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      Potential inhibitors against 2019-nCoV coronavirus M protease from clinically approved medicines

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          Abstract

          Coronaviruses, members of the family Coronaviridae and subfamily Coronavirinae, are enveloped positive-strand RNA viruses which have spikes of glycoproteins projecting from their viral envelopes, thus exhibit a corona or halo-like appearance (Masters and Perlman, 2013; Cui et al., 2019). Coronaviruses are the causal pathogens for a wide spectrum of respiratory and gastrointestinal diseases in both wild and domestic animals, including birds, pigs, rodents, etc (Dhama et al., 2014). Previous studies have found that six strains of coronaviruses are capable to infect humans, including four strains circulating yearly to cause common cold, and other two strains which are the source for severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS-CoV), respectively (Dhama et al., 2014; Cui et al., 2019). Starting from December 2019, a novel coronavirus, which was later named 2019-nCoV (‘n’ stands for novel), was found to cause Severe Acute Respiratory (SARI) symptoms, including fever, dyspnea, asthenia and pneumonia among people in Wuhan, China (Zhu et al., 2020; Lu et al., 2020; Hui et al., 2020). The first batch of patients infected by 2019-nCoV were almost all connected to a seafood market in Wuhan, which also trades wild animals. Later, contact transmission of 2019-nCoV among humans was confirmed, and the number of infected patients increased rapidly in Wuhan as well as other major cities in China. A series of actions have been taken by the Chinese government to control the epidemic of the virus, and effective medical methods are in urgent needs to prevent 2019-nCoV infection and cure the disease. Among all known RNA viruses, coronaviruses have the largest genomes, ranging from 26 kb to 32 kb in length (Regenmortel et al., 2000; Schoeman and Fielding, 2019). Besides encoding structural proteins, majority part of the coronavirus genome is transcribed and translated into a polypeptide, which encodes proteins essential for viral replication and gene expression (Lai and Holmes, 2001). The ∼306 aa long main protease (Mpro), a key enzyme for coronavirus replication, is also encoded by the polypeptide and responsible for processing the polypeptide into functional proteins (Lai and Holmes, 2001). The Mpro has similar cleavage-site specificity to that of picornavirus 3C protease (3Cpro), thus is also known as 3C-like protease (3CLpro) (Gorbalenya et al., 1989). Studies have shown that the Mpros of different coronaviruses are highly conserved in terms of both sequences and 3D structures (Xue et al., 2008). These features, together with its functional importance, have made Mpro an attractive target for the design of anticoronaviral drugs (Anand et al., 2003; Xue et al., 2008). To present, these are still no clinically approved antibodies or drugs specific for coronaviruses, which makes it difficult for curing 2019-nCoV caused diseases and controlling the associated pandemic. With the hope to identify candidate drugs for 2019-nCoV, we adopted a computational approach to screen for available commercial medicines which may function as inhibitors for the Mpro of 2019-nCoV. A previous attempt to predict drugs for the Mpro of SARS-CoV has identified two HIV-1 protease inhibitors, namely lopinavir and ritonavir, as potential candidates, both of which bind to the same target site of Mpro (Nukoolkarn et al., 2008). Clinical application of these two drugs on 2019-nCoV patients also appears to be effective, demonstrating the importance of the drug binding site for suppressing 2019-nCoV Mpro activity. To search for other drugs that may inhibit 2019-nCoV Mpro, we first evaluated the sequence and structural conservation of lopinavir/ritonavir binding site between SARS-CoV and 2019-nCoV. The protein sequences of SARS-CoV Mpro and 2019-nCoV Mpro are 96% identical (Fig 1 A), and the spatial structure of the previously reported lopinavir/ritonavir binding pocket is also conserved between SARS-CoV Mpro and 2019-nCoV Mpro (Fig. 1B). During the submission process of this manuscript, the crystal structure of 2019-nCoV Mpro was solved (PDB ID: 6LU7), of which the lopinavir/ritonavir binding pocket region is nearly identical to our predicted model (Fig. S1). The conserved amino acids Thr24-Asn28 and Asn119 (numbered according to positions in SARS-CoV Mpro because the present sequence of 2019-nCoV Mpro in GenBank is in polypeptide form) formed the binding pockets for lopinavir/ritonavir in the spatial structure of both SARS-CoV Mpro and 2019-nCoV Mpro, whereas the nearby non-conserved amino acids locate far away from the binding pocket, thus would not affect its structural conservation (Fig. 1B). Virtual docking of lopinavir/ritonavir to 2019-nCoV Mpro also showed high binding ability to the pocket site (Fig. 1C), similar to previous report for SARS-CoV Mpro (Nukoolkarn et al., 2008). Amino acids Thr24, Thr26, and Asn119 were predicted to be the key residues for binding the drugs ( Figs. 1C and S2), forming 2 hydrogen bonds with lopinavir and 3 hydrogen bonds with ritonavir, respectively. Fig. 1 Screen for potential 2019-nCoV Mpro inhibitors from commercial medicines. A: Sequence comparison between 2019-nCoV Mpro and SARS-Cov Mpro. Amino acids forming hydrogen bonds with drugs are shown in red, and their adjacent 5 amino acids on each side are shown in blue. Mutated amino acids rather than positive substitutions are shown in orange. B: Structural comparison of lopinavir/ritonavir binding pocket in SARS-CoV Mpro and 2019-nCoV Mpro. Ribbon models show the pocket structure of SARS-CoV Mpro (left) and 2019-nCoV Mpro (right), with α-helixes shown in red and β-sheets in cyan. Residues essential for lopinavir/ritonavir binding are shown in ball-and-stick format, of which Thr24, Thr26, and Asn28 are shown in purple, and Thr25, Leu27, and Asn119 are shown in blue. Protein solid surface model is shown to the right of each ribbon model, with the outer rim of the binding pocket marked by dashed yellow cycle. Mutations (marked in orange in panel A) are shown as gray balls, which are apart from the binding pocket. C: Docking model of lopinavir to 2019-nCoV Mpro. Left, overall docking model of lopinavir to 2019-nCoV Mpro; middle, enlargement of the lopinavir binding region; right, predicted chemical bonds between lopinavir and key residues of the binding pocket. D: Docking model of colistin to 2019-nCoV Mpro. Left, overall docking model of colistin to 2019-nCoV Mpro; right, predicted chemical bonds between colistin and key residues of the binding pocket. In (C) and (D), protein ribbon models are shown with the same diagram as described in (B), drugs are shown as sticks. Hydrogen bonds between drugs and amino acids are shown as dash lines, and Pi bonds are shown as orange lines. Fig. 1 Based on these results, we performed virtual docking to screen for commercial medicines in the DrugBank database that could bind to the above mentioned pocket site of 2019-nCoV Mpro, and identified 10 candidate clinical medicines (Table 1 ; Figs 1B and S3). These drugs could form hydrogen bonds with one or more residues among Thr24-Asn28 and Asn119, therefore theoretically, are capable to bind to the pocket formed by these amino acids and interfere the function of 2019-nCoV Mpro. Table 1 Predicted commercial medicines as potential inhibitors for 2019-nCoV Mpro. Table 1 Name H-bond count Vital residue taking part in H-bond formation Medical indication according to DrugBank Colistin 9 THR24, THR25, THR26 Antibiotic Valrubicin 7 THR24, THR25, THR26,ASN28, ASN119 Anthracycline, antitumor Icatibant 6 ASN28, ASN119 Hereditary angioedema Bepotastine 5 THR25, THR26, ASN119 Rhinitis, uriticaria/puritus Epirubicin 4 ASN28, ASN119 Antitumor Epoprostenol 4 ASN119 Vasodilator, platelet aggregation Vapreotide 3 THR24, ASN28, ASN119 Antitumor Aprepitant 3 ASN28, ASN119 Nausea, vomiting, antitumor Caspofungin 3 ASN119 Antifungal Perphenazine 2 ASN28, ASN119 Antipsychotic In summary, based on the structural information of clinical effective medicines for 2019-nCoV, we have predicted a list of commercial medicines which may function as inhibitors for 2019-nCoV by targeting its main protease Mpro. Compared to lopinavir/ritonavir, most of these predicted drugs could form more hydrogen bonds with 2019-nCoV Mpro, thus may have higher mutation tolerance than lopinavir/ritonavir. It should be noted that these results were obtained by in silico predictions, and further experiments are needed to validate the efficacy of those drugs. The binding pockets of these drugs on Mpro are conserved between SARS-CoV Mpro and 2019-nCoV Mpro, indicating the potential of these drugs as inhibitors for other coronaviruses with similar Mpro binding sites and pocket structures.

