The oral nucleoside prodrug GS-5245 is efficacious against SARS-CoV-2 and other endemic, epidemic, and enzootic coronaviruses

Sci Transl Med. 2024 May 22;16(748):eadj4504. doi: 10.1126/scitranslmed.adj4504. Epub 2024 May 22.

Abstract

Despite the wide availability of several safe and effective vaccines that prevent severe COVID-19, the persistent emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern (VOCs) that can evade vaccine-elicited immunity remains a global health concern. In addition, the emergence of SARS-CoV-2 VOCs that can evade therapeutic monoclonal antibodies underscores the need for additional, variant-resistant treatment strategies. Here, we characterize the antiviral activity of GS-5245, obeldesivir (ODV), an oral prodrug of the parent nucleoside GS-441524, which targets the highly conserved viral RNA-dependent RNA polymerase (RdRp). We show that GS-5245 is broadly potent in vitro against alphacoronavirus HCoV-NL63, SARS-CoV, SARS-CoV-related bat-CoV RsSHC014, Middle East respiratory syndrome coronavirus (MERS-CoV), SARS-CoV-2 WA/1, and the highly transmissible SARS-CoV-2 BA.1 Omicron variant. Moreover, in mouse models of SARS-CoV, SARS-CoV-2 (WA/1 and Omicron B1.1.529), MERS-CoV, and bat-CoV RsSHC014 pathogenesis, we observed a dose-dependent reduction in viral replication, body weight loss, acute lung injury, and pulmonary function with GS-5245 therapy. Last, we demonstrate that a combination of GS-5245 and main protease (Mpro) inhibitor nirmatrelvir improved outcomes in vivo against SARS-CoV-2 compared with the single agents. Together, our data support the clinical evaluation of GS-5245 against coronaviruses that cause or have the potential to cause human disease.

MeSH terms

  • Administration, Oral
  • Animals
  • Antiviral Agents* / pharmacology
  • Antiviral Agents* / therapeutic use
  • COVID-19 / virology
  • COVID-19 Drug Treatment
  • Chlorocebus aethiops
  • Coronavirus Infections / drug therapy
  • Coronavirus Infections / virology
  • Disease Models, Animal
  • Female
  • Humans
  • Mice
  • Nucleosides / chemistry
  • Nucleosides / pharmacology
  • Nucleosides / therapeutic use
  • Prodrugs* / pharmacology
  • Prodrugs* / therapeutic use
  • SARS-CoV-2* / drug effects
  • Vero Cells
  • Virus Replication / drug effects

Substances

  • Prodrugs
  • Antiviral Agents
  • Nucleosides

Supplementary concepts

  • SARS-CoV-2 variants