Drug Repurposing for COVID-19 using Graph Neural Network with Genetic, Mechanistic, and Epidemiological Validation

Amid the pandemic of 2019 novel coronavirus disease (COVID-19) infected by SARS-CoV-2, a vast amount of drug research for prevention and treatment has been quickly conducted, but these efforts have been unsuccessful thus far. Our objective is to prioritize repurposable drugs using a drug repurposing pipeline that systematically integrates multiple SARS-CoV-2 and drug interactions, deep graph neural networks, and in-vitro/population-based validations. We first collected all the available drugs (n= 3,635) involved in COVID-19 patient treatment through CTDbase. We built a SARS-CoV-2 knowledge graph based on the interactions among virus baits, host genes, pathways, drugs, and phenotypes. A deep graph neural network approach was used to derive the candidate representation based on the biological interactions. We prioritized the candidate drugs using clinical trial history, and then validated them with their genetic profiles, in vitro experimental efficacy, and electronic health records. We highlight the top 22 drugs including Azithromycin, Atorvastatin, Aspirin, Acetaminophen, and Albuterol. We further pinpointed drug combinations that may synergistically target COVID-19. In summary, we demonstrated that the integration of extensive interactions, deep neural networks, and rigorous validation can facilitate the rapid identification of candidate drugs for COVID-19 treatment.

[1]  P. Bhargava,et al.  Treatment with hydroxychloroquine, azithromycin, and combination in patients hospitalized with COVID-19 , 2020, International Journal of Infectious Diseases.

[2]  De-Ming Yang,et al.  A Review of SARS-CoV-2 and the Ongoing Clinical Trials , 2020, International journal of molecular sciences.

[3]  Andrew I. Su,et al.  The ReFRAME library as a comprehensive drug repurposing library and its application to the treatment of cryptosporidiosis , 2018, Proceedings of the National Academy of Sciences.

[4]  B. Comert,et al.  Effects of losartan treatment on T-cell activities and plasma leptin concentrations in primary hypertension , 2001, Journal of the renin-angiotensin-aldosterone system : JRAAS.

[5]  Taiwen Li,et al.  High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa , 2020, International Journal of Oral Science.

[6]  Krystal L. Matthews,et al.  FDA approved drugs with broad anti-coronaviral activity inhibit SARS-CoV-2 in vitro , 2020, bioRxiv.

[7]  L. Epstein,et al.  An algorithm for managing QT prolongation in coronavirus disease 2019 (COVID-19) patients treated with either chloroquine or hydroxychloroquine in conjunction with azithromycin: Possible benefits of intravenous lidocaine , 2020, HeartRhythm Case Reports.

[8]  C. Patel,et al.  In silico prediction of potential inhibitors for the main protease of SARS-CoV-2 using molecular docking and dynamics simulation based drug-repurposing , 2020, Journal of Infection and Public Health.

[9]  Siqin Feng,et al.  Eltrombopag is a potential target for drug intervention in SARS-CoV-2 spike protein , 2020, Infection, Genetics and Evolution.

[10]  A. Ferrante,et al.  Effect of mefloquine on the immune response in mice. , 1979, Transactions of the Royal Society of Tropical Medicine and Hygiene.

[11]  M. Hernán,et al.  Incidence and Severity of COVID-19 in HIV-Positive Persons Receiving Antiretroviral Therapy , 2020, Annals of Internal Medicine.

[12]  S. Klein,et al.  Estradiol, Progesterone, Immunomodulation, and COVID-19 Outcomes , 2020, Endocrinology.

[13]  Yongqi Yan,et al.  Novel coronavirus treatment with ribavirin: Groundwork for an evaluation concerning COVID‐19 , 2020, Journal of medical virology.

[14]  Sam Michael,et al.  An OpenData portal to share COVID-19 drug repurposing data in real time , 2020, bioRxiv.

[15]  Eytan Ruppin,et al.  Discovery of SARS-CoV-2 Antivirals through Large-scale Drug Repositioning , 2020, Nature.

[16]  Lixia Chen,et al.  Analysis of therapeutic targets for SARS-CoV-2 and discovery of potential drugs by computational methods , 2020, Acta Pharmaceutica Sinica B.

