Nelfinavir and Cepharanthine Show Some Potential as COVID-19 Treatment in Laboratory Tests

A combination of the HIV drug Nelfinavir and the anti-inflammatory Cepharanthine appear to be effective in clearing the SARS-CoV-2 virus in laboratory tests, researchers in Japan have said.

The study appears on the preprint website bioRxiv and it has not been peer-reviewed by experts to certify the findings. As such, the results should be taken with caution.

The team, led by Hirofumi Ohashi, from the National Institute of Infectious Diseases in Tokyo, screened a panel of over 300 drugs already approved by bodies such as the Food and Drugs Administration and the European Medicines Agency. They found two that appeared to have more potent antiviral activity on a SARS-CoV-2 cell culture, a process where cells are grown in controlled conditions, than other drugs currently being trialed as COVID-19 treatments. SARS-CoV-2 is the virus that causes COVID-19.

After identifying the two drugs, they carried out computer models to show Nelfinavir binds the virus to stop it replicating. Cepharanthine appears to stop attaching to and entering cells, they found.

Further models of in vitro antiviral activity, where the cells are outside of their normal biological setting, "drugs predicts that Nelfinavir will facilitate viral clearance," they wrote.

"Combining Nelfinavir/Cepharanthine enhanced their predicted efficacy to control viral proliferation, to ameliorate both the progression of disease and risk of transmission. In summary, this study identifies a new multidrug combination treatment for COVID-19."

At present, there are no approved treatments specifically for COVID-19. Several candidates are currently being tested in clinical trials around the world, including hydroxychloroquine, favipiravir and remdesivir. There have been over two million cases of the virus since it was first identified in December last year. Of these, almost 150,000 people have died.

Mirko Paiardini, from the Emory Vaccine Center at the Emory University School of Medicine, who was not involved in the research, told Newsweek the findings were of "potential interest." He said it is important to test clinically approved drugs against SARS-CoV-2. At present, there are no approved treatments specifically for COVID-19.

He said it is important to test clinically approved drugs against SARS-CoV-2.

However, he said there are also drawbacks to the research. Based on some of the data, the advantage of using both Nelfinavir and Cepharanthine, rather than Nelfinavir alone, is not clear.

"Testing [a] combination of drugs is a strength of the manuscript," he said. "The main limitation is that the entire study is in vitro, using cell lines, and that the only indication on how those drugs will impact SARS-CoV-2 replication is based on mathematical modeling. As such, the in vivo potential of the proposed combination is unknown."

Ohashi and colleagues say their findings are preliminary and that more research will be required to confirm the mechanisms that appear to behind both drugs' ability to stop SARS-CoV-2. "However, our observation that Nelfinavir and Cepharanthine target different steps in the viral life cycle support the development of multidrug combination therapies for treating COVID-19," they concluded.

Centers for Disease Control and Prevention Advice on Using Face Coverings to Slow Spread of COVID-19

  • CDC recommends wearing a cloth face covering in public where social distancing measures are difficult to maintain.
  • A simple cloth face covering can help slow the spread of the virus by those infected and by those who do not exhibit symptoms.
  • Cloth face coverings can be fashioned from household items. Guides are offered by the CDC.
  • Cloth face coverings should be washed regularly. A washing machine will suffice.
  • Practice safe removal of face coverings by not touching eyes, nose, and mouth, and wash hands immediately after removing the covering.

World Health Organization advice for avoiding spread of coronavirus disease (COVID-19)

Hygiene advice

  • Clean hands frequently with soap and water, or alcohol-based hand rub.
  • Wash hands after coughing or sneezing; when caring for the sick; before, during and after food preparation; before eating; after using the toilet; when hands are visibly dirty; and after handling animals or waste.
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  • Avoid touching your hands, nose and mouth. Do not spit in public.
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Medical advice

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  • Note any recent contact with others and travel details to provide to authorities who can trace and prevent spread of the disease.
  • Stay up to date on COVID-19 developments issued by health authorities and follow their guidance.

Mask and glove usage

  • Healthy individuals only need to wear a mask if taking care of a sick person.
  • Wear a mask if you are coughing or sneezing.
  • Masks are effective when used in combination with frequent hand cleaning.
  • Do not touch the mask while wearing it. Clean hands if you touch the mask.
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  • Regularly washing bare hands is more effective against catching COVID-19 than wearing rubber gloves.
  • The COVID-19 virus can still be picked up on rubber gloves and transmitted by touching your face.
laboratory stock
Stock image of a laboratory. Researchers used computer models to test approved drugs against SARS-CoV-2. iStock