Olgotrelvir, a dual inhibitor of SARS-CoV-2 M pro and cathepsin L, as a standalone antiviral oral intervention candidate for COVID-19.

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.
Competing Interests: Declaration of interests L.M., C.J., Y.K., J.L., Z.Z., L.D., and X.X. are shareholders of Sorrento Therapeutics, Inc. and employees of ACEA Therapeutics, Inc., which is a wholly owned subsidiary of Sorrento Therapeutics, Inc. N.S., C.P., K.S., H.X., L.K., M.R., M.B., and H.J. are employees and shareholders of Sorrento Therapeutics., Inc. X.Z., W.X., C.X., Y.B., L.X., Y.Z., H.Y., S.Q., Y.H., J.S., C.Z., T.L., Y. Li, N.L., Z.L., S.W., C.W., and W.S. are employees of ACEA Pharmaceutical Co. Ltd., a wholly owned subsidiary of ACEA Therapeutics, Inc. R.A. was an employee of Sorrento Therapeutics during the study. Sorrento Therapeutics has filed a PCT application (WO 2022/256434 Al) of the compound structures and the synthesis and the pre-clinical properties of olgotrelvir along with its potential treatment of COVID-19 as an antiviral agent.
(Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)