Melphalan for COVID-19

Background/Objectives: Effective anti-inflammatory treatment for COVID-19 is necessary. It was shown that ultra-low doses (100-fold lower than therapeutic ones) of alkylating drug melphalan (MEL) interact with cytokine cell receptors without DNA damage. A method of treating severe COVID-19 with ultra-low doses of MEL inhalations was proposed. The objective was to study the efficacy and safety of MEL inhalations for COVID-19 pneumonia treatment. Methods: An open-label comparative study (NCT04380376) with 120 patients divided into two groups was conducted. The control group (CG) received standard treatment, and the melphalan group (MG) also received seven daily 0.1 mg MEL inhalations. Changes in clinical improvement, inflammatory markers, and CT lung scan data were primary and secondary endpoints. Results: Patients in the MG showed significantly better clinical outcomes compared to the CG, with improvements in dyspnea according to the WHO Ordinal Scale of Clinical Improvement and the modified Borg Scale, CT scans, and inflammatory markers. No adverse effects (including irritant and bronchoconstrictor effects) possibly related to MEL were reported. Conclusions: This study demonstrated the efficacy of incorporating ultra-low-dose MEL inhalations into the therapeutic regimen for patients with COVID-19-associated pneumonia. This conclusion is supported by a statistically significant improvement in clinical outcomes, as assessed by the OSCI, a more rapid reduction in the severity of dyspnea, and a marked anti-inflammatory effect, evidenced by a faster decline in C-reactive protein levels. No adverse effects were observed with the proposed treatment method. Further large-scale randomized clinical trials are warranted to validate these findings and to evaluate the potential for the implementation of ultra-low-dose MEL inhalation in clinical practice.

Effective SARS-CoV-2 antiviral drugs are desperately needed. The SARS-CoV-2 main protease (Mpro) appears as an attractive target for drug development. We show that the existing pharmacopeia contains many drugs with potential for therapeutic repurposing as selective and potent inhibitors of SARS-CoV-2 Mpro. We screened a collection of ~6,070 drugs with a previous history of use in humans for compounds that inhibit the activity of Mpro in vitro and found ~50 compounds with activity against Mpro. Subsequent dose validation studies demonstrated 8 dose responsive hits with an IC50 ≤ 50 μM. Hits from our screen are enriched with hepatitis C NS3/4A protease targeting drugs including boceprevir, ciluprevir. narlaprevir, and telaprevir. This work suggests previous large-scale commercial drug development initiatives targeting hepatitis C NS3/4A viral protease should be revisited because some previous lead compounds may be more potent against SARS-CoV-2 Mpro than boceprevir and suitable for rapid repurposing.

According to the World Health Organization (WHO), in the second half of 2022, there are about 606 million confirmed cases of COVID-19 and almost 6,500,000 deaths around the world. A pandemic was declared by the WHO in March 2020 when the new coronavirus spread around the world. The short time between the first cases in Wuhan and the declaration of a pandemic initiated the search for ways to stop the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or to attempt to cure the disease COVID-19. More than ever, research groups are developing vaccines, drugs, and immunobiological compounds, and they are even trying to repurpose drugs in an increasing number of clinical trials. There are great expectations regarding the vaccine’s effectiveness for the prevention of COVID-19. However, producing sufficient doses of vaccines for the entire population and SARS-CoV-2 variants are challenges for pharmaceutical industries. On the contrary, efforts have been made to create different vaccines with different approaches so that they can be used by the entire population. Here, we summarize about 8162 clinical trials, showing a greater number of drug clinical trials in Europe and the United States and less clinical trials in low-income countries. Promising results about the use of new drugs and drug repositioning, monoclonal antibodies, convalescent plasma, and mesenchymal stem cells to control viral infection/replication or the hyper-inflammatory response to the new coronavirus bring hope to treat the disease.