INTRODUCTION
Coronaviruses are a large group of viruses that can cause a wide variety of diseases in humans and animals (
1). Human coronaviruses generally cause the common cold, a mild upper respiratory illness. However, global outbreaks of new human coronavirus infections with severe respiratory disease have periodically emerged from animal reservoirs, including severe acute respiratory syndrome coronavirus (SARS-CoV), Middle East respiratory syndrome coronavirus (MERS-CoV), and, most recently, SARS-CoV-2, the causative agent of coronavirus disease 2019 (COVID-19). SARS-CoV-2 emerged in China in December 2019 and subsequently rapidly spread throughout the world. Genetic analysis of SARS-CoV-2 revealed that it is closely related to SARS-like betacoronaviruses of bat origin, bat-SL-CoVZC45 and bat-SL-CoVZXC21 (
2). Despite the periodic emergence of new coronaviruses capable of infecting humans, there are currently no licensed vaccines or antiviral drugs against any coronaviruses, underscoring the urgent need for the development of preventive and therapeutic measures against pathogenic coronaviruses.
The coronavirus genome contains two overlapping open reading frames (ORF1a and ORF1b) at the 5′ end terminal, which encode polyproteins pp1a and pp1ab. The polyproteins are processed by a 3C-like protease [3CLpro or main protease (MPro)] (11 cleavage sites) and a papain-like protease (PLpro) (3 cleavage sites), resulting in 16 mature nonstructural proteins, including an RNA-dependent RNA polymerase (RdRp). Both 3CLpro and PLpro are essential for viral replication, making them attractive targets for drug development (
3–
7). Coronavirus 3CLpro is a cysteine protease that has two N-terminal domains containing two β-barrel chymotrypsin-like folds (
8–
10). The active site of 3CLpro is located in the cleft between the two domains and is characterized by a catalytic Cys-His dyad.
We have developed broad-spectrum inhibitors of an array of viruses, including coronaviruses and noroviruses (
11–
18) that use 3CLpro for viral replication and picornaviruses that use 3C protease (
19). We have shown efficacy of the coronavirus 3CLpro inhibitor GC376 (currently in clinical development) in animal models of coronavirus infection (
20,
21). Specifically, administration of GC376 to cats with feline infectious peritonitis (FIP), a coronavirus-induced systemic disease that is 100% fatal, reversed the progression of FIP and resulted in clinical remission (
20,
21). We have recently reported the results of exploratory in vitro studies using a dipeptidyl series of MERS-CoV 3CLpro inhibitors that embody a piperidine moiety as a new design element, as well as pertinent structural and biochemical studies (
17). Here, we report the development of 3CLpro inhibitors against multiple coronaviruses, including SARS-CoV-2, and demonstrate in vivo efficacy against MERS-CoV in a mouse model.
DISCUSSION
There are currently no approved vaccines or small-molecule therapeutics for the treatment of MERS-CoV, SARS-CoV, or SARS-CoV-2 infection. However, numerous preventive and therapeutic options are under development (
3–
7). The most clinically advanced antiviral compound with a broad spectrum of activity is remdesivir (GS-5734). This nucleoside analog was originally developed as an antiviral drug against Ebola virus and has been shown to be effective against both MERS-CoV and SARS-CoV in cell culture assays and in animal models of coronavirus infection (
23–
26). Prophylactic treatment or early therapeutic treatment of infected mice with remdesivir reduced MERS-CoV– or SARS-CoV–mediated weight loss and decreased lung virus titers and lung injury scores compared to those of vehicle-treated animals (
23,
26). Remdesvir also showed potent activity against SARS-CoV-2 in cell culture assays and animal models (
27) and was recently issued an emergency use authorization by the U.S. Food and Drug Administration as an investigational antiviral drug for COVID-19. Another nucleoside analog, EIDD-2801, which is a broad-spectrum inhibitor against multiple viruses including influenza viruses, was also shown to be effective against MERS-CoV and SARS-CoV in mouse models (
28).
