Some approaches to design of covalent inhibitors of SARS-CoV-2 main protease

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I last posted on Covid-19 early in 2021 and quite a lot has happened since then. Specifically, a number of vaccines are now available (I received my first dose of AstraZeneca CoviShield in May 2021 while still stranded in Trinidad) and paxlovid has been approved for use as a Covid-19 treatment (Derek describes his experiences taking paxlovid in this post).  The active ingredient of paxlovid is the SARS-CoV-2 main protease inhibitor nirmatrelvir and the ritonavir with which it is dosed serves only to reduce clearance of nirmatrelvir by inhibiting metabolic enzymes. In the current post, I’ll be looking at covalent inhibition of SARS-CoV-2 main protease with a specific focus on reversibility and here are some notes that I whipped up as a contribution to the Covid Moonshot.

Nirmatrelvir (1) is shown in Chart 1 along with SARS-CoV-2 main protease inhibitors from the Covid Moonshot (2), a group of (mainly) Sweden-based academic researchers (3) and Yale University (4).  Nirmatrelvir incorporates a nitrile group that forms a covalent bond with the catalytic cysteine and the other inhibitors bind non-covalently to the target. The first example of a nitrile-based cysteine protease inhibitor that I’m aware of was published over half a century ago and the nitrile warhead has since proved popular with designers of cysteine protease inhibitors (it has a small steric footprint and is not generally associated with metabolic lability or chemical instability). Furthermore, covalent bond formation between the thiol of a catalytic cysteine and the carbon of the nitrile warhead is typically reversible. Here’s a recent review on the nitrile group in covalent inhibitor design and this comparative study of electrophilic warheads may also be of interest.

At this point, we should be thinking about the directions in which design of SARS-CoV-2 main protease inhibitors needs to go. Two directions I see as potentially productive are dose reduction (a course of paxlovid treatment consists of two 150 mg nirmatrelvir tablets and one 100 mg ritonavir tablet taken twice daily for five days) and countering resistance (here’s a relevant article).

Two tactics for achieving a lower therapeutic dose are to increase affinity and reduce clearance. Dose prediction is not as easy as you might think because the predictions are typically very sensitive to input parameters. For example, a two-fold difference in IC50 would often be regarded as within normal assay variation by medicinal chemists but development scientists and clinicians would view doses of 300 mg and 600 mg very differently. 

Excessive clearance is a problem from the perspective of achieving adequate exposure and I'd also anticipate greater variability in exposure between patients when clearance is high. Clearance is clearly an issue for nirmatrelvir because it needs be co-dosed with ritonavir (to inhibit metabolic enzymes) and this has implications for patients taking other medications. Nirmatrelvir lacks aromatic rings and deuteration is an obvious tactic to reduce metabolic lability (although cost of goods is likely to be more of an issue than for a cancer medicine that you'll need to take out a second mortgage for). I would anticipate that bicyclo[1.1.1]pentanyl will be less prone to metabolism than t-butyl (CH bonds tend to be stronger in strained rings and for bridgehead CHs) and the binding mode suggests that this replacement could be accommodated. 

Details of resistance to nirmatrelvir (P2022 | Z2022) are starting to emerge and this information should be certainly be used in design and to assess other structural series. Nevertheless, if you’re genuinely concerned about potential for resistance then you really can’t afford to ignore conserved structural features in the target such as the catalytic residues (cysteine and histidine) and the oxyanion hole. I would also anticipate that the risk of resistance will increase with the spatial extent of the inhibitor.

This post is about covalent inhibitors. Although I’m pleasantly surprised by the potencies achieved for non-covalent SARS-Cov-2 Main Protease inhibitors, I consider making a virtue of non-covalent inhibition to be a serious error. Binding of covalent inhibitors to their targets can be reversible  or irreversible and, in the context of design, reversible covalent inhibitors have a lot more in common with non-covalent inhibitors than with irreversible covalent inhibitors (for example, you can't generally use mass spectroscopy to screen covalent fragments that bind reversibly). In the context of drug design, covalent bonds have much more stringent geometric requirements than non-covalent interactions such as hydrogen bonds.   

