CN107281210B - Application of azithromycin in resisting coronavirus infection - Google Patents

Abstract

The invention relates to application of azithromycin in preparing a medicament for resisting coronavirus infection, application of a medicinal composition containing the azithromycin in preparing a medicament for resisting coronavirus infection or combined application of the azithromycin and other antiviral medicaments.

Description

Application of azithromycin in resisting coronavirus infection

Technical Field

The invention relates to an application of azithromycin in preparing a medicine for resisting coronavirus infection, belonging to the technical field of medicines. The present invention encompasses the use of azithromycin, alone or in combination, in the prevention or treatment of coronaviruses.

Background

The virological classification of coronaviruses (CoV) belongs to the order reticulovirales (Nidovirales) the family Coronaviridae (Coronaviridae) the genus Coronaviridae (Coronavirinae). Coronaviruses are further classified into α -coronavirus, β -coronavirus and γ -coronavirus according to their evolution [ Gorbalenya AE, Enjuanes L, Ziebuhr J, et al. Nidovirales: evolving the largest RNA viral genome. Virus Res.2006,117:17-37 ] (FIG. 1).

Coronaviruses are spherical enveloped viruses with the diameter of 50-200nm, the genome of the coronaviruses is single-stranded positive-strand RNA, and the coronaviruses code for 4 structural proteins: spike protein (S), membrane protein (M), envelope protein (E), and nucleocapsid protein (N). Where the S protein is the only protein responsible for mediating viral entry into the host cell. S is a transmembrane protein with a molecular weight of 128-160kDa, and the S protein is embedded in the virus coat in the form of a trimer. Each S protein is in turn composed of S1 and S2 subunits, of which S1 is highly variable and functions primarily as a binding to host cell surface receptors; s2 is a conserved domain responsible for the fusion process of viruses [ Masters, PS.; perlman, s.coronaviridae.in Knipe, DM.; howley, PM., editors, fields virology, Philadelphia, Lippincott Williams & Wilkins.2013,825-858 ]. When coronaviruses enter the host cell in a pH-dependent manner, genetic material is released to the cytoplasm, allowing its RNA to bind to ribosomes and initiate the translation process due to the structural characteristics of its genomic 5 '-methylation and 3' -poly A sequences [ Sethna PB, Hung SL, Brian DA. Coronavir. subgeneric minus-strand RNAs and the potential for mRNA replication. Proc Natl Acad Sci.1989,86: 5626. sup. 5630. polyprotein). The genome of a coronavirus also encodes a polymerase, and new RNA can be generated using the coronavirus genomic RNA as a template by the polymerase using a host element. When both polyprotein and RNA genomes are synthesized, progeny new viral packaging begins, polyprotein is hydrolyzed by coronavirus proteases to become functional structural proteins, and the newly produced coronavirus buds out, is released outside the cell and begins a new round of infection [ Hogue BG, Machalmer CE. Coronavir structural proteins and virus assembly. in: Perlman S, Gallagher T, snijet EJ, eds. Nidovirus. Washington, DC: ASM Press.2008,179-200 ].

Coronaviruses infect the upper respiratory or digestive tract in mammals and humans. There are six types of coronavirus known to infect humans: human coronavirus OC43(Human coronavirus OC43, HCoV-OC43), Human coronavirus 229E (Human coronavirus 229E, HCoV-229E), Human coronavirus NL63(Human coronavirus NL63, HCoV-NL63), Human coronavirus HKU1(Human coronavirus HKU1, HCoV-HKU1), Severe acute respiratory syndrome coronavirus (Severe acute respiratory syndrome coronavirus, SARS-CoV) and Middle East respiratory syndrome coronavirus (Middle East respiratory syndrome coronavirus, MERS-CoV). After a person is infected with coronavirus, respiratory diseases are generally caused, the first four coronavirus strains generally cause the common cold of the person, and the clinical manifestations of the two coronavirus strains after the person is infected with the coronavirus are highly pathogenic respiratory distress syndrome.

Prior to 2003, it was generally recognized that such viral infections caused a low mortality rate of upper respiratory tract infections in patients. HCoV-229E and HCoV-OC43 are strains isolated from the upper respiratory tract of patients in the sixties of the last century [ McIntosh K.Coronavir: a comparative review. curr Top Microbiol Immunol.1974,63:85-129 ]. Coronaviruses are reported to be prevalent worldwide, with 10-15% of the common colds being caused by coronavirus infection [ Van Der Hoek, l.human coronaviruses: What do the house? Antiviral therapy.2007,12(4Pt B): 651-658; jump up wall, Dennis, The common color A review of The performance, European Journal of Internal medicine 2004,15(2): 79-88.). Human infection with HCoV-OC43, HCoV-229E, HCoV-NL63, or HCoV-HKU1 causes the common cold, and vaccines or specific drugs against these four viruses are currently not available.