Our group has been engaged in the discovery of broad-spectrum inhibitors targeting the 3CLpro of multiple human and animal coronaviruses. We initially generated dipeptidyl and tripeptidyl series of compounds (
29) and observed that the dipeptidyl compound series had superior pharmacokinetic (PK) profiles compared to the tripeptidyl compound series (
20). A representative compound of the dipeptidyl series is GC376, which is currently in clinical development for FIP in cats and COVID-19. The PK characteristics of multiple dipeptidyl compounds similar to compound
6j, including GC376, were examined through an intraperitoneal or subcutaneous administration in animals, including mice. It was determined that their maximum plasma concentration (C
max) values were >100-fold of the EC
50 for the target virus and that the elimination half-life (
T1/2) was 3 to 5 hours. The in vivo efficacy of GC376 against mice infected with MHV or murine norovirus has been demonstrated (
11,
15).
Inspection of previously obtained crystal structures of the dipeptidyl compounds in a complex with coronavirus 3CLpro (
17,
19) revealed the potential to achieve enhanced binding interactions with the S
4 subsite by introducing diverse functionalities at the cap position in the inhibitors. In the current study, a new dipeptidyl series focusing on the design of structural variants in the cap substructure were synthesized and evaluated for their activity against coronavirus 3CLpro. The EC
50 of GC376 against MERS-CoV was determined to be ~1 μM. One of our goals was to generate compounds with near or below 0.1 μM potency against MERS-CoV and other target coronaviruses. All synthesized compounds displayed varying degrees of inhibitory activity against multiple coronaviruses in the FRET enzyme assay and cell-based assays. Among these compounds,
6e showed the most potent antiviral activity against SARS-CoV-2 3CLpro in a FRET enzyme assay (IC
50, 0.17 μM) and cell-based assays (EC
50, 0.15 μM), and
6j showed the most potent antiviral activity against MERS-CoV with an EC
50 value of 0.04 μM (
Table 2).
It was previously demonstrated that optimal potency is attained when the P
1 and P
2 residues are a glutamine surrogate and Leu, respectively, and that replacement of the P
2 Leu with a cyclohexylalanine is inimical to potency (
17,
18). This is clearly evident when comparing the relative potencies of
6h and
7h versus
6i and
7i (
Table 1 and table S1). Furthermore, compounds with Leu at the P
2 position showed higher CC
50 values compared to those with cyclohexylalanine at P
2 (table S1). X-ray crystallography confirmed the mechanism of action of the inhibitors, which involves formation of a covalent bond between the active site cysteine and the carbonyl carbon of the aldehyde. X-ray crystallography also identified the structural determinants associated with binding, accounting for the observed differences in potency. The high-resolution cocrystal structures of 3CLpro inhibitors
7j and
7i with MERS-CoV 3CLpro also confirmed that the difference in activity arose from the loss of a H-bond with Gln
192 and the loss of two additional H-bonds from the displacement of Gln
167 and Phe
143 with
7i (fig. S2A). The nature of the interaction of
7j with the S
4 subsite is unique among the compounds examined and provides strong support for our approach, vis-à-vis our focus on the cap position for enhancing binding affinity and potency. Compound
7j was cocrystallized with MERS-CoV, SARS-CoV, and SARS-CoV-2 3CLpro. Superposition of compound
7j with these 3CLpro enzymes revealed a similar binding mode among all three proteases. However, a key difference lies with the different conformation adopted by the difluorocyclohexyl ring in the MERS-CoV 3CLpro S
4 subsite, enabling it to engage in additional H-bond binding interactions (
Fig. 2E and fig. S4). Compound
7j had a moderately lower potency against SARS-CoV 3CLpro and SARS-CoV-2 3CLpro compared to MERS-CoV 3CLpro in the FRET enzyme assay, suggesting that moieties forming H-bonds that were accommodated at the S
4 subsite had an important impact on potency. The barrier to the development of drug resistance increases when an inhibitor engages in H-bond interactions with the backbone of the 3CLpro.
