1
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Cox RM, Wolf JD, Lieberman NA, Lieber CM, Kang HJ, Sticher ZM, Yoon JJ, Andrews MK, Govindarajan M, Krueger RE, Sobolik EB, Natchus MG, Gewirtz AT, deSwart RL, Kolykhalov AA, Hekmatyar K, Sakamoto K, Greninger AL, Plemper RK. Therapeutic mitigation of measles-like immune amnesia and exacerbated disease after prior respiratory virus infections in ferrets. Nat Commun 2024; 15:1189. [PMID: 38331906 PMCID: PMC10853234 DOI: 10.1038/s41467-024-45418-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/23/2024] [Indexed: 02/10/2024] Open
Abstract
Measles cases have surged pre-COVID-19 and the pandemic has aggravated the problem. Most measles-associated morbidity and mortality arises from destruction of pre-existing immune memory by measles virus (MeV), a paramyxovirus of the morbillivirus genus. Therapeutic measles vaccination lacks efficacy, but little is known about preserving immune memory through antivirals and the effect of respiratory disease history on measles severity. We use a canine distemper virus (CDV)-ferret model as surrogate for measles and employ an orally efficacious paramyxovirus polymerase inhibitor to address these questions. A receptor tropism-intact recombinant CDV with low lethality reveals an 8-day advantage of antiviral treatment versus therapeutic vaccination in maintaining immune memory. Infection of female ferrets with influenza A virus (IAV) A/CA/07/2009 (H1N1) or respiratory syncytial virus (RSV) four weeks pre-CDV causes fatal hemorrhagic pneumonia with lung onslaught by commensal bacteria. RNAseq identifies CDV-induced overexpression of trefoil factor (TFF) peptides in the respiratory tract, which is absent in animals pre-infected with IAV. Severe outcomes of consecutive IAV/CDV infections are mitigated by oral antivirals even when initiated late. These findings validate the morbillivirus immune amnesia hypothesis, define measles treatment paradigms, and identify priming of the TFF axis through prior respiratory infections as risk factor for exacerbated morbillivirus disease.
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Affiliation(s)
- Robert M Cox
- Center for Translational Antiviral Research, Georgia State University Institute for Biomedical Sciences, Atlanta, GA, 30303, USA
| | - Josef D Wolf
- Center for Translational Antiviral Research, Georgia State University Institute for Biomedical Sciences, Atlanta, GA, 30303, USA
| | - Nicole A Lieberman
- Virology Division, Department of Laboratory Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Carolin M Lieber
- Center for Translational Antiviral Research, Georgia State University Institute for Biomedical Sciences, Atlanta, GA, 30303, USA
| | - Hae-Ji Kang
- Center for Translational Antiviral Research, Georgia State University Institute for Biomedical Sciences, Atlanta, GA, 30303, USA
| | - Zachary M Sticher
- Emory Institute for Drug Development, Emory University, Atlanta, GA, 30322, USA
| | - Jeong-Joong Yoon
- Center for Translational Antiviral Research, Georgia State University Institute for Biomedical Sciences, Atlanta, GA, 30303, USA
| | - Meghan K Andrews
- Emory Institute for Drug Development, Emory University, Atlanta, GA, 30322, USA
| | | | - Rebecca E Krueger
- Emory Institute for Drug Development, Emory University, Atlanta, GA, 30322, USA
| | - Elizabeth B Sobolik
- Virology Division, Department of Laboratory Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Michael G Natchus
- Emory Institute for Drug Development, Emory University, Atlanta, GA, 30322, USA
| | - Andrew T Gewirtz
- Center for Translational Antiviral Research, Georgia State University Institute for Biomedical Sciences, Atlanta, GA, 30303, USA
| | - Rik L deSwart
- Department of Viroscience, Erasmus MC, Rotterdam, Netherlands
| | | | - Khan Hekmatyar
- Advanced Translational Imaging Facility, Georgia State University, Atlanta, GA, 30303, USA
| | - Kaori Sakamoto
- Department of Pathology, College of Veterinary Medicine, University of Georgia, Athens, GA, 30602, USA
| | - Alexander L Greninger
- Virology Division, Department of Laboratory Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Richard K Plemper
- Center for Translational Antiviral Research, Georgia State University Institute for Biomedical Sciences, Atlanta, GA, 30303, USA.
