Middle East Respiratory Syndrome

Infectious Disease MONDO:0100116 Pathograph 2 Show in embeddings browser Viral Respiratory Infection

Middle East respiratory syndrome (MERS) is a severe viral respiratory infection caused by the Middle East respiratory syndrome coronavirus (MERS-CoV), a zoonotic betacoronavirus first isolated in 2012 from a patient in Saudi Arabia who died of pneumonia and renal failure. Dromedary camels are the reservoir for human spillover, and limited human-to-human transmission occurs, particularly in health-care settings. MERS-CoV enters host cells using dipeptidyl peptidase 4 (DPP4/CD26) as its receptor and causes a spectrum from asymptomatic infection to severe pneumonia, acute respiratory distress syndrome, and multiorgan failure, with a high case-fatality rate concentrated in older adults with comorbidities.

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2
Pathophys.
10
Phenotypes
2
Pathograph
1
Medical Actions
3
Datasets
⚙

Pathophysiology

2
MERS-CoV Spike-Mediated Entry via DPP4
MERS-CoV enters host cells through its spike (S) glycoprotein, whose receptor-binding S1 domain engages the host cell-surface enzyme dipeptidyl peptidase 4 (DPP4, also known as CD26); host serine proteases then prime the spike for membrane fusion. DPP4 is expressed on respiratory epithelium and pneumocytes, defining the tropism for the lower respiratory tract, and is also expressed on renal and intestinal epithelium and liver — a tissue distribution consistent with the extrapulmonary (notably renal and gastrointestinal) manifestations of severe MERS. Receptor engagement is independent of DPP4 enzymatic activity: clinically used gliptin DPP4 inhibitors do not block infection, so DPP4 serves as an attachment protein rather than through its peptidase catalysis. Because the receptor is a host protein, antibodies against DPP4 block infection — the host-directed-target logic shared with SARS-CoV-2/ACE2.
bronchial epithelial cell CL:0002328 Cell Ontology (CL) Relation: this pathophysiological event involves this cell type This pathophysiological event involves bronchial epithelial cell (CL:0002328). CL:0002328 is a cell type from the Cell Ontology. pulmonary alveolar type 2 cell CL:0002063 Cell Ontology (CL) Relation: this pathophysiological event involves this cell type This pathophysiological event involves pulmonary alveolar type 2 cell (CL:0002063). CL:0002063 is a cell type from the Cell Ontology.
DPP4 hgnc:3009 HUGO Gene Nomenclature Committee (hgnc) Relation: this pathophysiological event involves this gene This pathophysiological event involves DPP4 (hgnc:3009). hgnc:3009 is a gene from the HUGO Gene Nomenclature Committee.
virion attachment to host cell GO:0019062 Gene Ontology (GO) Relation: this pathophysiological event involves this biological process This pathophysiological event involves virion attachment to host cell (GO:0019062). GO:0019062 is a biological process from the Gene Ontology. symbiont entry into host cell GO:0046718 Gene Ontology (GO) Relation: this pathophysiological event involves this biological process This pathophysiological event involves symbiont entry into host cell (GO:0046718). GO:0046718 is a biological process from the Gene Ontology.
Downstream
Severe Lower Respiratory Infection and Systemic Spread Productive infection of the lower respiratory epithelium drives severe pneumonia that can progress to ARDS and multiorgan involvement.
Show evidence (4 references)
PMID:23486063 SUPPORT In Vitro
"Here we identify dipeptidyl peptidase 4 (DPP4; also known as CD26) as a functional receptor for hCoV-EMC."