We used a robust mouse model of MERS-CoV infection (
30–
32) to evaluate the efficacy of compounds
6j and
6h. hDPP4-KI mice expressing human dipeptidylpeptidase 4 were infected with a mouse-adapted MERS-CoV virus (MERS
MA-CoV). The infected mice develop fatal lung disease with severe inflammation and weight loss (
32). Furthermore, the lung pathology caused by MERS
MA-CoV infection of the hDPP4-KI mice closely resembles that of severe human MERS-CoV infection and is characterized by diffuse alveolar damage, pulmonary edema, hyaline membrane formation, and infiltration of lymphocytes into the alveolar septa (
22). In the current study, we demonstrated that survival rates in this mouse model were higher with
6j treatment compared to
6h treatment (
Fig. 3B). Compounds
6j and
6h share a near-identical structure except for the extra methylene group present in compound
6j. Compound
6h showed potent anti-3CLpro activity, whereas the antiviral activity of compound
6h in cell culture was lower than that of compound
6j (
Tables 1 and 2), which may have been the reason for its diminished therapeutic efficacy in the mouse model (
Fig. 3B).
Our findings indicate that therapeutic treatment of infected mice with compound
6j was associated with a reduction in lung viral load and lung pathology (
Fig. 4). Moreover, treatment of mice with
6j at 1 dpi resulted in the survival of infected mice, whereas delaying treatment initiation until 3 dpi resulted in decreased survival. Overall, mouse survival was markedly increased only when
6j was given to mice at 1 dpi (
P < 0.05;
Fig. 3, D and E). Treatment with compound
6j starting at 2 dpi resulted in moderately increased survival of infected mice, but this was not statistically significant (
P > 0.05). These results emphasize the importance of early therapeutic intervention in attaining a positive clinical outcome.
Earlier studies from our group showed that GC376 can cure fatal feline coronavirus disease in cats (
20,
21), demonstrating that a specific coronavirus protease inhibitor can be effective therapeutically against coronavirus disease in a natural host. The MERS-CoV mouse model used here provides proof of principle regarding the therapeutic potential of our protease inhibitors for treating severe human respiratory coronavirus disease. Limitations of the current study include differences in host receptor usage, mortality, and transmissibility between MERS-CoV and SARS-CoV-2. Thus, further evaluation of our protease inhibitors in mice, hamsters, or nonhuman primates experimentally infected with SARS-CoV-2 will be crucial to assess these inhibitors as potential therapeutic options for COVID-19.
Our study showed that these compounds were broadly active against the 3CLpro of several coronaviruses, with compound 6j displaying the highest activity against MERS-CoV and compound 6e displaying the highest activity against SARS-CoV-2. Clinical efficacy is influenced by many factors, including drug bioavailability, PK, metabolism, and the chemical stability of a compound. This poses a major challenge with respect to reliably predicting whether the difference in potency against different coronaviruses in assays in vitro can be translated to differences in clinical efficacy. Therefore, further research is needed to establish whether one protease inhibitor can be an effective therapeutic for both MERS-CoV and SARS-CoV-2 infections in humans. The results from our previous and current studies suggest that the dipeptidyl compound series can serve as a platform suitable for the structure-guided design of one or more inhibitors against highly virulent human coronaviruses. We have generated potent inhibitors of the 3CLpro of several coronaviruses, including SARS-CoV-2, and tested their efficacy in cultured cells and primary human airway epithelial cells. Furthermore, we have demonstrated proof-of-concept therapeutic efficacy for one 3CLpro inhibitor 6j in hDPP4-KI mice infected with MERSMA-CoV. Our study lays the foundation for advancing this compound series further along the drug development pipeline.
MATERIALS AND METHODS
Study design
The goal of this study was to evaluate the efficacy of 3CLpro inhibitors against human coronaviruses, including SARS-CoV-2, in a FRET enzyme assay and cell culture assays, as well as in a mouse model of MERS-CoV infection. Initial antiviral screening was performed with recombinant 3CLpro from SARS-CoV, MERS-CoV, and SARS-CoV-2 in the FRET enzyme assay. Antiviral activity was then assessed in cultured Huh-7 cells infected with MERS-CoV and Vero E6 cells infected with SARS-CoV-2. Selected 3CLpro inhibitors were further examined using x-ray cocrystallization with MERS-CoV, SARS-CoV, and SARS-CoV-2 3CLpro to elucidate the mechanism of action and identify the structural determinants of potency. Last, two selected compounds were evaluated for in vivo efficacy in a mouse model of MERS-CoV infection (hDPP4-KI mice expressing human dipeptidylpeptidase 4 infected with a mouse-adapted MERS-CoV). Age- and sex-matched mice were randomly assigned into various groups for virus infection and treatment studies. Microscopic analysis of lung lesions was conducted in a blinded manner; other experiments were not blinded. No mice were excluded from analysis.
