This article needs to be updated.(April 2022) |
External videos | |
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"How Humans Are Crowdsourcing a Cure to COVID-19", Coffee Break, May 3, 2020 | |
“Data coordination strategies used in the COVID Moonshot initiative”, Lizbe Koekemoer, Oxford University, November 17, 2020 | |
"Could the COVID Moonshot change how we design drugs?", Folding@home, January 21, 2021 |
The COVID Moonshot is a collaborative open-science project started in March 2020 with the goal of developing an un-patented oral antiviral drug to treat SARS-CoV-2, the virus causing COVID-19. [1] [2] COVID Moonshot researchers are targeting the proteins needed to form functioning new viral proteins. [3] They are particularly interested in proteases such as 3C-like protease (Mpro), a coronavirus nonstructural protein that mediates the breaking and replication of proteins. [2]
COVID Moonshot may be the first open-science community effort for the development of an antiviral drug. [2] Hundreds of scientists around the world, from academic and industrial organizations, have shared their expertise, resources, data, and results to more rapidly identify, screen, and test candidate compounds for the treatment of COVID-19. [4]
Development of antiviral drugs is a complicated and time-consuming multistage process. [5] The public sharing of information in the early stages of genome identification and protein structure identification has accelerated the process of searching for COVID-19 treatments and established a basis for the COVID Moonshot initiative. [6] [7]
On January 3, 2020, Chinese virologist Yong-Zhen Zhang of Fudan University and the Shanghai Public Health Clinical Center received a test sample from Wuhan, China, where patients had a pneumonia-like illness. By January 5, Zhang and his team had sequenced a virus from the sample and deposited its genome on GenBank, an international research database maintained by the United States National Center for Biotechnology Information. [8] [9] By January 11, 2020, Edward C. Holmes of the University of Sydney had Zhang's permission to publicly release the genome. [8] [10]
With that information, structural biologists world-wide began examining its protein structures. Investigators from the Center for Structural Genomics of Infectious Diseases (CSGID) and other groups began working to characterize the 3D structure of the proteins, sharing their results via the Protein Data Bank (PDB). [6] [7] [11]
Scientists were able to identify a key protein in the virus: 3C-like protease (Mpro). [6] [7] Crucial early X-ray crystallography was done by Zihe Rao and Haitao Yang in Shanghai, China. On January 26, 2020, they submitted a structure of Mpro bound to an inhibitor to the Protein Data Bank. It was released as of February 5, 2020. [6] [7] Rao began coordinating with David Stuart and Martin Walsh at Diamond Light Source, the United Kingdom's synchrotron facility. The Diamond group was able to develop and release a high-resolution crystal structure of unbound Mpro. [6] [7]
Approaches to accelerating drug development have been suggested, but identification of proteins and drug development commonly take years. [5] [6] It was possible to sequence the virus and characterize key proteins extremely quickly because the new virus was somewhat familiar. It had a 70–80% sequence similarity to the proteins in the SARS-CoV coronavirus that caused the SARS outbreak in 2002. Researchers could therefore build on what was already known about previous coronaviruses. [6]
Identifying and recreating viral proteins in the lab is a first step to developing drugs to attack them and vaccines to protect against them. [6] The COVID Moonshot initiative follows an approach to structure-based drug design in which researchers attempt to find a molecule that will bind tightly to a drug target and prevent it from carrying out its normal activities. [7] [2]
In the case of SARS-CoV-2, the coronavirus enters the body and then replicates its genomic RNA, building new copies that are incorporated into new, rapidly spreading viral particles. Protease enzymes or proteases are often desirable drug targets, because proteases are important in the formation and spreading of viral particles. Inhibition of viral proteases can inhibit the virus's ability to replicate itself and spread. [12]
3C-like protease (Mpro), a coronavirus nonstructural protein, is one of the main proteins involved in the replication and transcription of SARS-CoV-2. By understanding Mpro's structure and the ways in which it functions, scientists can identify possible candidates to preemptively bind to Mpro and block its activity. Mpro is not the only possible target for drug design, but it is a highly interesting one. [12]
In collaboration with the University of Oxford and the Weizmann Institute of Science in Rehovot, Israel, the facilities at Diamond Light were used to develop fragment screens [13] [14] [15] [7] utilizing crystallography [16] and mass spectrometry. [17] [18] Nir London's laboratory at the Weizmann Institute contributed technology for identifying compounds that bind irreversibly to target proteins. [4] Frank von Delft and the Nuffield Department of Medicine at the University of Oxford provided technology for rapid crystallographic fragment screening. [4]
Researchers examined thousands of possible fragments from diverse screening libraries and identified at least 71 possible protein–ligand crystal structures, chemical fragments which might have the potential to bind to Mpro. [19] [15] These results were immediately made available online. [4] [15]
The open release of the data and its announcement on Twitter on March 7, 2020, mark a critical point in the formation of COVID Moonshot. The scientists shared their information and challenged chemists worldwide to use that information to design potential openly available antiviral drug candidates. [7] [6] [9] They expected a couple of hundred submissions. By May 2020 more than 4,600 design submissions for potential inhibitors were received. [6] By January 2021, the number of unique compound designs had risen to 14,000. [7] In response, those involved began to shift from a spontaneous virtual collaboration to a larger and more organized network of partners with specialized skills and well-articulated goals. [20]
