TOP1 inhibition therapy protects against SARS-CoV-2-induced lethal inflammation.

The ongoing pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is currently affecting millions of lives worldwide. Large retrospective studies indicate that an elevated level of inflammatory cytokines and pro-inflammatory factors are associated with both increased disease severity and mortality. Here, using multidimensional epigenetic, transcriptional, in vitro, and in vivo analyses, we report that topoisomerase 1 (TOP1) inhibition suppresses lethal inflammation induced by SARS-CoV-2. Therapeutic treatment with two doses of topotecan (TPT), an FDA-approved TOP1 inhibitor, suppresses infection-induced inflammation in hamsters. TPT treatment as late as 4 days post-infection reduces morbidity and rescues mortality in a transgenic mouse model. These results support the potential of TOP1 inhibition as an effective host-directed therapy against severe SARS-CoV-2 infection. TPT and its derivatives are inexpensive clinical-grade inhibitors available in most countries. Clinical trials are needed to evaluate the efficacy of repurposing TOP1 inhibitors for severe coronavirus disease 2019 (COVID-19) in humans.
Competing Interests: Declaration of interests The García-Sastre Laboratory has received research support from Pfizer, Senhwa Biosciences, 7 Hills Pharma, Pharmamar, Blade Therapuetics, Avimex, Johnson & Johnson, Dynavax, Kenall Manufacturing, and ImmunityBio. A.G.-S. has consulting agreements for the following companies involving cash and/or stock: Vivaldi Biosciences, Contrafect, 7 Hills Pharma, Avimex, Vaxalto, Accurius, and Esperovax. M.J.T. is an employee of Enhanc3D Genomics. M. Spivakov is a co-founder of Enhanc3D Genomics. I. Marazzi is an inventor in the patent WO2017106466A1
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