Bench-to-bedside: Innovation of small molecule anti-SARS-CoV-2 drugs in China

The ongoing COVID-19 pandemic has resulted in millions of deaths globally, highlighting the need to develop potent prophylactic and therapeutic strategies against SARS-CoV-2. Small molecule inhibitors (remdesivir, Paxlovid, and molnupiravir) are essential complements to vaccines and play important roles in clinical treatment of SARS-CoV-2. Many advances have been made in development of anti-SARS-CoV-2 inhibitors in China, but progress in discovery and characterization of pharmacological activity, antiviral mechanisms, and clinical effi-cacy are limited. We review development of small molecule anti-SARS-CoV-2 drugs (azvudine [approved by the NMPA of China on July 25, 2022], VV116 [approved by the NMPA of China on January 29, 2023], FB2001, WPV01, pentarlandir, and cepharanthine) in China and summarize their pharmacological activity, potential mechanisms of action, clinical trials and use, and important milestones in their discovery. The role of structural biology in drug development is also reviewed. Future studies should focus on development of diverse second-generation inhibitors with excellent oral bioavailability, superior plasma half-life, increased antiviral activity against SARS-CoV-2 and its variants, high target specificity, minimal side effects, reduced drug-drug interactions, and improved lung histopathology.

Automated summary

The ongoing COVID-19 pandemic has highlighted the urgent need for potent prophylactic and therapeutic strategies against SARS-CoV-2. Small molecule inhibitors play a crucial role in the clinical treatment of SARS-CoV-2. China has made significant progress in the development of anti-SARS-CoV-2 drugs, but there is still limited knowledge regarding their pharmacological activity, antiviral mechanisms, and clinical efficacy. This review discusses the development of small molecule anti-SARS-CoV-2 drugs in China and summarizes their pharmacological activity, potential mechanisms of action, clinical trials and use, and important milestones in their discovery.