Comprehensive analysis of drugs to treat SARS‑CoV‑2 infection: Mechanistic insights into current COVID‑19 therapies (Review)

The major impact produced by the severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) focused many researchers attention to find treatments that can suppress transmission or ameliorate the disease. Despite the very fast and large flow of scientific data on possible treatment solutions, none have yet demonstrated unequivocal clinical utility against coronavirus disease 2019 (COVID‑19). This work represents an exhaustive and critical review of all available data on potential treatments for COVID‑19, highlighting their mechanistic characteristics and the strategy development rationale. Drug repurposing, also known as drug repositioning, and target based methods are the most used strategies to advance therapeutic solutions into clinical practice. Current in silico, in vitro and in vivo evidence regarding proposed treatments are summarized providing strong support for future research efforts.

Angiotensin receptor blockers in hypertension and cardiovascular diseases

Angiotensin receptor blockers are the newest class of antihypertensive agents marketed for the treatment of hypertension. There is now an important amount of evidence indicating that this class of drugs exerts beneficial effects in patients with a variety of cardiovascular disorders. Evidence-based medicine includes well controlled studies with mortality and morbidity endpoints in patients with left ventricular dysfunction after a myocardial infarction, congestive heart failure, cerebrovascular disease, type-2 diabetic subjects with renal dysfunction and high-risk hypertensive patients. In addition to these hard endpoints, treatment with angiotensin receptor blockers prevents the development of type-2 diabetes, promotes a more pronounced regression of left ventricular hypertrophy, decreases microalbuminuria and proteinuria in renal patients, ameliorates coronary and peripheral vascular endothelial dysfunction and decreases plasma levels of several markers of vascular inflammation. In summary, angiotensin receptor blockers are antihypertensive drugs with a very good profile in terms of efficacy, tolerability and cardiovascular protection. They represent an important step in the search for the ideal antihypertensive agent.

CoMFA and CoMSIA studies of angiotensin (AT1) receptor antagonists

Two 3D-QSAR methods--CoMFA and CoMSIA--were applied to a set of 38 angiotensin receptor (AT1) antagonists. The conformation and alignment of molecules were obtained by a novel method - consensus dynamics. The representation of biological activity, partial charge formalism, absolute orientation of the molecules in the grid, and grid spacing were also studied for their effect on the CoMFA models. The models were thoroughly validated through trials using scrambled activities and bootstrapping. The best CoMFA model had a cross-validated correlation coefficient ( q2) of 0.632, which improved with "region focusing" to 0.680. This model had a "predictive" r2 of 0.436 on a test series that was unique and with little representation in the training set. Although the "predictive" r2 of the best CoMSIA model, which included steric, electrostatic, and hydrogen bond acceptor fields was higher than that of the best CoMFA model, the other statistical parameters like q2, r2, F value, and s were unsatisfactory. The contour maps generated using the best CoMFA model were used to identify the structural features important for biological activity in these compounds.