Targeting SARS-CoV-2 Main Protease: A Successful Story Guided by an Drug Repurposing Approach.

The SARS-CoV-2 main protease (M) is a crucial enzyme for viral replication and has been considered an attractive drug target for the treatment of COVID-19. In this study, virtual screening techniques and assays were combined to identify novel M inhibitors starting from around 8000 FDA-approved drugs. The docking analysis highlighted 17 promising best , biologically characterized in terms of their M inhibitory activity. Among them, 7 cephalosporins and the oral anticoagulant betrixaban were able to block the enzyme activity in the micromolar range with no cytotoxic effect at the highest concentration tested. After the evaluation of the degree of conservation of M residues involved in the binding with the studied ligands, the ligands' activity on SARS-CoV-2 replication was assessed. The ability of betrixaban to affect SARS-CoV-2 replication associated to its antithrombotic effect could pave the way for its possible use in the treatment of hospitalized COVID-19 patients.