I generally favor reversible binding when targeting catalytic cysteines as discussed in these notes and this article. It is typically less difficult to design reversible covalent inhibitors to target a catalytic cysteine than it is to design irreversible covalent inhibitors because you can use crystal structures of protein-ligand complexes just as you would for non-covalent inhibitors. In contrast, the crystal of a protein-ligand complex (the reaction ‘product’) is not especially relevant in design of irreversible inhibitors because target engagement is under kinetic rather than thermodynamic control and the more relevant transition state models must therefore be generated computationally. Furthermore, assays for irreversible inhibitors are more complex, and assessment of functional selectivity and safety is more difficult than for reversible inhibitors. All that said, however, I’m certainly not of the view that irreversible inhibitors are inherently inferior to reversible inhibitors for targeting catalytic cysteines. This is also a good point to mention an article which shows how isosteric replacement (with an alkyne) of the nitrile warhead of the reversible cathepsin K inhibitor odanacatib results in an irreversible inhibitor (the article is particularly relevant if you’re interested in chemical probes for cysteine proteases).

I contributed some designs for reversible covalent inhibitors to the Covid Moonshot and it may be helpful to discuss some of them. Each design was intended to link the nitrile warhead to the ‘3-aminopyridine-like’ scaffold used in the Covid Moonshot which means that the designs all use a heteroaromatic P1 group (typically isoquinoline linked at C4) rather than the chiral P1 group (pyrrolidinone linked at C3) used for nirmatrelvir and a number of other SARS-CoV-2 main protease inhibitors. The ‘3-aminopyridine-like’ scaffold lacks essential hydrogen bond donors (elimination of hydrogen bond donors is suggested as a tactic for increasing aqueous solubility in this article). One of the cool things about the way the Covid Moonshot was set up is that I can link designs as they were originally submitted (often with a detailed rationale and proposed binding mode).

The most direct way to link a nitrile to the ‘3-aminopyridine-like’ scaffold is with methylene (5, Chart 2) but there is a problem with this approach because substituting anilides (and their aza-analogs) on nitrogen with sp3 carbon inverts the cis/trans geometrical preference of the anilides (I discussed the design implications of this in these notes).  This implies that binding of 5 to the target is expected to incur a conformational energy penalty and it is significant that N-methylation of 6 results in a large reduction in potency. Although 5 was inactive in the enzyme inhibition assay, I think that it would still be worth seeing if covalent bond formation can be observed by crystallography for this compound.

However, you won’t invert cis/trans geometrical preference if you substitute an anilide nitrogen with nitrogen rather than sp3 carbon (Chart 3). This was the basis for submitting 8, which is related to azapeptide nitriles, as a design.  Azapeptide nitriles [L2008 | Y2012 | L2019 | B2022] are typically more potent than the corresponding peptide nitriles and, to be honest, this remains something of a mystery to me (one possibility is that the imine nitrogen of the azapeptide nitrile adduct is more basic than that of the corresponding peptide nitrile adduct and is predominantly protonated under assay conditions). I see cyanohydrazines and cyanamides as functional groups that would be worth representing in fragment libraries if you want to target catalytic cysteine residues and I’ll point you toward a relevant crystal structure. The acyclic hydrazine and cyanamide substructures in 8 trigger structural alerts although there are approved drugs that incorporate acyclic hydrazine (atazanavir | bumadizone | gliclazide | goserelin | isocarboxazid | isoniazid) and N-cyano (cimetidine) substructures. The basis for these structural alerts is obscure and it’s worth noting that 8 is incorrectly flagged as an enamine and having a nitrogen-oxygen single bond. As a cautionary tale on structural alerts, I’ll refer you to this comment in which I read the riot act (i.e., the JMC guidelines for authors) to a number of ACS journal EiCs Nevertheless, I’d still worry about the presence of an acyclic hydrazine substructure although these concerns would be eased if each nitrogen atom was bonded to an electron-withdrawing group, as is the case for 8, and all NHs were capped (see 9).

An alternative tactic to counter inversion of the cis/trans geometrical preference is to lock the conformation with a ring and designs 10 and 11 (Chart 4) can be seen as 'hybrids' of 5 with 12 and 13 respectively (in fragment-based design, hybridization is usually referred to as fragment merging). The effect of the conformational lock can be clearly seen since 12 and 13 are essentially equipotent with 6 (the primary reason for proposing 12 and 13 as designs was actually to present the nitrile warhead to the catalytic cysteine). A substituent on carbon next to a lactam nitrogen tends to adopt an axial orientation and I’d anticipate that 10 will be less prone to epimerization than 11. Although I'm unaware of nitriles being deployed on cyclic amine substructures for cysteine protease inhibition, the structures of the DPP-4 inhibitors saxagliptin and vildagliptin are relevant.

