Due to the high prevalence and long incubation periods often without symptoms, the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has infected millions of individuals globally, causing the coronavirus disease 2019 (COVID-19) pandemic. Even with the recent approval of the anti-viral drug, remdesivir, and Emergency Use Authorization of monoclonal antibodies against S protein, bamlanivimab and casirimab/imdevimab, efficient and safe COVID-19 vaccines are still desperately demanded not only to prevent its spread but also to restore social and economic activities via generating mass immunization. Recent Emergency Use Authorization of Pfizer and BioNTech’s mRNA vaccine may provide a pathway forward, but monitoring of long-term immunity is still required, and diverse candidates are still under development. As the knowledge of SARS-CoV-2 pathogenesis and interactions with the immune system continues to evolve, a variety of drug candidates are under investigation and in clinical trials. Potential vaccines and therapeutics against COVID-19 include repurposed drugs, monoclonal antibodies, antiviral and antigenic proteins, peptides, and genetically engineered viruses. This paper reviews the virology and immunology of SARS-CoV-2, alternative therapies for COVID-19 to vaccination, principles and design considerations in COVID-19 vaccine development, and the promises and roles of vaccine carriers in addressing the unique immunopathological challenges presented by the disease. Graphical abstract Unlabelled Image
【저자키워드】 immune response, Neutralizing antibodies, COVID-19, Coronavirus disease 2019, SARS-CoV-2, Severe acute respiratory syndrome coronavirus 2, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), ACE2, angiotensin-converting enzyme 2, Coronavirus disease 2019 (COVID-19), vaccine delivery, RSV, respiratory syncytial virus, RBD, receptor binding domain, ARDS, acute respiratory distress syndrome, WHO, World Health Organization, CDC, Centers for Disease Control and Prevention, MSCs, mesenchymal stem cells, ADE, Antibody-dependent enhancement, EUA, Emergency Use Authorization, Ad, Adenovirus, NK cell, natural killer cell, APC, antigen presenting cell, E protein, envelope protein, M protein, membrane protein, N protein, nucleocapsid protein, S protein, spike protein, CTLs, cytotoxic T lymphocytes, DC, dendritic cell DC, AD, AAV, adeno-associated virus, LNPs, lipid nanoparticles, SARS, severe acute respiratory syndrome coronavirus, MERS, Middle East respiratory syndrome coronavirus, FDA, U.S Food and Drug Administration, TMPRSS2, transmembrane protease serine, NTD, N-terminal binding domain, PPRs, pattern recognition receptors, Type 1 IFNs, Type 1 interferons, Toll-like receptor, TLR,