2. Academic Validation
  3. Olgotrelvir, a dual inhibitor of SARS-CoV-2 Mpro and cathepsin L, as a standalone antiviral oral intervention candidate for COVID-19

Olgotrelvir, a dual inhibitor of SARS-CoV-2 Mpro and cathepsin L, as a standalone antiviral oral intervention candidate for COVID-19

  • Med. 2023 Dec 29:S2666-6340(23)00402-6. doi: 10.1016/j.medj.2023.12.004.
Long Mao 1,  Namir Shaabani 2,  Xiaoying Zhang 3,  Can Jin 1,  Wanhong Xu 3,  Christopher Argent 4,  Yulia Kushnareva 1,  Colin Powers 2,  Karen Stegman 2,  Jia Liu 1,  Hui Xie 2,  Changxu Xu 3,  Yimei Bao 3,  Lijun Xu 3,  Yuren Zhang 3,  Haigang Yang 3,  Shengdian Qian 3,  Yong Hu 3,  Jianping Shao 3,  Can Zhang 3,  Tingting Li 3,  Yi Li 3,  Na Liu 3,  Zhenhao Lin 3,  Shanbo Wang 3,  Chao Wang 3,  Wei Shen 3,  Yuanlong Lin 5,  Dan Shu 5,  Zhenhong Zhu 1,  Olivia Kotoi 1,  Lisa Kerwin 2,  Qing Han 6,  Ludmila Chumakova 1,  John Teijaro 7,  Mike Royal 2,  Mark Brunswick 2,  Robert Allen 2,  Henry Ji 2,  Hongzhou Lu 8,  Xiao Xu 9
Affiliations

Affiliations

  • 1 ACEA Therapeutics, Inc., San Diego, CA 92121, USA.
  • 2 Sorrento Therapeutics, Inc., San Diego, CA 92121, USA.
  • 3 ACEA Pharmaceutical Co., Ltd., Hangzhou, Zhejiang, P.R. China.
  • 4 Scientia Clinical Research Limited, Sydney, NSW, Australia.
  • 5 Shenzhen Third People's Hospital, SUSTech, Shenzhen, P.R. China.
  • 6 Structure Based Design, Inc., San Diego, CA 92121, USA.
  • 7 Department of Immunology and Microbial Science, The Scripps Research Institute, La Jolla, CA 92037, USA.
  • 8 Shenzhen Third People's Hospital, SUSTech, Shenzhen, P.R. China. Electronic address: [email protected].
  • 9 ACEA Therapeutics, Inc., San Diego, CA 92121, USA. Electronic address: [email protected].
PMID: 38181791 DOI: 10.1016/j.medj.2023.12.004
Abstract

Background: Oral Antiviral drugs with improved Antiviral potency and safety are needed to address current challenges in clinical practice for treatment of COVID-19, including the risks of rebound, drug-drug interactions, and emerging resistance.

Methods: Olgotrelvir (STI-1558) is designed as a next-generation Antiviral targeting the SARS-CoV-2 main protease (Mpro), an essential Enzyme for SARS-CoV-2 replication, and human Cathepsin L (CTSL), a key Enzyme for SARS-CoV-2 entry into host cells.

Findings: Olgotrelvir is a highly bioavailable oral prodrug that is converted in plasma to its active form, AC1115. The dual mechanism of action of olgotrelvir and AC1115 was confirmed by Enzyme activity inhibition assays and co-crystal structures of AC1115 with SARS-CoV-2 Mpro and human CTSL. AC1115 displayed Antiviral activity by inhibiting replication of all tested SARS-CoV-2 variants in Cell Culture systems. Olgotrelvir also inhibited viral entry into cells using SARS-CoV-2 Spike-mediated pseudotypes by inhibition of host CTSL. In the K18-hACE2 transgenic mouse model of SARS-CoV-2-mediated disease, olgotrelvir significantly reduced the virus load in the lungs, prevented body weight loss, and reduced cytokine release and lung pathologies. Olgotrelvir demonstrated potent activity against the nirmatrelvir-resistant Mpro E166 mutants. Olgotrelvir showed enhanced oral bioavailability in animal models and in humans with significant plasma exposure without ritonavir. In phase I studies (ClinicalTrials.gov: NCT05364840 and NCT05523739), olgotrelvir demonstrated a favorable safety profile and Antiviral activity.

Conclusions: Olgotrelvir is an oral inhibitor targeting Mpro and CTSL with high Antiviral activity and plasma exposure and is a standalone treatment candidate for COVID-19.

Funding: Funded by Sorrento Therapeutics.

Keywords

COVID-19; M(pro); Phase I trial; SARS-CoV-2 variants of concern; Translation to patients; anti-viral activity; cathepsin L; dual inhibitor; high plasma exposure; oral; standalone drug.

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