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Foltran D, Guilbeau-Frugier C, Marimpouy N, Beneyto M, Cherbi M, Bongard V, Maury P. Lack of temporal correlations between COVID pandemic waves and the occurrence of malignant ventricular arrhythmias. Europace 2023; 25:euad357. [PMID: 38051977 PMCID: PMC10751852 DOI: 10.1093/europace/euad357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 11/07/2023] [Accepted: 11/14/2023] [Indexed: 12/07/2023] Open
Abstract
AIMS Correlations between malignant ventricular arrhythmias and the COVID waves have never been investigated. METHODS AND RESULTS Prevalence of malignant ventricular arrhythmias/sudden cardiac death has been correlated to the four COVID waves between the onset of pandemic and end 2021. No significant correlation was present in the temporal evolution of both COVID patients/positive tests and incidence of malignant ventricular arrhythmias, which tended to decrease after vaccination onset. CONCLUSION We present evidence of complex higher-order periodicities and the co-existence of such regions with stable non-chaotic areas in ex vivo human hearts. We infer that the oscillation of the calcium cycling machinery is the primary mechanism of higher-order dynamics. These higher-order regions may act as niduses of instability and may provide targets for substrate-based ablation of VF.
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Affiliation(s)
- Deborah Foltran
- Cardiology, University Hospital Toulouse, 1, avenue du Pr Jean Poulhès - TSA 50032- 31059 Toulouse cedex 9, France
| | - Céline Guilbeau-Frugier
- Cardiology, University Hospital Toulouse, 1, avenue du Pr Jean Poulhès - TSA 50032- 31059 Toulouse cedex 9, France
| | - Nathan Marimpouy
- Cardiology, University Hospital Toulouse, 1, avenue du Pr Jean Poulhès - TSA 50032- 31059 Toulouse cedex 9, France
| | - Maxime Beneyto
- Cardiology, University Hospital Toulouse, 1, avenue du Pr Jean Poulhès - TSA 50032- 31059 Toulouse cedex 9, France
| | - Miloud Cherbi
- Cardiology, University Hospital Toulouse, 1, avenue du Pr Jean Poulhès - TSA 50032- 31059 Toulouse cedex 9, France
| | - Vanina Bongard
- Cardiology, University Hospital Toulouse, 1, avenue du Pr Jean Poulhès - TSA 50032- 31059 Toulouse cedex 9, France
| | - Philippe Maury
- Cardiology, University Hospital Toulouse, 1, avenue du Pr Jean Poulhès - TSA 50032- 31059 Toulouse cedex 9, France
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Yoon SH, Lee HL, Jeong DU, Lim KM, Park SJ, Kim KS. Assessment of the proarrhythmic effects of repurposed antimalarials for COVID-19 treatment using a comprehensive in vitro proarrhythmia assay (CiPA). Front Pharmacol 2023; 14:1220796. [PMID: 37649890 PMCID: PMC10464612 DOI: 10.3389/fphar.2023.1220796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/07/2023] [Indexed: 09/01/2023] Open
Abstract
Due to the outbreak of the SARS-CoV-2 virus, drug repurposing and Emergency Use Authorization have been proposed to treat the coronavirus disease 2019 (COVID-19) during the pandemic. While the efficiency of the drugs has been discussed, it was identified that certain compounds, such as chloroquine and hydroxychloroquine, cause QT interval prolongation and potential cardiotoxic effects. Drug-induced cardiotoxicity and QT prolongation may lead to life-threatening arrhythmias such as torsades de pointes (TdP), a potentially fatal arrhythmic symptom. Here, we evaluated the risk of repurposed pyronaridine or artesunate-mediated cardiac arrhythmias alone and in combination for COVID-19 treatment through in vitro and in silico investigations using the Comprehensive in vitro Proarrhythmia Assay (CiPA) initiative. The potential effects of each drug or in combinations on cardiac action potential (AP) and ion channels were explored using human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) and Chinese hamster ovary (CHO) cells transiently expressing cardiac ion channels (Nav1.5, Cav1.2, and hERG). We also performed in silico computer simulation using the optimized O'Hara-Rudy human ventricular myocyte model (ORd model) to classify TdP risk. Artesunate and dihydroartemisinin (DHA), the active metabolite of artesunate, are classified as a low risk of inducing TdP based on the torsade metric score (TMS). Moreover, artesunate does not significantly affect the cardiac APs of hiPSC-CMs even at concentrations up to 100 times the maximum serum concentration (Cmax). DHA modestly prolonged at APD90 (10.16%) at 100 times the Cmax. When considering Cmax, pyronaridine, and the combination of both drugs (pyronaridine and artesunate) are classified as having an intermediate risk of inducing TdP. However, when considering the unbound concentration (the free fraction not bound to carrier proteins or other tissues inducing pharmacological activity), both drugs are classified as having a low risk of inducing TdP. In summary, pyronaridine, artesunate, and a combination of both drugs have been confirmed to pose a low proarrhythmogenic risk at therapeutic and supratherapeutic (up to 4 times) free Cmax. Additionally, the CiPA initiative may be suitable for regulatory use and provide novel insights for evaluating drug-induced cardiotoxicity.
