First member of a new drug class to increase functions of cellular immunity in normal, healthy animals. It can act as either an immunostimulant agent or an immunosuppressive agent depending on dosing/timing. 

University of California, Davis

- Interferons
- Intravenous gammaglobulin
- Thymosin alpha-1
- Thymopentin
- Levamisole
- Cyclosporine A
- Chinese Medicine

Immunoenhancers as general supportive treatments 

- Zhang L, Liu Y. Potential interventions for novel coronavirus in China: a systematic review. J Med Virol 2020;92:479-90

Potential interventions for novel coronavirus in China: a systematic review.

Synthetic pentapeptide corresponding to active site of thymopoietin has been shown to restore antibody production in old mice and could enhance antibody response in humans when applied subcutaneously 3x/week at 50mg/dose.

Thymopentin

Type I interferons
- IFN-alpha inhibits replication of human and animal coronaviruses
- IFN-beta could inhibit replication of SARS-CoV
- IFN-gamma was reported as ineffective
Cells were able to partially restore their innate immune responsiveness to SARS-CoV after priming with small amounts of IFN.
Pegylated recombinant IFN-alpha-2-beta (registered drug for chronic HepC) could protect type 1 pneumocytes against SARS coronavirus infection in monkeys.
Interferons also been found to inhibit MERS-CoV replication.


Interferons

May be the safest immunomodulating drug available for long-term use in all ages, but has adverse reactions.
Used in the Singapore SARS outbreak, and 1/3 of critically ill patients developed venous thromboembolism.

Intravenous gammaglobulin

Thymic peptide hormone can restore homeostasis of immune system as an immunostimulant. It could be used as an immune enhancer to SARS patients and was effective in controlling the spread of the disease.
Methylprednisolone has been used in current COVID-19 treatment and the side effect of corticoid-induced death of thymocytes should be considered. Thymosin alpha-1 could be used before administration of methylprednisolone.

Thymosin alpha-1

Levamisole

An important immunosuppressive drug used in transplantation and treatment of autoimmune disorders. Cyclosporine A could inhibit cyclophilins and block the replication of coronavirus of all genera, including SARS-CoV. Non-immunosuppressive derivatives of cyclosporine A could be broad-range coronavirus inhibitors.

Cyclosporine A

Glycyrrhizin, an active component of licorice roots, could inhibit SARS-associated virus replication.
Baicalin, a Chinese herb, is a flavonoid and has been found to have the ability to inhibit SARS-CoV in vitro.
Ginseng stem-leaf saponins could also enhance specific antibody responses to viruses.

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