpena, tvrtke sa sjedištem u 5 Princes Gate Court, London, SW7 2QJ, Ujedinjeno Kraljevstvo.
',metaTitle:"Odredbe i uvjeti",metaDescription:"Ove Odredbe i uvjeti ističu pravila i regulacije u svezi korištenja IntechOpenove stranice www.intechopen.com i svih poddomena u vlasništvu IntechOpena, tvrtke sa sjedištem u 5 Princes Gate Court, London, SW7 2QJ, Ujedinjeno Kraljevstvo.",metaKeywords:null,canonicalURL:"/page/cro-terms-and-conditions",contentRaw:'[{"type":"htmlEditorComponent","content":"Pristupom na stranicu www.intechopen.com slažete se s ovim odredbama, sa svim primjenjivim zakonskim odredbama, te se slažete s poštovanjem svih lokalnih zakona. Korištenje i/ili pristup ovoj stranici temelji se na potpunom prihvaćanju ovih odredbi. Svi materijali na ovoj stranici zaštićeni su primjenjivim zakonima o autorskim pravima i žigu.
\\n\\nSljedeća terminologija odnosi se na Odredbe i uvjete, te na sve naše ugovore:
\\n\\nKlijent, stranka, vi, vaš odnosi se na vas, osobu koja pristupa ovoj stranici i prihvaća IntechOpenove Odredbe i uvjete;
\\n\\nKompanija, tvrtka, mi, naše odnosi se na tvrtku IntechOpen;
\\n\\nStranke, strane odnosi se na klijenta i na nas, ili samo na klijenta ili nas.
\\n\\nSve odredbe koje se odnose na ponudu, prihvat ili razmatranje plaćanja, a za koja mi pružamo asistenciju klijentu, bilo na ugovoreni ili fiksni način, a s ciljem da se ostvare potrebe i želje klijenta u svezi s našim uslugama, su podložne zakonskim odredbama Ujedinjenog Kraljevstva.
\\n\\nOsim ako nije suprotno navedeno, IntechOpen i/ili svi davatelji licence vlasnici su intelektualnog vlasništva nad svim materijalima na www.intechopen.com. Sva prava intelektualnog vlasništva su pridržana. Stranice sa www.intechopen.com možete gledati, preuzimati, dijeliti, dijeliti poveznice i printati za osobnu uporabu, a temeljem pravila sadržanih u ovim Odredbama i uvjetima.
\\n\\nMi koristimo kolačiće. Korištenjem IntechOpenove stranice slažete se s korištenjem kolačića u skladu s IntechOpenovom Politikom privatnosti. Većina modernih, interaktivnih stranica koristi kolačiće kako bi omogućila ponovno pronalaženje korisničkih detalja kod svakog posjeta. Na našoj stranici kolačići se uglavnom koriste kako bi omogućili funkcionalnost i olakšali posjetiteljima korištenje stranice.
\\n\\nIntechOpen ili njegovi suradnici niti u jednom slučaju neće biti odgovorni za štete (štete uključuju gubitak podataka ili profita, druge poslovne prekide, te sve ostale štete) koje nastanu zbog korištenja materijala na IntechOpenovoj stranici ili nemogućnosti da se iste koriste, čak i ako je IntechOpen ili njegov predstavnik o takvoj šteti obaviješten pismenim ili usmenim putem. Neke jurisdikcije ne dozvoljavaju ograničenja garancija ili ograničenja obveza za posljedične ili slučajne štete pa se u tom slučaju ova ograničenja možda ne odnose na vas.
\\n\\nMaterijali koji se pojavljuju na IntechOpenovoj stranici mogu sadržavati manje greške, tipfelere ili fotografske greške. IntechOpen može napraviti promjene na bilo kojem materijalu koji se nalazi na stranici u bilo koje vrijeme.
\\n\\nIntechOpen nije formalno povezan niti s jednom vanjskom stranicom čije poveznice vode na www.intechopen.com, osim ako to nije izravno navedeno. Iz tog razloga IntechOpen nije odgovoran za sadržaj koji se pojavljuje na takvim stranicama. Poveznica na IntechOpenovu stranicu ne implicira povezanost sa IntechOpenom. Korištenje takvih poveznica isključiva je odgovornost korisnika.
\\n\\nZadržavamo pravo vlasništva nad cjelokupnom stranicom www.intechopen.com i nad svim materijalom na toj stranici. Koristeći se našim uslugama, slažete se da maknete sve poveznice na našu stranicu odmah nakon što to od vas zatražimo. Također, zadržavamo pravo da ove Odredbe i uvjete, i politiku o poveznicama izmjenimo u bilo koje vrijeme. Koristeći se poveznicama na naše stranice slažete se s ovim Odredbama i uvjetima.
\\n\\nAko smatrate da je bilo koja poveznica na našoj stranici sumnjiva iz bilo kojeg razloga, molimo vas da nas kontaktirate. U tom slučaju razmotrit ćemo micanje poveznice s naše stranice, iako nismo obvezni to napraviti.
\\n\\nBez prethodne privole i izričite pisane dozvole, ne možete stvarati okvire oko naših stranica ili koristiti druge tehnike koje na bilo koji način mogu promijeniti prezentaciju ili izgled naše stranice.
\\n\\nIntechOpen može ove Odredbe izmijeniti u bilo koje vrijeme i bez prethodne obavijesti. Koristeći ovu stranicu vi se slažete s trenutnim Odredbama i uvjetima koje su na snazi.
\\n\\nOve Odredbe i uvjeti su sastavljeni u skladu s odredbama prava Ujedinjenog Kraljevstva, a za sve sporove nadležan je sud u Londonu, Ujedinjeno Kraljevstvo.
\\n"}]'},components:[{type:"htmlEditorComponent",content:"Pristupom na stranicu www.intechopen.com slažete se s ovim odredbama, sa svim primjenjivim zakonskim odredbama, te se slažete s poštovanjem svih lokalnih zakona. Korištenje i/ili pristup ovoj stranici temelji se na potpunom prihvaćanju ovih odredbi. Svi materijali na ovoj stranici zaštićeni su primjenjivim zakonima o autorskim pravima i žigu.
\n\nSljedeća terminologija odnosi se na Odredbe i uvjete, te na sve naše ugovore:
\n\nKlijent, stranka, vi, vaš odnosi se na vas, osobu koja pristupa ovoj stranici i prihvaća IntechOpenove Odredbe i uvjete;
\n\nKompanija, tvrtka, mi, naše odnosi se na tvrtku IntechOpen;
\n\nStranke, strane odnosi se na klijenta i na nas, ili samo na klijenta ili nas.
\n\nSve odredbe koje se odnose na ponudu, prihvat ili razmatranje plaćanja, a za koja mi pružamo asistenciju klijentu, bilo na ugovoreni ili fiksni način, a s ciljem da se ostvare potrebe i želje klijenta u svezi s našim uslugama, su podložne zakonskim odredbama Ujedinjenog Kraljevstva.
\n\nOsim ako nije suprotno navedeno, IntechOpen i/ili svi davatelji licence vlasnici su intelektualnog vlasništva nad svim materijalima na www.intechopen.com. Sva prava intelektualnog vlasništva su pridržana. Stranice sa www.intechopen.com možete gledati, preuzimati, dijeliti, dijeliti poveznice i printati za osobnu uporabu, a temeljem pravila sadržanih u ovim Odredbama i uvjetima.
