WO2021211098A1 - Prevention and treatment of viral infection-induced organ failure - Google Patents

Abstract

Compositions for and methods of preventing, reversing or treating viral infection-induced organ failure provided. The compositions and methods employ MG53, which can be in the form of recombinant human MG53. The MG53 may also be administered as a composition that expresses and releases MG53 after in vivo administration of said composition to a subject.

Description

PREVENTION AND TREATMENT OF VIRAL INFECTION-INDUCED ORGAN FAILURE

INCORPORATION BY REFERENCE

[001] In compliance with 37 CFR 1.52(e)(5), the instant application contains Sequence Listings which have been submitted in electronic format via EFS and which are hereby incorporated by reference. The sequence information contained in electronic file named TRIM43PCT_SEQ_ST25.txt, size 1 KB, created on April 14, 2020, using Patent-in 3.5.1, and Checker 4.4.6 is hereby incorporated by reference in its entirety.

STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH

[002] The U.S. Government has certain rights in this invention pursuant to the following grants. This work was supported by grants from the National Institutes of Health (NIH) to Dr. Jianjie Ma (grants No. DK106394, No. AR061385, No. AR070752, and No. HL138570), Department of Defense grant to Dr. Jianj ie Ma (DoD PR170989), and NIH grants to Dr. Jacob S. Yount (grants No. AI130110 and No. AH 42256). This work was also supported by a NIH T32 fellowship to Adam D. Kenney (funded by grant No. GM068412).

FIELD OF THE INVENTION

[003] The present invention concerns compositions for and methods of preventing, reversing, and/or treating viral infection-induced organ failure. A composition comprising (or expressing) a therapeutically effective amount of MG53 is administered to a subject suffering from a viral infection that induces organ failure, thereby preventing, reversing and/or treating organ failure. The invention also provides a method of decreasing the mortality rate in a population of subjects suffering from a viral infection that induces organ failure.

BACKGROUND OF THE INVENTION

[004] The etiology of Organ failure (OF; also referred to as multiple organ dysfunction syndrome (MODS), multiple organ failure (MOF), total organ failure (TOF), multisystem organ failure (MSOF)) has not been fully characterized; however, uncontrolled inflammatory response, uncontrolled immune response, or fibrosis have been suggested as being directly or indirectly causative. Many biomechanistic pathways exist for organ failure, and no broad- spectrum curative or preventative compound (agent, active ingredient) has been found. [005] Viral infection, bacterial infection, or physical injury may cause organ failure. Numerous viruses are known to cause mortality by inducing organ failure in subjects. Such viruses include disseminated herpes simplex virus- 1, Ebolavirus, Marburgvirus, coronavirus (CoV), hemorrhagic viruses, filovirus, rabies virus, AIDS/HIV, smallpox virus, influenza virus (A through D), Hanta virus (Hantavirus pulmonary syndrome), Dengue fever virus, rotavirus, SARS-CoV, MERS-CoV, SARS-CoV-2 (COVID-19), Coronavirus 229E, Coronavirus NI63, Coronavirus Oc43, Yellow fever virus, Lassa fever virus, Japanese encephalitis virus, Spanish influenza virus, Hong Kong influenza, Influenza A & B, Parainfluenza 1-4, Adenovirus, Coxsackievirus, Metapneumovirus, Rhinovirus/enterovirus, Respiratory syncytial virus and others. Some of these viruses target particular organs such as the lung, heart, kidney, and/or liver. For example, in influenza virus and SARS-CoV-2 infections, the primary cause of death is pneumonia and severe acute respiratory distress because the viruses target the lungs; however, multiple organ failure is also observed.

[006] The coronavirus disease 2019 (COVTD-19) outbreak caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a devastating global health emergency. In addition to COVTD-19, the world is continually facing the challenge of seasonal and emergent influenza viruses, and other aggressive viral infections in epidemic proportions on a yearly basis. Irrespective of the origin of viral infection, ARDS and vital organ (including heart, liver, intestine, and kidney) failures are the main cause of morbidity and mortality associated with viral infections. Acute respiratory infections also comprise a large threat for the soldiers and veterans due to exposure, close quarters, and environmental risks. Despite extensive basic and translational research into influenza and coronavirus, a vaccine against coronaviruses has yet to be developed. Moreover, there is not a universal influenza vaccine effective against all influenza virus subtypes due to its high propensity to mutate, requiring seasonal influenza vaccines to be updated annually based on a projection of what strain might be prevalent. The lack of preventive vaccines against these viruses makes emerging influenza and coronaviruses a serious global threat, and calls for alternative therapy to treat virus- induced ARDS and multi-organ failures.

