Laboratory of Virology.
Rocky Mountain Veterinary Branch, and.
JCI Insight. 2023 Feb 22;8(4):e166485. doi: 10.1172/jci.insight.166485.
The periodic emergence of SARS-CoV-2 variants of concern (VOCs) with unpredictable clinical severity and ability to escape preexisting immunity emphasizes the continued need for antiviral interventions. Two small molecule inhibitors, molnupiravir (MK-4482), a nucleoside analog, and nirmatrelvir (PF-07321332), a 3C-like protease inhibitor, have recently been approved as monotherapy for use in high-risk patients with COVID-19. As preclinical data are only available for rodent and ferret models, here we assessed the efficacy of MK-4482 and PF-07321332 alone and in combination against infection with the SARS-CoV-2 Delta VOC in the rhesus macaque COVID-19 model. Macaques were infected with the SARS-CoV-2 Delta variant and treated with vehicle, MK-4482, PF-07321332, or a combination of MK-4482 and PF-07321332. Clinical exams were performed at 1, 2, and 4 days postinfection to assess disease and virological parameters. Notably, use of MK-4482 and PF-07321332 in combination improved the individual inhibitory effect of both drugs, resulting in milder disease progression, stronger reduction of virus shedding from mucosal tissues of the upper respiratory tract, stronger reduction of viral replication in the lower respiratory tract, and reduced lung pathology. Our data strongly indicate superiority of combined MK-4482 and PF-07321332 treatment of SARS-CoV-2 infections as demonstrated in the closest COVID-19 surrogate model of human infection.
不断出现的具有不可预测临床严重程度和逃避现有免疫能力的 SARS-CoV-2 变异株(VOC)强调了继续需要抗病毒干预。两种小分子抑制剂,核苷类似物莫那比拉韦(MK-4482)和 3C 样蛋白酶抑制剂奈玛特韦(PF-07321332)最近已被批准作为 COVID-19 高危患者的单药治疗。由于临床前数据仅可用于啮齿动物和雪貂模型,因此我们在此评估了 MK-4482 和 PF-07321332 单独和联合使用对恒河猴 COVID-19 模型中 SARS-CoV-2 Delta VOC 感染的疗效。恒河猴感染 SARS-CoV-2 Delta 变异株,并给予载体、MK-4482、PF-07321332 或 MK-4482 和 PF-07321332 联合治疗。在感染后第 1、2 和 4 天进行临床检查,以评估疾病和病毒学参数。值得注意的是,MK-4482 和 PF-07321332 的联合使用改善了两种药物的单独抑制作用,导致疾病进展更轻微,从上呼吸道粘膜组织中病毒脱落的减少更明显,下呼吸道病毒复制的减少更明显,以及肺部病理减少。我们的数据强烈表明,MK-4482 和 PF-07321332 的联合治疗 SARS-CoV-2 感染具有优越性,这在最接近人类感染的 COVID-19 替代模型中得到了证明。