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Synergistic anti-SARS-CoV-2 activity of repurposed anti-parasitic drug combinations

Jitobaom et al., BMC Pharmacology and Toxicology, doi:10.1186/s40360-022-00580-8 (date from preprint)
Jun 2022  
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In Vitro study showing a strong synergistic effect of combinations of ivermectin, niclosamide, and chloroquine, with >10x reduction in IC50 compared to individual drugs.
8 preclinical studies support the efficacy of niclosamide for COVID-19:
Study covers ivermectin and niclosamide.
Jitobaom et al., 18 Jun 2022, peer-reviewed, 8 authors. Contact: prasert.aue@mahidol.ac.th (corresponding author).
In Vitro studies are an important part of preclinical research, however results may be very different in vivo.
This PaperNiclosamideAll
Synergistic anti-SARS-CoV-2 activity of repurposed anti-parasitic drug combinations
Kunlakanya Jitobaom, Chompunuch Boonarkart, Suwimon Manopwisedjaroen, Nuntaya Punyadee, Suparerk Borwornpinyo, Arunee Thitithanyanont, Panisadee Avirutnan, Prasert Auewarakul
BMC Pharmacology and Toxicology, doi:10.1186/s40360-022-00580-8
Background: COVID-19 pandemic has claimed millions of lives and devastated the health service system, livelihood, and economy in many countries worldwide. Despite the vaccination programs in many countries, the spread of the pandemic continues, and effective treatment is still urgently needed. Although some antiviral drugs have been shown to be effective, they are not widely available. Repurposing of anti-parasitic drugs with in vitro anti-SARS-CoV-2 activity is a promising approach being tested in many clinical trials. Combination of these drugs is a plausible way to enhance their effectiveness. Methods: The in vitro anti-SARS-CoV-2 activity of combinations of niclosamide, ivermectin and chloroquine were evaluated in Vero E6 and lung epithelial cells, Calu-3. Results: All the two-drug combinations showed higher potency resulting in up to 4-fold reduction in the half maximal inhibitory concentration (IC 50 ) values compared to individual drugs. Among these combinations, niclosamideivermectin achieved the highest inhibitory level of over 99%. Combination synergy analysis showed niclosamideivermectin combination to have the best synergy score with a mean Loewe synergy score of 4.28 and a peak synergy score of 24.6 in Vero E6 cells and a mean Loewe synergy score of 3.82 and a peak synergy score of 10.86 in Calu-3 cells. Conclusions: The present study demonstrated the benefit of drug combinations on anti-SARS-CoV-2 activity. Niclosamide and ivermectin showed the best synergistic profile and should be further tested in clinical trials.
Abbreviations Supplementary Information The online version contains supplementary material available at https:// doi. org/ 10. 1186/ s40360-022-00580-8. Additional file 1. Authors' contributions KJ performed drug treatment experiments, viral quantifications, analysis and was a major contributor in writing and revising the manuscript. CB performed virus infection, viral quantifications, and the optimization of the plaque assay for SARS-CoV-2 and prepared virus stock. SM performed virus isolation and the optimization of the plaque assay for SARS-CoV-2. NP performed analysis and prepared drug stock solutions. SB prepared cell lines and drug stock solutions. AT designed the study and edited the manuscript. PA 3, 4 reviewed and edited the manuscript. PA 1* designed and supervised the study, performed funding acquisitions, writing, and editing the manuscript. All authors read and approved the final manuscript. Declarations Ethics approval and consent to participate Not applicable. This work does not involve the use of human subjects and animals. All the procedures do not require IRB approval. Consent for publication Not applicable. This work does not contain data from any individual person. Competing interests The authors declare that they have no competing interests. • fast, convenient online submission • thorough peer review by experienced researchers in your field • rapid publication on acceptance • support for research data, including large and complex data types •..
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Ivermectin accelerates circulating nonstructural ' 'protein 1 (NS1) clearance in adult dengue patients: a combined phase 2/3 ' 'randomized double-blinded placebo controlled trial. Clin Infect Dis. ' '2021;72:e586–93.', 'journal-title': 'Clin Infect Dis'}, { 'key': '580_CR61', 'doi-asserted-by': 'publisher', 'first-page': '873', 'DOI': '10.1016/j.ymthe.2020.12.016', 'volume': '29', 'author': 'T Bobrowski', 'year': '2021', 'unstructured': 'Bobrowski T, Chen L, Eastman RT, Itkin Z, Shinn P, Chen CZ, et al. ' 'Synergistic and antagonistic drug combinations against SARS-CoV-2. Mol ' 'Ther. 2021;29:873–85.', 'journal-title': 'Mol Ther'}], 'container-title': 'BMC Pharmacology and Toxicology', 'original-title': [], 'language': 'en', 'link': [ { 'URL': 'https://link.springer.com/content/pdf/10.1186/s40360-022-00580-8.pdf', 'content-type': 'application/pdf', 'content-version': 'vor', 'intended-application': 'text-mining'}, { 'URL': 'https://link.springer.com/article/10.1186/s40360-022-00580-8/fulltext.html', 'content-type': 'text/html', 'content-version': 'vor', 'intended-application': 'text-mining'}, { 'URL': 'https://link.springer.com/content/pdf/10.1186/s40360-022-00580-8.pdf', 'content-type': 'application/pdf', 'content-version': 'vor', 'intended-application': 'similarity-checking'}], 'deposited': { 'date-parts': [[2022, 6, 18]], 'date-time': '2022-06-18T09:12:48Z', 'timestamp': 1655543568000}, 'score': 1, 'resource': { 'primary': { 'URL': 'https://bmcpharmacoltoxicol.biomedcentral.com/articles/10.1186/s40360-022-00580-8'}}, 'subtitle': [], 'short-title': [], 'issued': {'date-parts': [[2022, 6, 18]]}, 'references-count': 61, 'journal-issue': {'issue': '1', 'published-print': {'date-parts': [[2022, 12]]}}, 'alternative-id': ['580'], 'URL': 'http://dx.doi.org/10.1186/s40360-022-00580-8', 'relation': {}, 'ISSN': ['2050-6511'], 'subject': ['Pharmacology (medical)', 'Pharmacology'], 'container-title-short': 'BMC Pharmacol Toxicol', 'published': {'date-parts': [[2022, 6, 18]]}, 'assertion': [ { 'value': '5 January 2022', 'order': 1, 'name': 'received', 'label': 'Received', 'group': {'name': 'ArticleHistory', 'label': 'Article History'}}, { 'value': '9 June 2022', 'order': 2, 'name': 'accepted', 'label': 'Accepted', 'group': {'name': 'ArticleHistory', 'label': 'Article History'}}, { 'value': '18 June 2022', 'order': 3, 'name': 'first_online', 'label': 'First Online', 'group': {'name': 'ArticleHistory', 'label': 'Article History'}}, {'order': 1, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Declarations'}}, { 'value': 'Not applicable. This work does not involve the use of human subjects and ' 'animals. All the procedures do not require IRB approval.', 'order': 2, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Ethics approval and consent to participate'}}, { 'value': 'Not applicable. This work does not contain data from any individual person.', 'order': 3, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Consent for publication'}}, { 'value': 'The authors declare that they have no competing interests.', 'order': 4, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Competing interests'}}], 'article-number': '41'}
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