\n\nMi koristimo kolačiće. Korištenjem IntechOpenove stranice slažete se s korištenjem kolačića u skladu s IntechOpenovom Politikom privatnosti. Većina modernih, interaktivnih stranica koristi kolačiće kako bi omogućila ponovno pronalaženje korisničkih detalja kod svakog posjeta. Na našoj stranici kolačići se uglavnom koriste kako bi omogućili funkcionalnost i olakšali posjetiteljima korištenje stranice.
\n\nIntechOpen ili njegovi suradnici niti u jednom slučaju neće biti odgovorni za štete (štete uključuju gubitak podataka ili profita, druge poslovne prekide, te sve ostale štete) koje nastanu zbog korištenja materijala na IntechOpenovoj stranici ili nemogućnosti da se iste koriste, čak i ako je IntechOpen ili njegov predstavnik o takvoj šteti obaviješten pismenim ili usmenim putem. Neke jurisdikcije ne dozvoljavaju ograničenja garancija ili ograničenja obveza za posljedične ili slučajne štete pa se u tom slučaju ova ograničenja možda ne odnose na vas.
\n\nMaterijali koji se pojavljuju na IntechOpenovoj stranici mogu sadržavati manje greške, tipfelere ili fotografske greške. IntechOpen može napraviti promjene na bilo kojem materijalu koji se nalazi na stranici u bilo koje vrijeme.
\n\nIntechOpen nije formalno povezan niti s jednom vanjskom stranicom čije poveznice vode na www.intechopen.com, osim ako to nije izravno navedeno. Iz tog razloga IntechOpen nije odgovoran za sadržaj koji se pojavljuje na takvim stranicama. Poveznica na IntechOpenovu stranicu ne implicira povezanost sa IntechOpenom. Korištenje takvih poveznica isključiva je odgovornost korisnika.
\n\nZadržavamo pravo vlasništva nad cjelokupnom stranicom www.intechopen.com i nad svim materijalom na toj stranici. Koristeći se našim uslugama, slažete se da maknete sve poveznice na našu stranicu odmah nakon što to od vas zatražimo. Također, zadržavamo pravo da ove Odredbe i uvjete, i politiku o poveznicama izmjenimo u bilo koje vrijeme. Koristeći se poveznicama na naše stranice slažete se s ovim Odredbama i uvjetima.
\n\nAko smatrate da je bilo koja poveznica na našoj stranici sumnjiva iz bilo kojeg razloga, molimo vas da nas kontaktirate. U tom slučaju razmotrit ćemo micanje poveznice s naše stranice, iako nismo obvezni to napraviti.
\n\nBez prethodne privole i izričite pisane dozvole, ne možete stvarati okvire oko naših stranica ili koristiti druge tehnike koje na bilo koji način mogu promijeniti prezentaciju ili izgled naše stranice.
\n\nIntechOpen može ove Odredbe izmijeniti u bilo koje vrijeme i bez prethodne obavijesti. Koristeći ovu stranicu vi se slažete s trenutnim Odredbama i uvjetima koje su na snazi.
\n\nOve Odredbe i uvjeti su sastavljeni u skladu s odredbama prava Ujedinjenog Kraljevstva, a za sve sporove nadležan je sud u Londonu, Ujedinjeno Kraljevstvo.
\n"}]},successStories:{items:[]},authorsAndEditors:{filterParams:{},profiles:[{id:"396",title:"Dr.",name:"Vedran",middleName:null,surname:"Kordic",slug:"vedran-kordic",fullName:"Vedran Kordic",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/396/images/7281_n.png",biography:"After obtaining his Master's degree in Mechanical Engineering he continued his education at the Vienna University of Technology where he obtained his PhD degree in 2004. He worked as a researcher at the Automation and Control Institute, Faculty of Electrical Engineering, Vienna University of Technology until 2008. His studies in robotics lead him not only to a PhD degree but also inspired him to co-found and build the International Journal of Advanced Robotic Systems - world's first Open Access journal in the field of robotics.",institutionString:null,institution:{name:"TU Wien",country:{name:"Austria"}}},{id:"441",title:"Ph.D.",name:"Jaekyu",middleName:null,surname:"Park",slug:"jaekyu-park",fullName:"Jaekyu Park",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/441/images/1881_n.jpg",biography:null,institutionString:null,institution:{name:"LG Corporation (South Korea)",country:{name:"Korea, South"}}},{id:"465",title:"Dr",name:"Christian",middleName:null,surname:"Martens",slug:"christian-martens",fullName:"Christian Martens",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"479",title:"Dr.",name:"Valentina",middleName:null,surname:"Colla",slug:"valentina-colla",fullName:"Valentina Colla",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/479/images/358_n.jpg",biography:null,institutionString:null,institution:{name:"Sant'Anna School of Advanced Studies",country:{name:"Italy"}}},{id:"494",title:"PhD",name:"Loris",middleName:null,surname:"Nanni",slug:"loris-nanni",fullName:"Loris Nanni",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/494/images/system/494.jpg",biography:"Loris Nanni received his Master Degree cum laude on June-2002 from the University of Bologna, and the April 26th 2006 he received his Ph.D. in Computer Engineering at DEIS, University of Bologna. On September, 29th 2006 he has won a post PhD fellowship from the university of Bologna (from October 2006 to October 2008), at the competitive examination he was ranked first in the industrial engineering area. He extensively served as referee for several international journals. He is author/coauthor of more than 100 research papers. He has been involved in some projects supported by MURST and European Community. His research interests include pattern recognition, bioinformatics, and biometric systems (fingerprint classification and recognition, signature verification, face recognition).",institutionString:null,institution:null},{id:"496",title:"Dr.",name:"Carlos",middleName:null,surname:"Leon",slug:"carlos-leon",fullName:"Carlos Leon",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Seville",country:{name:"Spain"}}},{id:"512",title:"Dr.",name:"Dayang",middleName:null,surname:"Jawawi",slug:"dayang-jawawi",fullName:"Dayang Jawawi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Technology Malaysia",country:{name:"Malaysia"}}},{id:"528",title:"Dr.",name:"Kresimir",middleName:null,surname:"Delac",slug:"kresimir-delac",fullName:"Kresimir Delac",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/528/images/system/528.jpg",biography:"K. Delac received his B.Sc.E.E. degree in 2003 and is currentlypursuing a Ph.D. degree at the University of Zagreb, Faculty of Electrical Engineering andComputing. His current research interests are digital image analysis, pattern recognition andbiometrics.",institutionString:null,institution:{name:"University of Zagreb",country:{name:"Croatia"}}},{id:"557",title:"Dr.",name:"Andon",middleName:"Venelinov",surname:"Topalov",slug:"andon-topalov",fullName:"Andon Topalov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/557/images/1927_n.jpg",biography:"Dr. Andon V. Topalov received the MSc degree in Control Engineering from the Faculty of Information Systems, Technologies, and Automation at Moscow State University of Civil Engineering (MGGU) in 1979. He then received his PhD degree in Control Engineering from the Department of Automation and Remote Control at Moscow State Mining University (MGSU), Moscow, in 1984. From 1985 to 1986, he was a Research Fellow in the Research Institute for Electronic Equipment, ZZU AD, Plovdiv, Bulgaria. In 1986, he joined the Department of Control Systems, Technical University of Sofia at the Plovdiv campus, where he is presently a Full Professor. He has held long-term visiting Professor/Scholar positions at various institutions in South Korea, Turkey, Mexico, Greece, Belgium, UK, and Germany. And he has coauthored one book and authored or coauthored more than 80 research papers in conference proceedings and journals. His current research interests are in the fields of intelligent control and robotics.",institutionString:null,institution:{name:"Technical University of Sofia",country:{name:"Bulgaria"}}},{id:"585",title:"Prof.",name:"Munir",middleName:null,surname:"Merdan",slug:"munir-merdan",fullName:"Munir Merdan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/585/images/system/585.jpg",biography:"Munir Merdan received the M.Sc. degree in mechanical engineering from the Technical University of Sarajevo, Bosnia and Herzegovina, in 2001, and the Ph.D. degree in electrical engineering from the Vienna University of Technology, Vienna, Austria, in 2009.Since 2005, he has been at the Automation and Control Institute, Vienna University of Technology, where he is currently a Senior Researcher. His research interests include the application of agent technology for achieving agile control in the manufacturing environment.",institutionString:null,institution:null},{id:"605",title:"Prof",name:"Dil",middleName:null,surname:"Hussain",slug:"dil-hussain",fullName:"Dil Hussain",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/605/images/system/605.jpg",biography:"Dr. Dil Muhammad Akbar Hussain is a professor of Electronics Engineering & Computer Science at the Department of Energy Technology, Aalborg University Denmark. Professor Akbar has a Master degree in Digital Electronics from Govt. College University, Lahore Pakistan and a P-hD degree in Control Engineering from the School of Engineering and Applied Sciences, University of Sussex United Kingdom. Aalborg University has Two Satellite Campuses, one in Copenhagen (Aalborg University Copenhagen) and the other in Esbjerg (Aalborg University Esbjerg).