Identifies DPP4 (CD26) as the functional host receptor for MERS-CoV (hCoV-EMC), the druggable host-factor entry step. Evidence source is IN_VITRO as this is a cell-based receptor-identification study.
PMID:23486063 SUPPORT In Vitro
"Antibodies directed against DPP4 inhibited hCoV-EMC infection of primary human bronchial epithelial cells and Huh-7 cells."
Shows that blocking the host DPP4 receptor inhibits MERS-CoV infection of human bronchial epithelial cells, the host-directed antiviral proof of principle. Evidence source is IN_VITRO as this is a cell-culture experiment.
PMID:23486063 SUPPORT In Vitro
"In humans it is primarily expressed on the epithelial cells in kidney, small intestine, liver and prostate, and on activated leukocytes"
DPP4 tissue distribution — including renal, intestinal, and hepatic epithelium — is consistent with the extrapulmonary (renal and gastrointestinal) tropism of MERS beyond the respiratory tract. Evidence source is IN_VITRO as this receptor-characterization study reports the distribution of the host entry protein.
+ 1 more reference
Severe Lower Respiratory Infection and Systemic Spread
MERS-CoV replication in the lower respiratory tract produces severe pneumonia that frequently progresses to acute respiratory distress syndrome and respiratory failure. Systemic and extrapulmonary involvement — notably acute kidney injury and gastrointestinal symptoms — is common, and the disease carries a high case-fatality rate concentrated in older adults with comorbidities.
viral genome replication GO:0019079 Gene Ontology (GO) Relation: this pathophysiological event involves this biological process This pathophysiological event involves viral genome replication (GO:0019079). GO:0019079 is a biological process from the Gene Ontology. inflammatory response GO:0006954 Gene Ontology (GO) Relation: this pathophysiological event involves this biological process This pathophysiological event involves increased inflammatory response (GO:0006954). GO:0006954 is a biological process from the Gene Ontology. ↑ INCREASED
lung UBERON:0002048 Uberon multi-species anatomy ontology (UBERON) Relation: this pathophysiological event occurs in this anatomical location This pathophysiological event occurs in lung (UBERON:0002048). UBERON:0002048 is an anatomical location from the Uberon multi-species anatomy ontology.
Show evidence (3 references)
PMID:23075143 SUPPORT Human Clinical
"A previously unknown coronavirus was isolated from the sputum of a 60-year-old man who presented with acute pneumonia and subsequent renal failure with a fatal outcome in Saudi Arabia."
The index MERS case establishes the core severe phenotype — acute pneumonia with renal failure and a fatal outcome. Evidence source is HUMAN_CLINICAL as this is a clinical case report.
PMID:23891402 SUPPORT Human Clinical
"Disease caused by MERS-CoV presents with a wide range of clinical manifestations and is associated with substantial mortality in admitted patients who have medical comorbidities."
Descriptive cohort of 47 cases establishing the wide clinical spectrum and substantial mortality in comorbid patients. Evidence source is HUMAN_CLINICAL as this is a clinical case series.
PMID:23891402 SUPPORT Human Clinical
"28 patients died, a 60% case-fatality rate. The case-fatality rate rose with increasing age."
Quantifies the high case-fatality of hospitalized MERS in the primary Saudi cohort and its rise with age, supporting the severe outcome and age-dependent mortality. Evidence source is HUMAN_CLINICAL as this is a clinical case series.
⬡