The design submissions were stored in Collaborative Drug Discovery's CDD Vault, a database used for large-scale management of chemical structures, experimental protocols and experimental results. [4] Alpha Lee and Matt Robinson brought computational expertise from PostEra to the project. PostEra used techniques from artificial intelligence and machine learning to develop analysis tools for computational drug discovery, chemical synthesis and biochemical assays. When COVID Moonshot's appeal resulted in not hundreds but thousands of responses, they built a platform capable of triaging large numbers of compounds and designing routes for their synthetic formation. [4]
Supercomputer access was provided through the COVID-19 High Performance Computing (HPC) Consortium, accelerating the speed at which designs could be examined and compared. [21] [22] The distributed supercomputing initiative Folding@home has carried out multiple sprints to model novel protein structures and target desirable structures as a part of COVID Moonshot. [23] [24] [25]
Many of the criteria for selecting drug candidates were determined by the group's goals. An ideal drug candidate would be effective in treating COVID-19. It also would be easily and cheaply made, so that as many countries and companies as possible could produce and distribute it. The ingredients to make it should be easy to obtain, and the processes involved should be as simple as possible. A drug shouldn't require special handling (like refrigeration) and it should be easy to administer (a pill rather than an injection). [4] [20]
In a matter of months, researchers were able to identify more than 200 promising crystal structure designs and to begin creating and testing them in the lab. [26] Chris Schofield at the University of Oxford synthesized and tested 4 of the most promising of the novel designed peptides to demonstrate their ability to block and inhibit Mpro. [26] Freely available data from COVID Moonshot has also been used to assess the predictive ability of docking scores in suggesting the potency of SARS-CoV-2 M-pro inhibitors. [27]
To go beyond the design phase, possible drug candidates must be created and tested for both effectiveness and safety in animal and human trials. [28] The Wellcome Trust has committed to key initial funding to support this process. [20] Synthesis of candidates is being carried out in parallel, at sites including Ukraine (Enamine), India (Sai Life Sciences) and China (WuXi). [25] Annette von Delft of the University of Oxford and the National Institute for Health Research (NIHR)'s Oxford Biomedical Research Centre (BRC) is leading pre-clinical small molecule research related to COVID Moonshot. [29]
COVID Moonshot anticipates that they will select three pre-clinical candidates by March 2022,[ needs update ] to be followed by preclinical safety and toxicology testing and identification of needed chemistry, manufacturing and control (CMC) steps. Based on that data, the most promising candidate will be chosen. Phase-1 clinical trials, the first stage of testing in human subjects, are projected to begin by June 2023. [30] [20]
Unlike a vaccine, which increases immunity and protects against catching an infectious disease, an antiviral drug treats someone who is already sick by attacking the virus and countering its effects, potentially lessening both symptoms and further transmission. [2]
Mpro is present in other coronaviruses that cause disease, so an antiviral drug that targets Mpro may also be effective against coronaviruses such as SARS and MERS and future pandemics.[ citation needed ]
Mpro does not mutate easily, so it is less likely that variants of the virus will adapt that can avoid the effects of such a drug. [2]
Among the many participants in the COVID Moonshot project are the University of Oxford, University of Cambridge, Diamond Light Source, Weizmann Institute of Science in Rehovot, Israel, [31] [19] Temple University, [4] Memorial Sloan Kettering Cancer Center, PostEra, University of Johannesburg, and the Drugs for Neglected Diseases initiative (DNDi) in Switzerland. [20] Support for the project has come from a variety of philanthropic sources including the Wellcome Trust, COVID-19 Therapeutics Accelerator (CTA), Bill & Melinda Gates Foundation, [32] [20] LifeArc, [33] and through crowdsourcing. [4]
Because COVID Moonshot is based in open science and shared open data, any drug that the project develops can be manufactured and sold by whoever wishes to produce it, worldwide. Countries that are unable to buy or manufacture expensive licensed drugs would therefore have the opportunity to produce their own supplies, and competition between suppliers is likely to result in greater availability and reduced prices for consumers. [4]
This would circumvent issues around the time needed to vaccinate people worldwide. As of July 2021, it was estimated that at current rates, this was likely to take several years. Inequities in distribution will increase both the spreading of the virus and the risk that new and more dangerous variants will emerge. [34] [35]
Supporters of the COVID Moonshot initiative have argued that open-science drug discovery is an essential model for combating both current and future pandemics, and that the prevention of the spread of pandemic diseases is an essential public service. [4]
Protease inhibitors (PIs) are medications that act by interfering with enzymes that cleave proteins. Some of the most well known are antiviral drugs widely used to treat HIV/AIDS, hepatitis C and COVID-19. These protease inhibitors prevent viral replication by selectively binding to viral proteases and blocking proteolytic cleavage of protein precursors that are necessary for the production of infectious viral particles.
