The MERS was an epidemic in 2012 caused by a coronavirus. MERS stands for Middle Eastern Respiratory Syndrome and affects the lungs. Most MERS cases emerge from the Arabian peninsula (84%) and spread to 27 countries.
According to the European CDC, the total number of MERS cases is 2,543, with 886 deaths. MERS is a lot more dangerous than COVID-19, with a crude case fatality rate of 36%. COVID-19 has a crude mortality rate of 1% and 0.3% for those under 65 years old, according to Worldometers.info.
MERS is still around. In 2021, the European Centre for Disease Control reported,
From 1 January 2021 to 31 December 2021, 19 MERS-CoV cases have been reported in Saudi Arabia (17) and the United Arab Emirates (2), including eight deaths. In Saudi Arabia, all were primary cases, 10 of whom reported contact with camels. These 17 cases were reported in Riyadh (10), Makkah (4), and the Eastern Province (3)
Unlike the SARS-CoV-2, which uses ACE2 receptors to attach to human cells, the MERS coronavirus uses Dipeptidyl peptidase-4 (DPP4) as their functional receptors.
The sources of the infection in the Middle East are camels, but the origin was finally traced to bats. A new study from the Wuhan University in China found that another MERS pandemic or MERS-CoV-2 (coronavirus-2) can happen again.
The study, Close relatives of MERS-CoV in bats, use ACE2 as their functional receptors is available in bioRxiv as a preprint and has not been peer-reviewed.
The authors studied bat coronaviruses closest to the MERS named NeoCoV and PDF-2180-CoV (CoV=CoronaVirus). Both viruses can use the bat ACE2 receptors to enter cells but not human ACE2.
The reason for that is there is a molecule in human ACE2 receptors where the MERS viruses bind that prevents the NeoCoV and PDF-2180-CoV from attaching and infecting humans.
However, if a T510F mutation happens, the NeoCoV and PDF-2180-CoV will easily infect human cells. T510F mutation occurs when the amino acid threonine (T) is substituted by phenylalanine (F) at position number 510. A T510F mutation in the amino acid sequence of the receptor-binding motif (the part that can stick to human ACE2 receptors). An increased binding affinity and significant gain of infectivity will occur.
Absence of immunity
If this mutation happens in the NeoCoV and PDF-2180-CoV, it will result in a highly transmissible and more deadly coronavirus.
Right now, the Omicron has a secondary attack rate of 21.6%, according to Public Health Ontario. One person can infect 21 people. Add to that the case fatality rate of MERS, 36%, and you have a potential public health disaster.
The authors also tested if antibodies from a previous COVID-19 infection or MERS antibodies can neutralize the NeoCoV and PDF-2180-CoV. The graphs below show the absence of inhibition by antibodies from COVID-19 convalescent serum and MERS- specific nanobodies.
Humoral immunity triggered by prior infection or vaccination of other coronaviruses might be inadequate to protect humans from NeoCoV and PDF-2180-CoV infections because neither SARS-CoV-2 anti-sera nor ten tested anti-MERS-CoV nanobodies can cross-inhibit the infection caused by these two viruses.
The study’s abstract ends with,’
Our study demonstrates the first case of ACE2 usage in MERS-related viruses, shedding light on a potential bio-safety threat of the human emergence of an ACE2 using “MERS-CoV-2” with both high fatality and transmission rate.
Take-away
Coronaviruses constantly mutate. If MERS-CoV-2 happens, one in three people infected with it will die, and each one of them will spread it to 21 more people if it is as infectious as the Omicron variant.
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