In vivo studies were performed in animal biosafety level 3 facilities at the University of Iowa. All experiments were conducted under protocols approved by the Institutional Animal Care and Use Committee at the University of Iowa according to guidelines set by the Association for the Assessment and Accreditation of Laboratory Animal Care and the U.S. Department of Agriculture.
The studies with MERS-CoV and SARS-CoV-2 were performed in biosafety level 3 facilities at the University of Iowa. All experiments were conducted under protocols approved by the Institutional Biosafety Committee at the University of Iowa according to guidelines set by the Biosafety in Microbiological and Biomedical Laboratories, the U.S. Department of Health and Human Services, the U.S. Public Health Service, the U.S. Centers for Disease Control and Prevention, and the National Institutes of Health.
Synthesis of 3CL protease inhibitors
Compounds
6a to
6k and
7a to
7k were readily synthesized as illustrated in
Fig. 1 and are listed in
Table 1 and table S1. Briefly, the alcohol inputs were reacted with
l-Leucine isocyanate methyl ester or
l-cyclohexylalanine isocyanate methyl ester to yield dipeptides “
2”, which were then hydrolyzed to the corresponding acids with lithium hydroxide in aqueous tetrahydrofuran. The subsequent coupling of the acids to glutamine surrogate methyl ester “
8” (
33,
34) furnished compounds “
4”. Lithium borohydride reduction yielded alcohols “
5”, which were then oxidized to the corresponding aldehydes “
6” with Dess-Martin periodinane reagent. The bisulfite adducts “
7” were generated by treatment with sodium bisulfite in aqueous ethanol and ethyl acetate (
35).
FRET enzyme assay
The expression and purification of the 3CLpro of MERS-CoV and SARS-CoV were performed by a standard method described previously by our lab (
11,
19,
20). We also cloned and expressed the 3CLpro of SARS-CoV-2. The codon-optimized complementary DNA (cDNA) of the full length of 3CLpro of SARS-CoV-2 (GenBank accession number MN908947.3) fused with sequences encoding six histidine at the N terminus was synthesized by Integrated DNA (Coralville, IA). The synthesized gene was subcloned into the pET-28a(+) vector. The expression and purification of SARS-CoV-2 3CLpro were conducted after a standard procedure described by our lab (
19). Briefly, stock solutions of compounds
6a to
6k and
7a to
7k were prepared in dimethyl sulfoxide (DMSO) and diluted in assay buffer, which was composed of 20 mM Hepes buffer (pH 8) containing NaCl (200 mM), EDTA (0.4 mM), glycerol (60%), and 6 mM dithiothreitol (DTT). The protease (3CLpro of MERS-CoV, SARS-CoV, or SARS-CoV-2) was mixed with serial dilutions of each compound or with DMSO in 25 μl of assay buffer and incubated at 37°C for 30 min (MERS-CoV) or at room temperature for 1 hour (SARS-CoV and SARS-CoV-2), followed by the addition of 25 μl of assay buffer containing substrate (FAM-SAVLQ/SG-QXL 520, AnaSpec, Fremont, CA). The substrate was derived from the cleavage sites on the viral polyproteins of SARS-CoV. Fluorescence readings were obtained using an excitation wavelength of 480 nm and an emission wavelength of 520 nm on a fluorescence microplate reader (FLx800, BioTek, Winooski, VT) 1 hour after the addition of substrate. Relative fluorescence units (RFU) were determined by subtracting background values (substrate-containing well without protease) from the raw fluorescence values, as described previously (
19). The dose-dependent FRET inhibition curves were fitted with a variable slope by using GraphPad Prism software (GraphPad, La Jolla, CA) to determine the IC
50 values of the compounds.