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Affiliation(s)
- Seung-Hyun Yoon
- R&D Center for Advanced Pharmaceuticals and Evaluation, Korea Institute of Toxicology, Daejeon, Republic of Korea
- College of Veterinary Medicine, Research Institute of Veterinary Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Hyun-Lee Lee
- R&D Center for Advanced Pharmaceuticals and Evaluation, Korea Institute of Toxicology, Daejeon, Republic of Korea
| | - Da Un Jeong
- Intelligent Human Twin Research Center, Electronics and Telecommunications Research Institute, Daejeon, Republic of Korea
| | - Ki Moo Lim
- Department of IT Convergence Engineering, Kumoh National Institute of Technology, Gumi, Republic of Korea
| | - Seong-Jun Park
- College of Veterinary Medicine, Research Institute of Veterinary Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Ki-Suk Kim
- R&D Center for Advanced Pharmaceuticals and Evaluation, Korea Institute of Toxicology, Daejeon, Republic of Korea
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3
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In silico assessment on TdP risks of drug combinations under CiPA paradigm. Sci Rep 2023; 13:2924. [PMID: 36807374 PMCID: PMC9940090 DOI: 10.1038/s41598-023-29208-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 01/31/2023] [Indexed: 02/22/2023] Open
Abstract
Researchers have recently proposed the Comprehensive In-vitro Proarrhythmia Assay (CiPA) to analyze medicines' TdP risks. Using the TdP metric known as qNet, numerous single-drug effects have been studied to classify the medications as low, intermediate, and high-risk. Furthermore, multiple medication therapies are recognized as a potential method for curing patients, mainly when limited drugs are available. This work expands the TdP risk assessment of drugs by introducing a CiPA-based in silico analysis of the TdP risk of combined drugs. The cardiac cell model was simulated using the population of models approach incorporating drug-drug interactions (DDIs) models on several ion channels for various drug pairs. Action potential duration (APD90), qNet, and calcium duration (CaD90) were computed and analyzed as biomarker features. The drug combination maps were also used to illustrate combined medicines' TdP risk. We found that the combined drugs alter cell responses in terms of biomarkers such as APD90, qNet, and CaD90 in a highly nonlinear manner. The results also revealed that combinations of high-risk with low-risk and intermediate-risk with low-risk drugs could result in compounds with varying TdP risks depending on the drug concentrations.
