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Niclosamide: a potential treatment option for COVID-19

Vibhute et al., International Journal of Applied Pharmaceutics, doi:10.22159/ijap.2023v15i1.45850
Jan 2023  
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Review of niclosamide as a potential treatment option for COVID-19. Authors report antiviral activity against SARS-CoV-2 in vitro, with an IC50 of 0.28 μM. However, the currently available oral formulations limit systemic levels. To improve bioavailability, various formulation strategies have been explored for oral, inhalation, and intranasal delivery. Potential antiviral mechanisms include blocking viral endocytosis and inhibiting autophagy.
Reviews covering niclosamide for COVID-19 include1-6.
Vibhute et al., 7 Jan 2023, peer-reviewed, 5 authors. Contact: vibhuteshweta5@gmail.com.
This PaperNiclosamideAll
NICLOSAMIDE: A POTENTIAL TREATMENT OPTION FOR COVID-19
Shweta Vibhute, Aditi Kasar, Hrishikesh Mahale, Mahesh Gaikwad, Madhur Kulkarni
International Journal of Applied Pharmaceutics, doi:10.22159/ijap.2023v15i1.45850
Coronavirus Disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) poses a global health hazard due to its rapid dissemination and limited treatment options. Identification of possible treatments that may kill the virus, speed up the recovery, or reduce the case fatality rate is a need of hour. However, developing and producing particular COVID-19 medicines and vaccines is a time-consuming process with possibilities of clinical failures due to safety or efficacy issue. Medication repositioning is a safer and quicker approach for dealing with the COVID-19 worldwide threat right now. Out of 48 FDA-approved medicines tested against SARS-CoV-2, niclosamide is one amongst few that has shown potential in vitro antiviral activity against SARS-CoV-2. However, the currently available oral conventional formulation of niclosamide results in systemic medication levels those are unsatisfactory to inhibit SARS-CoV-2. Hence, various formulation strategies have been adapted in order to achieve an optimum therapeutic outcome of niclosamide when delivered via oral, inhalation, and intranasal routes. Some of these formulations are presently undergoing clinical trials. The current review focuses on the mechanisms of action of niclosamide and its repurposing effectiveness against COVID-19. The delivery strategies to improve its bioavailability have been overviewed. The recently completed and ongoing clinical trials have also been summarized.
CONFLICTS OF INTERESTS Declared none
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' 'Niclosamide as a potential nonsteroidal therapy for endometriosis that ' 'preserves reproductive function in an experimental mouse model. Biol ' 'Reprod. 