This is a good point at which to wrap up. If cysteine protease inhibition is a key component of pandemic preparedness strategy then you really do need to be thinking about covalent inhibition.  I'll be looking at some more design themes for covalent inhibitors of SARS-CoV-2 in the next Covid post.

Tom Lehrer's guide to design of SARS-CoV-3 main protease inhibitors for treatment of COVID-32

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It’s been ages since my last COVID-19 post (How not to repurpose a 'drug') and I’ll kick blogging off for 2021 with a follow up to an even older post (SARS-CoV-2 main protease. Crowdsourcing, peptidomimetics and fragments). I consider it unlikely that a SARS-CoV-2 main protease inhibitor, designed from scratch, will be available in time to have real impact on the current pandemic (in saying this, I’m making the huge assumption that defeat does not get snatched from the jaws of victory on the vaccination front). While many grinning Lean Six Sigma ‘belts’ (and their synchronously smiling allies in Human Resources) would denounce this as negative and defeatist, what I’m really getting at is that we need to think about targeting SARS-CoV-3 main protease when designing inhibitors for SARS-CoV-2 main protease. As Tom Lehrer advises in the intro to So Long, Mom, “If any songs are going to come from World War III, we better start writing them now”.

Happy New Year (this orchid opened during night of Dec 31/Jan 1)

If we’re designing a SARS-CoV-2 main protease inhibitor to also hit SARS-CoV-3 main protease then it’d be a good idea to engineer it to have greater affinity than necessary for the current target. In the fourth of his rules for air fighting, ‘Sailor’ Malan (readers may also be interested in his insights into fragment screening library design) asserts that “height gives you the initiative” which can be adapted for drug design as “affinity gives you the initiative”.  We should anticipate that inhibitors optimized against the current target will have lower affinity for the future target(s) although it’s obviously not a problem if this proves not to be the case. In any case, high affinity allows you to use a lower dose and that’s an important consideration if you’re planning for healthy people such as nurses and doctors to take the drug prophylactically in order to remain healthy. For a SARS-CoV-2 main protease inhibitor, I’d be looking at a target affinity of 1 nM (or better) which I believe would be achievable without causing too many self-appointed arbiters of 'compound quality' to spit feathers. Pfizer began a phase I study of the SARS-CoV-2 main protease inhibitor PF-00835321 (K_i = 0.27 nM; dosed intravenously as the phosphate pro-drug PF-07304814) in September 2020 although this compound had actually come from a discontinued SARS-CoV project. 

If we want to maximize the chances that a SARS-CoV-2 main protease inhibitor will exhibit comparative affinity for SARS-CoV-3 (or even SARS-CoV-4) then we need to exploit protein structural features that are likely to be conserved between the different main proteases. This points to milking as much activity as possible out of the core substructure of the inhibitor as a design strategy. With this in mind, I suggest that we really do need to exploit the catalytic cysteine if we’re serious about treating COVID-32 (or worried about SARS-CoV-2 main protease mutations). 

In drug design, we typically exploit a catalytic cysteine by forming a covalent bond between the thiol sulfur and an electrophilic atom in the molecular structure of the inhibitor (PF-00835321 uses the carbon of a carbonyl group to engage the catalytic cysteine). The functional group containing the electrophilic atom is commonly referred to as a “warhead” and covalent bond formation between cysteine can either be reversible or irreversible. Geometric constraints associated with covalent bond formation are typically a lot more stringent than for hydrogen bonds and you’ll make life much easier for yourself by getting the warhead into structures as early as possible in hit-to-lead. I generally recommend using reversible warheads in design of cysteine protease inhibitors (PF-00835321 binds reversibly to SARS-CoV-2) and present my reasoning in this document. In essence, irreversible inhibition adds complexity to design (both K_i and k_inact need to be controlled) while placing greater technical demands on the design team (e.g. for generation of the structural models for transition states required for structure-based design).

The argument typically presented in support of irreversible inhibition (and slow binding kinetics) is that it leads to longer duration of action. This argument emphasizes benefits of slow (or zero) off-rate during the elimination phase while ignoring disadvantages of slow on-rate during the distribution phase and I’ll point you to an insightful article by my former colleague Rutger Folmer. While there will be situations in which irreversible inhibition really is the best option, the decision as to whether to go for reversible or irreversible inhibitors is one that should be carefully considered at the start of the project. In drug discovery, it usually ends in tears once the tail starts wagging the dog as would be the case if choice of screening tactics (covalent fragment screening typically finds irreversible binders) were to dictate lead optimization strategy. In particular, I wouldn't really recommend the laissez faire approach to project management (“once the rockets are up, who cares where they come down”) chronicled by Tom Lehrer.