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Saadeh K, Nantha Kumar N, Fazmin IT, Edling CE, Jeevaratnam K. Anti-malarial drugs: Mechanisms underlying their proarrhythmic effects. Br J Pharmacol 2022; 179:5237-5258. [PMID: 36165125 PMCID: PMC9828855 DOI: 10.1111/bph.15959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/06/2022] [Accepted: 04/28/2022] [Indexed: 01/12/2023] Open
Abstract
Malaria remains the leading cause of parasitic death in the world. Artemisinin resistance is an emerging threat indicating an imminent need for novel combination therapy. Given the key role of mass drug administration, it is pivotal that the safety of anti-malarial drugs is investigated thoroughly prior to widespread use. Cardiotoxicity, most prominently arrhythmic risk, has been a concern for anti-malarial drugs. We clarify the likely underlying mechanisms by which anti-malarial drugs predispose to arrhythmias. These relate to disruption of (1) action potential upstroke due to effects on the sodium currents, (2) action potential repolarisation due to effects on the potassium currents, (3) cellular calcium homeostasis, (4) mitochondrial function and reactive oxygen species production and (5) cardiac fibrosis. Together, these alterations promote arrhythmic triggers and substrates. Understanding these mechanisms is essential to assess the safety of these drugs, stratify patients based on arrhythmic risk and guide future anti-malarial drug development.
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Affiliation(s)
- Khalil Saadeh
- Faculty of Health and Medical SciencesUniversity of SurreyGuildfordUK,School of Clinical Medicine, Addenbrooke's HospitalUniversity of CambridgeCambridgeUK
| | | | - Ibrahim Talal Fazmin
- Faculty of Health and Medical SciencesUniversity of SurreyGuildfordUK,School of Clinical Medicine, Addenbrooke's HospitalUniversity of CambridgeCambridgeUK
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Zeng S, Li Y, Zhu W, Luo Z, Wu K, Li X, Fang Y, Qin Y, Chen W, Li Z, Zou L, Liu X, Yi L, Fan S. The Advances of Broad-Spectrum and Hot Anti-Coronavirus Drugs. Microorganisms 2022; 10:microorganisms10071294. [PMID: 35889013 PMCID: PMC9317368 DOI: 10.3390/microorganisms10071294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 02/01/2023] Open
Abstract
Coronaviruses, mainly including severe acute respiratory syndrome virus, severe acute respiratory syndrome coronavirus 2, Middle East respiratory syndrome virus, human coronavirus OC43, chicken infectious bronchitis virus, porcine infectious gastroenteritis virus, porcine epidemic diarrhea virus, and murine hepatitis virus, can cause severe diseases in humans and livestock. The severe acute respiratory syndrome coronavirus 2 is infecting millions of human beings with high morbidity and mortality worldwide, and the multiplicity of swine epidemic diarrhea coronavirus in swine suggests that coronaviruses seriously jeopardize the safety of public health and that therapeutic intervention is urgently needed. Currently, the most effective methods of prevention and control for coronaviruses are vaccine immunization and pharmacotherapy. However, the emergence of mutated viruses reduces the effectiveness of vaccines. In addition, vaccine developments often lag behind, making it difficult to put them into use early in the outbreak. Therefore, it is meaningful to screen safe, cheap, and broad-spectrum antiviral agents for coronaviruses. This review systematically summarizes the mechanisms and state of anti-human and porcine coronavirus drugs, in order to provide theoretical support for the development of anti-coronavirus drugs and other antivirals.
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Affiliation(s)
- Sen Zeng
- College of Veterinary Medicine, South China Agricultural University, No. 483 Wushan Road, Tianhe District, Guangzhou 510642, China; (S.Z.); (Y.L.); (W.Z.); (Z.L.); (K.W.); (X.L.); (Y.F.); (Y.Q.); (W.C.); (Z.L.); (L.Z.); (X.L.)
- Guangdong Laboratory for Lingnan Modern Agriculture, Guangzhou 510642, China
| | - Yuwan Li
- College of Veterinary Medicine, South China Agricultural University, No. 483 Wushan Road, Tianhe District, Guangzhou 510642, China; (S.Z.); (Y.L.); (W.Z.); (Z.L.); (K.W.); (X.L.); (Y.F.); (Y.Q.); (W.C.); (Z.L.); (L.Z.); (X.L.)