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2
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Jacobs L, van der Westhuyzen A, Pribut N, Dentmon ZW, Cui D, D’Erasmo MP, Bartsch PW, Liu K, Cox RM, Greenlund SF, Plemper RK, Mitchell D, Marlow J, Andrews MK, Krueger RE, Sticher ZM, Kolykhalov AA, Natchus MG, Zhou B, Pelly SC, Liotta DC. Design and Optimization of Novel Competitive, Non-peptidic, SARS-CoV-2 M pro Inhibitors. ACS Med Chem Lett 2023; 14:1434-1440. [PMID: 37849558 PMCID: PMC10577883 DOI: 10.1021/acsmedchemlett.3c00335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/15/2023] [Indexed: 10/19/2023] Open
Abstract
The SARS-CoV-2 main protease (Mpro) has been proven to be a highly effective target for therapeutic intervention, yet only one drug currently holds FDA approval status for this target. We were inspired by a series of publications emanating from the Jorgensen and Anderson groups describing the design of potent, non-peptidic, competitive SARS-CoV-2 Mpro inhibitors, and we saw an opportunity to make several design modifications to improve the overall pharmacokinetic profile of these compounds without losing potency. To this end, we created a focused virtual library using reaction-based enumeration tools in the Schrödinger suite. These compounds were docked into the Mpro active site and subsequently prioritized for synthesis based upon relative binding affinity values calculated by FEP+. Fourteen compounds were selected, synthesized, and evaluated both biochemically and in cell culture. Several of the synthesized compounds proved to be potent, competitive Mpro inhibitors with improved metabolic stability profiles.
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Affiliation(s)
- Leon Jacobs
- Department
of Chemistry, Emory University, Atlanta, Georgia 30322, United States
| | | | - Nicole Pribut
- Department
of Chemistry, Emory University, Atlanta, Georgia 30322, United States
| | - Zackery W. Dentmon
- Department
of Chemistry, Emory University, Atlanta, Georgia 30322, United States
| | - Dan Cui
- COVID-19
Emergency Response, Centers for Disease
Control and Prevention, Atlanta, Georgia 30329, United States
| | - Michael P. D’Erasmo
- Department
of Chemistry, Emory University, Atlanta, Georgia 30322, United States
| | - Perry W. Bartsch
- Department
of Chemistry, Emory University, Atlanta, Georgia 30322, United States
| | - Ken Liu
- Department
of Chemistry, Emory University, Atlanta, Georgia 30322, United States
| | - Robert M. Cox
- Center for
Translational Antiviral Research, Institute for Biomedical Sciences, Georgia State University, Atlanta, Georgia 30303, United States
| | - Sujay F. Greenlund
- Center for
Translational Antiviral Research, Institute for Biomedical Sciences, Georgia State University, Atlanta, Georgia 30303, United States
| | - Richard K. Plemper
- Center for
Translational Antiviral Research, Institute for Biomedical Sciences, Georgia State University, Atlanta, Georgia 30303, United States
| | - Deborah Mitchell
- Emory
Institute for Drug Development, Emory University, Atlanta, Georgia 30322, United States
| | - Joshua Marlow
- Emory
Institute for Drug Development, Emory University, Atlanta, Georgia 30322, United States
| | - Meghan K. Andrews
- Emory
Institute for Drug Development, Emory University, Atlanta, Georgia 30322, United States
| | - Rebecca E. Krueger
- Emory
Institute for Drug Development, Emory University, Atlanta, Georgia 30322, United States
| | - Zachary M. Sticher
- Emory
Institute for Drug Development, Emory University, Atlanta, Georgia 30322, United States
| | - Alexander A. Kolykhalov
- Emory
Institute for Drug Development, Emory University, Atlanta, Georgia 30322, United States
| | - Michael G. Natchus
- Emory
Institute for Drug Development, Emory University, Atlanta, Georgia 30322, United States
| | - Bin Zhou
- COVID-19
Emergency Response, Centers for Disease
Control and Prevention, Atlanta, Georgia 30329, United States
| | - Stephen C. Pelly
- Department