Severe Epidemic is caused by spreading severe acute respiratory syndrome coronavirus (SARS-CoV) in China from 11 months to 7 months in 2002, which accounts for 8096 people with 774 deaths among them, and the mortality rate is 9.6% [ "Epidemic and Pandemic Alert and Response (EPR)". World Health Organization ]. The initial symptoms of SARS-CoV infection in patients are fever, muscular soreness, and sore throat. As the condition progresses, the breath is short and breathlessness is followed by pneumonia symptoms of viral pneumonia or bacterial secondary infection. Patients are treated predominantly with interferon and symptomatic or supportive Therapy, and no specific drugs or vaccines have been available to date [ Roberts A, Thomas WD, Guarner J, Lamirande EW, Babcock GJ, Greenough TC, Vogel L, Hayes N, Sullivan JL, Zaki S, Subbarao K, Ambrosin DM. "Therapy with a lung access response syndrome-associated syndrome-virus-neutral-Therapy-J infection, J infection Dis.193(5): 685. ].

The middle east respiratory syndrome coronavirus (MERS-CoV) is another coronavirus that is infectious to humans with high lethality. MERS-CoV was first isolated in saudi arabia in 2012 and was originally named "new coronavirus 2012" [ "ECDC Rapid rise Assessment-segment disease associated with a novel coronavirus".19Feb 2013.Retrieved 22Apr 2014 ]. The virus has emerged in 26 countries, and by 2016 at 3/23 days, there are a total of 1698 diagnosed infections, of which 609 die with a 36% mortality rate [ http:// www.who.int/emergences/mers-cov/en/, WHO ]. Epidemic research results show that bat is the original host of the virus, and the virus is spread from bat to camel and then from camel to human in the mid-nineties of the last century. There is no evidence that the virus can spread interpersonal. The clinical manifestations of respiratory syndrome in the middle east are fever, fever with chills, cough, shortness of breath, muscular soreness, diarrhea, nausea, vomiting, abdominal pain, etc. At present, no MERS-CoV specific medicine exists.

Due to the lack of clinical medication for treating coronavirus infection, the development of drugs for such viruses is of great significance.

Azithromycin (structural formula I) is a 15-membered ring macrolide antibiotic, which is combined with a 50s subunit of a bacterial ribonucleoprotein body to prevent the extension of a peptide chain and influence the synthesis of bacterial protein to achieve the bacteriostatic action, is effective to most gram-positive bacteria, partial negative bacteria and some atypical pathogenic bacteria, and is a drug with the strongest bacteriostatic activity on gram-negative cocci such as gonococcus, meningococcus and the like in the macrolide antibiotic; the effect on gram-negative bacilli is obviously enhanced compared with that of erythromycin. The bacteriostatic action of the azithromycin on the haemophilus influenzae is 4-8 times stronger than that of the erythromycin; has good antibacterial effect on enterobacter and vibrio cholerae. Through retrieval, no report of anti-coronavirus activity of azithromycin is found.

The invention is based on applying coronavirus infected cell model to commonly screen 1600 existing medicines on the market, and is used for finding out a medicine capable of blocking coronavirus from infecting host cells. The invention relates to an application patent of the existing new application of a medicament.

Disclosure of Invention

The invention aims to provide the application of the azithromycin shown in the structural formula (I) in the medicines for preventing or treating the coronavirus, and the application of the pharmaceutical composition containing the azithromycin shown in the structural formula (I) in the medicines for preventing or treating the coronavirus,

in order to solve the technical problem, the invention provides the following technical scheme:

the first aspect of the technical proposal of the invention provides the application of azithromycin shown as a structural formula (I) in the drugs for preventing or treating coronavirus,

the second aspect of the technical proposal of the invention provides the application of the pharmaceutical composition containing the azithromycin shown in the structural formula (I) in the drugs for preventing or treating the coronavirus,

in the above applications, the pharmaceutical composition may further comprise other antiviral agents.