- Guangdong Laboratory for Lingnan Modern Agriculture, Guangzhou 510642, China
| | - Wenhui Zhu
- College of Veterinary Medicine, South China Agricultural University, No. 483 Wushan Road, Tianhe District, Guangzhou 510642, China; (S.Z.); (Y.L.); (W.Z.); (Z.L.); (K.W.); (X.L.); (Y.F.); (Y.Q.); (W.C.); (Z.L.); (L.Z.); (X.L.)
- Guangdong Laboratory for Lingnan Modern Agriculture, Guangzhou 510642, China
| | - Zipeng Luo
- College of Veterinary Medicine, South China Agricultural University, No. 483 Wushan Road, Tianhe District, Guangzhou 510642, China; (S.Z.); (Y.L.); (W.Z.); (Z.L.); (K.W.); (X.L.); (Y.F.); (Y.Q.); (W.C.); (Z.L.); (L.Z.); (X.L.)
- Guangdong Laboratory for Lingnan Modern Agriculture, Guangzhou 510642, China
| | - Keke Wu
- College of Veterinary Medicine, South China Agricultural University, No. 483 Wushan Road, Tianhe District, Guangzhou 510642, China; (S.Z.); (Y.L.); (W.Z.); (Z.L.); (K.W.); (X.L.); (Y.F.); (Y.Q.); (W.C.); (Z.L.); (L.Z.); (X.L.)
- Key Laboratory of Zoonosis Prevention and Control of Guangdong Province, Guangzhou 510642, China
| | - Xiaowen Li
- College of Veterinary Medicine, South China Agricultural University, No. 483 Wushan Road, Tianhe District, Guangzhou 510642, China; (S.Z.); (Y.L.); (W.Z.); (Z.L.); (K.W.); (X.L.); (Y.F.); (Y.Q.); (W.C.); (Z.L.); (L.Z.); (X.L.)
- Key Laboratory of Zoonosis Prevention and Control of Guangdong Province, Guangzhou 510642, China
| | - Yiqi Fang
- College of Veterinary Medicine, South China Agricultural University, No. 483 Wushan Road, Tianhe District, Guangzhou 510642, China; (S.Z.); (Y.L.); (W.Z.); (Z.L.); (K.W.); (X.L.); (Y.F.); (Y.Q.); (W.C.); (Z.L.); (L.Z.); (X.L.)
- Guangdong Laboratory for Lingnan Modern Agriculture, Guangzhou 510642, China
| | - Yuwei Qin
- College of Veterinary Medicine, South China Agricultural University, No. 483 Wushan Road, Tianhe District, Guangzhou 510642, China; (S.Z.); (Y.L.); (W.Z.); (Z.L.); (K.W.); (X.L.); (Y.F.); (Y.Q.); (W.C.); (Z.L.); (L.Z.); (X.L.)
- Guangdong Laboratory for Lingnan Modern Agriculture, Guangzhou 510642, China
| | - Wenxian Chen
- College of Veterinary Medicine, South China Agricultural University, No. 483 Wushan Road, Tianhe District, Guangzhou 510642, China; (S.Z.); (Y.L.); (W.Z.); (Z.L.); (K.W.); (X.L.); (Y.F.); (Y.Q.); (W.C.); (Z.L.); (L.Z.); (X.L.)
- Key Laboratory of Zoonosis Prevention and Control of Guangdong Province, Guangzhou 510642, China
| | - Zhaoyao Li
- College of Veterinary Medicine, South China Agricultural University, No. 483 Wushan Road, Tianhe District, Guangzhou 510642, China; (S.Z.); (Y.L.); (W.Z.); (Z.L.); (K.W.); (X.L.); (Y.F.); (Y.Q.); (W.C.); (Z.L.); (L.Z.); (X.L.)
- Key Laboratory of Zoonosis Prevention and Control of Guangdong Province, Guangzhou 510642, China
| | - Linke Zou
- College of Veterinary Medicine, South China Agricultural University, No. 483 Wushan Road, Tianhe District, Guangzhou 510642, China; (S.Z.); (Y.L.); (W.Z.); (Z.L.); (K.W.); (X.L.); (Y.F.); (Y.Q.); (W.C.); (Z.L.); (L.Z.); (X.L.)