2016 Oct 1;95(4):76. doi: 10.1095/biolreprod.116.140236, PMID ' '27535961.', 'DOI': '10.1095/biolreprod.116.140236'}, { 'key': '1055362', 'doi-asserted-by': 'crossref', 'unstructured': 'Tao H, Zhang Y, Zeng X, Shulman GI, Jin S. Niclosamide ' 'ethanolamine-induced mild mitochondrial uncoupling improves diabetic ' 'symptoms in mice. Nat Med. 2014 Nov;20(11):1263-9. doi: 10.1038/nm.3699, ' 'PMID 25282357.', 'DOI': '10.1038/nm.3699'}, { 'key': '1055363', 'doi-asserted-by': 'crossref', 'unstructured': 'Gwisai T, Hollingsworth NR, Cowles S, Tharmalingam N, Mylonakis E, Fuchs ' 'BB. Repurposing niclosamide as a versatile antimicrobial surface coating ' 'against device-associated, hospital-acquired bacterial infections. ' 'Biomed Mater. 2017 Jul 12;12(4):045010. doi: 10.1088/1748-605X/aa7105, ' 'PMID 28471351.', 'DOI': '10.1088/1748-605X/aa7105'}, { 'key': '1055364', 'doi-asserted-by': 'crossref', 'unstructured': 'Gassen NC, Niemeyer D, Muth D, Corman VM, Martinelli S, Gassen A. SKP2 ' 'attenuates autophagy through Beclin1-ubiquitination and its inhibition ' 'reduces MERS-coronavirus infection. Nat Commun. 2019 Dec 18;10(1):5770. ' 'doi: 10.1038/s41467-019-13659-4, PMID 31852899.', 'DOI': '10.1038/s41467-019-13659-4'}, { 'key': '1055365', 'doi-asserted-by': 'crossref', 'unstructured': 'Arshad U, Pertinez H, Box H, Tatham L, Rajoli RKR, Curley P. ' 'Prioritization of anti-SARS-Cov-2 drug repurposing opportunities based ' 'on plasma and target site concentrations derived from their established ' 'human pharmacokinetics. Clin Pharmacol Ther. 2020 Oct;108(4):775-90. ' 'doi: 10.1002/cpt.1909, PMID 32438446.', 'DOI': '10.1002/cpt.1909'}, { 'key': '1055366', 'doi-asserted-by': 'crossref', 'unstructured': 'Gui M, Song W, Zhou H, Xu J, Chen S, Xiang Y. Cryo-electron microscopy ' 'structures of the SARS-CoV spike glycoprotein reveal a prerequisite ' 'conformational state for receptor binding. Cell Res. 2017 ' 'Jan;27(1):119-29. doi: 10.1038/cr.2016.152, PMID 28008928.', 'DOI': '10.1038/cr.2016.152'}, { 'key': '1055367', 'doi-asserted-by': 'crossref', 'unstructured': 'Thomson G. COVID-19: social distancing, ACE 2 receptors, protease ' 'inhibitors and beyond? Int J Clin Pract. 2020 Jul;74(7):e13503. doi: ' '10.1111/ijcp.13503, PMID 32187421.', 'DOI': '10.1111/ijcp.13503'}, { 'key': '1055368', 'doi-asserted-by': 'crossref', 'unstructured': 'Jurgeit A, McDowell R, Moese S, Meldrum E, Schwendener R, Greber UF. ' 'Niclosamide is a proton carrier and targets acidic endosomes with broad ' 'antiviral effects. PLOS Pathog. 2012;8(10):e1002976. doi: ' '10.1371/journal.ppat.1002976, PMID 23133371.', 'DOI': '10.1371/journal.ppat.1002976'}, { 'key': '1055369', 'doi-asserted-by': 'crossref', 'unstructured': 'Pindiprolu SKSS, Pindiprolu SH. Plausible mechanisms of niclosamide as ' 'an antiviral agent against COVID-19. Med Hypotheses. 2020 Apr ' '22;140:109765. doi: 10.1016/j.mehy.2020.109765, PMID 32361588.', 'DOI': '10.1016/j.mehy.2020.109765'}, { 'key': '1055370', 'doi-asserted-by': 'crossref', 'unstructured': 'Gassen NC, Papies J, Bajaj T, Dethloff F, Emanuel J, Weckmann K. ' 'Analysis of SARS-CoV-2-controlled autophagy reveals spermidine, MK-2206, ' 'and niclosamide as putative antiviral therapeutics. Microbiology. 