The coronavirus of the first and second aspects of the invention is preferably a human-infecting coronavirus; further, the coronavirus is preferably SARS-CoV (Severe acute respiratory syndrome coronavirus), MERS-CoV (Middle East respiratory syndrome coronavirus) or common cold coronavirus; the common cold-causing coronavirus is preferably Human coronavirus OC43(Human coronavirus OC43), Human coronavirus 229E (Human coronavirus 229E), Human coronavirus NL63(Human coronavirus NL63) and Human coronavirus HKU1(Human coronavirus HKU 1).

The second aspect of the present invention relates to a pharmaceutical composition comprising as an active ingredient a compound according to the first aspect of the present invention. The pharmaceutical composition may be prepared according to methods well known in the art. The compounds of the invention may be formulated into any dosage form suitable for human or animal use by combining them with one or more pharmaceutically acceptable solid or liquid excipients and/or adjuvants. The compounds of the present invention are generally present in the pharmaceutical compositions in an amount of from 0.1 to 95% by weight.

The compounds of the present invention or pharmaceutical compositions containing them may be administered in unit dosage form by enteral or parenteral routes, such as oral, intravenous, intramuscular, subcutaneous, nasal, oromucosal, ophthalmic, pulmonary and respiratory, dermal, vaginal, rectal, and the like.

The dosage form for administration may be a liquid, solid or semi-solid dosage form. The liquid dosage forms can be solution (including true solution and colloidal solution), emulsion (including o/w type, w/o type and multiple emulsion), suspension, injection (including water injection, powder injection and infusion), eye drop, nose drop, lotion, liniment, etc.; the solid dosage form can be tablet (including common tablet, enteric coated tablet, buccal tablet, dispersible tablet, chewable tablet, effervescent tablet, orally disintegrating tablet), capsule (including hard capsule, soft capsule, and enteric coated capsule), granule, powder, pellet, dripping pill, suppository, pellicle, patch, aerosol (powder), spray, etc.; semisolid dosage forms can be ointments, gels, pastes, and the like.

The compound can be prepared into common preparations, sustained release preparations, controlled release preparations, targeting preparations and various particle delivery systems.

For tableting the compounds of the invention, a wide variety of excipients known in the art may be used, including diluents, binders, wetting agents, disintegrants, lubricants, glidants. The diluent can be starch, dextrin, sucrose, glucose, lactose, mannitol, sorbitol, xylitol, microcrystalline cellulose, calcium sulfate, calcium hydrogen phosphate, calcium carbonate, etc.; the wetting agent can be water, ethanol, isopropanol, etc.; the adhesive can be starch slurry, dextrin, syrup, Mel, glucose solution, microcrystalline cellulose, acacia slurry, gelatin slurry, sodium carboxymethylcellulose, methylcellulose, hydroxypropyl methylcellulose, ethyl cellulose, acrylic resin, carbomer, polyvinylpyrrolidone, polyethylene glycol, etc.; the disintegrant can be dry starch, microcrystalline cellulose, low-substituted hydroxypropyl cellulose, crosslinked polyvinylpyrrolidone, crosslinked sodium carboxymethylcellulose, sodium carboxymethyl starch, sodium bicarbonate and citric acid, polyoxyethylene sorbitol fatty acid ester, sodium dodecyl sulfate, etc.; the lubricant and glidant may be talc, silicon dioxide, stearate, tartaric acid, liquid paraffin, polyethylene glycol, and the like.

The tablets may be further formulated into coated tablets, such as sugar-coated tablets, film-coated tablets, enteric-coated tablets, or double-layer and multi-layer tablets.

To encapsulate the administration units, the active ingredient of the compounds of the invention can be mixed with diluents and glidants and the mixture can be placed directly into hard or soft capsules. Or the effective component of the compound of the invention can be prepared into granules or pellets with diluent, adhesive and disintegrating agent, and then placed into hard capsules or soft capsules. The various diluents, binders, wetting agents, disintegrants, glidants used to prepare the compound tablets of the present invention may also be used to prepare capsules of the compound of the present invention.

In order to prepare the compound of the invention into injection, water, ethanol, isopropanol, propylene glycol or the mixture of the water, the ethanol, the isopropanol and the propylene glycol can be used as a solvent, and a proper amount of solubilizer, cosolvent, pH regulator and osmotic pressure regulator which are commonly used in the field can be added. The solubilizer or cosolvent can be poloxamer, lecithin, hydroxypropyl-beta-cyclodextrin, etc.; the pH regulator can be phosphate, acetate, hydrochloric acid, sodium hydroxide, etc.; the osmotic pressure regulator can be sodium chloride, mannitol, glucose, phosphate, acetate, etc. For example, mannitol and glucose can be added as proppant for preparing lyophilized powder for injection.