Ritonavir, sold under the brand name Norvir, is an antiretroviral medication used along with other medications to treat HIV/AIDS. This combination treatment is known as highly active antiretroviral therapy (HAART). Ritonavir is a protease inhibitor, though it now mainly serves to boost the potency of other protease inhibitors. It may also be used in combination with other medications to treat hepatitis C and COVID-19. It is taken by mouth.
Angiotensin-converting enzyme 2 (ACE2) is an enzyme that can be found either attached to the membrane of cells (mACE2) in the intestines, kidney, testis, gallbladder, and heart or in a soluble form (sACE2). Both membrane bound and soluble ACE2 are integral parts of the renin–angiotensin–aldosterone system (RAAS) that exists to keep the body's blood pressure in check. mACE2 is cleaved by the enzyme ADAM17 in a process regulated by substrate presentation. ADAM17 cleavage releases the extracellular domain creating soluble ACE2 (sACE2). ACE2 enzyme activity opposes the classical arm of the RAAS by lowering blood pressure through catalyzing the hydrolysis of angiotensin II into angiotensin (1–7). Angiotensin (1-7) in turns binds to MasR receptors creating localized vasodilation and hence decreasing blood pressure. This decrease in blood pressure makes the entire process a promising drug target for treating cardiovascular diseases.
Lopinavir is an antiretroviral of the protease inhibitor class. It is used against HIV infections as a fixed-dose combination with another protease inhibitor, ritonavir (lopinavir/ritonavir).
Rudi Pauwels is a Belgian pharmacologist and biotech entrepreneur.
Camostat is a serine protease inhibitor. Serine protease enzymes have a variety of functions in the body, and so camostat has a diverse range of uses. Camostat is approved in Japan for the treatment of chronic pancreatitis and postoperative reflux esophagitis. The oral proteolytic enzyme inhibitor has been on the market since 1985 under the trade name Foipan Tablets. The manufacturer is Ono Pharmaceutical. The drug is used in the treatment of some forms of cancer and is also effective against some viral infections, as well as inhibiting fibrosis in liver or kidney disease or pancreatitis.
Simeprevir, sold under the brand name Olysio among others, is a medication used in combination with other medications for the treatment of hepatitis C. It is specifically used for hepatitis C genotype 1 and 4. Medications it is used with include sofosbuvir or ribavirin and peginterferon-alfa. Cure rates are in 80s to 90s percent. It may be used in those who also have HIV/AIDS. It is taken by mouth once daily for typically 12 weeks.
The 3C-like protease (3CLpro) or main protease (Mpro), formally known as C30 endopeptidase or 3-chymotrypsin-like protease, is the main protease found in coronaviruses. It cleaves the coronavirus polyprotein at eleven conserved sites. It is a cysteine protease and a member of the PA clan of proteases. It has a cysteine-histidine catalytic dyad at its active site and cleaves a Gln–(Ser/Ala/Gly) peptide bond.
Severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) is a strain of coronavirus that causes COVID-19, the respiratory illness responsible for the COVID-19 pandemic. The virus previously had the provisional name 2019 novel coronavirus (2019-nCoV), and has also been called human coronavirus 2019. First identified in the city of Wuhan, Hubei, China, the World Health Organization designated the outbreak a public health emergency of international concern from January 30, 2020, to May 5, 2023. SARS‑CoV‑2 is a positive-sense single-stranded RNA virus that is contagious in humans.
Drug repositioning is the repurposing of an approved drug for the treatment of a different disease or medical condition than that for which it was originally developed. This is one line of scientific research which is being pursued to develop safe and effective COVID-19 treatments. Other research directions include the development of a COVID-19 vaccine and convalescent plasma transfusion.