2020. ' 'doi: 10.1101/2020.04.15.997254.', 'DOI': '10.1101/2020.04.15.997254'}, { 'key': '1055371', 'doi-asserted-by': 'crossref', 'unstructured': 'Lodhi DS, Panwar AS, Dongre N. Review study on analysis of the ' 'solubility of biopharmaceutical classification system class ii drugs in ' 'a self-emulsifying drug delivery system. Asian J Pharm Clin Res. 2021; ' 'Dec 16:36-45.', 'DOI': '10.22159/ajpcr.2022.v15i2.43303'}, { 'key': '1055372', 'doi-asserted-by': 'crossref', 'unstructured': 'Eduardo B. Contribution to the improvement of an oral formulation of ' 'niclosamide, an antihelmintic drug candidate for repurposing in ' 'SARS-CoV-2 and other viruses; 2020. doi: 10.26434/chemrxiv.12056187.v1', 'DOI': '10.26434/chemrxiv.12056187.v1'}, { 'key': '1055373', 'doi-asserted-by': 'crossref', 'unstructured': 'Rehman MU, Khan MA, Khan WS, Shafique M, Khan M. Fabrication of ' 'niclosamide loaded solid lipid nanoparticles: in vitro characterization ' 'and comparative in vivo evaluation. Artif Cells Nanomed Biotechnol. 2018 ' 'Dec;46(8):1926-34. doi: 10.1080/21691401.2017.1396996, PMID 29113501.', 'DOI': '10.1080/21691401.2017.1396996'}, { 'key': '1055374', 'doi-asserted-by': 'crossref', 'unstructured': 'Grifasi F, Chierotti MR, Gaglioti K, Gobetto R, Maini L, Braga D. Using ' 'salt cocrystals to improve the solubility of niclosamide. Cryst Growth ' 'Des. 2015 Apr 1;15(4):1939-48. doi: 10.1021/acs.cgd.5b00106.', 'DOI': '10.1021/acs.cgd.5b00106'}, { 'key': '1055375', 'doi-asserted-by': 'crossref', 'unstructured': 'Sanphui P, Kumar SS, Nangia A. Pharmaceutical cocrystals of niclosamide. ' 'Cryst Growth Des. 2012 Sep 5;12(9):4588-99. doi: 10.1021/cg300784v.', 'DOI': '10.1021/cg300784v'}, { 'key': '1055376', 'doi-asserted-by': 'crossref', 'unstructured': 'Xie Y, Yao Y. Octenylsuccinate hydroxypropyl phytoglycogen enhances the ' 'solubility and in vitro antitumor efficacy of niclosamide. Int J Pharm. ' '2018 Jan 15;535(1-2):157-63. doi: 10.1016/j.ijpharm.2017.11.004, PMID ' '29113805.', 'DOI': '10.1016/j.ijpharm.2017.11.004'}, { 'key': '1055377', 'doi-asserted-by': 'crossref', 'unstructured': 'Zeyada MS, Abdel Rahman N, El-Karef A, Yahia S, El-Sherbiny IM, Eissa ' 'LA. Niclosamide-loaded polymeric micelles ameliorate hepatocellular ' 'carcinoma in vivo through targeting Wnt and Notch pathways. Life Sci. ' '2020 Nov 15;261:118458. doi: 10.1016/j.lfs.2020.118458, PMID 32961231.', 'DOI': '10.1016/j.lfs.2020.118458'}, { 'key': '1055378', 'doi-asserted-by': 'crossref', 'unstructured': 'Costabile G, d’Angelo I, Rampioni G, Bondì R, Pompili B, Ascenzioni F. ' 'Toward repositioning niclosamide for antivirulence therapy of ' 'Pseudomonas aeruginosa Lung infections: development of inhalable ' 'formulations through nanosuspension technology. Mol Pharm. 2015 Aug ' '3;12(8):2604-17. doi: 10.1021/acs.molpharmaceut.5b00098, PMID 25974285.', 'DOI': '10.1021/acs.molpharmaceut.5b00098'}, { 'key': '1055379', 'doi-asserted-by': 'crossref', 'unstructured': 'Naqvi S, Mohiyuddin S, Gopinath P. Niclosamide loaded biodegradable ' 'chitosan nanocargoes: an in vitro study for potential application in ' 'cancer therapy. R Soc Open Sci. 2017 Nov;4(11):170611. doi: ' '10.1098/rsos.170611, PMID 29291056.', 'DOI': '10.1098/rsos.170611'}, { 'key': '1055380', 'doi-asserted-by': 'crossref', 'unstructured': 