In addition, colorants, preservatives, flavors, or other additives may also be added to the pharmaceutical preparation, if desired.

The inventors of the present invention have found that azithromycin specifically blocks infection of host cells by coronaviruses.

Can also be used in combination with other antiviral drugs.

For the purpose of administration and enhancing the therapeutic effect, the drug or pharmaceutical composition of the present invention can be administered by any known administration method.

The dosage of the pharmaceutical composition of the compound of the present invention to be administered may vary widely depending on the nature and severity of the disease to be prevented or treated, the individual condition of the patient or animal, the route and dosage form of administration, and the like. Generally, a suitable daily dosage range for a compound of the invention is from 0.001 to 150mg/kg body weight, preferably from 0.1 to 100mg/kg body weight, more preferably from 1 to 60mg/kg body weight, most preferably from 2 to 30mg/kg body weight. The above-described dosage may be administered in one dosage unit or divided into several dosage units, depending on the clinical experience of the physician and the dosage regimen including the use of other therapeutic means.

The compounds or compositions of the present invention may be administered alone or in combination with other therapeutic or symptomatic agents. When the compound of the present invention acts synergistically with other therapeutic agents, its dosage should be adjusted according to actual circumstances.

Advantageous technical effects

Azithromycin has been used clinically as an antibacterial drug for a long time, and has definite safety, drug metabolism characteristics and toxic and side effects. The discovery of the new application of the medicine for resisting coronavirus can quickly enable the medicine to be applied to common cold caused by human coronavirus and high-risk symptom infection caused by human coronavirus, and relieve serious epidemic situation.

Drawings

FIG. 1 Corona Virus Classification

Figure 2 azithromycin blocks SARS-CoV infectious activity

Figure 3 Azithromycin blocks MERS-CoV infectious activity

Detailed Description

Example 1 principle of screening model

The entry of coronaviruses into host cells is the first step in viral infection, and inhibition of viral entry can effectively block viral infection. The coronavirus envelope surface Spike protein (Spike, S) is a key protein for the coronavirus entry process.

We applied SARS-CoV envelope S Gene (SARS-CoV S, Gene Bank: AY278741.1) and MERS-CoV envelope S Gene (MERS-CoV S, Gene Bank: JX869059.2), respectively. Expression of S protein plasmid and HIV core plasmid (pNL 4-3-Luc-R) by Co-transfection ^- E ^- ) SARS-CoV recombinant virus SARS-S/HIV with S Protein as shell wrapping HIV core is available [ Ying Guo, Jennifer Tinosucik, Susanna McReynolds, Michael Farzan, Belliur S.Prahabar, Thomas Gallagher, Lijun Rong and Michael Caffey. identification of a New Region of SARS-CoV S Protein Critical for Viral entry. journal of Molecular biology 2009,394: 600-.]And MERS-CoV recombinant virus MERS-S/HIV [ Grehan K, Ferrara F, Temperton N.an optimized method for the production of MERS-CoV spike expressing viral vectors. methods X.2015,2: 379-.]. The virus particle has the following characteristics: 1) the selectivity of the virus for the host cell depends on the properties of the spike protein S; 2) because env, nef and vpr genes on the HIV vector are deleted, the virus can only enter host cells once and cannot replicate, so the virus is safe; 3) the HIV vectorThe luciferase reporter gene is carried, so that the infected cells express luciferase, and the luciferase activity is detected to indicate the virus infection degree of the cells. Meanwhile, we also prepared VSV-G/HIV recombinant viruses with the glycoprotein of VSV (VSV-G) as the outer membrane protein as a model control group. Specific coronavirus entry inhibitors are considered to be specific when the compounds inhibit HCoV-S/HIV viral entry without significant inhibition of VSV-G/HIV viral entry.

EXAMPLE 2 pharmacodynamic Experimental method for anti-SARS-CoV infection

In the present invention, SARS coronavirus Urbani (Gene Bank: AY278741.1) strain was used. Recombinant virus preparation [ Ying Guo, Jennifer Tisonnik, Susanna McReynolds, Michael Farzan, Belliur S.Prabohaw, Thomas Gallagher, Lijun Rong and Michael Caffey. identification of a New Region of SARS-CoV S Protein criterion for Viral entry. journal of Molecular biology 2009,394: 600-.]: cotransfection of pcDNA3.1/SARS-S plasmid and pNL4-3-Luc-R ^- E ^- Plasmid is transferred to 293T cells, supernatant is collected 48h after transfection, the supernatant is filtered by a 0.45 mu m filter membrane, the supernatant contains SARS-S/HIV virus particles, and the recombinant virus can be used for infection. The VSV-G/HIV recombinant virus was prepared in the same manner.

