Abstract

Increased transmissibility of the pandemic severe acute respiratory coronavirus 2 (SARS-CoV-2) has been noted to occur at lower ambient temperatures. This is seemingly related to a better replication of most respiratory viruses, including SARS-CoV-2, at lower-than-core body temperatures (i.e., 33 °C vs 37 °C). Also, intrinsic characteristics of SARS-CoV-2 make it a heat-susceptible pathogen. Thermotherapy has successfully been used to combat viral infections in plants which could otherwise result in great economic losses; 90% of viruses causing infections in plants are positive-sense single-stranded ribonucleic acid (+ssRNA) viruses, a characteristic shared by SARS-CoV-2. Thus, it is possible to envision the use of heat-based interventions (thermotherapy or mild-temperature hyperthermia) in patients with COVID-19 for which moderate cycles (every 8–12 h) of mild-temperature hyperthermia (1–2 h) have been proposed. However, there are potential safety and mechanistic concerns which could limit the use of thermotherapy only to patients with mild-to-moderate COVID-19 to prevent disease progression rather than to treat patients who have already progressed to severe-to-critical COVID-19. Here, we review the characteristics of SARS-CoV-2 which make it a heat-susceptible virus, potential host mechanisms which could be enhanced at higher temperatures to aid viral clearance, and how thermotherapy could be investigated as a modality of treatment in patients with COVID-19 while taking into consideration potential risks.

摘要

大流行性严重急性呼吸道冠状病毒2（SARS-CoV-2）的传播能力增加是在较低的环境温度下发生的。看来这与在低于核心温度（即33°C vs 37°C）的大多数呼吸道病毒（包括SARS-CoV-2）的更好复制有关。另外，SARS-CoV-2的内在特征使其成为热敏感病原体。热疗法已成功地用于抵抗植物中的病毒感染，否则可能导致巨大的经济损失。SARS-CoV-2具有90％的导致植物感染的病毒是正链单核糖核酸（+ ssRNA）病毒。因此，可以设想对COVID-19的患者进行基于热的干预（热疗或中温热疗），对于这些患者，中度温热（1-2小时）的周期中等（每8-12小时）建议的。但是，存在潜在的安全性和机械问题，这可能会将热疗仅限于轻度至中度COVID-19的患者使用，以防止疾病进展，而不是治疗已经发展为重度至严重COVID-19的患者。在这里，我们回顾了SARS-CoV-2的特征，它使其成为一种热敏感病毒，可能在更高温度下增强的辅助宿主机制可以帮助清除病毒，以及如何研究将热疗法作为治疗方式用于治疗SARS-CoV-2。 COVID-19，同时考虑了潜在的风险。