of Chemistry, Emory University, Atlanta, Georgia 30322, United States
| | - Dennis C. Liotta
- Department
of Chemistry, Emory University, Atlanta, Georgia 30322, United States
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3
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Cox RM, Lieber CM, Wolf JD, Karimi A, Lieberman NAP, Sticher ZM, Roychoudhury P, Andrews MK, Krueger RE, Natchus MG, Painter GR, Kolykhalov AA, Greninger AL, Plemper RK. Comparing molnupiravir and nirmatrelvir/ritonavir efficacy and the effects on SARS-CoV-2 transmission in animal models. Nat Commun 2023; 14:4731. [PMID: 37550333 PMCID: PMC10406822 DOI: 10.1038/s41467-023-40556-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 08/01/2023] [Indexed: 08/09/2023] Open
Abstract
Therapeutic options against SARS-CoV-2 are underutilized. Two oral drugs, molnupiravir and paxlovid (nirmatrelvir/ritonavir), have received emergency use authorization. Initial trials suggested greater efficacy of paxlovid, but recent studies indicated comparable potency in older adults. Here, we compare both drugs in two animal models; the Roborovski dwarf hamster model for severe COVID-19-like lung infection and the ferret SARS-CoV-2 transmission model. Dwarf hamsters treated with either drug survive VOC omicron infection with equivalent lung titer reduction. Viral RNA copies in the upper respiratory tract of female ferrets receiving 1.25 mg/kg molnupiravir twice-daily are not significantly reduced, but infectious titers are lowered by >2 log orders and direct-contact transmission is stopped. Female ferrets dosed with 20 or 100 mg/kg nirmatrelvir/ritonavir twice-daily show 1-2 log order reduction of viral RNA copies and infectious titers, which correlates with low nirmatrelvir exposure in nasal turbinates. Virus replication resurges towards nirmatrelvir/ritonavir treatment end and virus transmits efficiently (20 mg/kg group) or partially (100 mg/kg group). Prophylactic treatment with 20 mg/kg nirmatrelvir/ritonavir does not prevent spread from infected ferrets, but prophylactic 5 mg/kg molnupiravir or 100 mg/kg nirmatrelvir/ritonavir block productive transmission. These data confirm reports of similar efficacy in older adults and inform on possible epidemiologic benefit of antiviral treatment.
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Affiliation(s)
- Robert M Cox
- Center for Translational Antiviral Research, Georgia State University Institute for Biomedical Sciences, Atlanta, GA, 30303, USA
| | - Carolin M Lieber
- Center for Translational Antiviral Research, Georgia State University Institute for Biomedical Sciences, Atlanta, GA, 30303, USA
| | - Josef D Wolf
- Center for Translational Antiviral Research, Georgia State University Institute for Biomedical Sciences, Atlanta, GA, 30303, USA
| | - Amirhossein Karimi
- Center for Translational Antiviral Research, Georgia State University Institute for Biomedical Sciences, Atlanta, GA, 30303, USA
| | - Nicole A P Lieberman
- Virology Division, Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, 98185, USA
| | - Zachary M Sticher
- Emory Institute for Drug Development, Emory University, Atlanta, GA, USA
| | - Pavitra Roychoudhury
- Virology Division, Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, 98185, USA
| | - Meghan K Andrews
- Emory Institute for Drug Development, Emory University, Atlanta, GA, USA
| | - Rebecca E Krueger
- Emory Institute for Drug Development, Emory University, Atlanta, GA, USA
| | - Michael G Natchus
- Emory Institute for Drug Development, Emory University, Atlanta, GA, USA
| | - George R Painter
- Emory Institute for Drug Development, Emory University, Atlanta, GA, USA
- Department of Pharmacology, Emory University, Atlanta, GA, 30322, USA
| | | | - Alexander L Greninger
- Virology Division, Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, 98185, USA
| | - Richard K Plemper
- Center for Translational Antiviral Research, Georgia State University Institute for Biomedical Sciences, Atlanta, GA, 30303, USA.
