TMPRSS2 inhibitor found to be a novel and effective therapeutic option against pan-variant SARS-CoV-2 infections

In a recent study published in Nature, researchers assessed the efficacy of small molecule protease inhibitors of transmembrane serine protease 2 (TMPRSS2) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern (VOCs) Alpha, Beta, Gamma, and Delta in mice and human lung cells.

Study: A TMPRSS2 inhibitor acts as a pan-SARS-CoV-2 prophylactic and therapeutic. Image Credit: Wirestock Creators/Shutterstock
Study: A TMPRSS2 inhibitor acts as a pan-SARS-CoV-2 prophylactic and therapeutic. Image Credit: Wirestock Creators/Shutterstock

Background

Studies have reported that SARS-CoV-2 depends on host cellular pathways, such as the hijacking of TMPRSS2-related proteases for viral entry. This indicates that TMPRSS2 are potential therapeutic targets to prevent SARS-CoV-2 infection. The development of such host-directed antivirals (HDA) could protect against SARS-CoV-2 variant infections, for which vaccines developed during the initial coronavirus disease 2019 (COVID-19) period may have limited efficacy.

The authors of the present study previously designed peptidomimetic compounds that exhibited potent antiviral efficacy at impeding influenza A H1N1 virus infection of cultured human airway epithelial cells (Calu-3) by inhibition of serine proteases. The team hypothesized that these compounds would also be effective against SARS-CoV-2 VOCs since the TMPRSS2 cleavage sites of SARS-CoV-2 and the H1N1 virus are similar.

About the study

In the present study, researchers expanded on previous work they had conducted and developed a library of peptidomimetic compounds that inhibited TMPRSS2 activity and investigated their efficacy against SARS-CoV-2 VOCs in human lung cells and mice.

The peptidomimetics’ efficacy was evaluated using cellular assays that measured TMPRSS2-dependant inhibition of proteolytic activity. The compounds tested were Camostat mesylate (Cm), N-0130, N-0438, N-0678, N-0676, N-0386, N-1296, and N-0385 and their corresponding inhibition efficacies were 56%, 72%, 84%, 5%, 8%, 73%, 16% and 83%, respectively. N-0100 did not inhibit TMPRSS2 proteolytic activity.

The half-maximal inhibitory concentrations (IC50) of Cm, N-0130, N-0438, N-0386 and N-0385 compounds were17.5, 3.1 ,5.2, 3.9, 1.9 nM, respectively. As a result, N-0130, N-0385, N-0386, and N-0438 were the four most promising peptidomimetic compounds.

These four peptidomimetic compounds were subsequently tested at 100 nM concentrations for anti- SARS-CoV-2 activity using Calu-3 cells. The cells were subjected to immunohistochemistry (IHC) analysis for staining of double-stranded ribonucleic acid (dsRNA) and nucleocapsid, which are markers of viral replication and translation, respectively.

The compounds Cm, N-0100, N-0678, N-0676, N-0386, N-1296, N-0385 and N-0385(OH) inhibited SARS-CoV-2 by >83%, 93%, <23%, <53%,>99%, <44%, >99%, and <23%, respectively. Thus, TMPRSS2-inhibiting peptidomimetics were also inhibitors of SARS-CoV-2 replication and translation in Calu-3 cells. Additionally, consistent inhibitory profiles across dsRNA and nucleocapsid were observed.

The peptidomimetics that demonstrated >75% inhibition of SARS-CoV-2 (N-0385, N-0385(OH), and Cm) were further assessed for the extracellular release of SARS-CoV-2 virions from Calu-3 cells using plaque assays with 40 nM and 200 nM doses of the compounds. Both concentrations of N-0385 reduced viral titers by almost 97%.

The efficacy of the lead candidate, N-0385 (100nM) was further assessed in donor-derived human colonoids against SARS-CoV-2 Alpha, Beta, Gamma, and Delta VOCs. The team quantified messenger RNA (mRNA) expression of TMPRSS2 and angiotensin-converting enzyme 2 (ACE2) in the colonoids using quantitative polymerase chain reaction (qPCR) and subsequently investigated the colonoids’ susceptibility to SARS-CoV-2 infection. N-0385 demonstrated a selectivity index of >106 and >99% inhibition of SARS-CoV-2 in human lung cells and patient-derived colonoids.

After establishing N-0385 efficacy in cellulo and in vitro, the team investigated whether administering N-0385 intranasally could improve survival and morbidity in vivo. K18-hACE2 was administered one intranasal dose of 7.2 mg/kg daily of N-0385(OH), N-0385, or control (0.9% saline) for eight days. The animals were challenged with SARS-CoV-2 (1 x 103 plaque-forming units (PFU)/mouse) and monitored till 14 days post-infection (dpi).

Findings

The N-0385(OH)-treated mice and saline-control mice demonstrated 15% and 14% weight loss, respectively, whereas the N-0385 treated mice only lost 3% of their weight. This weight loss was lowest when N-0385 was administered at the time of infection. Moreover, most N-0385(OH)-treated mice and saline control mice were dead at 14 dpi whereas most of the N-0385-treated mice (70%) survived.

Additionally, histological examination revealed no brain lesions and minimal lung pathologies in N-0385-treated mice.

Based on these results, the team evaluated a shorter four-day N-0385 treatment regimen using K18-hACE2 mice. Furthermore, they also investigated single dose N-0385 pan-variant effectiveness of N-0385 against SARS-CoV-2 in mice. N-0385 demonstrated substantial cross-protection, in equivalent amounts when used as the short (four-day) or standard (eight-day) regimens.

Conclusions

Overall, the study findings showed that N-0385 had a low nanomolar pan-variant anti-SARS-CoV-2 activity and could be used as an effective prophylactic and therapeutic option when used in multiple or single-dose regimens.

Journal reference:
Pooja Toshniwal Paharia

Written by

Pooja Toshniwal Paharia

Pooja Toshniwal Paharia is an oral and maxillofacial physician and radiologist based in Pune, India. Her academic background is in Oral Medicine and Radiology. She has extensive experience in research and evidence-based clinical-radiological diagnosis and management of oral lesions and conditions and associated maxillofacial disorders.

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