Pathograph

Use the checkboxes to hide or show graph categories. Hover nodes for evidence and cross-linked metadata.
Pathograph: causal mechanism network for Middle East Respiratory Syndrome Interactive directed graph showing how pathophysiology mechanisms, phenotypes, genetic factors and variants, experimental models, environmental triggers, and treatments relate through causal and linked edges.
●

Phenotypes

10
Blood 2
Lymphopenia FREQUENT Decreased total lymphocyte count HP:0001888 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Lymphopenia, annotated with Decreased total lymphocyte count (HP:0001888). HP:0001888 is a phenotype from the Human Phenotype Ontology.
Show evidence (1 reference)
PMID:23891402 SUPPORT Human Clinical
"lymphopenia (16 [34%])"
Lymphopenia was present in 16 of 47 patients (34%) in the primary Saudi cohort, supporting a FREQUENT band. Evidence source is HUMAN_CLINICAL as this is a clinical case series.
Thrombocytopenia FREQUENT HP:0001873 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Thrombocytopenia (HP:0001873). HP:0001873 is a phenotype from the Human Phenotype Ontology.
Show evidence (1 reference)
PMID:23891402 SUPPORT Human Clinical
"thrombocytopenia (17 [36%])"
Thrombocytopenia was present in 17 of 47 patients (36%) in the primary Saudi cohort, supporting a FREQUENT band. Evidence source is HUMAN_CLINICAL as this is a clinical case series.
Digestive 2
Diarrhea OCCASIONAL HP:0002014 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Diarrhea (HP:0002014). HP:0002014 is a phenotype from the Human Phenotype Ontology.
Show evidence (1 reference)
PMID:23891402 SUPPORT Human Clinical
"diarrhoea (12 [26%])"
Diarrhoea was reported in 12 of 47 patients (26%) in the primary Saudi cohort, supporting an OCCASIONAL band. Evidence source is HUMAN_CLINICAL as this is a clinical case series.
Vomiting OCCASIONAL HP:0002013 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Vomiting (HP:0002013). HP:0002013 is a phenotype from the Human Phenotype Ontology.
Show evidence (1 reference)
PMID:23891402 SUPPORT Human Clinical
"vomiting (ten [21%])"
Vomiting was reported in 10 of 47 patients (21%) in the primary Saudi cohort, supporting an OCCASIONAL band. Evidence source is HUMAN_CLINICAL as this is a clinical case series.
Genitourinary 1
Acute Kidney Injury HP:0001919 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Acute kidney injury (HP:0001919). HP:0001919 is a phenotype from the Human Phenotype Ontology.
Show evidence (1 reference)
PMID:23075143 SUPPORT Human Clinical
"A previously unknown coronavirus was isolated from the sputum of a 60-year-old man who presented with acute pneumonia and subsequent renal failure with a fatal outcome in Saudi Arabia."
The index case developed renal failure, the characteristic extrapulmonary manifestation. Evidence source is HUMAN_CLINICAL as this is a clinical case report.
Immune 1
Pneumonia HP:0002090 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Pneumonia (HP:0002090). HP:0002090 is a phenotype from the Human Phenotype Ontology.
Show evidence (2 references)
PMID:23075143 SUPPORT Human Clinical
"A previously unknown coronavirus was isolated from the sputum of a 60-year-old man who presented with acute pneumonia and subsequent renal failure with a fatal outcome in Saudi Arabia."
The index case presented with acute pneumonia. Evidence source is HUMAN_CLINICAL as this is a clinical case report.
PMID:23891402 SUPPORT Human Clinical
"All patients had abnormal findings on chest radiography, ranging from subtle to extensive unilateral and bilateral abnormalities."
Every patient in the 47-case cohort had abnormal chest radiography, reflecting the near-universal pulmonary involvement of symptomatic MERS. Evidence source is HUMAN_CLINICAL as this is a clinical case series.
Metabolism 1
Fever VERY_FREQUENT HP:0001945 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Fever (HP:0001945). HP:0001945 is a phenotype from the Human Phenotype Ontology.
Show evidence (1 reference)
PMID:23891402 SUPPORT Human Clinical
"Common symptoms at presentation were fever (46 [98%])"
Fever was the most common presenting symptom in the 47-case series, present in 46 of 47 (98%), supporting a VERY_FREQUENT band. Evidence source is HUMAN_CLINICAL as this is a clinical case series.
Respiratory 2
Cough VERY_FREQUENT HP:0012735 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Cough (HP:0012735). HP:0012735 is a phenotype from the Human Phenotype Ontology.
Show evidence (1 reference)
PMID:23891402 SUPPORT Human Clinical
"cough (39 [83%])"
Cough was present in 39 of 47 patients (83%) in the primary Saudi cohort, supporting a VERY_FREQUENT band. Evidence source is HUMAN_CLINICAL as this is a clinical case series.
Dyspnea FREQUENT HP:0002094 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Dyspnea (HP:0002094). HP:0002094 is a phenotype from the Human Phenotype Ontology.
Show evidence (1 reference)
PMID:23891402 SUPPORT Human Clinical
"shortness of breath (34 [72%])"
Shortness of breath (dyspnea) was present in 34 of 47 patients (72%) in the primary Saudi cohort, supporting a FREQUENT band. Evidence source is HUMAN_CLINICAL as this is a clinical case series.
Constitutional 1
Myalgia FREQUENT HP:0003326 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Myalgia (HP:0003326). HP:0003326 is a phenotype from the Human Phenotype Ontology.
Show evidence (1 reference)
PMID:23891402 SUPPORT Human Clinical
"myalgia (15 [32%])"
Myalgia was reported in 15 of 47 patients (32%) in the primary Saudi cohort, supporting a FREQUENT band. Evidence source is HUMAN_CLINICAL as this is a clinical case series.
💊

Medical Actions

1
Supportive Care
Action: Supportive CareNCI Thesaurus (NCIT) Relation: this treatment is this clinical intervention This treatment is Supportive Care (NCIT:C15747). NCIT:C15747 is a clinical intervention from the NCI Thesaurus. NCIT:C15747
Management of MERS is primarily supportive, including supplemental oxygen and respiratory support (up to mechanical ventilation/ECMO for ARDS); no antiviral therapy is approved as standard of care, and management of severe disease is organ-supportive.
📊