\n· He is a member of prestigious IEEE (Institute of Electrical and Electronics Engineers), and IAENG (International Association of Engineers) organizations. \n· He is the chief Editor of the Journal of Software Engineering.\n· He is the member of the Editorial Board of International Journal of Computer Science and Software Technology (IJCSST) and International Journal of Computer Engineering and Information Technology. \n· He is also the Editor of Communication in Computer and Information Science CCIS-20 by Springer.\n· Reviewer For Many Conferences\nHe is the lead person in making collaboration agreements between Aalborg University and many universities of Pakistan, for which the MOU’s (Memorandum of Understanding) have been signed.\nProfessor Akbar is working in Academia since 1990, he started his career as a Lab demonstrator/TA at the University of Sussex. After finishing his P. hD degree in 1992, he served in the Industry as a Scientific Officer and continued his academic career as a visiting scholar for a number of educational institutions. In 1996 he joined National University of Science & Technology Pakistan (NUST) as an Associate Professor; NUST is one of the top few universities in Pakistan. In 1999 he joined an International Company Lineo Inc, Canada as Manager Compiler Group, where he headed the group for developing Compiler Tool Chain and Porting of Operating Systems for the BLACKfin processor. The processor development was a joint venture by Intel and Analog Devices. In 2002 Lineo Inc., was taken over by another company, so he joined Aalborg University Denmark as an Assistant Professor.\nProfessor Akbar has truly a multi-disciplined career and he continued his legacy and making progress in many areas of his interests both in teaching and research. He has contributed in stochastic estimation of control area especially, in the Multiple Target Tracking and Interactive Multiple Model (IMM) research, Ball & Beam Control Problem, Robotics, Levitation Control. He has contributed in developing Algorithms for Fingerprint Matching, Computer Vision and Face Recognition. He has been supervising Pattern Recognition, Formal Languages and Distributed Processing projects for several years. He has reviewed many books on Management, Computer Science. Currently, he is an active and permanent reviewer for many international conferences and symposia and the program committee member for many international conferences.\nIn teaching he has taught the core computer science subjects like, Digital Design, Real Time Embedded System Programming, Operating Systems, Software Engineering, Data Structures, Databases, Compiler Construction. 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The application of this test has significantly changed the practice of medical laboratories in which it is used for detection and quantification of molecules such as hormones, peptides, antibodies, and proteins. Various technical variants of this test can detect antigen (native or foreign) or antibody, determine the intensity of the immune response whether pathological or not; the type of induced immune response as well as the innate immunity potential; and much more. These capabilities, as well as the high sensitivity and robustness of the test and a small price, make it possible to quickly and reliably diagnose diseases in most laboratories. Besides, ELISA is a test that is also used in veterinary medicine, toxicology, allergology, food industry, etc. Despite the fact that it has existed for almost 50 years, different ELISA tests with different technical solutions are still being developed, which improves and expands the application of the this exceptional test. The aim of this chapter is to empower the rider to optimize, standardize and validate an enzyme linked immunosorbent assay.",book:{id:"9850",slug:"norovirus",title:"Norovirus",fullTitle:"Norovirus"},signatures:"Rajna Minic and Irena Zivkovic",authors:[{id:"325806",title:"Ph.D.",name:"Irena",middleName:null,surname:"Zivkovic",slug:"irena-zivkovic",fullName:"Irena Zivkovic"},{id:"325839",title:"Dr.",name:"Rajna",middleName:null,surname:"Minic",slug:"rajna-minic",fullName:"Rajna Minic"}]},{id:"56750",title:"Laboratory Approach to Anemia",slug:"laboratory-approach-to-anemia",totalDownloads:6181,totalCrossrefCites:2,totalDimensionsCites:4,abstract:"Anemia is a major cause of morbidity and mortality worldwide and can be defined as a decreased quantity of circulating red blood cells (RBCs). The epidemiological studies suggested that one-third of the world’s population is affected with anemia. Anemia is not a disease, but it is instead the sign of an underlying basic pathological process. However, the sign may function as a compass in the search for the cause. Therefore, the prediagnosis revealed by thorough investigation of this sign should be supported by laboratory parameters according to the underlying pathological process. We expect that this review will provide guidance to clinicians with findings and laboratory tests that can be followed from the initial stage in the anemia search.",book:{id:"5942",slug:"current-topics-in-anemia",title:"Current Topics in Anemia",fullTitle:"Current Topics in Anemia"},signatures:"Ebru Dündar Yenilmez and Abdullah Tuli",authors:[{id:"183998",title:"Ph.D.",name:"Ebru",middleName:null,surname:"Dündar Yenilmez",slug:"ebru-dundar-yenilmez",fullName:"Ebru Dündar Yenilmez"},{id:"209103",title:"Prof.",name:"Abdullah",middleName:null,surname:"Tuli",slug:"abdullah-tuli",fullName:"Abdullah Tuli"}]},{id:"33133",title:"Waist Circumference in Children and Adolescents from Different Ethnicities",slug:"waist-circumference-in-children-and-adolescents-from-different-ethnicities",totalDownloads:8e3,totalCrossrefCites:4,totalDimensionsCites:7,abstract:null,book:{id:"642",slug:"childhood-obesity",title:"Childhood Obesity",fullTitle:"Childhood Obesity"},signatures:"Peter Schwandt and Gerda-Maria Haas",authors:[{id:"29867",title:"Prof.",name:"Peter",middleName:null,surname:"Schwandt",slug:"peter-schwandt",fullName:"Peter Schwandt"}]}],onlineFirstChaptersFilter:{topicId:"185",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"81939",title:"Translational Research on Chagas Disease: Focusing on Drug Combination and Repositioning",slug:"translational-research-on-chagas-disease-focusing-on-drug-combination-and-repositioning",totalDownloads:19,totalDimensionsCites:0,doi:"10.5772/intechopen.104231",abstract:"Chagas disease, caused by the protozoan Trypanosoma cruzi, is a major neglected disease endemic to Latin America, associated to significant morbimortality comprising a remarkable socioeconomic problem mainly for low-income tropical populations. The present chapter focuses translational research on Chagas disease, approaching drug combinations and repositioning, particularly exploiting the parasite oxidative stress by prospecting