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4
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Lieber CM, Aggarwal M, Yoon JJ, Cox RM, Kang HJ, Sourimant J, Toots M, Johnson SK, Jones CA, Sticher ZM, Kolykhalov AA, Saindane MT, Tompkins SM, Planz O, Painter GR, Natchus MG, Sakamoto K, Plemper RK. 4'-Fluorouridine mitigates lethal infection with pandemic human and highly pathogenic avian influenza viruses. PLoS Pathog 2023; 19:e1011342. [PMID: 37068076 PMCID: PMC10138230 DOI: 10.1371/journal.ppat.1011342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 04/27/2023] [Accepted: 04/03/2023] [Indexed: 04/18/2023] Open
Abstract
Influenza outbreaks are associated with substantial morbidity, mortality and economic burden. Next generation antivirals are needed to treat seasonal infections and prepare against zoonotic spillover of avian influenza viruses with pandemic potential. Having previously identified oral efficacy of the nucleoside analog 4'-Fluorouridine (4'-FlU, EIDD-2749) against SARS-CoV-2 and respiratory syncytial virus (RSV), we explored activity of the compound against seasonal and highly pathogenic influenza (HPAI) viruses in cell culture, human airway epithelium (HAE) models, and/or two animal models, ferrets and mice, that assess IAV transmission and lethal viral pneumonia, respectively. 4'-FlU inhibited a panel of relevant influenza A and B viruses with nanomolar to sub-micromolar potency in HAE cells. In vitro polymerase assays revealed immediate chain termination of IAV polymerase after 4'-FlU incorporation, in contrast to delayed chain termination of SARS-CoV-2 and RSV polymerase. Once-daily oral treatment of ferrets with 2 mg/kg 4'-FlU initiated 12 hours after infection rapidly stopped virus shedding and prevented transmission to untreated sentinels. Treatment of mice infected with a lethal inoculum of pandemic A/CA/07/2009 (H1N1)pdm09 (pdmCa09) with 4'-FlU alleviated pneumonia. Three doses mediated complete survival when treatment was initiated up to 60 hours after infection, indicating a broad time window for effective intervention. Therapeutic oral 4'-FlU ensured survival of animals infected with HPAI A/VN/12/2003 (H5N1) and of immunocompromised mice infected with pdmCa09. Recoverees were protected against homologous reinfection. This study defines the mechanistic foundation for high sensitivity of influenza viruses to 4'-FlU and supports 4'-FlU as developmental candidate for the treatment of seasonal and pandemic influenza.