Related Datasets

3
Transcriptomic Analysis Of circRNAs/miRNAs/mRNAs upon Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection geo:GSE139516
Human circular RNAs can function in competing endogenous RNA (ceRNA) network by sponging miRNA and regulating gene expression. Viruses are evolved to regulate noncoding RNAs such as miRNAs and circRNAs to facilitate their propagation and pathogenesis. Studies on how host ceRNAs upon human coronavirus infection were scarce, and the functions of circRNAs during the infection of Middle East respiratory syndrome coronavirus (MERS-CoV) has not been deeply revealed. Therefore, we conducted a whole transcriptional profile (RNA-seq) analysis to compare the expression of circRNAs, miRNAs and mRNAs between the mock-infected and MERS-CoV-infected human lung adenocarcinoma (Calu-3) cells.
human BULK RNA SEQ n=27
PMID:32223537
Identified by GEO DataSets index search for Middle East Respiratory Syndrome (scripts/discover_datasets.py); accession and metadata verified against NCBI E-utilities on 2026-08-01. Title, sample count, and organism are GEO's own values.
Transcriptomic analysis of the Novel Middle East Respiratory Syndrome Coronavirus (Human, MRC5 cells) geo:GSE56192
We will use the EMC/2012 strain of the novel beta Coronavirus called Middle East Respiratory Syndrome Coronavirus (MERS-CoV). It was initially passaged on Vero E6 cells in Saudi Arabia before being sequenced at the Erasmus Medical College in Rotterdam, Netherlands by Dr Ron Fouchier. We propose to perform a time course of infection of hCoV-EMC on MRC5 cells (Human Lung origin) and Vero cells (African Green Monkey Kidney cells). Both cell lines readily grow and replicate the virus.
human BULK RNA SEQ n=37
Identified by GEO DataSets index search for Middle East Respiratory Syndrome (scripts/discover_datasets.py); accession and metadata verified against NCBI E-utilities on 2026-08-01. Title, sample count, and organism are GEO's own values.
The N-terminal Region of Middle East Respiratory Syndrome Coronavirus Accessory Protein 8b is Essential for Enhanced Virulence of an Attenuated Murine Coronavirus geo:GSE188514
Middle East respiratory syndrome coronavirus (MERS-CoV) is a beta coronavirus that emerged in 2012, causing severe pneumonia and renal failure. MERS-CoV encodes five accessory proteins. Some of them have been shown to interfere with host antiviral immune response. However, the roles of protein 8b in innate immunity and viral virulence was rarely studied. Here, we introduced individual MERS-CoV accessory protein genes into the genome of an attenuated murine coronavirus (Mouse hepatitis virus, MHV), respectively and found accessory protein 8b could enhance viral replication in vivo and in vitro, and increase the lethality of infected mice.
mouse BULK RNA SEQ n=10
PMID:34817197
Identified by GEO DataSets index search for Middle East Respiratory Syndrome (scripts/discover_datasets.py); accession and metadata verified against NCBI E-utilities on 2026-08-01. Title, sample count, and organism are GEO's own values.
{ }