prooxidant compounds combined with antagonists of antioxidant systems, for developing low-cost and safe therapies for this infection. The pertinent literature on protozoal parasitic diseases is reviewed as well as on repurposing disulfiram aiming the combination with the Chagas disease drug of choice benznidazole. Both disulfiram and its first derivative sodium diethyldithiocarbamate (DETC) are able not only to inhibit p-glycoprotein, possibly reverting resistance phenotypes, but also to reduce toxicity of numerous other drugs, heavy metals, etc. Therefore, this innovation, presently in clinical research, may furnish a novel therapeutic for T. cruzi infections overcoming the adverse effects and refractory cases that impair the effectiveness of Chagas disease treatment.",book:{id:"11377",title:"Chagas Disease - From Cellular and Molecular Aspects of Trypanosoma cruzi-Host Interactions to the Clinical Intervention",coverURL:"https://cdn.intechopen.com/books/images_new/11377.jpg"},signatures:"Marcos André Vannier-Santos, Ana Márcia Suarez-Fontes, Juliana Almeida-Silva, Alessandra Lifsitch Viçosa, Sandra Aurora Chavez Perez, Alejandro Marcel Hasslocher-Moreno, Gabriel Parreiras Estolano da Silveira, Luciana Fernandes Portela and Roberto Magalhães Saraiva"},{id:"81702",title:"The Saga of Selenium Treatment Investigation in Chagas Disease Cardiopathy: Translational Research in a Neglected Tropical Disease in Brazil",slug:"the-saga-of-selenium-treatment-investigation-in-chagas-disease-cardiopathy-translational-research-in",totalDownloads:8,totalDimensionsCites:0,doi:"10.5772/intechopen.103772",abstract:"This chapter describes the steps from basic research to the definition of a putative public health recommendation in the clinical protocols and therapeutic guidelines for selenium (Se) supplementation for patients with Chagas disease. From 1998 to 2018, we conducted a translational research project to test the concept that chronic Chagas disease cardiopathy (CCC) severity could be associated with low levels of blood selenium (Se), and if oral Se supplementation could help to sustain the asymptomatic cardiac stage and reduce disease severity. Pre-clinical studies in mice and a clinical trial conducted in the early asymptomatic cardiac stage of CCC patients (B stage) were performed, identified as “Selenium Treatment of Chagasic Cardiopathy (STCC)” trial. The roadmap of the selenium project was/is a real saga, with important obstacles that tested team resilience and revealed Brazilian conditions of science development. We discuss the main possible mechanisms involved in the physiopathology of CCC and the lessons learned in this process. In this chapter, we also organized the timeline of the translational project and described the crucial moments of the journey, as well as the next steps driving the research teams and their international and health industry connections.",book:{id:"11377",title:"Chagas Disease - From Cellular and Molecular Aspects of Trypanosoma cruzi-Host Interactions to the Clinical Intervention",coverURL:"https://cdn.intechopen.com/books/images_new/11377.jpg"},signatures:"Tania C. de Araujo-Jorge, Anna Cristina C. Carvalho, Roberto R. Ferreira, Luciana R. Garzoni, Beatriz M.S. Gonzaga, Marcelo T. Holanda, Gilberto M. Sperandio da Silva, Maria da Gloria Bonecini-Almeida, Mauro F.F. Mediano, Roberto M. Saraiva and Alejandro M. Hasslocher-Moreno"},{id:"81938",title:"How Do Mouse Strains and Inoculation Routes Influence the Course of Experimental Trypanosoma cruzi Infection?",slug:"how-do-mouse-strains-and-inoculation-routes-influence-the-course-of-experimental-trypanosoma-cruzi-i",totalDownloads:13,totalDimensionsCites:0,doi:"10.5772/intechopen.104461",abstract:"Chagas’ disease outcomes depend on several factors including parasite and host genetics, immune response, and route of infection. In this study, we investigate the influence of inoculation route and host genetic background on the establishment and development of Chagas disease in mice, using an isolate of Trypanosoma cruzi SC2005 strain (TcII), which was obtained from an oral Chagas’ disease outbreak in Santa Catarina, Brazil. Comparative analysis of the immunopathological, histopathological, and hematological profiles of mice was performed demonstrating the influence of the route of infection in disease severity. In outbred mice, intraperitoneal (IP) infection led to higher infection and mortality rates and more severe parasitaemia, when compared with intragastric (IG) infection. Nevertheless, tissue colonization was similar, showing severe damage in the heart, with intense lymphocytic inflammatory infiltrates, regardless of the route of infection. On the other hand, in mice IG-infected, the host genetic background influences the start timing of immune response against Trypanosoma cruzi. The susceptible BALB/c inbred mouse strain presented an earlier development of a cytotoxic cellular profile, when compared with A mice. We hypothesize that the cytotoxic response mounted before the parasitaemia increase allowed for a milder manifestation of Chagas’ disease in intragastrically infected mice.",book:{id:"11377",title:"Chagas Disease - From Cellular and Molecular Aspects of Trypanosoma cruzi-Host Interactions to the Clinical Intervention",coverURL:"https://cdn.intechopen.com/books/images_new/11377.jpg"},signatures:"Flávia de Oliveira Cardoso, Carolina Salles Domingues, Tânia Zaverucha do Valle and Kátia da Silva Calabrese"},{id:"81814",title:"Evaluation of Molecular Variability of Isolates of Trypanosoma cruzi in the State of Rio de Janeiro-Brazil",slug:"evaluation-of-molecular-variability-of-isolates-of-trypanosoma-cruzi-in-the-state-of-rio-de-janeiro-",totalDownloads:11,totalDimensionsCites:0,doi:"10.5772/intechopen.104498",abstract:"Trypanosoma cruzi, the etiological agent of Chagas disease, presents considerable heterogeneity among populations of isolates within the sylvatic and domestic cycle. This study aims to evaluate the genetic diversity of 14 isolates collected from specimens of Triatoma vitticeps from Triunfo, Conceição de Macabu, and Santa Maria Madalena cities (Rio de Janeiro—Brazil). By using PCR based on the mini-exon gene, all isolates showed a profile characteristic of bands zymodeme III and with a lower intensity characteristic of TcII. To verify possible hybrids among the strains analyzed, the polymorphisms analysis of the MSH2 gene was performed. HhaI restriction enzyme digestion products resulted in characteristic TcII fragments only, demonstrating the absence of hybrids strains. In our attempt to characterize isolation in accordance with the reclassification of T. cruzi into six new groups called DTUs (“discrete typing unit”), we genotyped the mitochondrial cytochrome oxidase subunit two gene, ribosomal RNA gen (24Sα rDNA), and the spliced leader intergenic region (SL-IR). This procedure showed that TcII, TcIII, and TcIV are circulating in this area. This highlights the diversity of parasites infecting specimens of T. vitticeps, emphasizing the habit of wild type and complexity of the region epidemiological study that presents potential mixed populations.",book:{id:"11377",title:"Chagas Disease - From Cellular and Molecular Aspects of Trypanosoma cruzi-Host Interactions to the Clinical Intervention",coverURL:"https://cdn.intechopen.com/books/images_new/11377.jpg"},signatures:"Helena Keiko Toma, Luciana Reboredo de Oliveira da Silva, Teresa Cristina Monte Gonçalves, Renato da Silva Junior and Jacenir R. Santos-Mallet"},{id:"81252",title:"Modulation of Host Cell Apoptosis by Trypanosoma cruzi: Repercussions in the Development of Chronic Chagasic Cardiomyopathy",slug:"modulation-of-host-cell-apoptosis-by-trypanosoma-cruzi-repercussions-in-the-development-of-chronic-c",totalDownloads:33,totalDimensionsCites:0,doi:"10.5772/intechopen.103740",abstract:"Trypanosoma cruzi is an intracellular parasite, which causes Chagas disease, affecting millions of people throughout the world. T. cruzi can invade several cell types, among which macrophages and cardiomyocytes stand