Infection [ Ying Guo, Jennifer Tisonnik, Susanna McReynolds, Michael Farzan, Belllur S.Prabohaw, Thomas Gallagher, Lijun Rong and Michael Caffey. identification of a New Region of SARS-CoV S Protein criterion for Viral entry. journal of Molecular biology 2009,394: 600-.]: a plasmid expressing human angiotensin transferase II (Homo sapiens ACE2, Gene Bank: AB046569.1) was transferred to 293T cells using a modified calcium phosphate method. The day before infection, the ratio of each well is 6X 10 ⁴ Density of individual cells 293T-ACEII cells were seeded onto 24-well plates. The positive control compound or the compound to be screened is dissolved in DMSO, added to the cell culture medium 15 minutes before infection, and the DMSO solvent is used as a blank control. The cells were infected by addition of appropriate dilutions of virus fluid. After 48 hours of infection, the supernatant was discarded, and then 50. mu.l of cell lysate (Promega) was added to each well of infected cells to lyse the cells, and 30. mu.l of fluorescence was addedAfter mixing the luciferase substrate (Promega) with 20. mu.l of cell lysate, the relative activity of luciferase in the cells was measured by FB15 fluorescence detector (Sirius), and the intensity of the activity reflects the level of virus infection. The results show that azithromycin is effective in inhibiting the infection of host cells by SARS-CoV virus at a median inhibitory concentration of 0.11. mu.M (FIG. 2, Table 1). At a final concentration of 10. mu.M, azithromycin had no inhibitory effect on VSVG/HIV infection.

TABLE 1

Example 3 pharmacodynamic test method for resisting MERS-CoV infection

In the present invention, a strain of Human betaxonavirus 2c EMC/2012(Gene Bank: JX869059.2) was used. Recombinant virus preparation [ Grehan K, Ferrara F, Temperton N.an optimized method for the production of MERS-CoV spike expression viral vectors. MethodsX.2015,2: 379-.]: co-transfection of pCMV3/MERS-S plasmid and pNL4-3-Luc-R ^- E ^- Plasmids are transferred to 293T cells, supernatant is collected 48h after transfection, and the supernatant is filtered through a 0.45 mu m filter membrane, wherein MERS-S/HIV virus particles are contained in the supernatant, and the recombinant virus can be used for infection.

Infection: plasmids expressing human CD26(Gene Bank: NM-001935.3) were transferred to 293T cells using the modified calcium phosphate method. The day before infection, the ratio of each well is 6X 10 ⁴ Density of individual cells 293T-CD26 cells were seeded onto 24-well plates. The positive control compound or the compound to be screened is dissolved in DMSO, added to the cell culture medium 15 minutes before infection, and the DMSO solvent is used as a blank control. The cells were infected by addition of appropriate dilutions of virus fluid. After 48 hours of infection, the supernatant was discarded, 50. mu.l of cell lysate (Promega) was added to each well of the infected cells to lyse the cells, 30. mu.l of luciferase substrate (Promega) was mixed with 20. mu.l of cell lysate and the relative activity of cellular luciferase was measured using an FB15 fluorescence detector (Sirius) instrument, the intensity of the activity reflecting the level of infection by the virus. The results show that azithromycin can effectively inhibit the infection of host cells by MERS-CoV virus, and half of the azithromycin can inhibit the infection of host cellsThe prepared concentration was 0.10. mu.M (FIG. 3, Table 2).

TABLE 2

Example 4 cytotoxicity assays

The cytotoxicity of the azithromycin on 293T cells is measured by an MTS method, and the result shows that the azithromycin has no cytotoxicity at the final concentration of 10 mu M.

Claims (3)

1. The azithromycin with the structural formula (I) is applied to preparing the drugs for resisting the coronavirus infection, the coronavirus is selected from severe acute respiratory syndrome coronavirus SARS-CoV or middle east respiratory syndrome coronavirus MERS-CoV,

2. an application of a pharmaceutical composition in preparing anti-coronavirus infection medicines is characterized in that the pharmaceutical composition contains azithromycin shown as a structural formula (I) and a pharmaceutically acceptable carrier or excipient, the coronavirus is selected from severe acute respiratory syndrome coronavirus SARS-CoV or middle east respiratory syndrome coronavirus MERS-CoV,

3. the use according to claim 2, wherein said pharmaceutical composition further comprises an additional antiviral agent.

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