Source YAML

click to show 
name: Middle East Respiratory Syndrome
creation_date: "2026-06-28T00:00:00Z"
description: >
  Middle East respiratory syndrome (MERS) is a severe viral respiratory infection
  caused by the Middle East respiratory syndrome coronavirus (MERS-CoV), a
  zoonotic betacoronavirus first isolated in 2012 from a patient in Saudi Arabia
  who died of pneumonia and renal failure. Dromedary camels are the reservoir for
  human spillover, and limited human-to-human transmission occurs, particularly in
  health-care settings. MERS-CoV enters host cells using dipeptidyl peptidase 4
  (DPP4/CD26) as its receptor and causes a spectrum from asymptomatic infection to
  severe pneumonia, acute respiratory distress syndrome, and multiorgan failure,
  with a high case-fatality rate concentrated in older adults with comorbidities.
category: Infectious Disease
parents:
- Viral Respiratory Infection
synonyms:
- MERS
- MERS-CoV infection
- Middle East respiratory syndrome coronavirus infection
disease_term:
  preferred_term: Middle East respiratory syndrome
  term:
    id: MONDO:0100116
    label: Middle East respiratory syndrome
pathophysiology:
- name: MERS-CoV Spike-Mediated Entry via DPP4
  conforms_to: "host_directed_antiviral_dependency#Host Receptor and Protease Engagement"
  description: >
    MERS-CoV enters host cells through its spike (S) glycoprotein, whose
    receptor-binding S1 domain engages the host cell-surface enzyme dipeptidyl
    peptidase 4 (DPP4, also known as CD26); host serine proteases then prime the
    spike for membrane fusion. DPP4 is expressed on respiratory epithelium and
    pneumocytes, defining the tropism for the lower respiratory tract, and is
    also expressed on renal and intestinal epithelium and liver — a tissue
    distribution consistent with the extrapulmonary (notably renal and
    gastrointestinal) manifestations of severe MERS. Receptor engagement is
    independent of DPP4 enzymatic activity: clinically used gliptin DPP4
    inhibitors do not block infection, so DPP4 serves as an attachment protein
    rather than through its peptidase catalysis. Because the receptor is a host
    protein, antibodies against DPP4 block infection — the host-directed-target
    logic shared with SARS-CoV-2/ACE2.
  genes:
  - preferred_term: DPP4
    term:
      id: hgnc:3009
      label: DPP4
  cell_types:
  - preferred_term: bronchial epithelial cell
    term:
      id: CL:0002328
      label: bronchial epithelial cell
  - preferred_term: pulmonary alveolar type 2 cell
    term:
      id: CL:0002063
      label: pulmonary alveolar type 2 cell
  biological_processes:
  - preferred_term: virion attachment to host cell
    term:
      id: GO:0019062
      label: virion attachment to host cell
  - preferred_term: symbiont entry into host cell
    term:
      id: GO:0046718
      label: symbiont entry into host cell
  evidence:
  - reference: PMID:23486063
    reference_title: Dipeptidyl peptidase 4 is a functional receptor for the emerging human coronavirus-EMC.
    supports: SUPPORT
    evidence_source: IN_VITRO
    snippet: >-
      Here we identify dipeptidyl peptidase 4 (DPP4; also known as CD26) as a
      functional receptor for hCoV-EMC.
    explanation: >-
      Identifies DPP4 (CD26) as the functional host receptor for MERS-CoV
      (hCoV-EMC), the druggable host-factor entry step. Evidence source is IN_VITRO
      as this is a cell-based receptor-identification study.
  - reference: PMID:23486063
    reference_title: Dipeptidyl peptidase 4 is a functional receptor for the emerging human coronavirus-EMC.
    supports: SUPPORT
    evidence_source: IN_VITRO
    snippet: >-
      Antibodies directed against DPP4 inhibited hCoV-EMC infection of primary
      human bronchial epithelial cells and Huh-7 cells.
    explanation: >-
      Shows that blocking the host DPP4 receptor inhibits MERS-CoV infection of
      human bronchial epithelial cells, the host-directed antiviral proof of
      principle. Evidence source is IN_VITRO as this is a cell-culture experiment.
  - reference: PMID:23486063
    reference_title: Dipeptidyl peptidase 4 is a functional receptor for the emerging human coronavirus-EMC.
    supports: SUPPORT
    evidence_source: IN_VITRO
    snippet: >-
      In humans it is primarily expressed on the epithelial cells in kidney,
      small intestine, liver and prostate, and on activated leukocytes
    explanation: >-
      DPP4 tissue distribution — including renal, intestinal, and hepatic
      epithelium — is consistent with the extrapulmonary (renal and
      gastrointestinal) tropism of MERS beyond the respiratory tract. Evidence
      source is IN_VITRO as this receptor-characterization study reports the
      distribution of the host entry protein.
  - reference: PMID:23486063
    reference_title: Dipeptidyl peptidase 4 is a functional receptor for the emerging human coronavirus-EMC.
    supports: SUPPORT
    evidence_source: IN_VITRO
    snippet: >-
      hCoV-EMC infection could not be blocked by the DPP4 inhibitors sitagliptin,
      vildagliptin, saxagliptin or P32/98
    explanation: >-
      MERS-CoV entry depends on DPP4 as an attachment receptor rather than on its
      peptidase catalytic activity: clinically used gliptin DPP4 inhibitors did
      not block infection. Evidence source is IN_VITRO as this is a cell-culture
      inhibitor experiment.
  downstream:
  - target: Severe Lower Respiratory Infection and Systemic Spread
    description: >-
      Productive infection of the lower respiratory epithelium drives severe
      pneumonia that can progress to ARDS and multiorgan involvement.