[17]  Tero Aittokallio,et al.  Network Pharmacology Strategies Toward Multi-Target Anticancer Therapies: From Computational Models to Experimental Design Principles , 2014, Current pharmaceutical design.

[18]  L. Roshangar,et al.  Vaccine development and therapeutic design for 2019‐nCoV/SARS‐CoV‐2: Challenges and chances , 2020, Journal of cellular physiology.

[19]  G. Tiram,et al.  Immune-mediated approaches against COVID-19 , 2020, Nature Nanotechnology.

[20]  T. Warner,et al.  Anti-platelet therapy: cyclo-oxygenase inhibition and the use of aspirin with particular regard to dual anti-platelet therapy. , 2011, British journal of clinical pharmacology.

[21]  Vineet D. Menachery,et al.  Type I and Type III Interferons Restrict SARS-CoV-2 Infection of Human Airway Epithelial Cultures , 2020, Journal of Virology.

[22]  D. Raoult,et al.  Teicoplanin: an alternative drug for the treatment of COVID-19? , 2020, International Journal of Antimicrobial Agents.

[23]  Bhumi M. Shah,et al.  In silico studies on therapeutic agents for COVID-19: Drug repurposing approach , 2020, Life Sciences.

[24]  George Karypis,et al.  Repurpose Open Data to Discover Therapeutics for COVID-19 Using Deep Learning , 2020, Journal of proteome research.

[25]  Hao Li,et al.  Calcium channel blocker amlodipine besylate therapy is associated with reduced case fatality rate of COVID-19 patients with hypertension , 2020, medRxiv.

[26]  V. M. Patil,et al.  A systematic review on use of aminoquinolines for the therapeutic management of COVID-19: Efficacy, safety and clinical trials , 2020, Life Sciences.

[27]  E. Hawk,et al.  Beyond COX-1: the effects of aspirin on platelet biology and potential mechanisms of chemoprevention , 2017, Cancer and Metastasis Reviews.

[28]  D. Jans,et al.  The FDA-approved drug ivermectin inhibits the replication of SARS-CoV-2 in vitro , 2020, Antiviral Research.

[29]  S. Goutelle,et al.  Azithromycin for COVID-19: More Than Just an Antimicrobial? , 2020, Clinical Drug Investigation.

[30]  Mubarak A. Alamri,et al.  Structural basis of SARS-CoV-2 3CLpro and anti-COVID-19 drug discovery from medicinal plants , 2020, Journal of Pharmaceutical Analysis.

[31]  Geoffrey E. Hinton,et al.  Visualizing non-metric similarities in multiple maps , 2011, Machine Learning.

[32]  R. Reiter,et al.  COVID-19: Melatonin as a potential adjuvant treatment , 2020, Life Sciences.

[33]  Taro Kawai,et al.  Toll-Like Receptor Signaling Pathways , 2014, Front. Immunol..

[34]  Z. Li,et al.  Anti-cancer Drug Synergy Prediction in Understudied Tissues using Transfer Learning , 2020, bioRxiv.

[35]  R. Perlis,et al.  Identifying common pharmacotherapies associated with reduced COVID-19 morbidity using electronic health records , 2020, medRxiv.

[36]  Angela N. Brooks,et al.  A Next Generation Connectivity Map: L1000 Platform and the First 1,000,000 Profiles , 2017, Cell.

[37]  I. Solaimanzadeh Nifedipine and Amlodipine Are Associated With Improved Mortality and Decreased Risk for Intubation and Mechanical Ventilation in Elderly Patients Hospitalized for COVID-19 , 2020, Cureus.

[38]  Albert-László Barabási,et al.  Network-based prediction of drug combinations , 2019, Nature Communications.

[39]  I. Solaimanzadeh Acetazolamide, Nifedipine and Phosphodiesterase Inhibitors: Rationale for Their Utilization as Adjunctive Countermeasures in the Treatment of Coronavirus Disease 2019 (COVID-19) , 2020, Cureus.

[40]  M. Okano,et al.  Cohort Study , 2020, Definitions.

[41]  Albert-László Barabási,et al.  Network-based approach to prediction and population-based validation of in silico drug repurposing , 2018, Nature Communications.

[42]  C. Cava,et al.  In Silico Discovery of Candidate Drugs against Covid-19 , 2020, Viruses.

