1. Introduction
Coronaviruses are responsible for causing seasonal respiratory tract infections (RTIs) in people and are associated with common cold symptoms [
1]. The highly pathogenic human coronaviruses (HCoVs) such as severe acute respiratory syndrome (SARS) associated coronavirus (SARS-CoV), Middle East respiratory syndrome–related coronavirus (MERS-CoV) and the novel SARS-CoV-2 cause infection to epithelial cells of the bronchi and pneumocytes, which could lead to life-threatening lung injuries [
2]. Among these three, the SARS-CoV-2 virus which emerged in December 2019 exhibits faster human-to-human transmission, and resulted in over 780 million confirmed cases and 7 million reported deaths due to the novel coronavirus disease (COVID-19) [
3]. Long COVID, also known as postacute sequelae of SARS-CoV-2 infection or COVID-19 (PASC) [
4,
5], may affect typically 3.1% of the population, especially those aged 35 to 69 years, females, people living in more deprived areas, those working in social care, those aged 16 years or over who were not working and not looking for work, and those with another activity-limiting health condition or disability [
6].
SARS-CoV-2 employs a multi-subunit machinery for replication and transcription. Non-structural proteins (Nsp's) produced as cleavage products due to the open reading frame 1a and 1b (ORF1a and ORF1b) facilitate viral replication and transcription [
7]. One of these, known as Nsp12 or RNA-dependent RNA polymerase (RdRp), catalyzes the synthesis of viral RNA and plays a central role in the replication and transcription cycle of SARS-CoV-2 with Nsp7 and Nsp8 as co-factors [
8,
9]. Therefore, Nsp12 is considered a primary target for antiviral agents, with the potential for treating COVID-19 [
10], and possibly other coronaviral diseases because it is a highly conserved motif. For example, sequence alignment results from the literature shows 96% common identity between SARS-CoV and SARS-CoV-2 [
11].
In this work, as we shall be using RdRp as a key target let us first describe its components: it has the Nsp12 catalytic subunit, two accessory subunits (Nsp8 and Nsp7), and more than two turns of RNA template-product duplex [
12]. The RdRp domain is analogous to a cupped right hand, consisting of the finger ‘F’ (amino acid residues 398–581, 628–687), palm (amino acid residues 582–627, 688–815) and thumb (amino acid residues 816–919) subdomains found in all single-subunit polymerases [
13]. An in-depth structural analysis depicts the Nsp12 subunit binding to the first turn of RNA between its F and thumb sub-domains. The core protein consists of a single chain of 942 amino acids. The active site comprises of five conserved Nsp12 elements that are found in the palm motif. The amino acids Asp760 and Asp761 (
Figure 1) are necessary for synthesis, which binds to the 3′ end of the RNA. The RNA template is positioned by the supplementary Nsp12 finger motif. The second turn is positioned by two copies of Nsp8 that bind to the cleft on the opposite sides. As RNA exits, large helical extensions of Nsp8 protrude and create positively charged sliding poles that are necessary for coronaviruses to replicate their lengthy genomes [
14]. Structural stability requires two Zinc (Zn) ions interacting with the residues present in the N-terminal domain (His295, Cys301, Cys306, Cys310) and finger domain (Cys487, His642, Cys645, Cys646). The presence of Zn in this site indicates its crucial role in stabilizing the overall 3D structure of the protein [
15]. The binding of drugs to the amino acid residues in motif F of RdRp results in the aversion of entry of the substrate and divalent cations into the central active site cavity, thereby inhibiting the catalytic activity of the enzyme and preventing the RNA replication [
16].