Antiviral cell-based assays
Some compounds in the
6a to
6k and
7a to
7k series were also investigated for their antiviral activity against the replication of MERS-CoV, FIPV, or MHV-1 in Huh-7, CRFK, or L929 cells, respectively (
19). Briefly, medium containing DMSO (<0.1%) or each compound (up to 100 μM) was added to confluent cells, which were immediately infected with viruses at a multiplicity of infection (MOI) of 0.01. After incubation of the cells at 37°C for 24 hours, viral titers were determined with the median tissure culture infectious dose (TCID
50) method (FIPV or MHV) with the CRFK or L929 cells or plaque assay with Vero81 cells (MERS-CoV). For SARS-CoV-2, confluent Vero E6 cells were inoculated with ~50 to 100 PFU per well, and medium containing various concentrations of each compound and agar was applied to the cells. After 48 to 72 hours, plaques in each well were counted. EC
50 values were determined by GraphPad Prism software using a variable slope (GraphPad, La Jolla, CA) (
19). To confirm that these inhibitors also inhibit SARS-CoV-2 in primary human cells, differentiated human airway epithelial cells from three donors were used as previously described (
36,
37). Two compounds (
6j and
6e) were tested for their antiviral effects against SARS-CoV-2. Briefly, airway epithelial cells were washed with phosphate-buffered saline (PBS), and SARS-CoV-2 was inoculated at a MOI of 0.1 for 1 hour. After the inoculum was removed, media containing
6j (2 μM) or
6e (0.5 μM) was added. After 48 hours, cells were subjected to a freeze/thaw cycle, and virus titers were determined by plaque assay on Vero E6 cells.
Measurement of cytotoxicity
The 50% cytotoxic concentration (CC50) for compounds 6a to 6k and 7a to 7k was determined in Huh-7, CRFK, or L929 cells. Confluent cells grown in 96-well plates were incubated with various concentrations (1 to 100 μM) of each compound for 72 hours. Cell cytotoxicity was measured by a CytoTox 96 nonradioactive cytotoxicity assay kit (Promega, Madison, WI), and the CC50 values were calculated using a variable slope by GraphPad Prism software. The in vitro therapeutic index was calculated by dividing the CC50 by the EC50.
Protein purification, crystallization, and data collection in x-ray crystallographic studies
MERS-CoV 3CLpro and SARS-CoV 3CLpro were purified as described previously (
17,
19). An
Escherichia coli codon-optimized construct encoding residues Ser
3264 to Phe
3568 of the orf1ab polyprotein (SARS-CoV-2 3CLpro, Genebank accession number QHD43415.1) was cloned into a pET His6 Sumo TEV LIC cloning vector (2S-T, Addgene). Expression and initial Ni-column purification were performed as described for MERS-CoV 3CLpro and SARS-CoV 3CLpro. The Small Ubiquitin-like Modifier protein (SUMO) fusion elution fractions of SARS-CoV-2 were dialyzed against 20 mM tris (pH 8.0) and 100 mM NaCl and treated with the tobacco etch virus (TEV) protease (1:10, w/w) overnight. This mixture was loaded onto a 5-ml HisTrap HP column (GE Healthcare) equilibrated with 20 mM tris (pH 8.0) and 100 mM NaCl and eluted with 20 mM tris (pH 8.0), 100 mM NaCl, and 500 mM imidazole using an ÄKTA Pure fast protein liquid chromatography (FPLC). The flow-through fractions containing SARS-CoV-2 3CLpro without the SUMO fusion were loaded onto a Superdex 75 10/300 GL size exclusion column equilibrated with 20 mM tris (pH 8.0) and 100 mM NaCl. The fractions were pooled and concentrated to 9.6 mg/ml for crystallization screening. Note that four residues from cloning (Ser-Asn-Ile-Gly) remain at the N terminus after treatment with TEV protease.