- name: Severe Lower Respiratory Infection and Systemic Spread
  description: >
    MERS-CoV replication in the lower respiratory tract produces severe pneumonia
    that frequently progresses to acute respiratory distress syndrome and
    respiratory failure. Systemic and extrapulmonary involvement — notably acute
    kidney injury and gastrointestinal symptoms — is common, and the disease
    carries a high case-fatality rate concentrated in older adults with
    comorbidities.
  biological_processes:
  - preferred_term: viral genome replication
    term:
      id: GO:0019079
      label: viral genome replication
  - preferred_term: inflammatory response
    term:
      id: GO:0006954
      label: inflammatory response
    modifier: INCREASED
  locations:
  - preferred_term: lung
    term:
      id: UBERON:0002048
      label: lung
  evidence:
  - reference: PMID:23075143
    reference_title: Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: >-
      A previously unknown coronavirus was isolated from the sputum of a
      60-year-old man who presented with acute pneumonia and subsequent renal
      failure with a fatal outcome in Saudi Arabia.
    explanation: >-
      The index MERS case establishes the core severe phenotype — acute pneumonia
      with renal failure and a fatal outcome. Evidence source is HUMAN_CLINICAL as
      this is a clinical case report.
  - reference: PMID:23891402
    reference_title: "Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: >-
      Disease caused by MERS-CoV presents with a wide range of clinical
      manifestations and is associated with substantial mortality in admitted
      patients who have medical comorbidities.
    explanation: >-
      Descriptive cohort of 47 cases establishing the wide clinical spectrum and
      substantial mortality in comorbid patients. Evidence source is HUMAN_CLINICAL
      as this is a clinical case series.
  - reference: PMID:23891402
    reference_title: "Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: >-
      28 patients died, a 60% case-fatality rate. The case-fatality rate rose
      with increasing age.
    explanation: >-
      Quantifies the high case-fatality of hospitalized MERS in the primary Saudi
      cohort and its rise with age, supporting the severe outcome and
      age-dependent mortality. Evidence source is HUMAN_CLINICAL as this is a
      clinical case series.
  downstream: []
phenotypes:
- category: Respiratory
  name: Pneumonia
  description: >
    Severe viral pneumonia is the defining manifestation of symptomatic MERS.
  phenotype_term:
    preferred_term: Pneumonia
    term:
      id: HP:0002090
      label: Pneumonia
  evidence:
  - reference: PMID:23075143
    reference_title: Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: >-
      A previously unknown coronavirus was isolated from the sputum of a
      60-year-old man who presented with acute pneumonia and subsequent renal
      failure with a fatal outcome in Saudi Arabia.
    explanation: >-
      The index case presented with acute pneumonia. Evidence source is
      HUMAN_CLINICAL as this is a clinical case report.
  - reference: PMID:23891402
    reference_title: "Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: >-
      All patients had abnormal findings on chest radiography, ranging from
      subtle to extensive unilateral and bilateral abnormalities.
    explanation: >-
      Every patient in the 47-case cohort had abnormal chest radiography,
      reflecting the near-universal pulmonary involvement of symptomatic MERS.
      Evidence source is HUMAN_CLINICAL as this is a clinical case series.
- category: Constitutional
  name: Fever
  description: >
    Fever is the most common presenting symptom of MERS.
  phenotype_term:
    preferred_term: Fever
    term:
      id: HP:0001945
      label: Fever
  frequency: VERY_FREQUENT
  evidence:
  - reference: PMID:23891402
    reference_title: "Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: >-
      Common symptoms at presentation were fever (46 [98%])
    explanation: >-
      Fever was the most common presenting symptom in the 47-case series, present
      in 46 of 47 (98%), supporting a VERY_FREQUENT band. Evidence source is
      HUMAN_CLINICAL as this is a clinical case series.
- category: Respiratory
  name: Cough
  description: >
    Cough is a common presenting symptom of MERS, reported in the majority of the
    47-case Saudi series.
  phenotype_term:
    preferred_term: Cough
    term:
      id: HP:0012735
      label: Cough
  frequency: VERY_FREQUENT
  evidence:
  - reference: PMID:23891402
    reference_title: "Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: >-
