key: cord-0730004-lxmjxmiv
authors: Chan, Jasper Fuk-Woo; Chan, Kwok-Hung; Yuen, Kwok-Yung
title: Reply to Leow
date: 2013-10-15
journal: J Infect Dis
DOI: 10.1093/infdis/jit328
sha: af6840e4bb0d871930b027f38f90be0de003c6f9
doc_id: 730004
cord_uid: lxmjxmiv

nan

the virus for endocrine tissues might be important to our understanding of the pathogenesis of this highly fatal disease and optimization of treatment strategies. In particular, the therapeutic roles or potential detrimental effects of systemic corticosteroids, which were used empirically in the early disease stages in some of the patients with MERS-CoV infection, remain unclear [3] .

Since the publication of our article, the MERS-CoV epidemic has continued to evolve without obvious signs of being completely controlled. The total number of laboratory-confirmed cases in 10 countries over 3 continents has increased to 90 with 45 fatalities as of 21 July 2013. Although an animal reservoir of MERS-CoV has been suggested [6] [7] [8] , the definitive source has so far not been identified. The epidemiological emergency posted by the evolving outbreak also calls for the development of effective antiviral treatment. In addition to supportive treatment such as extracorporeal membrane oxygenation and renal replacement therapy, combinational ribavirin and interferon-α2b has recently been shown to exhibit in vitro anti-MERS-CoV activity [9] . The efficacies of other potential therapeutic strategies including interferons, antiviral peptides targeting the heptad repeat 2 region of the MERS-CoV Spike (S) protein, and S1 domain-dipeptidyl peptidase 4 interface inhibitors should be determined in further laboratory and clinical studies [3, 10] .

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