out. Chagas disease goes through two stages: acute and chronic. If it becomes chronic, its most severe form is the chagasic chronic cardiomyopathy, which accounts for most of the fatalities due to this disease. For parasites to persist for long enough in cells, they should evade several host immune responses, one of these being apoptosis. Apoptosis is a type of programmed cell death described as a well-ordered and silent collection of steps that inevitably lead cells to a noninflammatory death. Cells respond to infection by initiating their own death to combat the infection. As a result, several intracellular microorganisms have developed different strategies to overcome host cell apoptosis and persist inside cells. It has been shown that T. cruzi has the ability to inhibit host cells apoptosis and can also induce apoptosis of cells that combat the parasite such as cytotoxic T cells. The aim of this chapter is to present up-to-date information about the molecules and mechanisms engaged by T. cruzi to achieve this goal and how the modulation of apoptosis by T. cruzi reflects in the development of chronic chagasic cardiomyopathy.",book:{id:"11377",title:"Chagas Disease - From Cellular and Molecular Aspects of Trypanosoma cruzi-Host Interactions to the Clinical Intervention",coverURL:"https://cdn.intechopen.com/books/images_new/11377.jpg"},signatures:"Fiordaliso Carolina Román-Carraro, Diego Maurizio Coria-Paredes, Arturo A. Wilkins-Rodríguez and Laila Gutiérrez-Kobeh"},{id:"80917",title:"Digestive Disorders in Chagas Disease: Megaesophagus and Chagasic Megacolon",slug:"digestive-disorders-in-chagas-disease-megaesophagus-and-chagasic-megacolon",totalDownloads:25,totalDimensionsCites:0,doi:"10.5772/intechopen.102871",abstract:"Chagas disease, also known as American trypanosomiasis, caused by Trypanosoma cruzi and transmitted by hematophagous vectors, is a parasitic disease, which according to the WHO ranks fourth as a cause of loss of potential years of life due to complications that can occur in multiple body systems. According to the reports presented by the World Health Organization, there are between 16 and 18 million infected people in the world, predominantly in endemic areas of Latin America, of which only 1% receives an adequate diagnosis and full treatment, thereby that the chronic phase comes to present digestive disorders that are one of the main causes of loss in the quality of life of patients, as well as complications that can lead to life-threatening surgical emergencies.",book:{id:"11377",title:"Chagas Disease - From Cellular and Molecular Aspects of Trypanosoma cruzi-Host Interactions to the Clinical Intervention",coverURL:"https://cdn.intechopen.com/books/images_new/11377.jpg"},signatures:"Víctor Hugo García Orozco, Juan Enrique Villalvazo Navarro, Carlos Solar Aguirre, Carlos Manuel Ibarra Ocampo, César Iván Díaz Sandoval, Carlos Alejandro Ortíz Gallegos, Diego Javier Oregel Camacho and Araceli Noriega Bucio"}],onlineFirstChaptersTotal:6},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:89,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:104,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:32,numberOfPublishedChapters:318,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:12,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:141,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:129,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:113,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:106,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:5,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:15,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}}]},series:{item:{id:"6",title:"Infectious Diseases",doi:"10.5772/intechopen.71852",issn:"2631-6188",scope:"This series will provide a comprehensive overview of recent research trends in various Infectious Diseases (as per the most recent Baltimore classification). Topics will include general overviews of infections, immunopathology, diagnosis, treatment, epidemiology, etiology, and current clinical recommendations for managing infectious diseases. Ongoing issues, recent advances, and future diagnostic approaches and therapeutic strategies will also be discussed. This book series will focus on various aspects and properties of infectious diseases whose deep understanding is essential for safeguarding the human race from losing resources and economies due to pathogens.",coverUrl:"https://cdn.intechopen.com/series/covers/6.jpg",latestPublicationDate:"June 25th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:13,editor:{id:"131400",title:"Prof.",name:"Alfonso J.",middleName:null,surname:"Rodriguez-Morales",slug:"alfonso-j.-rodriguez-morales",fullName:"Alfonso J. Rodriguez-Morales",profilePictureURL:"https://mts.intechopen.com/storage/users/131400/images/system/131400.png",biography:"Dr. Rodriguez-Morales is an expert in tropical and emerging diseases, particularly zoonotic and vector-borne diseases (especially arboviral diseases). He is the president of the Travel Medicine Committee of the Pan-American Infectious Diseases Association (API), as well as the president of the Colombian Association of Infectious Diseases (ACIN). He is a member of the Committee on Tropical Medicine, Zoonoses, and Travel Medicine of ACIN. He is a vice-president of the Latin American Society for Travel Medicine (SLAMVI) and a Member of the Council of the International Society for Infectious Diseases (ISID). Since 2014, he has been recognized as a Senior Researcher, at the Ministry of Science of Colombia. He is a professor at the Faculty of Medicine of the Fundacion Universitaria Autonoma de las Americas, in Pereira, Risaralda, Colombia. He is an External Professor, Master in Research on Tropical Medicine and International Health, Universitat de Barcelona, Spain. He is also a professor at the Master in Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru. In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. He is currently the Editor in Chief of the journal Travel Medicine and Infectious Diseases. His Scopus H index is 47 (Google Scholar H index, 68).",institutionString:"Institución Universitaria Visión de las Américas, Colombia",institution:null},editorTwo:null,editorThree:null},subseries:{paginationCount:4,paginationItems:[{id:"3",title:"Bacterial Infectious Diseases",coverUrl:"https://cdn.intechopen.com/series_topics/covers/3.jpg",isOpenForSubmission:!1,editor:null,editorTwo:null,editorThree:null},{id:"4",title:"Fungal Infectious Diseases",coverUrl:"https://cdn.intechopen.com/series_topics/covers/4.jpg",isOpenForSubmission:!0,editor:{id:"174134",title:"Dr.",name:"Yuping",middleName:null,surname:"Ran",slug:"yuping-ran",fullName:"Yuping Ran",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bS9d6QAC/Profile_Picture_1630330675373",biography:"Dr. Yuping Ran, Professor, Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China. Completed the Course Medical Mycology, the Centraalbureau voor Schimmelcultures (CBS), Fungal Biodiversity Centre, Netherlands (2006). International Union of Microbiological Societies (IUMS) Fellow, and International Emerging Infectious Diseases (IEID) Fellow, Centers for Diseases Control and Prevention (CDC), Atlanta, USA. Diploma of Dermatological Scientist, Japanese Society for Investigative Dermatology. Ph.D. of Juntendo University, Japan. Bachelor’s and Master’s degree, Medicine, West China University of Medical Sciences. Chair of Sichuan Medical Association Dermatology Committee. General Secretary of The 19th Annual Meeting of Chinese Society of Dermatology and the Asia Pacific Society for Medical Mycology (2013). In charge of the Annual Medical Mycology Course over 20-years authorized by National Continue Medical Education Committee of China. Member of the board of directors of the Asia-Pacific Society for Medical Mycology (APSMM). Associate editor of Mycopathologia. Vice-chief of the editorial board of Chinses Journal of Mycology, China. Board Member and Chair of Mycology Group of Chinese Society of Dermatology.",institutionString:null,institution:{name:"Sichuan