Using in silico viral kinetic models to guide therapeutic strategies
during a pandemic: An example in SARS-CoV-2
Abstract
AIM: We propose the use of in silico mathematical models to provide
insights that optimize therapeutic interventions designed to eradicate
respiratory infection during a pandemic. A modelling and simulation
framework is provided using SARS-CoV-2 as an example, considering
applications of both treatment and prophylaxis. METHODS: A target
cell-limited model was used to quantify the viral infection dynamics of
SARS-CoV-2 in a pooled population of 105 infected patients. Parameter
estimates from the resulting model were used to simulate and compare the
impact of various interventions against meaningful viral load endpoints.
RESULTS: Robust parameter estimates were obtained for the basic
reproduction number, viral release rate and infected-cell mortality from
the infection model. These estimates were informed by the largest
dataset currently available for SARS-CoV-2 viral time course. The
utility of this model was demonstrated using simulations, which
hypothetically introduced inhibitory or stimulatory drug mechanisms at
various target sites within the viral life-cycle. We show that early
intervention is crucial to achieving therapeutic benefit when
monotherapy is administered. In contrast, combination regimens of two or
three drugs may provide improved outcomes if treatment is initiated
late. The latter is relevant to SARS-CoV-2, where the period between
infection and symptom onset is relatively long. CONCLUSIONS: The use of
in silico models can provide viral load predictions that can rationalize
therapeutic strategies against an emerging viral pathogen.