- Guangdong Laboratory for Lingnan Modern Agriculture, Guangzhou 510642, China
| | - Xiaodi Liu
- College of Veterinary Medicine, South China Agricultural University, No. 483 Wushan Road, Tianhe District, Guangzhou 510642, China; (S.Z.); (Y.L.); (W.Z.); (Z.L.); (K.W.); (X.L.); (Y.F.); (Y.Q.); (W.C.); (Z.L.); (L.Z.); (X.L.)
- Guangdong Laboratory for Lingnan Modern Agriculture, Guangzhou 510642, China
| | - Lin Yi
- College of Veterinary Medicine, South China Agricultural University, No. 483 Wushan Road, Tianhe District, Guangzhou 510642, China; (S.Z.); (Y.L.); (W.Z.); (Z.L.); (K.W.); (X.L.); (Y.F.); (Y.Q.); (W.C.); (Z.L.); (L.Z.); (X.L.)
- Guangdong Laboratory for Lingnan Modern Agriculture, Guangzhou 510642, China
- Key Laboratory of Zoonosis Prevention and Control of Guangdong Province, Guangzhou 510642, China
- Correspondence: (L.Y.); (S.F.); Fax: +86-20-8528-0245 (S.F.)
| | - Shuangqi Fan
- College of Veterinary Medicine, South China Agricultural University, No. 483 Wushan Road, Tianhe District, Guangzhou 510642, China; (S.Z.); (Y.L.); (W.Z.); (Z.L.); (K.W.); (X.L.); (Y.F.); (Y.Q.); (W.C.); (Z.L.); (L.Z.); (X.L.)
- Guangdong Laboratory for Lingnan Modern Agriculture, Guangzhou 510642, China
- Key Laboratory of Zoonosis Prevention and Control of Guangdong Province, Guangzhou 510642, China
- Correspondence: (L.Y.); (S.F.); Fax: +86-20-8528-0245 (S.F.)
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Zhao Y, Zhang J, Zheng K, Thai S, Simpson RJ, Kinlaw AC, Xu Y, Wei J, Cui X, Buse JB, Stürmer T, Wang T. Serious Cardiovascular Adverse Events Associated with Hydroxychloroquine/Chloroquine Alone or with Azithromycin in Patients with COVID-19: A Pharmacovigilance Analysis of the FDA Adverse Event Reporting System (FAERS). Drugs Real World Outcomes 2022; 9:231-241. [PMID: 35386046 PMCID: PMC8985751 DOI: 10.1007/s40801-022-00300-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The use of hydroxychloroquine or chloroquine (HCQ/CQ) as monotherapy or combined with azithromycin for the treatment of coronavirus disease 2019 (COVID-19) may increase the risk of serious cardiovascular adverse events (SCAEs). OBJECTIVE Our objective was to describe and evaluate the risk of SCAEs with HCQ/CQ as monotherapy or combined with azithromycin compared with that for therapeutic alternatives. METHODS We performed a disproportionality analysis and descriptive case series using the US FDA Adverse Event Reporting System. RESULTS Compared with remdesivir, HCQ/CQ was associated with increased reporting of SCAEs (reporting odds ratio [ROR] 2.1; 95% confidence interval [CI] 1.8-2.5), torsade de pointes (TdP)/QTc prolongation (ROR 35.4; 95% CI 19.4-64.5), and ventricular arrhythmia (ROR 2.5; 95% CI 1.6-3.9); similar results were found in comparison with other therapeutic alternatives. Compared with lopinavir/ritonavir, HCQ/CQ was associated with increased reporting of ventricular arrhythmia (ROR 10.5; 95% CI 3.3-33.4); RORs were larger when HCQ/CQ was used in combination with azithromycin. In 2020, 312 of the 575 reports of SCAEs listed concomitant use of HCQ/CQ and azithromycin, including QTc prolongation (61.4%), ventricular arrhythmia (12.0%), atrial fibrillation (8.2%), TdP (4.9%), and cardiac arrest (4.4%); 88 (15.3%) cases resulted in hospitalization and 79 (13.7%) resulted in death. In total, 122 fatal QTc prolongation-related cardiovascular reports were associated with 1.4 times higher odds of reported death than those induced by SCAEs; 87 patients received more than one QTc-prolonging agent. CONCLUSIONS Patients treated with HCQ/CQ monotherapy or HCQ/CQ + azithromycin may be at increased risk of SCAEs, TdP/QTc prolongation, and ventricular arrhythmia. Cardiovascular risks need to be considered when evaluating the benefit/harm balance of treatment with HCQ/CQ, especially with the concurrent use of QTc-prolonging agents and cytochrome P450 3A4 inhibitors when treating COVID-19.