Purified MERS-CoV 3CLpro, SARS-CoV 3CLpro, and SARS-CoV-2 3CLpro in 100 mM NaCl and 20 mM tris (pH 8.0) were concentrated to 10.6 mg/ml (0.3 mM), 22 mg/ml (0.64 mM), and 9.6 mg/ml (0.28 mM), respectively, for crystallization screening. All crystallization experiments were set up using an NT8 drop-setting robot (Formulatrix Inc.) and UVXPO MRC (Molecular Dimensions) sitting-drop vapor diffusion plates at 18°C. One hundred nanoliters of protein and 100 nl of crystallization solution were dispensed and equilibrated against 50 μl of the latter. Stock solutions (100 mM) of compounds 6b, 6d, 6g, 6h, 7i, and 7j were prepared in DMSO, and complexes were generated by mixing 1 μl of the ligand (2 mM) with 49 μl (0.29 mM) of the protease and incubating on ice for 1 hour. Crystals of the MERS-CoV 3CLpro inhibitor complexes were obtained from the following conditions: compounds 6b, 6d, 6g, and 6h: ProPlex screen (Molecular Dimensions) condition E2 [8% (w/v) poly(ethylene glycol) (PEG) 8000 and 100 mM sodium citrate (pH 5.0)], compound 7i: ProPlex screen (Molecular Dimensions) condition B8 [15% (w/v) PEG 4000, 100 mM sodium citrate (pH 5.0), and 100 mM magnesium chloride], and compound 7j: Index HT screen (Hampton Research) condition F6 [25% (w/v) PEG 3350, 100 mM bis-tris (pH 5.5), and 200 mM ammonium sulfate]. Crystals of the SARS-CoV 3CLpro complex with compound 7j were obtained from the Index HT screen (Hampton Research) condition H8 [15% (w/v) PEG 3350 and 100 mM magnesium formate]. Crystals of the SARS-CoV-2 3CLpro complex with compound 7j were obtained in 1 to 2 days from the PACT HT screen (Molecular Dimensions) condition D7 [20% (w/v) PEG 6000, 100 mM tris (pH 8.0), and 200 mM NaCl]. Samples were transferred to a fresh drop containing 80% crystallant and 20% (v/v) PEG 200 before storing in liquid nitrogen. X-ray diffraction data were collected at the Advanced Photon Source beamline 17-ID using a Dectris PILATUS 6M (MERS-CoV 3CLpro and SARS-CoV 3CLpro) and Dectris EIGER2 X 9M (SARS-CoV-2 3CLpro) pixel array detector.
Solution and refinement of crystal structures
Intensities were integrated using XDS (
38,
39) using autoPROC (
40), and the Laue class analysis and data scaling were performed with Aimless (
41). Structure solution was conducted by molecular replacement with Phaser (
42) using a previously determined structure of MERS 3CLpro [Protein Data Bank (PDB): 5WKK (
17)] and SARS-CoV 3CLpro [PDB: 1Q2W (
43)] and SARS-CoV-2 3CLpro [PDB: 6LU7(
44)] as the search models. Structure refinement and manual model building were conducted with Phenix (
45) and Coot (
46), respectively. Disordered side chains were truncated to the point for which electron density could be observed. Structure validation was conducted with MolProbity (
47), and figures were prepared using the CCP4MG package (
48). Crystallographic data are provided in table S2.
Therapeutic treatment in a mouse model of MERS-CoV infection
The two best compounds (
6j and
6h) in the series were examined for their in vivo efficacy using 10-week-old male hDPP4-KI mice infected with MERS
MA-CoV (
30). In the first study, animals were divided into three groups (
n = 5 to 6) and were lightly anesthetized with ketamine/xylazine and infected with 50 μl of 750 PFU MERS
MA-CoV via intranasal inoculation. Compound
6j or
6h were formulated in 10% ethanol and 90% PEG400 and given to mice from 1 to 10 dpi at 50 mg/kg per day (once per day) via intraperitoneal administration. The control mice received vehicle. Animals were weighed daily and monitored for 15 days. Animals were euthanized when an animal lost 30% of initial weight or at 15 dpi.
In the next study, treatment with compound
6j was delayed up to 3 dpi to determine the impact of delayed treatment on mouse survival. Animals were divided into five groups (
n = 5), and compound
6j (50 mg/kg per day, once per day) was administered to mice starting at 1, 2, or 3 days after virus challenge (1, 2, or 3 dpi, respectively) until 10 dpi. Mice were monitored for weight loss and survival as described above for 15 days after virus challenge. As controls, vehicle (10% ethanol and 90% PEG400) was administered equivalently to the experimental compound, or animals received no treatment (untreated). The third study was conducted to assess the effects of therapeutic treatment of compound
6j in the lungs. For lung harvest and virus titration, animals were divided into three groups (
n = 4) of mice, and compound
6j (50 mg/kg per day, once per day) or vehicle was administered to mice starting at 1 dpi until euthanasia. Animals were euthanized at 3 or 5 dpi, and lungs were removed aseptically, disassociated with a manual homogenizer in 1× PBS, briefly centrifuged, and supernatants removed. Samples were titered on Vero81 cells as reported elsewhere (
49). For lung histopathology analyses, animals were divided into two groups (
n = 5), and compound
6j (50 mg/kg per day, once per day) or vehicle was administered to mice starting at 1 dpi for 5 days. Mice were euthanized at 6 dpi, lungs were fixed with 10% formalin, and hematoxylin and eosin–stained tissues were examined by a veterinary pathologist using the postexamination method of masking (
50). Briefly, tissues were scored in an ordinal manner for edema and hyaline membrane formation using the following scale: 0, none; 1, rare (<5 alveoli); 2, <33% of lung fields; 3, 34 to 66% lung fields; and 4, >66% lung fields (
30).