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Affiliation(s)
- Carolin M Lieber
- Center for Translational Antiviral Research, Georgia State University Institute for Biomedical Sciences, Atlanta, Georgia, United States of America
| | - Megha Aggarwal
- Center for Translational Antiviral Research, Georgia State University Institute for Biomedical Sciences, Atlanta, Georgia, United States of America
| | - Jeong-Joong Yoon
- Center for Translational Antiviral Research, Georgia State University Institute for Biomedical Sciences, Atlanta, Georgia, United States of America
| | - Robert M Cox
- Center for Translational Antiviral Research, Georgia State University Institute for Biomedical Sciences, Atlanta, Georgia, United States of America
| | - Hae-Ji Kang
- Center for Translational Antiviral Research, Georgia State University Institute for Biomedical Sciences, Atlanta, Georgia, United States of America
| | - Julien Sourimant
- Center for Translational Antiviral Research, Georgia State University Institute for Biomedical Sciences, Atlanta, Georgia, United States of America
| | - Mart Toots
- Center for Translational Antiviral Research, Georgia State University Institute for Biomedical Sciences, Atlanta, Georgia, United States of America
| | - Scott K Johnson
- Center for Vaccines and Immunology, University of Georgia, Athens, Georgia, United States of America
| | - Cheryl A Jones
- Center for Vaccines and Immunology, University of Georgia, Athens, Georgia, United States of America
| | - Zachary M Sticher
- Emory Institute for Drug Development, Emory University, Atlanta, Georgia, United States of America
| | - Alexander A Kolykhalov
- Emory Institute for Drug Development, Emory University, Atlanta, Georgia, United States of America
| | - Manohar T Saindane
- Emory Institute for Drug Development, Emory University, Atlanta, Georgia, United States of America
| | - Stephen M Tompkins
- Center for Vaccines and Immunology, University of Georgia, Athens, Georgia, United States of America
| | - Oliver Planz
- Department of Immunology, Interfaculty Institute for Cell Biology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - George R Painter
- Emory Institute for Drug Development, Emory University, Atlanta, Georgia, United States of America
| | - Michael G Natchus
- Emory Institute for Drug Development, Emory University, Atlanta, Georgia, United States of America
| | - Kaori Sakamoto
- Department of Pathology, College of Veterinary Medicine, University of Georgia, Athens, Georgia, United States of America
| | - Richard K Plemper
- Center for Translational Antiviral Research, Georgia State University Institute for Biomedical Sciences, Atlanta, Georgia, United States of America
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5
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Cox RM, Lieber CM, Wolf JD, Karimi A, Lieberman NAP, Sticher ZM, Roychoudhury P, Andrews MK, Krueger RE, Natchus MG, Painter GR, Kolykhalov AA, Greninger AL, Plemper RK. Paxlovid-like nirmatrelvir/ritonavir fails to block SARS-CoV-2 transmission in ferrets. bioRxiv 2022:2022.11.20.517271. [PMID: 36451893 PMCID: PMC9709798 DOI: 10.1101/2022.11.20.517271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Despite the continued spread of SARS-CoV-2 and emergence of variants of concern (VOC) that are capable of escaping preexisting immunity, therapeutic options are underutilized. In addition to preventing severe disease in high-risk patients, antivirals may contribute to interrupting transmission chains. The FDA has granted emergency use authorizations for two oral drugs, molnupiravir and paxlovid. Initial clinical trials suggested an efficacy advantage of paxlovid, giving it a standard-of-care-like status in the United States. However, recent retrospective clinical studies suggested a more comparable efficacy of both drugs in preventing complicated disease and case-fatalities in older adults. For a direct efficacy comparison under controlled conditions, we assessed potency of both drugs against SARS-CoV-2 in two relevant animal models; the Roborovski dwarf hamster model for severe COVID-19 in high-risk patients and the ferret model of upper respiratory tract disease and transmission. After infection of dwarf hamsters with VOC omicron, paxlovid and molnupiravir were efficacious in mitigating severe disease and preventing death. However, a pharmacokinetics-confirmed human equivalent dose of paxlovid did not significantly reduce shed SARS-CoV-2 titers in ferrets and failed to block virus transmission to untreated direct-contact ferrets, whereas transmission was fully suppressed in a group of animals treated with a human-equivalent dose of molnupiravir. Prophylactic administration of molnupiravir to uninfected ferrets in direct contact with infected animals blocked productive SARS-CoV-2 transmission, whereas all contacts treated with prophylactic paxlovid became infected. These data confirm retrospective reports of similar therapeutic benefit of both drugs for older adults, and reveal that treatment with molnupiravir, but not paxlovid, may be suitable to reduce the risk of SARS-CoV-2 transmission.