'Zhang X, Zhang Y, Zhang T, Zhang J, Wu B. Significantly enhanced ' 'bioavailability of niclosamide through submicron lipid emulsions with or ' 'without PEG-lipid: a comparative study. J Microencapsul. ' '2015;32(5):496-502. doi: 10.3109/02652048.2015.1057251, PMID 26079596.', 'DOI': '10.3109/02652048.2015.1057251'}, { 'key': '1055381', 'doi-asserted-by': 'crossref', 'unstructured': 'Ye Y, Zhang X, Zhang T, Wang H, Wu B. Design and evaluation of ' 'injectable niclosamide nanocrystals prepared by wet media milling ' 'technique. Drug Dev Ind Pharm. 2015;41(9):1416-24. doi: ' '10.3109/03639045.2014.954585, PMID 25204767.', 'DOI': '10.3109/03639045.2014.954585'}, { 'key': '1055382', 'doi-asserted-by': 'crossref', 'unstructured': 'Hobson JJ, Savage AC, Dwyer AB, Unsworth C, Massam J, Arshad U. Scalable ' 'nanoprecipitation of niclosamide and in vivo demonstration of ' 'long-acting delivery after intramuscular injection. Nanoscale. 2021 Apr ' '7;13(13):6410-6. doi: 10.1039/d1nr00309g, PMID 33885522.', 'DOI': '10.1039/D1NR00309G'}, { 'key': '1055383', 'doi-asserted-by': 'crossref', 'unstructured': 'Choi G, Piao H, Rejinold NS, Yu S, Kim KY, Jin GW. ' 'Hydrotalcite-niclosamide nanohybrid as oral formulation towards ' 'SARS-CoV-2 viral infections. Pharmaceuticals (Basel). 2021 May ' '19;14(5):486. doi: 10.3390/ph14050486, PMID 34069716.', 'DOI': '10.3390/ph14050486'}, { 'key': '1055384', 'doi-asserted-by': 'crossref', 'unstructured': 'Yu S, Piao H, Rejinold NS, Jin G, Choi G, Choy JH. Niclosamide-clay ' 'intercalates coated with nonionic polymer for enhanced bioavailability ' 'toward COVID-19 treatment. Polymers. 2021 Mar 26;13(7):1044. doi: ' '10.3390/polym13071044, PMID 33810527.', 'DOI': '10.3390/polym13071044'}, { 'key': '1055385', 'doi-asserted-by': 'crossref', 'unstructured': 'Wang G, Gaikwad H, McCarthy MK, Gonzalez-Juarrero M, Li Y, Armstrong M. ' 'Lipid nanoparticle formulation of niclosamide (Nano NCM) effectively ' 'inhibits SARS-CoV-2 replication in vitro. Precis Nanomed. 2021 Apr ' '17;4(1):724-37. doi: 10.33218/001c.18813, PMID 34676370.', 'DOI': '10.33218/001c.18813'}, { 'key': '1055386', 'doi-asserted-by': 'crossref', 'unstructured': 'Jara MO, Warnken ZN, Williams RO. Amorphous solid dispersions and the ' 'contribution of nanoparticles to in vitro dissolution and in vivo ' 'testing: niclosamide as a case study. Pharmaceutics. 2021 Jan ' '14;13(1):97. doi: 10.3390/pharmaceutics13010097, PMID 33466598.', 'DOI': '10.3390/pharmaceutics13010097'}, { 'key': '1055387', 'doi-asserted-by': 'crossref', 'unstructured': 'Chu H, Chan JFW, Wang Y, Yuen TTT, Chai Y, Hou Y. Comparative ' 'replication and immune activation profiles of SARS-CoV-2 and SARS-CoV in ' 'human lungs: an ex vivo study with implications for the pathogenesis of ' 'COVID-19. Clinical Infectious Diseases. 2020 Sep 12;71(6):1400-9. doi: ' '10.1093/cid/ciaa410.', 'DOI': '10.1093/cid/ciaa410'}, { 'key': '1055388', 'doi-asserted-by': 'crossref', 'unstructured': 'Damiani S, Fiorentino M, De Palma A, Foschini MP, Lazzarotto T, ' 'Gabrielli L. Pathological post-mortem findings in lungs infected with ' 'SARS-CoV-2. J Pathol. 