Statistical analysis
The analysis of survival curves in groups was performed using a log-rank (Mantel-Cox) test and a Gehan-Breslow-Wilcoxon test using GraphPad Prism software (San Diego, CA). Log-transformed viral titers in the lungs and lung edema and hyaline membrane formation in groups of mice were analyzed with multiple t tests using GraphPad Prism software.
Acknowledgements
We thank Rudragouda Channappanavar for performing the initial assays demonstrating drug efficacy against MERS-CoV. We thank D. George for technical assistance.
Funding: This research was supported in part by grants from the NIH (R01 AI109039 to K.-O.C. and P01 AI060699 and R01 AI129269 to S.P.). Use of the University of Kansas Protein Structure Laboratory was supported by a grant from the National Institute of General Medical Sciences (P30GM110761) of the NIH. Use of the IMCA-CAT beamline 17-ID at the Advanced Photon Source was supported by the companies of the Industrial Macromolecular Crystallography Association through a contract with Hauptman-Woodward Medical Research Institute. Use of the Advanced Photon Source was supported by the U.S. Department of Energy, Office of Science, Office of Basic Energy Sciences under contract no. DE-AC02-06CH11357.
Author contributions: K.-O.C., Y.K., S.P., and W.C.G. conceptualized the study; W.C.G. designed the compound series optimization; A.D.R. executed the compound synthesis; S.P. designed the cell culture and animal studies; J.Z. and S.M. investigated the cell culture assays with MERS-CoV and SARS-CoV-2, respectively; J.Z. executed the animal studies with selected compounds, and D.K.M. performed histopathology; S.L. designed the x-ray cocrystallography studies and analysis; S.L., M.M.K., and K.P.B. performed the x-ray cocrystallography. K.-O.C. and Y.K. established the enzyme assays and provided the enzymes for x-ray cocrystallography; Y.K. and K.D.P. performed inhibitor testing in the FRET enzyme assay; K.-O.C., Y.K., W.C.G., and S.L. prepared the original draft of the paper; K.-O.C., Y.K., W.C.G., S.P., and S.L. reviewed and edited the paper.
Competing interests: The authors declare that they have no competing interests. The Kansas State University, the Wichita State University, and the University of Iowa have jointly filed a provisional patent application #63001781 entitled “Broad spectrum antivirals against coronaviruses” that covers compounds
6j and
6h as well as related compounds, with K.-O.C., Y.K., S.P., and W.C.G. as coinventors.
Data and materials availability: All data associated with this study are present in the paper or the Supplementary Materials. Coronavirus 3CLpro enzymes and inhibitors are available from K.-O.C. under a materials transfer agreement with the Kansas State University. Coordinates and structure factors for the 3CLpro inhibitor complexes are deposited in the Worldwide Protein Data Bank (wwPDB) with the following accession codes: MERS-CoV 3CLpro with inhibitor
6b (6VGY),
6d (6VGZ),
6g (6VH0),
6h (6VH1),
7i (6VH2), and
7j (6VH3); SARS-CoV 3CLpro with inhibitor
7j (6W2A); SARS-CoV-2 3CLpro with inhibitor
7j (6XMK). This work is licensed under a Creative Commons Attribution 4.0 International (CC BY 4.0) license, which permits unrestricted use, distribution, and reproduction in any medium, provided that the original work is properly cited. To view a copy of this license, visit
http://creativecommons.org/licenses/by/4.0/. This license does not apply to the figures/photos/artwork or other content included in the article that is credited to a third party; obtain authorization from the rights holder before using this material.