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6
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Wittwer K, Anderson DE, Pfeffermann K, Cox RM, Wolf JD, Santibanez S, Mankertz A, Plesker R, Sticher ZM, Kolkykhalov AA, Natchus MG, Pfaller CK, Plemper RK, von Messling V. Small-molecule polymerase inhibitor protects non-human primates from measles and reduces shedding. Nat Commun 2021; 12:5233. [PMID: 34475387 PMCID: PMC8413292 DOI: 10.1038/s41467-021-25497-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 08/12/2021] [Indexed: 01/26/2023] Open
Abstract
Measles virus (MeV) is a highly contagious pathogen that enters the human host via the respiratory route. Besides acute pathologies including fever, cough and the characteristic measles rash, the infection of lymphocytes leads to substantial immunosuppression that can exacerbate the outcome of infections with additional pathogens. Despite the availability of effective vaccine prophylaxis, measles outbreaks continue to occur worldwide. We demonstrate that prophylactic and post-exposure therapeutic treatment with an orally bioavailable small-molecule polymerase inhibitor, ERDRP-0519, prevents measles disease in squirrel monkeys (Saimiri sciureus). Treatment initiation at the onset of clinical signs reduced virus shedding, which may support outbreak control. Results show that this clinical candidate has the potential to alleviate clinical measles and augment measles virus eradication. Measles virus is highly contagious and outbreaks occur worldwide. Here the authors show that the orally bioavailable small-molecule polymerase inhibitor ERDRP-0519 prevents measles disease in squirrel monkeys and reduces virus shedding.
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Affiliation(s)
- Kevin Wittwer
- Veterinary Medicine Division, Paul-Ehrlich-Institute, Langen, Germany
| | - Danielle E Anderson
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore
| | | | - Robert M Cox
- Institute for Biomedical Sciences, Georgia State University, Atlanta, GA, USA
| | - Josef D Wolf
- Institute for Biomedical Sciences, Georgia State University, Atlanta, GA, USA
| | - Sabine Santibanez
- WHO European Regional Reference Laboratory for Measles and Rubella, Robert Koch-Institute, Berlin, Germany
| | - Annette Mankertz
- WHO European Regional Reference Laboratory for Measles and Rubella, Robert Koch-Institute, Berlin, Germany
| | - Roland Plesker
- Veterinary Medicine Division, Paul-Ehrlich-Institute, Langen, Germany
| | - Zachary M Sticher
- Emory Institute for Drug Development, Emory University, Atlanta, GA, USA
| | | | - Michael G Natchus
- Emory Institute for Drug Development, Emory University, Atlanta, GA, USA
| | | | - Richard K Plemper
- Institute for Biomedical Sciences, Georgia State University, Atlanta, GA, USA.
| | - Veronika von Messling
- Veterinary Medicine Division, Paul-Ehrlich-Institute, Langen, Germany.,Life Sciences Unit, Federal Ministry of Education and Research, Berlin, Germany
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7
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Toots M, Yoon JJ, Cox RM, Hart M, Sticher ZM, Makhsous N, Plesker R, Barrena AH, Reddy PG, Mitchell DG, Shean RC, Bluemling GR, Kolykhalov AA, Greninger AL, Natchus MG, Painter GR, Plemper RK. Characterization of orally efficacious influenza drug with high resistance barrier in ferrets and human airway epithelia. Sci Transl Med 2020; 11:11/515/eaax5866. [PMID: 31645453 DOI: 10.1126/scitranslmed.aax5866] [Citation(s) in RCA: 191] [Impact Index Per Article: 47.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/19/2019] [Accepted: 09/20/2019] [Indexed: 12/13/2022]
Abstract
