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Montelukast and Telmisartan as Inhibitors of SARS-CoV-2 Omicron Variant

Mulgaonkar et al., Pharmaceutics, doi:10.3390/pharmaceutics15071891
Jul 2023  
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29th treatment shown to reduce risk in November 2021, now with p = 0.0041 from 9 studies.
Lower risk for hospitalization and cases.
No treatment is 100% effective. Protocols combine treatments.
5,100+ studies for 111 treatments. c19early.org
In Silico and In Vitro study showing that montelukast and telmisartan inhibit SARS-CoV-2 wild-type and the omicron variant. In Silico analysis found montelukast and telmisartan bind to the SARS-CoV-2 spike protein receptor binding domain (RBD) at the ACE2 binding interface. In Vitro, both drugs inhibited wild-type SARS-CoV-2 plaque formation in Vero cells at 50μM. For the omicron variant, montelukast showed inhibition at 1-50μM while telmisartan was only effective at 50μM.
4 preclinical studies support the efficacy of montelukast for COVID-19:
In Silico studies predict inhibition of SARS-CoV-2 with montelukast or metabolites via binding to the spikeA,1 (and specifically the receptor binding domainB,2), MproC,1, RNA-dependent RNA polymeraseD,1, PLproE,1, nucleocapsidF,1, and helicaseG,1 proteins. Montelukast inhibits SARS-CoV-2 omicron infection in Vero cells at 1μM2 and inhibits platelet activation induced by plasma from COVID-19 patients3.
a. The trimeric spike (S) protein is a glycoprotein that mediates viral entry by binding to the host ACE2 receptor, is critical for SARS-CoV-2's ability to infect host cells, and is a target of neutralizing antibodies. Inhibition of the spike protein prevents viral attachment, halting infection at the earliest stage.
b. The receptor binding domain is a specific region of the spike protein that binds ACE2 and is a major target of neutralizing antibodies. Focusing on the precise binding site allows highly specific disruption of viral attachment with reduced potential for off-target effects.
c. The main protease or Mpro, also known as 3CLpro or nsp5, is a cysteine protease that cleaves viral polyproteins into functional units needed for replication. Inhibiting Mpro disrupts the SARS-CoV-2 lifecycle within the host cell, preventing the creation of new copies.
d. RNA-dependent RNA polymerase (RdRp), also called nsp12, is the core enzyme of the viral replicase-transcriptase complex that copies the positive-sense viral RNA genome into negative-sense templates for progeny RNA synthesis. Inhibiting RdRp blocks viral genome replication and transcription.
e. The papain-like protease (PLpro) has multiple functions including cleaving viral polyproteins and suppressing the host immune response by deubiquitination and deISGylation of host proteins. Inhibiting PLpro may block viral replication and help restore normal immune responses.
f. The nucleocapsid (N) protein binds and encapsulates the viral genome by coating the viral RNA. N enables formation and release of infectious virions and plays additional roles in viral replication and pathogenesis. N is also an immunodominant antigen used in diagnostic assays.
g. The helicase, or nsp13, protein unwinds the double-stranded viral RNA, a crucial step in replication and transcription. Inhibition may prevent viral genome replication and the creation of new virus components.
Mulgaonkar et al., 5 Jul 2023, USA, peer-reviewed, 9 authors. Contact: sfernando@tamu.edu (corresponding author).
In Vitro studies are an important part of preclinical research, however results may be very different in vivo.
This PaperMontelukastAll
Montelukast and Telmisartan as Inhibitors of SARS-CoV-2 Omicron Variant
Nirmitee Mulgaonkar, Haoqi Wang, Junrui Zhang, Christopher M Roundy, Wendy Tang, Sankar Prasad Chaki, Alex Pauvolid-Corrêa, Gabriel L Hamer, Sandun Fernando
Pharmaceutics, doi:10.3390/pharmaceutics15071891
Earlier studies with montelukast (M) and telmisartan (T) have revealed their potential antiviral properties against SARS-CoV-2 wild-type (WT) but have not assessed their efficacy against emerging Variants of Concern (VOCs) such as Omicron. Our research fills this gap by investigating these drugs' impact on VOCs, a topic that current scientific literature has largely overlooked. We employed computational methodologies, including molecular mechanics and machine learning tools, to identify drugs that could potentially disrupt the SARS-CoV-2 spike RBD-ACE2 protein interaction. This led to the identification of two FDA-approved small molecule drugs, M and T, conventionally used for treating asthma and hypertension, respectively. Our study presents an additional potential use for these drugs as antivirals. Our results show that both M and T can inhibit not only the WT SARS-CoV-2 but also, in the case of M, the Omicron variant, without reaching cytotoxic concentrations. This novel finding fills an existing gap in the literature and introduces the possibility of repurposing these drugs for SARS-CoV-2 VOCs, an essential step in responding to the evolving global pandemic.
Supplementary Materials: The following supporting information can be downloaded at: https: //www.mdpi.com/article/10.3390/pharmaceutics15071891/s1, Figure S1 : Protein information of SARS-CoV-2 RBD-ACE2 complex (PDB: 6VW1) with secondary structure assessment; Table S1 : RMSD and RMSF evaluation for the last 25 ns and entire MD simulation trajectory, respectively; Table S2 : Prime/MM-GBSA binding free energy calculations for MD of screened compounds with SARS-CoV-2 RBD-ACE2 complex from wild type (WT), and omicron variant; Figure S2: (A Conflicts of Interest: The authors declare no conflict of interest.
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Please send us corrections, updates, or comments. c19early involves the extraction of 100,000+ datapoints from thousands of papers. Community updates help ensure high accuracy. Treatments and other interventions are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. FLCCC and WCH provide treatment protocols.
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