Here's some information that may be of interest if you're selecting or designing warheads to form covalent bonds with catalytic cysteines. First, a couple of comparative studies of reversible and irreversible warheads. Second, some papain inhibition data taken from the literature ( B1977 | W1972 | L1971 ), summarized in the graphic below, that are relevant to fragment library design.

Off-target activity is always a concern in drug design since this can cause toxicity (it’s often considered politer to say “adverse drug reaction” rather than use the uncouth T-word although Tom Lehrer provides a useful perspective) and that’s a strong rationale for trying to achieve a low therapeutic dose. It’s my understanding (still wading through literature) that SARS-CoV-2 main protease functions in the endoplasmic reticulum which means that the relevant physiological pH is close to neutral. Many proteases (potential anti-targets for SARS-CoV-2 main protease inhibitors) function in acidic compartments such as lysosomes and the presence of a basic center in the molecular structure of an inhibitor will tend to draw it into these acidic compartments. When designing SARS-CoV-2 inhibitors, the safest option is simply to avoid basic centers (see F2005) . In particular, to link a ‘gratuitous’ basic center and an irreversible warhead would be to tempt launchpad misadventure.

I'll conclude the post with an observation that the COVID-19 pandemic seems to have triggered a parallel pandemic in scholarly publishing which is forcing scientists to be more creative in finding new ways to getting their messages to stand out. I'll let Tom Lehrer have the last word.   

SARS-CoV-2 main protease. Crowdsourcing, peptidomimetics and fragments

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“Just take the ball and throw it where you want to. Throw strikes. Home plate don’t move.”

Satchel Paige (1906-1982) 

The COVID Moonshot and OSC19 are examples of what are sometimes called crowdsourced or open source approaches to drug discovery. While I’m not particularly keen on the use of the term ‘open source’ in this context, I have absolutely no quibble with the goal of seeking cures and treatments for diseases that are ignored by commercial drug discovery organizations. Open source drug discovery originated with OSDD in India and it should be noted that the approach has also been pioneered for malaria by OSM.  I see crowdsourcing primarily as a different way to organize and resource drug discovery rather than as a radically different way to do drug discovery.

One point that’s not always appreciated by cheminformaticians, computational chemists and drug discovery scientists in academia is that there’s a bit more to drug discovery than making predictions. In particular, I advise those seeking to transform drug discovery to ensure that they actually know what a drug needs to do and understand the constraints under which drug discovery scientists work. Currently, it does not appear to be possible to predict the effects of compounds in live humans from molecular structure with the accuracy needed for prediction-driven design and this is the primary reason that drug discovery is incremental in nature. A big part of drug discovery is generation of the information needed in order to maintain progress and there are gains to be had by doing this as efficiently as possible. Efficient generation of information, in turn, requires a degree of coordination that may prove difficult to achieve in a crowdsourced project.

The SARS-CoV-2 main protease (Mpro) is one of a number of potential targets of interest in the search for COVID-19 therapies. Like the cathepsins that are (or, at least, have been) of interest to the pharma/biotech industry as potential targets for therapeutic intervention, Mpro is a cysteine protease. If I’d been charged with quickly delivering an inhibitor of Mpro as a candidate drug then I’d be taking a very close look at how the pharma/biotech industry has pursued cysteine protease targets. Balacatib, odanacatib (cathepsin K inhibitors) and petesicatib (cathepsin S inhibitor) can each be described as a peptidomimetic with a warhead (nitrile) that forms a covalent bond reversibly with the catalytic cysteine.

A number of peptidomimetic Mpro inhibitors have been described in the literature and this blog post by Chris Southan may be of interest. I’ve been looking at the published inhibitors shown below in Chart 1 (which exhibit antiviral activity and have been subjected to pharmacokinetic and toxicological evaluation) and have written some notes on mapping the structure-activity relationship for compounds like these. I should stress that compounds discussed in these notes are not expected to be dramatically more potent than the two shown in Chart 1 (in fact, I expect at least one to be significantly less potent). Nevertheless, I would argue that assay results for these proposed synthetic targets would inform design.