      cough (39 [83%])
    explanation: >-
      Cough was present in 39 of 47 patients (83%) in the primary Saudi cohort,
      supporting a VERY_FREQUENT band. Evidence source is HUMAN_CLINICAL as this
      is a clinical case series.
- category: Respiratory
  name: Dyspnea
  description: >
    Shortness of breath is a frequent presenting symptom and reflects progression
    to severe lower respiratory disease.
  phenotype_term:
    preferred_term: Dyspnea
    term:
      id: HP:0002094
      label: Dyspnea
  frequency: FREQUENT
  evidence:
  - reference: PMID:23891402
    reference_title: "Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: >-
      shortness of breath (34 [72%])
    explanation: >-
      Shortness of breath (dyspnea) was present in 34 of 47 patients (72%) in the
      primary Saudi cohort, supporting a FREQUENT band. Evidence source is
      HUMAN_CLINICAL as this is a clinical case series.
- category: Renal
  name: Acute Kidney Injury
  description: >
    Renal failure is a characteristic extrapulmonary complication of severe MERS.
  phenotype_term:
    preferred_term: Acute kidney injury
    term:
      id: HP:0001919
      label: Acute kidney injury
  evidence:
  - reference: PMID:23075143
    reference_title: Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: >-
      A previously unknown coronavirus was isolated from the sputum of a
      60-year-old man who presented with acute pneumonia and subsequent renal
      failure with a fatal outcome in Saudi Arabia.
    explanation: >-
      The index case developed renal failure, the characteristic extrapulmonary
      manifestation. Evidence source is HUMAN_CLINICAL as this is a clinical case
      report.
- category: Gastrointestinal
  name: Diarrhea
  description: >
    Gastrointestinal symptoms including diarrhea occur in a substantial minority of
    MERS cases.
  phenotype_term:
    preferred_term: Diarrhea
    term:
      id: HP:0002014
      label: Diarrhea
  frequency: OCCASIONAL
  evidence:
  - reference: PMID:23891402
    reference_title: "Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: >-
      diarrhoea (12 [26%])
    explanation: >-
      Diarrhoea was reported in 12 of 47 patients (26%) in the primary Saudi
      cohort, supporting an OCCASIONAL band. Evidence source is HUMAN_CLINICAL as
      this is a clinical case series.
- category: Gastrointestinal
  name: Vomiting
  description: >
    Vomiting occurs as part of the gastrointestinal symptom complex in a minority
    of MERS cases.
  phenotype_term:
    preferred_term: Vomiting
    term:
      id: HP:0002013
      label: Vomiting
  frequency: OCCASIONAL
  evidence:
  - reference: PMID:23891402
    reference_title: "Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: >-
      vomiting (ten [21%])
    explanation: >-
      Vomiting was reported in 10 of 47 patients (21%) in the primary Saudi
      cohort, supporting an OCCASIONAL band. Evidence source is HUMAN_CLINICAL as
      this is a clinical case series.
- category: Musculoskeletal
  name: Myalgia
  description: >
    Myalgia is a common systemic symptom at presentation in MERS.
  phenotype_term:
    preferred_term: Myalgia
    term:
      id: HP:0003326
      label: Myalgia
  frequency: FREQUENT
  evidence:
  - reference: PMID:23891402
    reference_title: "Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: >-
      myalgia (15 [32%])
    explanation: >-
      Myalgia was reported in 15 of 47 patients (32%) in the primary Saudi
      cohort, supporting a FREQUENT band. Evidence source is HUMAN_CLINICAL as
      this is a clinical case series.
- category: Hematologic
  name: Lymphopenia
  description: >
    Lymphopenia is a characteristic laboratory feature of MERS, reflecting the
    lymphotropic and immunopathologic component of severe infection.
  phenotype_term:
    preferred_term: Lymphopenia
    term:
      id: HP:0001888
      label: Decreased total lymphocyte count
  frequency: FREQUENT
  evidence:
  - reference: PMID:23891402
    reference_title: "Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: >-
      lymphopenia (16 [34%])
    explanation: >-
      Lymphopenia was present in 16 of 47 patients (34%) in the primary Saudi
      cohort, supporting a FREQUENT band. Evidence source is HUMAN_CLINICAL as
      this is a clinical case series.
- category: Hematologic
  name: Thrombocytopenia
  description: >
    Thrombocytopenia is a laboratory abnormality seen in a substantial minority of
    MERS cases.
  phenotype_term:
    preferred_term: Thrombocytopenia
    term:
      id: HP:0001873
      label: Thrombocytopenia
  frequency: FREQUENT
  evidence:
  - reference: PMID:23891402