University",institutionURL:null,country:{name:"China"}}},editorTwo:null,editorThree:null},{id:"5",title:"Parasitic Infectious Diseases",coverUrl:"https://cdn.intechopen.com/series_topics/covers/5.jpg",isOpenForSubmission:!0,editor:{id:"67907",title:"Dr.",name:"Amidou",middleName:null,surname:"Samie",slug:"amidou-samie",fullName:"Amidou Samie",profilePictureURL:"https://mts.intechopen.com/storage/users/67907/images/system/67907.jpg",biography:"Dr. Amidou Samie is an Associate Professor of Microbiology at the University of Venda, in South Africa, where he graduated for his PhD in May 2008. He joined the Department of Microbiology the same year and has been giving lectures on topics covering parasitology, immunology, molecular biology and industrial microbiology. He is currently a rated researcher by the National Research Foundation of South Africa at category C2. He has published widely in the field of infectious diseases and has overseen several MSc’s and PhDs. His research activities mostly cover topics on infectious diseases from epidemiology to control. His particular interest lies in the study of intestinal protozoan parasites and opportunistic infections among HIV patients as well as the potential impact of childhood diarrhoea on growth and child development. He also conducts research on water-borne diseases and water quality and is involved in the evaluation of point-of-use water treatment technologies using silver and copper nanoparticles in collaboration with the University of Virginia, USA. He also studies the use of medicinal plants for the control of infectious diseases as well as antimicrobial drug resistance.",institutionString:null,institution:{name:"University of Venda",institutionURL:null,country:{name:"South Africa"}}},editorTwo:null,editorThree:null},{id:"6",title:"Viral Infectious Diseases",coverUrl:"https://cdn.intechopen.com/series_topics/covers/6.jpg",isOpenForSubmission:!0,editor:{id:"158026",title:"Prof.",name:"Shailendra K.",middleName:null,surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. Saxena",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRET3QAO/Profile_Picture_2022-05-10T10:10:26.jpeg",biography:"Professor Dr. Shailendra K. Saxena is a vice dean and professor at King George's Medical University, Lucknow, India. 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He also obtained an MSc in Molecular and Genetic Medicine, and a Ph.D. in Clinical Immunology and Human Genetics from the University of Sheffield, UK. He also completed a short-term fellowship in Pediatric Clinical Immunology and Bone Marrow Transplantation at Newcastle General Hospital, England. Dr. Rezaei is a Full Professor of Immunology and Vice Dean of International Affairs and Research, at the School of Medicine, Tehran University of Medical Sciences, and the co-founder and head of the Research Center for Immunodeficiencies. He is also the founding president of the Universal Scientific Education and Research Network (USERN). Dr. Rezaei has directed more than 100 research projects and has designed and participated in several international collaborative projects. He is an editor, editorial assistant, or editorial board member of more than forty international journals. He has edited more than 50 international books, presented more than 500 lectures/posters in congresses/meetings, and published more than 1,100 scientific papers in international journals.",institutionString:"Tehran University of Medical Sciences",institution:{name:"Tehran University of Medical Sciences",country:{name:"Iran"}}},{id:"180733",title:"Dr.",name:"Jean",middleName:null,surname:"Engohang-Ndong",slug:"jean-engohang-ndong",fullName:"Jean Engohang-Ndong",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/180733/images/system/180733.png",biography:"Dr. Jean Engohang-Ndong was born and raised in Gabon. After obtaining his Associate Degree of Science at the University of Science and Technology of Masuku, Gabon, he continued his education in France where he obtained his BS, MS, and Ph.D. in Medical Microbiology. He worked as a post-doctoral fellow at the Public Health Research Institute (PHRI), Newark, NJ for four years before accepting a three-year faculty position at Brigham Young University-Hawaii. Dr. Engohang-Ndong is a tenured faculty member with the academic rank of Full Professor at Kent State University, Ohio, where he teaches a wide range of biological science courses and pursues his research in medical and environmental microbiology. Recently, he expanded his research interest to epidemiology and biostatistics of chronic diseases in Gabon.",institutionString:"Kent State University",institution:{name:"Kent State University",country:{name:"United States of America"}}},{id:"188773",title:"Prof.",name:"Emmanuel",middleName:null,surname:"Drouet",slug:"emmanuel-drouet",fullName:"Emmanuel Drouet",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/188773/images/system/188773.png",biography:"Emmanuel Drouet, PharmD, is a Professor of Virology at the Faculty of Pharmacy, the University Grenoble-Alpes, France. As a head scientist at the Institute of Structural Biology in Grenoble, Dr. Drouet’s research investigates persisting viruses in humans (RNA and DNA viruses) and the balance with our host immune system. He focuses on these viruses’ effects on humans (both their impact on pathology and their symbiotic relationships in humans). He has an excellent track record in the herpesvirus field, and his group is engaged in clinical research in the field of Epstein-Barr virus diseases. He is the editor of the online Encyclopedia of Environment and he coordinates the Universal Health Coverage education program for the BioHealth Computing Schools of the European Institute of Science.",institutionString:null,institution:{name:"Grenoble Alpes University",country:{name:"France"}}},{id:"131400",title:"Prof.",name:"Alfonso J.",middleName:null,surname:"Rodriguez-Morales",slug:"alfonso-j.-rodriguez-morales",fullName:"Alfonso J. Rodriguez-Morales",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/131400/images/system/131400.png",biography:"Dr. Rodriguez-Morales is an expert in tropical and emerging diseases, particularly zoonotic and vector-borne diseases (especially arboviral diseases). He is the president of the Travel Medicine Committee of the Pan-American Infectious Diseases Association (API), as well as the president of the Colombian Association of Infectious Diseases (ACIN). He is a member of the Committee on Tropical Medicine, Zoonoses, and Travel Medicine of ACIN. He is a vice-president of the Latin American Society for Travel Medicine (SLAMVI) and a Member of the Council of the International Society for Infectious Diseases (ISID). Since 2014, he has been recognized as a Senior Researcher, at the Ministry of Science of Colombia. He is a professor at the Faculty of Medicine of the Fundacion Universitaria Autonoma de las Americas, in Pereira, Risaralda, Colombia. He is an External Professor, Master in Research on Tropical Medicine and International Health, Universitat de Barcelona, Spain. He is also a professor at the Master in Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru. In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. He is currently the Editor in Chief of the journal Travel Medicine and Infectious Diseases. His Scopus H index is 47 (Google Scholar H index, 68).",institutionString:"Institución Universitaria Visión de las Américas, Colombia",institution:null},{id:"332819",title:"Dr.",name:"Chukwudi Michael",middleName:"Michael",surname:"Egbuche",slug:"chukwudi-michael-egbuche",fullName:"Chukwudi Michael Egbuche",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/332819/images/14624_n.jpg",biography:"I an Dr. Chukwudi Michael Egbuche. I am a Senior Lecturer in the Department of Parasitology and Entomology, Nnamdi Azikiwe University, Awka.",institutionString:null,institution:{name:"Nnamdi Azikiwe University",country:{name:"Nigeria"}}},{id:"284232",title:"Mr.",name:"Nikunj",middleName:"U",surname:"Tandel",slug:"nikunj-tandel",fullName:"Nikunj