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          Most cited references6

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          A Novel Coronavirus from Patients with Pneumonia in China, 2019

          Summary In December 2019, a cluster of patients with pneumonia of unknown cause was linked to a seafood wholesale market in Wuhan, China. A previously unknown betacoronavirus was discovered through the use of unbiased sequencing in samples from patients with pneumonia. Human airway epithelial cells were used to isolate a novel coronavirus, named 2019-nCoV, which formed a clade within the subgenus sarbecovirus, Orthocoronavirinae subfamily. Different from both MERS-CoV and SARS-CoV, 2019-nCoV is the seventh member of the family of coronaviruses that infect humans. Enhanced surveillance and further investigation are ongoing. (Funded by the National Key Research and Development Program of China and the National Major Project for Control and Prevention of Infectious Disease in China.)
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            The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health — The latest 2019 novel coronavirus outbreak in Wuhan, China

            The city of Wuhan in China is the focus of global attention due to an outbreak of a febrile respiratory illness due to a coronavirus 2019-nCoV. In December 2019, there was an outbreak of pneumonia of unknown cause in Wuhan, Hubei province in China, with an epidemiological link to the Huanan Seafood Wholesale Market where there was also sale of live animals. Notification of the WHO on 31 Dec 2019 by the Chinese Health Authorities has prompted health authorities in Hong Kong, Macau, and Taiwan to step up border surveillance, and generated concern and fears that it could mark the emergence of a novel and serious threat to public health (WHO, 2020a, Parr, 2020). The Chinese health authorities have taken prompt public health measures including intensive surveillance, epidemiological investigations, and closure of the market on 1 Jan 2020. SARS-CoV, MERS-CoV, avian influenza, influenza and other common respiratory viruses were ruled out. The Chinese scientists were able to isolate a 2019-nCoV from a patient within a short time on 7 Jan 2020 and perform genome sequencing of the 2019-nCoV. The genetic sequence of the 2019-nCoV has become available to the WHO on 12 Jan 2020 and this has facilitated the laboratories in different countries to produce specific diagnostic PCR tests for detecting the novel infection (WHO, 2020b). The 2019-nCoV is a β CoV of group 2B with at least 70% similarity in genetic sequence to SARS-CoV and has been named 2019-nCoV by the WHO. SARS is a zoonosis caused by SARS-CoV, which first emerged in China in 2002 before spreading to 29 countries/regions in 2003 through a travel-related global outbreak with 8,098 cases with a case fatality rate of 9.6%. Nosocomial transmission of SARS-CoV was common while the primary reservoir was putatively bats, although unproven as the actual source and the intermediary source was civet cats in the wet markets in Guangdong (Hui and Zumla, 2019). MERS is a novel lethal zoonotic disease of humans endemic to the Middle East, caused by MERS-CoV. Humans are thought to acquire MERS-CoV infection though contact with camels or camel products with a case fatality rate close to 35% while nosocomial transmission is also a hallmark (Azhar et al., 2019). The recent outbreak of clusters of viral pneumonia due to a 2019-nCoV in the Wuhan market poses significant threats to international health and may be related to sale of bush meat derived from wild or captive sources at the seafood market. As of 10 Jan 2020, 41 patients have been diagnosed to have infection by the 2019-nCoV animals. The onset of illness of the 41 cases ranges from 8 December 2019 to 2 January 2020. Symptoms include fever (>90% cases), malaise, dry cough (80%), shortness of breath (20%) and respiratory distress (15%). The vital signs were stable in most of the cases while leucopenia and lymphopenia were common. Among the 41 cases, six patients have been discharged, seven patients are in critical care and one died, while the remaining patients are in stable condition. The fatal case involved a 61 year-old man with an abdominal tumour and cirrhosis who was admitted to a hospital due to respiratory failure and severe pneumonia. The diagnoses included severe pneumonia, acute respiratory distress syndrome, septic shock and multi-organ failure. The 2019-nCoV infection in Wuhan appears clinically milder than SARS or MERS overall in terms of severity, case fatality rate and transmissibility, which increases the risk of cases remaining undetected. There is currently no clear evidence of human