COVID-19 drug development is the research process to develop preventative therapeutic prescription drugs that would alleviate the severity of coronavirus disease 2019 (COVID-19). From early 2020 through 2021, several hundred drug companies, biotechnology firms, university research groups, and health organizations were developing therapeutic candidates for COVID-19 disease in various stages of preclinical or clinical research, with 419 potential COVID-19 drugs in clinical trials, as of April 2021.
3CLpro-1 is an antiviral drug related to rupintrivir which acts as a 3CL protease inhibitor and was originally developed for the treatment of human enterovirus 71. It is one of the most potent of a large series of compounds developed as inhibitors of the viral enzyme 3CL protease, with an in vitroIC50 of 200 nM. It also shows activity against coronavirus diseases such as SARS and MERS, and is under investigation as a potential treatment agent for the viral disease COVID-19.
GC376 is a broad-spectrum antiviral medication under development by the biopharmaceutical company Anivive Lifesciences for therapeutic uses in humans and animals. Anivive licensed the exclusive worldwide patent rights to GC376 from Kansas State University. As of 2020, GC376 is being investigated as treatment for COVID-19. GC376 shows activity against many human and animal viruses including coronavirus and norovirus; the most extensive research has been multiple in vivo studies in cats treating a coronavirus which causes deadly feline infectious peritonitis. Other research supports use in porcine epidemic diarrhea virus.
Broad-spectrum antivirals (BSAs) are a class of molecules or compounds, which inhibit the infection of multiple viruses from the same or different virus families. BSAs could be divided into experimental and investigational agents, and approved drugs. BSAs work by inhibiting viral proteins or by targeting host cell factors and processes exploited by different viruses during infection. As of 2021, there are 150 known BSAs in varying stages of development, effective against 78 human viruses. BSAs are potential candidates for treatment of emerging and re-emerging viruses, such as ebola, marburg, and SARS-CoV-2. Many BSAs show antiviral activity against other viruses than originally investigated. Efforts in drug repurposing for SARS-CoV-2 is currently underway. A database of BSAs and viruses they inhibit could be found here.
Aloxistatin is a drug which acts as a cysteine protease inhibitor and has anticoagulant effects. It is a synthetic analogue of E-64, a natural product derived from fungi. It was researched for the treatment of muscular dystrophy but was not successful in human clinical trials, though it has continued to be investigated for treatment of spinal cord injury, stroke and Alzheimer's disease.
M. Joanne Lemieux is a Canadian scientist who is a Professor of Structural Biology at the University of Alberta. She studies the structures of membrane proteins that are critical to disease in an effort to identify novel therapeutic strategies. During the COVID-19 pandemic Lemieux worked to develop an antiviral drug that could protect people from coronavirus disease.
Nirmatrelvir is an antiviral medication developed by Pfizer which acts as an orally active 3C-like protease inhibitor. It is part of a nirmatrelvir/ritonavir combination used to treat COVID-19 and sold under the brand name Paxlovid.
Lufotrelvir (PF-07304814) is an antiviral drug developed by Pfizer which acts as a 3CL protease inhibitor. It is a prodrug with the phosphate group being cleaved in vivo to yield the active agent PF-00835231. Lufotrelvir is in human clinical trials for the treatment of COVID-19, and shows good activity against COVID-19 including several variant strains, but unlike the related drug nirmatrelvir it is not orally active and must be administered by intravenous infusion, and so has been the less favoured candidate for clinical development overall.
The nidoviral papain-like protease is a papain-like protease protein domain encoded in the genomes of nidoviruses. It is expressed as part of a large polyprotein from the ORF1a gene and has cysteine protease enzymatic activity responsible for proteolytic cleavage of some of the N-terminal viral nonstructural proteins within the polyprotein. A second protease also encoded by ORF1a, called the 3C-like protease or main protease, is responsible for the majority of further cleavages. Coronaviruses have one or two papain-like protease domains; in SARS-CoV and SARS-CoV-2, one PLPro domain is located in coronavirus nonstructural protein 3 (nsp3). Arteriviruses have two to three PLP domains. In addition to their protease activity, PLP domains function as deubiquitinating enzymes (DUBs) that can cleave the isopeptide bond found in ubiquitin chains. They are also "deISGylating" enzymes that remove the ubiquitin-like domain interferon-stimulated gene 15 (ISG15) from cellular proteins. These activities are likely responsible for antagonizing the activity of the host innate immune system. Because they are essential for viral replication, papain-like protease domains are considered drug targets for the development of antiviral drugs against human pathogens such as MERS-CoV, SARS-CoV, and SARS-CoV-2.
Olgotrelvir (STI-1558) is an experimental antiviral medication being studied as a potential treatment for COVID-19. It is believed to work by inhibiting the SARS-CoV-2 main protease (Mpro), a key enzyme that SARS-CoV-2 needs to replicate, and by blocking viral entry.