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Affiliation(s)
- Ying Zhao
- Department of Pharmacy, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jingru Zhang
- Department of Biostatistics, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, USA
| | - Kai Zheng
- Department of Pharmacy, Beijing Cancer Hospital, Beijing, China
| | - Sydney Thai
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 2101 McGavran-Greenberg Hall, Campus Box 7453, Chapel Hill, 27599, USA
| | - Ross J Simpson
- Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, USA
| | - Alan C Kinlaw
- Department of Pharmaceutical Outcomes and Policy, University of North Carolina School of Pharmacy, Chapel Hill, USA
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Yang Xu
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China
| | - Jingkai Wei
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - Xiangli Cui
- Department of Pharmacy, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - John B Buse
- Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, USA
| | - Til Stürmer
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 2101 McGavran-Greenberg Hall, Campus Box 7453, Chapel Hill, 27599, USA
| | - Tiansheng Wang
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 2101 McGavran-Greenberg Hall, Campus Box 7453, Chapel Hill, 27599, USA.
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Iacopetta D, Ceramella J, Catalano A, Saturnino C, Pellegrino M, Mariconda A, Longo P, Sinicropi MS, Aquaro S. COVID-19 at a Glance: An Up-to-Date Overview on Variants, Drug Design and Therapies. Viruses 2022; 14:573. [PMID: 35336980 PMCID: PMC8950852 DOI: 10.3390/v14030573] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 02/06/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a member of the Coronavirus family which caused the worldwide pandemic of human respiratory illness coronavirus disease 2019 (COVID-19). Presumably emerging at the end of 2019, it poses a severe threat to public health and safety, with a high incidence of transmission, predominately through aerosols and/or direct contact with infected surfaces. In 2020, the search for vaccines began, leading to the obtaining of, to date, about twenty COVID-19 vaccines approved for use in at least one country. However, COVID-19 continues to spread and new genetic mutations and variants have been discovered, requiring pharmacological treatments. The most common therapies for COVID-19 are represented by antiviral and antimalarial agents, antibiotics, immunomodulators, angiotensin II receptor blockers, bradykinin B2 receptor antagonists and corticosteroids. In addition, nutraceuticals, vitamins D and C, omega-3 fatty acids and probiotics are under study. Finally, drug repositioning, which concerns the investigation of existing drugs for new therapeutic target indications, has been widely proposed in the literature for COVID-19 therapies. Considering the importance of this ongoing global public health emergency, this review aims to offer a synthetic up-to-date overview regarding diagnoses, variants and vaccines for COVID-19, with particular attention paid to the adopted treatments.
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Affiliation(s)
- Domenico Iacopetta
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Arcavacata di Rende, Italy; (D.I.); (J.C.); (M.P.); (M.S.S.); (S.A.)
| | - Jessica Ceramella
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Arcavacata di Rende, Italy; (D.I.); (J.C.); (M.P.); (M.S.S.); (S.A.)
| | - Alessia Catalano
- Department of Pharmacy-Drug Sciences, University of Bari “Aldo Moro”, 70126 Bari, Italy
| | - Carmela Saturnino
- Department of Science, University of Basilicata, 85100 Potenza, Italy; (C.S.); (A.M.)