to human transmission. At present, 739 close contacts including 419 healthcare workers are being quarantined and monitored for any development of symptoms (WHO, 2020b, Center for Health Protection and HKSAR, 2020). No new cases have been detected in Wuhan since 3 January 2020. However the first case outside China was reported on 13th January 2020 in a Chinese tourist in Thailand with no epidemiological linkage to the Huanan Seafood Wholesale Market. The Chinese Health Authorities have carried out very appropriate and prompt response measures including active case finding, and retrospective investigations of the current cluster of patients which have been completed; The Huanan Seafood Wholesale Market has been temporarily closed to carry out investigation, environmental sanitation and disinfection; Public risk communication activities have been carried out to improve public awareness and adoption of self-protection measures. Technical guidance on novel coronavirus has been developed and will continue to be updated as additional information becomes available. However, many questions about the new coronavirus remain. While it appears to be transmitted to humans via animals, the specific animals and other reservoirs need to be identified, the transmission route, the incubation period and characteristics of the susceptible population and survival rates. At present, there is however very limited clinical information of the 2019-nCoV infection and data are missing in regard to the age range, animal source of the virus, incubation period, epidemic curve, viral kinetics, transmission route, pathogenesis, autopsy findings and any treatment response to antivirals among the severe cases. Once there is any clue to the source of animals being responsible for this outbreak, global public health authorities should examine the trading route and source of movement of animals or products taken from the wild or captive conditions from other parts to Wuhan and consider appropriate trading restrictions or other control measures to limit. The rapid identification and containment of a novel coronavirus virus in a short period of time is a re-assuring and a commendable achievement by China’s public health authorities and reflects the increasing global capacity to detect, identify, define and contain new outbreaks. The latest analysis show that the Wuhan CoV cluster with the SARS CoV.10 (Novel coronavirus - China (01): (HU) WHO, phylogenetic tree Archive Number: 20200112.6885385). This outbreak brings back memories of the novel coronavirus outbreak in China, the severe acute respiratory syndrome (SARS) in China in 2003, caused by a novel SARS-CoV-coronavirus (World Health Organization, 2019a). SARS-CoV rapidly spread from southern China in 2003 and infected more than 3000 people, killing 774 by 2004, and then disappeared – never to be seen again. However, The Middle East Respiratory Syndrome (MERS) Coronavirus (MERS-CoV) (World Health Organization, 2019b), a lethal zoonotic pathogen that was first identified in humans in the Kingdom of Saudi Arabia (KSA) in 2012 continues to emerge and re-emerge through intermittent sporadic cases, community clusters and nosocomial outbreaks. Between 2012 and December 2019, a total of 2465 laboratory-confirmed cases of MERS-CoV infection, including 850 deaths (34.4% mortality) were reported from 27 countries to WHO, the majority of which were reported by KSA (2073 cases, 772 deaths. Whilst several important aspects of MERS-CoV epidemiology, virology, mode of transmission, pathogenesis, diagnosis, clinical features, have been defined, there remain many unanswered questions, including source, transmission and epidemic potential. The Wuhan outbreak is a stark reminder of the continuing threat of zoonotic diseases to global health security. More significant and better targeted investments are required for a more concerted and collaborative global effort, learning from experiences from all geographical regions, through a ‘ONE-HUMAN-ENIVRONMENTAL-ANIMAL-HEALTH’ global consortium to reduce the global threat of zoonotic diseases (Zumla et al., 2016). Sharing experience and learning from all geographical regions and across disciplines will be key to sustaining and further developing the progress being made. Author declarations All authors have a specialist interest in emerging and re-emerging pathogens. FN, RK, OD, GI, TDMc, CD and AZ are members of the Pan-African Network on Emerging and Re-emerging Infections (PANDORA-ID-NET) funded by the European and Developing Countries Clinical Trials Partnership the EU Horizon 2020 Framework Programme for Research and Innovation. AZ is a National Institutes of Health Research senior investigator. All authors declare no conflicts of interest.