2021 Jan;253(1):31-40. doi: 10.1002/path.5549, ' 'PMID 32930394.', 'DOI': '10.1002/path.5549'}, { 'key': '1055389', 'doi-asserted-by': 'crossref', 'unstructured': 'Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX. Clinical characteristics ' 'of coronavirus disease 2019 in China. N Engl J Med. 2020 Apr ' '30;382(18):1708-20. doi: 10.1056/NEJMoa2002032, PMID 32109013.', 'DOI': '10.1056/NEJMoa2002032'}, { 'key': '1055390', 'doi-asserted-by': 'crossref', 'unstructured': 'Brunaugh AD, Seo H, Warnken Z, Ding L, Seo SH, Smyth HDC. Development ' 'and evaluation of inhalable composite niclosamide-lysozyme particles: A ' 'broad-spectrum, patient-adaptable treatment for coronavirus infections ' 'and sequalae. PLOS ONE. 2021;16(2):e0246803. doi: ' '10.1371/journal.pone.0246803, PMID 33571320.', 'DOI': '10.1371/journal.pone.0246803'}, { 'key': '1055391', 'doi-asserted-by': 'crossref', 'unstructured': 'Jara MO, Warnken ZN, Sahakijpijarn S, Moon C, Maier EY, Christensen DJ. ' 'Niclosamide inhalation powder made by thin-film freezing: multi-dose ' 'tolerability and exposure in rats and pharmacokinetics in hamsters. Int ' 'J Pharm. 2021 Jun 15;603:120701. doi: 10.1016/j.ijpharm.2021.120701, ' 'PMID 33989748.', 'DOI': '10.1016/j.ijpharm.2021.120701'}, { 'key': '1055392', 'doi-asserted-by': 'crossref', 'unstructured': 'Yamaoka Tojo M. Vascular endothelial glycocalyx damage in COVID-19. Int ' 'J Mol Sci. 2020 Dec 19;21(24):E9712. doi: 10.3390/ijms21249712, PMID ' '33352699.', 'DOI': '10.3390/ijms21249712'}, { 'key': '1055393', 'doi-asserted-by': 'crossref', 'unstructured': 'Rejinold NS, Choi G, Piao H, Choy JH. Bovine serum albumin-coated ' 'niclosamide-Zein nanoparticles as potential injectable medicine against ' 'COVID-19. Materials. 2021 Jul 7;14(14):3792. doi: 10.3390/ma14143792.', 'DOI': '10.3390/ma14143792'}], 'container-title': 'International Journal of Applied Pharmaceutics', 'original-title': [], 'link': [ { 'URL': 'https://innovareacademics.in/journals/index.php/ijap/article/download/45850/27480', 'content-type': 'application/pdf', 'content-version': 'vor', 'intended-application': 'text-mining'}, { 'URL': 'https://innovareacademics.in/journals/index.php/ijap/article/download/45850/27522', 'content-type': 'text/html', 'content-version': 'vor', 'intended-application': 'text-mining'}, { 'URL': 'https://innovareacademics.in/journals/index.php/ijap/article/download/45850/27480', 'content-type': 'unspecified', 'content-version': 'vor', 'intended-application': 'similarity-checking'}], 'deposited': { 'date-parts': [[2023, 1, 11]], 'date-time': '2023-01-11T07:59:59Z', 'timestamp': 1673423999000}, 'score': 1, 'resource': {'primary': {'URL': 'https://innovareacademics.in/journals/index.php/ijap/article/view/45850'}}, 'subtitle': [], 'short-title': [], 'issued': {'date-parts': [[2023, 1, 7]]}, 'references-count': 55, 'URL': 'http://dx.doi.org/10.22159/ijap.2023v15i1.45850', 'relation': {}, 'ISSN': ['0975-7058'], 'subject': [], 'container-title-short': 'Int J App Pharm', 'published': {'date-parts': [[2023, 1, 7]]}}
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