The Drug Repurposing Hub: a next-generation drug library and information resource

TLDR: This work hand-curated a collection of 4,707 compounds, experimentally confirmed their identities, and annotated them with literature-reported targets, to assemble a comprehensive library of drugs that have reached the clinic and established a blueprint for others to easily assemble such a repurposing library.

Abstract: To the Editor: Drug repurposing, the application of an existing therapeutic to a new disease indication, holds promise of rapid clinical impact at a lower cost than de novo drug development. So far, there has not been a systematic effort to identify such opportunities, limited in part by the lack of a comprehensive library of clinical compounds suitable for testing. To address this challenge, we hand-curated a collection of 4,707 compounds, experimentally confirmed their identities, and annotated them with literature-reported targets. The collection includes 3,422 drugs that are marketed around the world or that have been tested in human clinical trials. Compounds were obtained from more than 50 chemical vendors, and the purity of each sample was established. We have thus established a blueprint for others to easily assemble such a repurposing library, and we have created an online Drug Repurposing Hub (http:// www.broadinstitute.org/repurposing) that contains detailed annotation for each of the compounds. Repurposing is attractive and pragmatic, given the substantial cost and time requirements—on average, a decade or more—for drug development1. In addition, a large number of potential drugs never reach clinical testing. Moreover, fewer than 15% of compounds that enter clinical development ultimately receive approval, despite the majority of them being deemed safe2. For either approved or failed drugs for which safety has already been established, finding new indications can rapidly bring benefits to patients. Prior drug-repurposing successes span disease areas; examples include the cyclooxygenase inhibitor aspirin to treat coronary-artery disease, the phosphodiesterase inhibitor sildenafil to treat erectile dysfunction, and the antibiotic erythromycin for impaired gastric motility (Supplementary Table 1)3. Even drugs associated with troubling side effects merit reconsideration, as evidenced by the successful repurposing of the antiemetic thalidomide to treat multiple myeloma4. Risk-mediating measures for avoiding the potential teratogenicity of thalidomide and its derivatives are reasonable in patients with life-threatening cancer, whereas the use of these drugs to treat nausea remains unacceptable. Although the benefits of repurposing are clear, successes thus far have been mostly serendipitous. Systematic, large-scale repurposing efforts have not been possible owing to the lack of a definitive physical drug collection, the low quality of drug annotations, and insufficient readouts of drug activity from which new indications can be predicted. Recent technological advances have enabled a step change in our ability to assess drug activities comprehensively. For example, perturbational gene expression profiles can now be obtained at high throughput across multiple cell types5. Gene expression profiling has enabled recent repurposing discoveries, including sirolimus for glucocorticoid-resistant acute lymphocytic leukemia, topiramate for inflammatory-bowel disease, and imipramine for small-cell lung cancer. For cancer therapeutics, a recently developed assay known as PRISM, which uses barcoded cell lines, enables rapid testing of many drugs against a large number of cancer cell lines in pools6. Molecular features of the cell lines (for example, gene expression, mutation, or copy-number variation) can then be used to identify predictive biomarkers of drug sensitivity (Supplementary Table 2). Finally, morphologic changes in cells can be assessed using high-throughput microscopy and machine-learning approaches. Such imaging-based screening unexpectedly identified the cholesterol drug lovastatin as a potent inhibitor of leukemia stem cells. To take advantage of these advances in experimental methods, we sought to assemble a comprehensive library of drugs that have reached the clinic. Surprisingly, we found that no such chemical library of approved and clinical trial drugs is available for purchase. In particular, drugs that have been tested in clinical trials but did not reach approval are not readily accessible. Even obtaining a complete list of such drugs and their annotations is challenging. A prior effort led by the US National Institutes of Health (NIH) focused on drugs approved by the US Food and Drug Administration (FDA), but the library has few compounds that have yet to achieve FDA approval7. Some chemical vendors offer a subset of approved drugs, but most of these commercial libraries overlap in their content and include only a small fraction of the approximately 10,000 drugs that have reached the clinic in the United States and Europe. Given that no complete collection exists, we launched a three-step effort to create the Repurposing Library by (i) identifying and purchasing compounds; (ii) comprehensively annotating their known activities and clinical indications; and (iii) experimentally confirming drug identity and purity. We employed two approaches to identify clinical-drug structures for the Repurposing Library. First, we searched existing databases, both publicly accessible and proprietary, for clinically tested drugs and then manually integrated them to ensure sufficient drug coverage and chemical-structure reliability (Supplementary Table 3). Sources included DrugBank, the NCATS NCGC Pharmaceutical Collection (NPC), Thomson Reuters Integrity, Thomson Reuters Cortellis, and Citeline Pharmaprojects7–9. Second, we located marketed or approved ingredient lists from regulatory agencies worldwide, including the FDA. After structure standardization and the removal of duplicates, approximately 10,000 small-molecule drugs with disclosed structures were found to have reached clinical development. Most of these drugs are not widely available in commercial screening libraries. Through structure-matching (as opposed to relying on compound names), chemical suppliers were identified for 5,691 compounds (Fig. 1). Controlled substances, nonpharmaceutical substances, and redundant elemental formulations were not pursued further. To assemble the collection, we ultimately purchased 8,584 samples (representing 5,691 unique compounds) from 75 chemical vendors, at an average cost of $29 per sample. We performed chemical-structure analysis on all clinical-drug structures (whether commercially available or not) to assess the extent of The Drug Repurposing Hub: a next-generation drug library and information resource