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              Outbreak of pneumonia of unknown etiology in Wuhan, China: The mystery and the miracle

              Since December 2019, a total of 41 cases of pneumonia of unknown etiology have been confirmed in Wuhan city, Hubei Province, China. Wuhan city is a major transportation hub with a population of more than 11 million people. Most of the patients visited a local fish and wild animal market last month. At a national press conference held today, Dr Jianguo Xu, an academician of the Chinese Academy of Engineering, who led a scientific team announced that a new‐type coronavirus, tentatively named by World Health Organization as the 2019‐new coronavirus (2019‐nCoV), had caused this outbreak. 1 The 2019‐nCoV has a different coronavirus‐specific nucleic acid sequence from known human coronavirus species, which are similar to some of the beta coronaviruses identified in bats. 2 , 3 The virus‐specific nucleic acid sequences were detected in lung fluid, blood and throat swab samples in 15 patients and the virus that was isolated showed a typical coronavirus appearance under electron microscopy. Further research will be conducted to better understand the new coronavirus to develop antiviral agents and vaccines. 4 We applauded the excellent job that has been done so far. The infection was first described in December. Within 9 days, a special team consisted of physicians, scientists and epidemiologists who ruled out several extremely contagious pathogens including SARS, which killed hundreds of people more than a decade ago, and MERS. This has surely alleviated environmental concerns as Hong Kong authorities had quickly stepped up the disinfection of trains and airplanes and checks of passengers due to this outbreak. Most of the patients visited the fish and wild animal market last month in Wuhan. This fish and wild animal market also sold live animals such as poultry, bats, marmots, and snakes. All patients received prompt supportive treatment in quarantine. Among them, seven patients were in serious condition and one patient died. All of the 42 patients so far confirmed were from China except one Thailand patient who was a traveler from Wuhan. Eight patients have been cured of the disease and were discharged from the hospital last week. The 2019‐nCoV now have been isolated from multiple patients and appears to be the culprit. But the mystery has not been completely solved yet. Until there is a formal published scientific manuscript, the facts can be argued, particularly regarding causality despite these facts having been officially announced. The data collected so far is not enough to confirm the causal relationship between the new‐type coronavirus and the respiratory disease based on classical Koch's postulates or modified ones as suggested by Fredricks and Relman. 5 The viral‐specific nucleic acids were only discovered in 15 patients, and successful virus culture was extremely limited to only a few patients. There remains considerable work to be done to differentiate between colonization, shedding, and infection. Additional strains of the 2019‐nCoV need to be isolated to study their homologies. It is expected that antigens and monoclonal antibodies will be developed so serology can be used to confirm previous and acute infection status. The episode demonstrates further the need for rapid and accurate detection and identification methods that can be used in the local hospitals and clinics bearing the burden of identifying and treating patients. Recently, the Clinical Laboratory Improvement Amendments (CLIA) of 1988 has waived highly sensitive and specific molecular devices known as CLIA‐waived devices so that these devices are gradually becoming available for point of care testing. Finally, the epidemiological similarity between this outbreak and that of SARS in 2002‐2003 6 is striking. SARS was then traced to animal markets 7 and eventually to palm civets. 8 Later bats were identified as animal reservoirs. 9 Could this novel coronavirus be originated from wild animals? The family Coronaviridae includes two subfamilies. 10 One, the subfamily Coronavirinae, contains a substantial number of pathogens of mammals that individually cause a remarkable variety of diseases, including pneumonia. In humans, coronaviruses are among the spectrum of viruses that cause the common cold as well as more severe respiratory disease—specifically SARS and MERS, which are both zoonoses. The second subfamily, Torovirinae, contains pathogens of both terrestrial and aquatic animals. The genus Torovirus includes the type species, equine torovirus (Berne virus), which was first isolated from a horse with diarrhea, and the Breda virus, which was first isolated from neonatal calves with diarrhea. White bream virus from fish is the type species of the genus Bafinivirus. However, there is no evidence so far that the seafood from the fish and animal market caused 2019‐nCoV‐associated pneumonia. This epidemiologic similarity clearly provides a starting point for the further investigation of this outbreak. In the meantime, this fish and animal market has been closed until the epidemiological work determines the animal host of this novel coronavirus. Only then will the miracle be complete.
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                Author and article information

                Contributors
                Journal
                J Genet Genomics
                J Genet Genomics
                Journal of Genetics and Genomics
                Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, and Genetics Society of China. Published by Elsevier Limited and Science Press.
                1673-8527
                1673-8527
                13 February 2020
                13 February 2020
                :
                Affiliations
                [a ]Key Laboratory of Genetic Network Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing 100101, China
                [b ]University of Chinese Academy of Sciences, Beijing 100049 , China
                [c ]Innovation Academy for Seed Design, Chinese Academy of Sciences, Beijing 100101, China
                Author notes
                []Corresponding author: xjwang@ 123456genetics.ac.cn
                Article
                S1673-8527(20)30027-8
                10.1016/j.jgg.2020.02.001
                7128649
                32173287
                6be35c9c-8580-4a2b-b1e2-40fdb4210680
                © 2020 Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, and Genetics Society of China. Published by Elsevier Limited and Science Press.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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                : 28 January 2020
                : 8 February 2020
                : 8 February 2020
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