So far, the standard drugs of choice for treatment have been the emergency use authorized (EUA) drugs, nirmatrelvir and remdesivir. Nirmatrelvir is an orally available main protease inhibitor [
17], while remdesivir is an RdRp inhibitor that is administered parenterally. The EUA status of remdesivir was revoked on April 2022, and approval as a supplemental new drug application (sNDA) has been given in December 2022 [
16]. However, a recent study published in
The Lancet shows that while remdesivir could reduce the risk it had an insignificant effect in ventilated COVID-19 patients [
17]. Nirmatrelvir, a main protease inhibitor, exhibited promising antiviral effects but was susceptible to rapid degradation. To mitigate this issue, ritonavir, a protease inhibitor, was incorporated in a combined formulation which received FDA approval as the first oral antiviral pill PAXLOVID [
18]. Other drugs that have shown promise include molnupiravir [
19], favipiravir [
20] and fluvoxamine [
21,
22]. However, molnupiravir and favipiravir are no longer recommended as the former drug has poor clinical outcomes [
23,
24,
25] and the latter showed ineffective in viral clearance [
26,
27,
28]. Although fluvoxamine has been shown to have both immunomodulatory effects [
29] as well as anti-viral effect [
21,
30,
31], it is clear that this drug can only be used in combination and not in its own [
21,
29].
Therefore, the quest to identify potential molecules to treat COVID-19 and PASC is still ongoing [
32]. In the literature, when databases of molecules including synthetic and natural origin were screened against RdRp [
33,
34,
35,
36,
37,
38,
39,
40] together with other non-structural proteins (Nsp's) [
41,
42,
43,
44] inhibitors, such studies suggest the use of natural substances as alternative to remdesivir. Few studies also reported the screening of analogues of different scaffolds such as quinolines [
40], cytidines [
45] and andrographolides [
46]. Notably, drug repurposing efforts across the world have proposed several drugs that are yet to be tested
in vitro [
13,
32,
38,
39,
40,
47,
48,
49,
50,
51,
52,
53,
54]. As RdRp is a key target
, this paper looks at a class of small molecules called bisphosphonates (BPs) for four reasons: 1. The use of BPs is associated with a significant three- to five-fold reduction in the incidence of SARS-CoV-2 testing, COVID-19 diagnosis, and COVID-19-related hospitalization during the pandemic [
55]; 2. BP scaffolds exhibit competitive binding to the nidovirus RdRp-associated nucleotidyl (NiRAN) transferase domain [
56]; 3
. Our prior experience with an immunomodulatory drug, fluvoxamine in
in silico and
ex vivo studies [
21]; and 4. Our recent study which has shown that alendronate, a BP drug, shows more promising
in silico results compared to remdesivir [
32]. Therefore, we shall further explore BPs in detail as it is the focus of this follow-up study.
BPs are a class of small-molecule drugs that have two phosphonate groups. They are categorized into nitrogen-containing (amino-BPs) and nitrogen-free BPs (non-amino-BPs). They are mainly used to treat osteoporosis, Paget's disease of the bone, and to lower high calcium levels in people with cancer [
57]. In addition, amino-BPs control the activation, expansion, and function of a significant portion of human γδT cells (i.e., it reduces the amount of circulation γδT cells), as well as neutrophils, monocytes and macrophages. They can also modify the dendritic cell's ability to present antigens to the immune system. Results from animal experiments indicate that both amino-BPs and non-amino-BPs have strong adjuvant-like effects of increasing antibody and T-cell responses to viral antigens. [
58]. Acknowledging the range of immunomodulatory effects and their binding with RdRP inspired us to investigate these as prospective COVID-19 drug candidates [
55,
56,
58].
Author Contributions
Conceptualization, M.M.U-.R., M.S., and S.S.V.; methodology, M.M.U-.R., C.K.S., A.C. and P.V.K..; software, P.V.K., R.P.J., S.R.J.; validation, M.M.U-.R., M.S., and S.S.V.; formal analysis, M.M.U-.R., C.K.S., A.C., and P.V.K.; investigation, C.K.S., R.P.J., S.R.J.; resources, M.S., and S.S.V.; data curation, M.M.U-.R., and C.K.S.; writing—original draft preparation, M.M.U-.R., and C.K.S.; writing—review and editing, M.M.U-.R., M.S., and S.S.V.; visualization, M.M.U-.R., A.C. and M.S.; supervision, M.S., and S.S.V. All authors have read and agreed to the published version of the manuscript.