| | - Michele Pellegrino
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Arcavacata di Rende, Italy; (D.I.); (J.C.); (M.P.); (M.S.S.); (S.A.)
| | - Annaluisa Mariconda
- Department of Science, University of Basilicata, 85100 Potenza, Italy; (C.S.); (A.M.)
| | - Pasquale Longo
- Department of Chemistry and Biology, University of Salerno, Via Giovanni Paolo II, 132, 84084 Fisciano, Italy;
| | - Maria Stefania Sinicropi
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Arcavacata di Rende, Italy; (D.I.); (J.C.); (M.P.); (M.S.S.); (S.A.)
| | - Stefano Aquaro
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Arcavacata di Rende, Italy; (D.I.); (J.C.); (M.P.); (M.S.S.); (S.A.)
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8
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Thomet U, Amuzescu B, Knott T, Mann SA, Mubagwa K, Radu BM. Assessment of proarrhythmogenic risk for chloroquine and hydroxychloroquine using the CiPA concept. Eur J Pharmacol 2021; 913:174632. [PMID: 34785211 PMCID: PMC8590616 DOI: 10.1016/j.ejphar.2021.174632] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 10/29/2021] [Accepted: 11/11/2021] [Indexed: 12/25/2022]
Abstract
Chloroquine and hydroxychloroquine have been proposed recently as therapy for SARS-CoV-2-infected patients, but during 3 months of extensive use concerns were raised related to their clinical effectiveness and arrhythmogenic risk. Therefore, we estimated for these compounds several proarrhythmogenic risk predictors according to the Comprehensive in vitro Proarrhythmia Assay (CiPA) paradigm. Experiments were performed with either CytoPatch™2 automated or manual patch-clamp setups on HEK293T cells stably or transiently transfected with hERG1, hNav1.5, hKir2.1, hKv7.1+hMinK, and on Pluricyte® cardiomyocytes (Ncardia), using physiological solutions. Dose-response plots of hERG1 inhibition fitted with Hill functions yielded IC50 values in the low micromolar range for both compounds. We found hyperpolarizing shifts of tens of mV, larger for chloroquine, in the voltage-dependent activation but not inactivation, as well as a voltage-dependent block of hERG current, larger at positive potentials. We also found inhibitory effects on peak and late INa and on IK1, with IC50 of tens of μM and larger for chloroquine. The two compounds, tested on Pluricyte® cardiomyocytes using the β-escin-perforated method, inhibited IKr, ICaL, INa peak, but had no effect on If. In current-clamp they caused action potential prolongation. Our data and those from literature for Ito were used to compute proarrhythmogenic risk predictors Bnet (Mistry HB, 2018) and Qnet (Dutta S et al., 2017), with hERG1 blocking/unblocking rates estimated from time constants of fractional block. Although the two antimalarials are successfully used in autoimmune diseases, and chloroquine may be effective in atrial fibrillation, assays place these drugs in the intermediate proarrhythmogenic risk group.
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Affiliation(s)
- Urs Thomet
- Anaxon A.G., Brünnenstrasse 90, 3018, Bern, Switzerland
| | - Bogdan Amuzescu
- Dept. Anatomy, Animal Physiology & Biophysics, Faculty of Biology, University of Bucharest, Splaiul Independentei 91-95, 050095, Bucharest, Romania.
| | - Thomas Knott
- CytoBioScience Inc., 3463 Magic Drive, San Antonio, TX, 78229, USA
| | - Stefan A Mann
- Cytocentrics Bioscience GmbH, Nattermannallee 1, 50829, Cologne, Germany
| | - Kanigula Mubagwa
- Dept. Cardiovascular Sciences, Faculty of Medicine, K U Leuven, B-3000, Leuven, Belgium; Dept. Basic Sciences, Faculty of Medicine, Université Catholique de Bukavu, Bukavu, DR Congo
| | - Beatrice Mihaela Radu
- Dept. Anatomy, Animal Physiology & Biophysics, Faculty of Biology, University of Bucharest, Splaiul Independentei 91-95, 050095, Bucharest, Romania
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