Tandel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/284232/images/8275_n.jpg",biography:'Mr. Nikunj Tandel has completed his Master\'s degree in Biotechnology from VIT University, India in the year of 2012. He is having 8 years of research experience especially in the field of malaria epidemiology, immunology, and nanoparticle-based drug delivery system against the infectious diseases, autoimmune disorders and cancer. He has worked for the NIH funded-International Center of Excellence in Malaria Research project "Center for the study of complex malaria in India (CSCMi)" in collaboration with New York University. The preliminary objectives of the study are to understand and develop the evidence-based tools and interventions for the control and prevention of malaria in different sites of the INDIA. Alongside, with the help of next-generation genomics study, the team has studied the antimalarial drug resistance in India. Further, he has extended his research in the development of Humanized mice for the study of liver-stage malaria and identification of molecular marker(s) for the Artemisinin resistance. At present, his research focuses on understanding the role of B cells in the activation of CD8+ T cells in malaria. Received the CSIR-SRF (Senior Research Fellow) award-2018, FIMSA (Federation of Immunological Societies of Asia-Oceania) Travel Bursary award to attend the IUIS-IIS-FIMSA Immunology course-2019',institutionString:"Nirma University",institution:{name:"Nirma University",country:{name:"India"}}},{id:"334383",title:"Ph.D.",name:"Simone",middleName:"Ulrich",surname:"Ulrich Picoli",slug:"simone-ulrich-picoli",fullName:"Simone Ulrich Picoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334383/images/15919_n.jpg",biography:"Graduated in Pharmacy from Universidade Luterana do Brasil (1999), Master in Agricultural and Environmental Microbiology from Federal University of Rio Grande do Sul (2002), Specialization in Clinical Microbiology from Universidade de São Paulo, USP (2007) and PhD in Sciences in Gastroenterology and Hepatology (2012). She is currently an Adjunct Professor at Feevale University in Medicine and Biomedicine courses and a permanent professor of the Academic Master\\'s Degree in Virology. She has experience in the field of Microbiology, with an emphasis on Bacteriology, working mainly on the following topics: bacteriophages, bacterial resistance, clinical microbiology and food microbiology.",institutionString:null,institution:{name:"Universidade Feevale",country:{name:"Brazil"}}},{id:"229220",title:"Dr.",name:"Amjad",middleName:"Islam",surname:"Aqib",slug:"amjad-aqib",fullName:"Amjad Aqib",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229220/images/system/229220.png",biography:"Dr. Amjad Islam Aqib obtained a DVM and MSc (Hons) from University of Agriculture Faisalabad (UAF), Pakistan, and a PhD from the University of Veterinary and Animal Sciences Lahore, Pakistan. Dr. Aqib joined the Department of Clinical Medicine and Surgery at UAF for one year as an assistant professor where he developed a research laboratory designated for pathogenic bacteria. Since 2018, he has been Assistant Professor/Officer in-charge, Department of Medicine, Manager Research Operations and Development-ORIC, and President One Health Club at Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan. He has nearly 100 publications to his credit. His research interests include epidemiological patterns and molecular analysis of antimicrobial resistance and modulation and vaccine development against animal pathogens of public health concern.",institutionString:"Cholistan University of Veterinary and Animal Sciences",institution:null},{id:"62900",title:"Prof.",name:"Fethi",middleName:null,surname:"Derbel",slug:"fethi-derbel",fullName:"Fethi Derbel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/62900/images/system/62900.jpeg",biography:"Professor Fethi Derbel was born in 1960 in Tunisia. He received his medical degree from the Sousse Faculty of Medicine at Sousse, University of Sousse, Tunisia. He completed his surgical residency in General Surgery at the University Hospital Farhat Hached of Sousse and was a member of the Unit of Liver Transplantation in the University of Rennes, France. He then worked in the Department of Surgery at the Sahloul University Hospital in Sousse. Professor Derbel is presently working at the Clinique les Oliviers, Sousse, Tunisia. His hospital activities are mostly concerned with laparoscopic, colorectal, pancreatic, hepatobiliary, and gastric surgery. He is also very interested in hernia surgery and performs ventral hernia repairs and inguinal hernia repairs. He has been a member of the GREPA and Tunisian Hernia Society (THS). During his residency, he managed patients suffering from diabetic foot, and he was very interested in this pathology. For this reason, he decided to coordinate a book project dealing with the diabetic foot. Professor Derbel has published many articles in journals and collaborates intensively with IntechOpen Access Publisher as an editor.",institutionString:"Clinique les Oliviers",institution:null},{id:"300144",title:"Dr.",name:"Meriem",middleName:null,surname:"Braiki",slug:"meriem-braiki",fullName:"Meriem Braiki",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/300144/images/system/300144.jpg",biography:"Dr. Meriem Braiki is a specialist in pediatric surgeon from Tunisia. She was born in 1985. She received her medical degree from the University of Medicine at Sousse, Tunisia. She achieved her surgical residency training periods in Pediatric Surgery departments at University Hospitals in Monastir, Tunis and France.\r\nShe is currently working at the Pediatric surgery department, Sidi Bouzid Hospital, Tunisia. Her hospital activities are mostly concerned with laparoscopic, parietal, urological and digestive surgery. She has published several articles in diffrent journals.",institutionString:"Sidi Bouzid Regional Hospital",institution:null},{id:"229481",title:"Dr.",name:"Erika M.",middleName:"Martins",surname:"de Carvalho",slug:"erika-m.-de-carvalho",fullName:"Erika M. de Carvalho",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229481/images/6397_n.jpg",biography:null,institutionString:null,institution:{name:"Oswaldo Cruz Foundation",country:{name:"Brazil"}}},{id:"186537",title:"Prof.",name:"Tonay",middleName:null,surname:"Inceboz",slug:"tonay-inceboz",fullName:"Tonay Inceboz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/186537/images/system/186537.jfif",biography:"I was graduated from Ege University of Medical Faculty (Turkey) in 1988 and completed his Med. PhD degree in Medical Parasitology at the same university. I became an Associate Professor in 2008 and Professor in 2014. I am currently working as a Professor at the Department of Medical Parasitology at Dokuz Eylul University, Izmir, Turkey.\n\nI have given many lectures, presentations in different academic meetings. I have more than 60 articles in peer-reviewed journals, 18 book chapters, 1 book editorship.