August 6, 2021

expert reaction to lab study looking at the hyperlipidaemic drug fenofibrate and infection by SARS-CoV-2 in cell culture models

A study published in Frontiers in Pharmacology looks at the effect of the hyperlipidaemic drug fenofibrate, and its active form (fenofibric acid), on SARS-COV-2 infection in human cells in the laboratory.

Dr Peter English, Retired Consultant in Communicable Disease Control, Former Editor of Vaccines in Practice, Immediate past Chair of the BMA Public Health Medicine Committee, said:

“This paper goes into detail about how and why a drug like Fenofibrate might be effective in preventing or treating Covid-19.  It explains how the drug might bind to the spike protein, blocking its binding to the ACE2 receptor sites, and thus preventing it from entering cells and causing infection.

“Inasmuch as the drug might work by interfering with this ACE2 binding, it in some ways mimics one of the ways in which the immune system works – by producing antibodies which bind to this site with similar effects.  The immune system is far more complex, and does a lot more than this; but there is a parallel here.

“I am not a laboratory scientist, so I will leave others to comment on methodological issues.

“As a public health doctor and former clinician, I should point out that many drugs seem to have plausibility, and this can be confirmed in laboratory studies; but that this plausibility often fails to translate into useful clinical efficacy.  This paper describes a purely laboratory (what we used to call “in vitro”) study.

“If this in vitro finding translates into a useful clinical effect, it may add another drug to our armoury.

“But we still have to remember that Covid-19 disease has several stages or phases:

1. An initial pre-symptomatic or asymptomatic phase; which may move on to…
2. An early, flu-like illness with fever, prostration, etc., which lasts for about a week…
3. A more serious illness which starts in a minority of patients about 10 days after the onset of illness, and requires hospital admission, respiratory support and so on. This stage of the disease is caused by an overreaction of the immune system, and is no longer caused by the presence of the virus.
4. In some patients – even after a fairly minor illness – there can be persistent symptoms, sometimes referred to as Long Covid.

“Patients in phases i and ii above will not be admitted to hospital as a result of their Covid infection; yet it is only in these phases of the illness that drugs that can prevent or reduce cellular invasion by the SARS-CoV-2 virus will have any benefit.

“It therefore seems extremely unlikely that Fenofibrate will be of value in treating patients once they are ill enough to be admitted to hospital.

“Treating everybody with no or minor symptoms might possibly reduce infection rates; but would require extremely widescale use, so even rare and minor side-effects would be a problem (as they are with vaccines); and the drug would have to be very cheap.

“There may be a place for such treatments – if they are ever proven to be clinically effective – in preventing disease in vulnerable patients who have been exposed and in whom vaccination has not been possible or may be ineffective (e.g. some forms of immunosuppression); and conceivably, if the drug proves highly effective in preventing infection, in some individuals in preparation for e.g. hospital admission, to reduce the likelihood of their being infected on admission.

“At present, however, all of this is fairly speculative because as yet this drug has not yet moved from laboratory-based studies.”

‘The Hyperlipidaemic Drug Fenofibrate Significantly Reduces Infection by SARS-CoV-2 in Cell Culture Models’ by Scott P. Davies et al. was published in Frontiers in Pharmacology at 05:00 UK time on Friday 6 August 2021.

DOI: 10.3389/fphar.2021.660490

All our previous output on this subject can be seen at this weblink:

www.sciencemediacentre.org/tag/covid-19

Declared interests

Dr Peter English: “Dr English is on the editorial board of Vaccines Today: an unpaid, voluntary, position. While he is also a member of the BMA’s Public Health Medicine Committee, this comment is made in a personal capacity.”