[43]  Benjamin J. Polacco,et al.  A SARS-CoV-2 Protein Interaction Map Reveals Targets for Drug-Repurposing , 2020, Nature.

[44]  Erwan L'Her,et al.  Compassionate Use of Remdesivir for Patients with Severe Covid-19 , 2020, The New England journal of medicine.

[45]  M. Carroll,et al.  Sirolimus enhances remission induction in patients with high risk acute myeloid leukemia and mTORC1 target inhibition , 2018, Investigational New Drugs.

[46]  C. Mattingly,et al.  The Comparative Toxicogenomics Database (CTD). , 2003, Environmental health perspectives.

[47]  Ruili Huang,et al.  The NCGC Pharmaceutical Collection: A Comprehensive Resource of Clinically Approved Drugs Enabling Repurposing and Chemical Genomics , 2011, Science Translational Medicine.

[48]  Sameh K. Mohamed,et al.  Discovering protein drug targets using knowledge graph embeddings , 2019, Bioinform..

[49]  Jure Leskovec,et al.  Inductive Representation Learning on Large Graphs , 2017, NIPS.

[50]  Adrià Cereto-Massagué,et al.  Prediction of Novel Inhibitors of the Main Protease (M-pro) of SARS-CoV-2 through Consensus Docking and Drug Reposition , 2020, International journal of molecular sciences.

[51]  Paul A Clemons,et al.  The Connectivity Map: Using Gene-Expression Signatures to Connect Small Molecules, Genes, and Disease , 2006, Science.

[52]  Max Welling,et al.  Modeling Relational Data with Graph Convolutional Networks , 2017, ESWC.

[53]  A. Takami Possible role of low-dose etoposide therapy for hemophagocytic lymphohistiocytosis by COVID-19 , 2020, International Journal of Hematology.

[54]  Qi Zhou,et al.  Mechanism of thrombocytopenia in COVID-19 patients , 2020, Annals of Hematology.

[55]  C. Salles Correspondence COVID-19: Melatonin as a potential adjuvant treatment , 2020, Life Sciences.

[56]  Fang Wu,et al.  C-Reactive Protein Level May Predict the Risk of COVID-19 Aggravation , 2020, Open forum infectious diseases.

[57]  D. Gurwitz Repurposing current therapeutics for treating COVID‐19: A vital role of prescription records data mining , 2020, Drug development research.

[58]  J. Medina-Franco,et al.  Shifting from the single to the multitarget paradigm in drug discovery. , 2013, Drug discovery today.

[59]  F. Cheng,et al.  Network-based drug repurposing for novel coronavirus 2019-nCoV/SARS-CoV-2 , 2020, Cell Discovery.

[60]  C. Jagannath,et al.  Emerging Prevention and Treatment Strategies to Control COVID-19 , 2020, Pathogens.

[61]  R. Hamoudi,et al.  Cardiovascular medications and regulation of COVID-19 receptors expression , 2020, International Journal of Cardiology Hypertension.

[62]  Vineet D. Menachery,et al.  Type I and Type III IFN Restrict SARS-CoV-2 Infection of Human Airway Epithelial Cultures , 2020, bioRxiv.

[63]  Yuan Wei,et al.  A Trial of Lopinavir–Ritonavir in Adults Hospitalized with Severe Covid-19 , 2020, The New England journal of medicine.

[64]  Christopher De Sa,et al.  Data Programming: Creating Large Training Sets, Quickly , 2016, NIPS.

[65]  Han-Ming Shen,et al.  Targeting the Endocytic Pathway and Autophagy Process as a Novel Therapeutic Strategy in COVID-19 , 2020, International journal of biological sciences.

[66]  Max Welling,et al.  Variational Graph Auto-Encoders , 2016, ArXiv.

[67]  Lars Schmidt-Thieme,et al.  BPR: Bayesian Personalized Ranking from Implicit Feedback , 2009, UAI.

[68]  Zhao Li,et al.  Anticancer drug synergy prediction in understudied tissues using transfer learning , 2020, J. Am. Medical Informatics Assoc..

[69]  Jure Leskovec,et al.  Modeling polypharmacy side effects with graph convolutional networks , 2018, bioRxiv.