Model-Informed Drug Repurposing: Viral Kinetic Modeling to Prioritize
Rational Drug Combinations for COVID-19
Abstract
Aim: We hypothesize that the efficacy of COVID-19 therapeutic candidates
will be better predicted by understanding their effects at various
points on a viral cell cycle, in particular, the specific rate
constants, and that drugs acting independently of these specific
discrete sites may not yield expected efficacy. We hypothesize that
drugs, or combinations of drugs that act at specific multiple sites on
the viral life cycle have the highest probability of success in the
treatment of early infection phase in COVID-19 patients. Methods: Using
a target cell limited model structure that had been used to characterize
viral load dynamics from COVID-19 patients, we performed simulations to
show that combinations of therapeutics targeting specific rate constants
have greater probability of efficacy and supportive rationale for
clinical trial evaluation. Results: Based on the known kinetics of the
SARS-CoV-2 life cycle, we rank ordered potential targeted approaches
involving repurposed, low-potency agents. We suggest that targeting
multiple points central to viral replication within infected host cells
or release from those cells is a viable strategy for reducing both viral
load and host cell infection. In addition, we observed that the
time-window opportunity for a therapeutic intervention to effect
duration of viral shedding exceeds the effect on sparing epithelial
cells from infection or impact on viral load AUC. Furthermore, the
impact on reduction on duration of shedding may extend further in
patients who exhibit a prolonged shedder phenotype. Conclusions: Our
work highlights the use of model-informed tools to better rationalize
effective treatments for COVID-19.