Olgotrelvir, a dual inhibitor of SARS-CoV-2 Mpro and cathepsin L, as a standalone antiviral oral intervention candidate for COVID-19
Long Mao, Namir Shaabani, Xiaoying Zhang, Can Jin, Wanhong Xu, Christopher Argent, Yulia Kushnareva, Colin Powers, Karen Stegman, Jia Liu, Huimin Xie, Changxu Xu, Yimei Bao, Lijun Xu, Yuren Zhang, Haigang Yang, Shengdian Qian, Yong Hu, Jianping Shao, Can Zhang, Tingting Li, Yi Li, Na Liu, Zhenhao Lin, Shanbo Wang, Chao Wang, Weiliang Shen, Yuanlong Lin, Dan Shu, Zhenhong Zhu, Olivia Kotoi, Lisa Kerwin, Qing Han, Ludmila Chumakova, John R. Teijaro, Mike A. Royal, Mark Brunswick, Robert D. Allen, Henry Ji, Hongzhou Lu, Xiaohong Xu
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 (M pro ), 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 M pro 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 M pro 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 M pro and CTSL with high antiviral activity and plasma exposure and is a standalone treatment candidate for COVID-19. Funding Funded by Sorrento Therapeutics.