My assessment of these compounds is that there is significant room for improvement and I think that it would be relatively easy to achieve a pIC50 of 8 (corresponding to an IC50 of 10 nM) using the aldehyde warhead. I’d consider taking an aldehyde forward (there are options for dosing as a prodrug) although it really would be much better if there was also the option to exchange this warhead for the nitrile (a warhead that is much-loved by industrial medicinal chemists since it’s rugged, polar and contributes minimally to molecular size). While I’d anticipate that replacement of aldehyde with nitrile will lead to a reduction in potency, it’s necessary to quantify the potency loss to enable the potential of nitriles to be properly assessed. The binding mode observed for 1 is shown below in Figure 1 and it’s likely that the groove region will need to be more fully exploited (this article will give you an idea of the sort of thing I have in mind) in order to achieve acceptable potency if the aldehyde warhead is replaced by nitrile.

The COVID Moonshot project currently appears to be in what many industrial drug discovery scientists would call the hit-to-lead phase.  In my view the principal objective of hit-to-lead work is to create options since having options will give the lead optimization team room to manoeuvre (you can think of hit-to-lead work as being a bit like playing in midfield). The COVID Moonshot project is currently focused on exploitation of hits from a fragment screen against MPro and, while I’d question whether this approach is likely to get to a candidate drug more quickly than the conventional structure-based design used in industry to pursue cathepsins, it’s certainly an interesting project that I’m happy to contribute to. It’s also worth mentioning that fragment screens have been run against SARS-CoV-2 Nsp3 macrodomain at UCSF and Diamond since there are no known inhibitors for this target.

Here’s a blog post by Pat Walters in which he examines the structure-activity relationships emerging for the fragment-derived inhibitors. Specifically, he uses a metric known as the Structure-Activity Landscape Index (SALI) to quantify the sensitivity of activity to structural changes. Medicinal chemists apply the term ‘activity cliff’ to situations where a small change in structure results in a large change in activity and I’ve argued that the idea of quantifying the sensitivity of a physicochemical effect to structural modifications goes all the way back to Hammett.  One point that comes out of Pat’s post is that it’s difficult to establish structure-activity relationships for low affinity ligands with a conventional biochemical assay. When applying fragment-based approaches in lead discovery, there are distinct advantages to being able to measure low binding affinity (~ 1 mM) since this allows fragment-based structure-activity relationships to be explored prior to synthetic elaboration of fragment hits. As Pat notes, inadequate solubility in assay buffer clearly places limits on the affinity that can be reliably measured in any assay although interference with the readout of a biochemical assay can also lead to misleading results. This is one reason that biophysical detection of binding using methods such as surface plasmon resonance (SPR) are favored in fragment-based lead discovery. Here’s an article by some of my former colleagues which shows how you can assess the impact of interference with the readout of a biochemical assay (and even correct for it if the effect isn’t too great).     

My first contribution to the COVID Moonshot project is illustrated in Chart 2 and the fragment-derived inhibitor 3 from which I started is also featured in Pat’s post. From inspection of the crystal structure, I noticed that the catalytic cysteine might be targeted by linking a ‘reversible’ warhead from the amide nitrogen (4 and 5). Although this might look fine on paper, the experimental data in this article suggest that linking any saturated carbon to the amide nitrogen will bias the preferred amide geometry away from trans to cis. Provided that the intrinsic gain in affinity resulting from linking the warhead is greater than the cost of adopting the bound conformation, the structural modification will lead to a net increase in affinity and the structures could be locked (here's an article that shows how this can work) into the bound conformation (e.g. by forming a ring).

In addition to being accessible to a warhead linked from the amide nitrogen of 3, the catalytic cysteine is also within striking distance of the carbonyl carbon and it would be prudent to consider the possibility that 3 and its analogs can function as substrates for Mpro. There is precedent for this type of behavior and I’ll point you toward an article that notes that a series of esters identified as cruzain inhibitors can function as substrates and more recent article that presents cruzain inhibitors that I’d consider to be potential substrates. A crystal structure of the protein-ligand complex is potentially misleading in this context since the enzyme might not be catalytically active. I believe that 6 could be used to explore this possibility since the carbonyl carbon would be expected to be more electrophilic and 3-hydroxy, 4-methylpyridine would be expected to be a better leaving group than its 3-amino analog.

This is a good point to wrap things up. I think that Satchel Paige gave us some pretty good advice on how to approach drug discovery and that's yet another reason that Black Lives Matter.