Influenza viruses constitute a major health threat and economic burden globally, frequently exacerbated by preexisting or rapidly emerging resistance to antiviral therapeutics. To address the unmet need of improved influenza therapy, we have created EIDD-2801, an isopropylester prodrug of the ribonucleoside analog N 4-hydroxycytidine (NHC, EIDD-1931) that has shown broad anti-influenza virus activity in cultured cells and mice. Pharmacokinetic profiling demonstrated that EIDD-2801 was orally bioavailable in ferrets and nonhuman primates. Therapeutic oral dosing of influenza virus-infected ferrets reduced group pandemic 1 and group 2 seasonal influenza A shed virus load by multiple orders of magnitude and alleviated fever, airway epithelium histopathology, and inflammation, whereas postexposure prophylactic dosing was sterilizing. Deep sequencing highlighted lethal viral mutagenesis as the underlying mechanism of activity and revealed a prohibitive barrier to the development of viral resistance. Inhibitory concentrations were low nanomolar against influenza A and B viruses in disease-relevant well-differentiated human air-liquid interface airway epithelia. Correlating antiviral efficacy and cytotoxicity thresholds with pharmacokinetic profiles in human airway epithelium models revealed a therapeutic window >1713 and established dosing parameters required for efficacious human therapy. These data recommend EIDD-2801 as a clinical candidate with high potential for monotherapy of seasonal and pandemic influenza virus infections. Our results inform EIDD-2801 clinical trial design and drug exposure targets.
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Affiliation(s)
- Mart Toots
- Institute for Biomedical Sciences, Georgia State University, Atlanta, GA 30303, USA
| | - Jeong-Joong Yoon
- Institute for Biomedical Sciences, Georgia State University, Atlanta, GA 30303, USA
| | - Robert M Cox
- Institute for Biomedical Sciences, Georgia State University, Atlanta, GA 30303, USA
| | - Michael Hart
- Institute for Biomedical Sciences, Georgia State University, Atlanta, GA 30303, USA
| | - Zachary M Sticher
- Emory Institute for Drug Development, Emory University, Atlanta, GA 30322, USA
| | - Negar Makhsous
- Virology Division, Department of Laboratory Medicine, University of Washington, Seattle, WA 98195, USA
| | - Roland Plesker
- Veterinary Medicine Division, Paul-Ehrlich-Institute, Federal Institute for Vaccines and Biomedicines, 63225 Langen, Germany
| | - Alec H Barrena
- Institute for Biomedical Sciences, Georgia State University, Atlanta, GA 30303, USA
| | - Prabhakar G Reddy
- Emory Institute for Drug Development, Emory University, Atlanta, GA 30322, USA
| | - Deborah G Mitchell
- Emory Institute for Drug Development, Emory University, Atlanta, GA 30322, USA
| | - Ryan C Shean
- Virology Division, Department of Laboratory Medicine, University of Washington, Seattle, WA 98195, USA
| | - Gregory R Bluemling
- Emory Institute for Drug Development, Emory University, Atlanta, GA 30322, USA
| | | | - Alexander L Greninger
- Virology Division, Department of Laboratory Medicine, University of Washington, Seattle, WA 98195, USA
| | - Michael G Natchus
- Emory Institute for Drug Development, Emory University, Atlanta, GA 30322, USA
| | - George R Painter
- Emory Institute for Drug Development, Emory University, Atlanta, GA 30322, USA.,Department of Pharmacology, Emory University, Atlanta, GA 30322, USA
| | - Richard K Plemper
- Institute for Biomedical Sciences, Georgia State University, Atlanta, GA 30303, USA.
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8
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Painter GR, Bowen RA, Bluemling GR, DeBergh J, Edpuganti V, Gruddanti PR, Guthrie DB, Hager M, Kuiper DL, Lockwood MA, Mitchell DG, Natchus MG, Sticher ZM, Kolykhalov AA. The prophylactic and therapeutic activity of a broadly active ribonucleoside analog in a murine model of intranasal venezuelan equine encephalitis virus infection. Antiviral Res 2019; 171:104597. [DOI: 10.1016/j.antiviral.2019.104597] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/02/2019] [Accepted: 09/04/2019] [Indexed: 11/28/2022]
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