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丙戊酸的使用与降低 COVID-19 感染风险和降低疾病严重程度有关:流行病学和体外分析揭示了机制见解。

Valproic acid use is associated with diminished risk of contracting COVID-19, and diminished disease severity: Epidemiologic and in vitro analysis reveal mechanistic insights.

机构信息

Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, University of Texas Health Science Center San Antonio, San Antonio, Texas, United States of America.

Department of Urology, University of Texas Health Science Center San Antonio, San Antonio, Texas, United States of America.

出版信息

PLoS One. 2024 Aug 2;19(8):e0307154. doi: 10.1371/journal.pone.0307154. eCollection 2024.


DOI:10.1371/journal.pone.0307154
PMID:39093886
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11296636/
Abstract

The SARS-CoV-2 pandemic has caused unprecedented worldwide infections from persistent mutant variants with various degrees of infectivity and virulence. The elusiveness of a highly penetrant, worldwide vaccination strategy suggests that the complete eradication of SARS-CoV-2 is unlikely. Even with the advent of new antiviral agents, the disease burden worldwide continues to exceed current preventative and therapeutic strategies. Greater interest has been placed towards the development of affordable,broadly effective antiviral therapeutics. Here, we report that the small branched-chain fatty acid Valproic acid (VPA), approved for maintenance of seizure and bipolar disorder, has a novel anti- coronavirus activity that can be augmented with the addition of a long-chain, polyunsaturated omega-3 fatty acid, Docosahexaenoic acid (DHA). An EMR-based epidemiological study of patients tested for COVID-19 demonstrated a correlation exists between a reduced infection rate in patients treated withVPA of up to 25%, as well as a decreased risk of emergency room visits, hospitalization, ICU admission,and use of mechanical ventilation. In vitro studies have demonstrated that VPA modifies gene expression in MRC5 cells. Interestingly, VPA correlates with the inhibition of several SARS-CoV2 interacting genes and the greater inhibition of alpha-coronavirus HCoV-229E (a "common cold" virus) and SARS-CoV2. The VPA-DHA combination activates pre-existing intracellular antiviral mechanisms normally repressed by coronaviruses. Gene expression profiles demonstrate subtle differences in overall gene expression between VPA-treated and VPA-DHA-treated cells. HCoV-229E infection caused an intensely different response with a marked induction of multiple intracellular inflammatory genes. Changes in gene expression took at least 24 hours to manifest and most likely why prior drug screens failed to identify any antiviral VPA activity despite in silico predictions. This report demonstrates an interaction between HDAC inhibition and the potent activation of cellular antiviral responses. A foundation now exists for a low-cost, highly effective antiviral strategy when supplemented with DHA.

摘要

SARS-CoV-2 大流行导致持续变异的具有不同程度传染性和毒力的突变体在全球范围内前所未有地感染。具有高度渗透性的全球疫苗接种策略难以实现,这表明完全消灭 SARS-CoV-2 是不可能的。即使有了新的抗病毒药物,全球疾病负担仍继续超过当前的预防和治疗策略。人们对开发负担得起的、广泛有效的抗病毒治疗方法的兴趣更大。在这里,我们报告称,小分子支链脂肪酸丙戊酸(VPA)已被批准用于预防癫痫发作和双相情感障碍,它具有新型的抗冠状病毒活性,并且可以通过添加长链多不饱和ω-3 脂肪酸二十二碳六烯酸(DHA)来增强。对接受 COVID-19 检测的患者进行的基于 EMR 的流行病学研究表明,接受 VPA 治疗的患者感染率降低了 25%,急诊就诊、住院、入住 ICU 和使用机械通气的风险降低,两者之间存在相关性。体外研究表明,VPA 可改变 MRC5 细胞中的基因表达。有趣的是,VPA 与抑制几种 SARS-CoV2 相互作用的基因相关,并且与α冠状病毒 HCoV-229E(“普通感冒”病毒)和 SARS-CoV2 的抑制作用更大相关。VPA-DHA 联合激活了通常被冠状病毒抑制的内源性抗病毒机制。基因表达谱显示,VPA 处理和 VPA-DHA 处理的细胞之间的总体基因表达存在细微差异。HCoV-229E 感染引起强烈的不同反应,导致多个细胞内炎症基因明显诱导。基因表达的变化至少需要 24 小时才能显现,这很可能是为什么尽管进行了计算机预测,但先前的药物筛选仍未能确定任何具有抗病毒活性的 VPA 的原因。该报告证明了 HDAC 抑制与细胞抗病毒反应的有效激活之间的相互作用。当与 DHA 补充时,现在为低成本,高度有效的抗病毒策略奠定了基础。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/632d/11296636/0bcf1cc9a860/pone.0307154.g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/632d/11296636/623012d6e820/pone.0307154.g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/632d/11296636/8f23b9547850/pone.0307154.g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/632d/11296636/611b5b97f7f5/pone.0307154.g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/632d/11296636/7baef753204a/pone.0307154.g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/632d/11296636/7d468f4bfb5d/pone.0307154.g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/632d/11296636/27f2e94502b1/pone.0307154.g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/632d/11296636/0bcf1cc9a860/pone.0307154.g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/632d/11296636/623012d6e820/pone.0307154.g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/632d/11296636/8f23b9547850/pone.0307154.g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/632d/11296636/611b5b97f7f5/pone.0307154.g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/632d/11296636/7baef753204a/pone.0307154.g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/632d/11296636/7d468f4bfb5d/pone.0307154.g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/632d/11296636/27f2e94502b1/pone.0307154.g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/632d/11296636/0bcf1cc9a860/pone.0307154.g007.jpg

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引用本文的文献

[1]
Valproate Administration to Adult 5xFAD Mice Upregulates Expression of Neprilysin and Improves Olfaction and Memory.

J Mol Neurosci. 2024-11-16

本文引用的文献

[1]
The free fatty acid-binding pocket is a conserved hallmark in pathogenic β-coronavirus spike proteins from SARS-CoV to Omicron.

Sci Adv. 2022-11-25

[2]
Linoleic acid binds to SARS-CoV-2 RdRp and represses replication of seasonal human coronavirus OC43.

Sci Rep. 2022-11-9

[3]
Immunomodulation by intravenous omega-3 fatty acid treatment in older subjects hospitalized for COVID-19: A single-blind randomized controlled trial.

Clin Transl Med. 2022-9

[4]
Potential of Omega 3 Supplementation for Coronavirus Disease 2019 (COVID-19): A Scoping Review.

Int J Gen Med. 2022-4-11

[5]
Valproate: Not All Boxed Warnings Are Created Equal.

Ann Pharmacother. 2022-12

[6]
[Valproic Acid Could Help in the Fight Against COVID-19: a case-control study].

Neurologia. 2022-2-14

[7]
Exposure to valproic acid is associated with less pulmonary infiltrates and improvements in diverse clinical outcomes and laboratory parameters in patients hospitalized with COVID-19.

PLoS One. 2022

[8]
The fatty acid site is coupled to functional motifs in the SARS-CoV-2 spike protein and modulates spike allosteric behaviour.

Comput Struct Biotechnol J. 2021-12-11

[9]
Drug repurposing for COVID-19 using graph neural network and harmonizing multiple evidence.

Sci Rep. 2021-11-30

[10]
Long-term use of valproic acid reduced mortality in bipolar disorder patients in a Taiwanese population: An association analysis using the national health insurance research database (NHIRD).

J Psychiatr Res. 2022-5

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