Key result
All tested antiviral drugs can interact with components of the hERG potassium channel canonical binding site in silico, and 30 µM remdesivir inhibited hERG current by 38% in vitro.
Why the study?
Repurposed COVID-19 antiviral drugs may carry arrhythmogenic risks via hERG channel interactions, but the binding profiles of atazanavir, remdesivir, and favipiravir remain poorly defined.
In silico modeling and patch-clamp data suggest that repurposed COVID-19 antivirals like remdesivir, lopinavir, ritonavir, and atazanavir can interact with the hERG channel, highlighting potential proarrhythmic liabilities, while favipiravir may have a lower risk.
May signal hERG-related QT risk with antivirals; leaves open clinical arrhythmia relevance pending human data.
Background: In the absence of SARS-CoV-2 specific antiviral treatments, various repurposed pharmaceutical approaches are under investigation for the treatment of COVID-19. Antiviral drugs considered for this condition include atazanavir, remdesivir, lopinavir-ritonavir, and favipiravir. Whilst the combination of lopinavir and ritonavir has been previously linked to prolongation of the QTc interval on the ECG and risk of torsades de pointes arrhythmia, less is known in this regard about atazanavir, remdesivir, and favipiravir. Unwanted abnormalities of drug-induced QTc prolongation by diverse drugs are commonly mediated by a single cardiac anti-target, the hERG potassium channel. This computational modeling study was undertaken in order to explore the ability of these five drugs to interact with known determinants of drug binding to the hERG channel pore. Methods: Atazanavir, remdesivir, ritonavir, lopinavir and favipiravir were docked to in silico models of the pore domain of hERG, derived from cryo-EM structures of hERG and the closely related EAG channel. Results: Atazanavir was readily accommodated in the open hERG channel pore in proximity to the S6 Y652 and F656 residues, consistent with published experimental data implicating these aromatic residues in atazanavir binding to the channel. Lopinavir, ritonavir, and remdesivir were also accommodated in the open channel, making contacts in a model-dependent fashion with S6 aromatic residues and with residues at the base of the selectivity filter/pore helix. The ability of remdesivir (at 30 μM) to inhibit the channel was confirmed using patch-clamp recording. None of these four drugs could be accommodated in the closed channel structure. Favipiravir, a much smaller molecule, was able to fit within the closed channel and could adopt multiple binding poses in the open channel, but with few simultaneous interactions with key binding residues. Only favipiravir and remdesivir showed the potential to interact with lateral pockets below the selectivity filter of the channel. Conclusions: All the antiviral drugs studied here can, in principle, interact with components of the hERG potassium channel canonical binding site, but are likely to differ in their ability to access lateral binding pockets. Favipiravir's small size and relatively paucity of simultaneous interactions may confer reduced hERG liability compared to the other drugs. Experimental structure-function studies are now warranted to validate these observations.
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Al‐Moubarak et al. (2021) studied hERG potassium channel liability of COVID-19 antivirals. COVID-19 antivirals (atazanavir, remdesivir, lopinavir, ritonavir, favipiravir) vs. Control (Tyrode's solution) was evaluated on hERG channel current inhibition. All tested antiviral drugs can interact with components of the hERG potassium channel canonical binding site in silico, and 30 µM remdesivir inhibited hERG current by 38% in vitro.
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