    reference_title: "Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: >-
      thrombocytopenia (17 [36%])
    explanation: >-
      Thrombocytopenia was present in 17 of 47 patients (36%) in the primary Saudi
      cohort, supporting a FREQUENT band. Evidence source is HUMAN_CLINICAL as
      this is a clinical case series.
treatments:
- name: Supportive Care
  description: >
    Management of MERS is primarily supportive, including supplemental oxygen and
    respiratory support (up to mechanical ventilation/ECMO for ARDS); no antiviral
    therapy is approved as standard of care, and management of severe disease is
    organ-supportive.
  treatment_term:
    preferred_term: Supportive Care
    term:
      id: NCIT:C15747
      label: Supportive Care
notes: >-
  Created as part of the Respiratory Infections project (Intercept-aligned,
  pandemic-potential coronavirus backlog item). Conforms to the
  host_directed_antiviral_dependency module via the DPP4 receptor entry node,
  paralleling SARS-CoV-2/ACE2. The infectious_agent (NCBITaxon) block for
  MERS-CoV was omitted at creation and is described in the text; it can be added
  later.
datasets:
- accession: geo:GSE139516
  title: Transcriptomic Analysis Of circRNAs/miRNAs/mRNAs upon Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection
  description: Human circular RNAs can function in competing endogenous RNA (ceRNA) network by sponging miRNA and regulating gene expression. Viruses are evolved to regulate noncoding RNAs such as miRNAs and circRNAs to facilitate their propagation and pathogenesis. Studies on how host ceRNAs upon human coronavirus infection were scarce, and the functions of circRNAs during the infection of Middle East respiratory syndrome coronavirus (MERS-CoV) has not been deeply revealed. Therefore, we conducted a whole transcriptional profile (RNA-seq) analysis to compare the expression of circRNAs, miRNAs and mRNAs between the mock-infected and MERS-CoV-infected human lung adenocarcinoma (Calu-3) cells.
  organism:
    preferred_term: human
    term:
      id: NCBITaxon:9606
      label: Homo sapiens
  data_type: BULK_RNA_SEQ
  sample_count: 27
  publication: PMID:32223537
  notes: Identified by GEO DataSets index search for Middle East Respiratory Syndrome (scripts/discover_datasets.py); accession and metadata verified against NCBI E-utilities on 2026-08-01. Title, sample count, and organism are GEO's own values.
- accession: geo:GSE56192
  title: Transcriptomic analysis of the Novel Middle East Respiratory Syndrome Coronavirus (Human, MRC5 cells)
  description: We will use the EMC/2012 strain of the novel beta Coronavirus called Middle East Respiratory Syndrome Coronavirus (MERS-CoV). It was initially passaged on Vero E6 cells in Saudi Arabia before being sequenced at the Erasmus Medical College in Rotterdam, Netherlands by Dr Ron Fouchier. We propose to perform a time course of infection of hCoV-EMC on MRC5 cells (Human Lung origin) and Vero cells (African Green Monkey Kidney cells). Both cell lines readily grow and replicate the virus.
  organism:
    preferred_term: human
    term:
      id: NCBITaxon:9606
      label: Homo sapiens
  data_type: BULK_RNA_SEQ
  sample_count: 37
  notes: Identified by GEO DataSets index search for Middle East Respiratory Syndrome (scripts/discover_datasets.py); accession and metadata verified against NCBI E-utilities on 2026-08-01. Title, sample count, and organism are GEO's own values.
- accession: geo:GSE188514
  title: The N-terminal Region of Middle East Respiratory Syndrome Coronavirus Accessory Protein 8b is Essential for Enhanced Virulence of an Attenuated Murine Coronavirus
  description: Middle East respiratory syndrome coronavirus (MERS-CoV) is a beta coronavirus that emerged in 2012, causing severe pneumonia and renal failure. MERS-CoV encodes five accessory proteins. Some of them have been shown to interfere with host antiviral immune response. However, the roles of protein 8b in innate immunity and viral virulence was rarely studied. Here, we introduced individual MERS-CoV accessory protein genes into the genome of an attenuated murine coronavirus (Mouse hepatitis virus, MHV), respectively and found accessory protein 8b could enhance viral replication in vivo and in vitro, and increase the lethality of infected mice.
  organism:
    preferred_term: mouse
    term:
      id: NCBITaxon:10090
      label: Mus musculus
  data_type: BULK_RNA_SEQ
  sample_count: 10
  publication: PMID:34817197
  notes: Identified by GEO DataSets index search for Middle East Respiratory Syndrome (scripts/discover_datasets.py); accession and metadata verified against NCBI E-utilities on 2026-08-01. Title, sample count, and organism are GEO's own values.