\n\nMy research interests are Echinococcus granulosus, Echinococcus multilocularis (diagnosis, life cycle, in vitro and in vivo cultivation), and Trichomonas vaginalis (diagnosis, PCR, and in vitro cultivation).",institutionString:"Dokuz Eylül University",institution:{name:"Dokuz Eylül University",country:{name:"Turkey"}}},{id:"71812",title:"Prof.",name:"Hanem Fathy",middleName:"Fathy",surname:"Khater",slug:"hanem-fathy-khater",fullName:"Hanem Fathy Khater",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/71812/images/1167_n.jpg",biography:"Prof. Khater is a Professor of Parasitology at Benha University, Egypt. She studied for her doctoral degree, at the Department of Entomology, College of Agriculture, Food and Natural Resources, University of Missouri, Columbia, USA. She has completed her Ph.D. degrees in Parasitology in Egypt, from where she got the award for “the best scientific Ph.D. dissertation”. She worked at the School of Biological Sciences, Bristol, England, the UK in controlling insects of medical and veterinary importance as a grant from Newton Mosharafa, the British Council. Her research is focused on searching of pesticides against mosquitoes, house flies, lice, green bottle fly, camel nasal botfly, soft and hard ticks, mites, and the diamondback moth as well as control of several parasites using safe and natural materials to avoid drug resistances and environmental contamination.",institutionString:null,institution:{name:"Banha University",country:{name:"Egypt"}}},{id:"99780",title:"Prof.",name:"Omolade",middleName:"Olayinka",surname:"Okwa",slug:"omolade-okwa",fullName:"Omolade Okwa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/99780/images/system/99780.jpg",biography:"Omolade Olayinka Okwa is presently a Professor of Parasitology at Lagos State University, Nigeria. She has a PhD in Parasitology (1997), an MSc in Cellular Parasitology (1992), and a BSc (Hons) Zoology (1990) all from the University of Ibadan, Nigeria. She teaches parasitology at the undergraduate and postgraduate levels. She was a recipient of a Commonwealth fellowship supported by British Council tenable at the Centre for Entomology and Parasitology (CAEP), Keele University, United Kingdom between 2004 and 2005. She was awarded an Honorary Visiting Research Fellow at the same university from 2005 to 2007. \nShe has been an external examiner to the Department of Veterinary Microbiology and Parasitology, University of Ibadan, MSc programme between 2010 and 2012. She is a member of the Nigerian Society of Experimental Biology (NISEB), Parasitology and Public Health Society of Nigeria (PPSN), Science Association of Nigeria (SAN), Zoological Society of Nigeria (ZSN), and is Vice Chairperson of the Organisation of Women in Science (OWSG), LASU chapter. She served as Head of Department of Zoology and Environmental Biology, Lagos State University from 2007 to 2010 and 2014 to 2016. She is a reviewer for several local and international journals such as Unilag Journal of Science, Libyan Journal of Medicine, Journal of Medicine and Medical Sciences, and Annual Research and Review in Science. \nShe has authored 45 scientific research publications in local and international journals, 8 scientific reviews, 4 books, and 3 book chapters, which includes the books “Malaria Parasites” and “Malaria” which are IntechOpen access publications.",institutionString:"Lagos State University",institution:{name:"Lagos State University",country:{name:"Nigeria"}}},{id:"273100",title:"Dr.",name:"Vijay",middleName:null,surname:"Gayam",slug:"vijay-gayam",fullName:"Vijay Gayam",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/273100/images/system/273100.jpeg",biography:"Dr. Vijay Bhaskar Reddy Gayam is currently practicing as an internist at Interfaith Medical Center in Brooklyn, New York, USA. He is also a Clinical Assistant Professor at the SUNY Downstate University Hospital and Adjunct Professor of Medicine at the American University of Antigua. He is a holder of an M.B.B.S. degree bestowed to him by Osmania Medical College and received his M.D. at Interfaith Medical Center. His career goals thus far have heavily focused on direct patient care, medical education, and clinical research. He currently serves in two leadership capacities; Assistant Program Director of Medicine at Interfaith Medical Center and as a Councilor for the American\r\nFederation for Medical Research. As a true academician and researcher, he has more than 50 papers indexed in international peer-reviewed journals. He has also presented numerous papers in multiple national and international scientific conferences. His areas of research interest include general internal medicine, gastroenterology and hepatology. He serves as an editor, editorial board member and reviewer for multiple international journals. His research on Hepatitis C has been very successful and has led to multiple research awards, including the 'Equity in Prevention and Treatment Award” from the New York Department of Health Viral Hepatitis Symposium (2018) and the 'Presidential Poster Award” awarded to him by the American College of Gastroenterology (2018). He was also awarded 'Outstanding Clinician in General Medicine” by Venus International Foundation for his extensive research expertise and services, perform over and above the standard expected in the advancement of healthcare, patient safety and quality of care.",institutionString:"Interfaith Medical Center",institution:{name:"Interfaith Medical Center",country:{name:"United States of America"}}},{id:"93517",title:"Dr.",name:"Clement",middleName:"Adebajo",surname:"Meseko",slug:"clement-meseko",fullName:"Clement Meseko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/93517/images/system/93517.jpg",biography:"Dr. Clement Meseko obtained DVM and PhD degree in Veterinary Medicine and Virology respectively. He has worked for over 20 years in both private and public sectors including the academia, contributing to knowledge and control of infectious disease. Through the application of epidemiological skill, classical and molecular virological skills, he investigates viruses of economic and public health importance for the mitigation of the negative impact on people, animal and the environment in the context of Onehealth. \r\nDr. Meseko’s field experience on animal and zoonotic diseases and pathogen dynamics at the human-animal interface over the years shaped his carrier in research and scientific inquiries. He has been part of the investigation of Highly Pathogenic Avian Influenza incursions in sub Saharan Africa and monitors swine Influenza (Pandemic influenza Virus) agro-ecology and potential for interspecies transmission. He has authored and reviewed a number of journal articles and book chapters.",institutionString:"National Veterinary Research Institute",institution:{name:"National Veterinary Research Institute",country:{name:"Nigeria"}}},{id:"158026",title:"Prof.",name:"Shailendra K.",middleName:null,surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. Saxena",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRET3QAO/Profile_Picture_2022-05-10T10:10:26.jpeg",biography:"Professor Dr. Shailendra K. Saxena is a vice dean and professor at King George's Medical University, Lucknow, India. His research interests involve understanding the molecular mechanisms of host defense during human viral infections and developing new predictive, preventive, and therapeutic strategies for them using Japanese encephalitis virus (JEV), HIV, and emerging viruses as a model via stem cell and cell culture technologies. His research work has been published in various high-impact factor journals (Science, PNAS, Nature Medicine) with a high number of citations. He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. Dr. Saxena is a fellow of various international societies/academies including the Royal College of Pathologists, United Kingdom; Royal Society of Medicine, London; Royal Society of Biology, United Kingdom; Royal Society of Chemistry, London; and Academy of Translational Medicine Professionals, Austria. He was named a Global Leader in Science by The Scientist. He is also an international opinion leader/expert in vaccination for Japanese encephalitis by IPIC (UK).",institutionString:"King George's Medical University",institution:{name:"King George's Medical University",country:{name:"India"}}},{id:"94928",title:"Dr.",name:"Takuo",middleName:null,surname:"Mizukami",slug:"takuo-mizukami",fullName:"Takuo Mizukami",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94928/images/6402_n.jpg",biography:null,institutionString:null,institution:{name:"National Institute of Infectious Diseases",country:{name:"Japan"}}},{id:"233433",title:"Dr.",name:"Yulia",middleName:null,surname:"Desheva",slug:"yulia-desheva",fullName:"Yulia Desheva",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/233433/images/system/233433.png",biography:"Dr. Yulia Desheva is a leading researcher at the Institute of Experimental Medicine, St. Petersburg, Russia. 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