Drug Design Strategies to Avoid Resistance in Direct-Acting Antivirals and Beyond
- 7 January 2021
- journal article
- review article
- Published by American Chemical Society (ACS) in Chemical Reviews
- Vol. 121 (6), 3238-3270
- https://doi.org/10.1021/acs.chemrev.0c00648
Abstract
Drug resistance is prevalent across many diseases, rendering therapies ineffective with severe financial and health consequences. Rather than accepting resistance after the fact, proactive strategies need to be incorporated into the drug design and development process to minimize the impact of drug resistance. These strategies can be derived from our experience with viral disease targets where multiple generations of drugs had to be developed to combat resistance and avoid antiviral failure. Significant efforts including experimental and computational structural biology, medicinal chemistry, and machine learning have focused on understanding the mechanisms and structural basis of resistance against direct-acting antiviral (DAA) drugs. Integrated methods show promise for being predictive of resistance and potency. In this review, we give an overview of this research for human immunodeficiency virus type 1, hepatitis C virus, and influenza virus and the lessons learned from resistance mechanisms of DAAs. These lessons translate into rational strategies to avoid resistance in drug design, which can be generalized and applied beyond viral targets. While resistance may not be completely avoidable, rational drug design can and should incorporate strategies at the outset of drug development to decrease the prevalence of drug resistance.Keywords
Funding Information
- National Institute of Allergy and Infectious Diseases (R01 AI085051, R21 AI149716)
- National Institute of General Medical Sciences (F31 GM103259, F31 GM111101, F31 GM119345, F31 GM131635, P01 GM109767, R01 GM135919)
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