[007] Many studies have shown that SARS-CoV predominantly infects airway and alveolar epithelial cells, vascular endothelial cells, and macrophages. The early onset of rapid viral replication may cause massive epithelial and endothelial cell death and vascular leakage, triggering the event of exuberant “inflammatory cytokine storm”. In addition, SARS-CoV-2 and/or influenza infection may also cause injury and death of macrophages and lymphocytes, which compromise the innate and adaptive immune responses. Inflammatory cytokine storm- induced tissue injuries are a key contributing factor to respiratory dysfunction and multi-organ failure associated with virus infection. Major clinical manifestations of ARDS, including arterial hypoxemia and pulmonary edema, are direct consequences of the disrupted airway and alveolar barrier function. Therefore, effective ARDS treatment and multi-organ protection requires suppressing the virus-induced inflammatory cytokine storm, resolution of alveolar edema, and most critically the restoration of epithelial and endothelial barrier integrity.

[008] Methods of preparing, isolating, and/or using MG53 (mitsugumin 53; TRIM72) are known: US7981866, W02008/054561, W02008/060776, W02009/073808,

W02010/141810, WO2010/009312, US2011/0202033, US2011/0287004, US2011/0287015, US2013/0123340, WO2011/142744, WO2012/061793, US 8420338, US8603993, US8603992, US9139630, US9458465, US9494602, US9505821, US2014/0024594, WO2012/134478, WO2012/135868, US2015/0110778, W02013/036610, US2012/0213737, and WO2016/109638.

[009] US7981866 to Ma suggests that MG53 may have direct antiviral properties; however, the instant inventors have determined, as discussed herein, that MG53 does not have a direct antiviral property (at least in the virus tested herein), because it does not inhibit viral replication in cells infected with influenza virus.

[010] Fibrosis is known to be etiologically related to organ failure. Guo et al. (Exp. Cell Res. (2018), 362(2), 436-443) report that MG53 could induce atrial fibrosis. Chen et al. (J. Cell. Physiol. (2019), 234(10), 17749-17756) report that MG53 causes cardiac fibrosis. Liu et al. (Circ. (2015), 131(9), 795-804) report that cardiac-specific transgenic expression of MG53 induces diabetic cardiomyopathy in mice. Hu et al. (Biochim. Biophys. Acta (2018), 1864(5), part B, 1984-1990) report that sustained upregulation of MG53 disturbs metabolic processes and contributes to the development of muscle metabolic disorders. US8383602 to Kao states that “TRIM72 overexpression inhibits myogenesis” and “the inhibition of TRIM72 acts exclusively on skeletal muscle and heart muscle but does not affect IGF-I signaling pathway in other tissues”.

[Oil] Based upon the above art, the artisan would not expect MG53 to be useful toward preventing, reversing or treating acute or chronic organ failure, and it would be very unexpected to find that MG53 could be used to prevent, reverse or treat viral infection-induced organ failure, be it acute (short-term) or chronic (long-term).

[012] It would be an advancement in the art to provide a method of and composition for preventing, reversing, and/or treating organ failure.

SUMMARY OF THE INVENTION

[013] The present inventors seek to prevent, reverse or treat viral infection-induced organ failure by administration of MG53 or of an MG53 -expressing composition. The compositions and dosage forms herein can achieve said goal(s).

[014] One object of the invention is to provide a recombinant human MG53 (rhMG53) protein for preventing, reversing, and/or treating viral infection-induced organ failure. Another object of the invention is to administer said rhMG53 to a subject having a virus infection that induces organ failure. Another object of the invention is to reduce the mortality rate in a population of subjects infected with a virus that induces fatal organ failure. Yet another object of the invention is to mitigate virus infection-induced fibrosis of one or more organs of a subject infected with a virus that induces organ fibrosis. In order to achieve key objectives, the present invention provides the following technical solutions.

[015] An aspect of the invention provides a method of preventing viral infection-induced organ failure, the method comprising administering to a subject, infected with a virus that induces organ failure, one or more doses of MG53, thereby preventing said organ failure. The subject may or may not have contracted said viral infection before administration of MG53. [016] Another aspect of the invention provides a method of preventing viral infection- induced organ failure, the method comprising administering to a subject, at risk of being infected with a virus that induces organ failure, one or more doses of MG53, thereby preventing said organ failure, said subject not yet having contracted said viral infection prior to administration of MG53.

[017] Another aspect of the invention provides a method of reversing viral infection- induced organ failure, the method comprising administering to a subject, exhibiting (indicated with) viral infection-induced organ failure, one or more doses of MG53, thereby reversing said organ failure. Said subject would have already contracted said viral infection and would already be exhibiting one or more signs/symptoms of failure of one or more organs. [018] Another aspect of the invention provides a method of reducing the mortality rate in a population of subjects having a viral infection that causes mortality due to organ failure, the method comprising administering to subjects of said population one or more doses of MG53, thereby reducing the mortality rate in said population of subjects.

[019] Another aspect of the invention provides a method of mitigating (e.g. ameliorating, treating, curing) virus-infection induced organ fibrosis, which may or may not be fatal, the method comprising administering to a subject, infected with a virus that induces organ fibrosis, one or more doses of MG53, thereby mitigating fibrosis of one or more organs of said subject. [020] In some embodiments, said organ failure is short-term or acute organ failure, meaning organ failure that occurs over a period of hours, days, weeks or up to about three months.

[021] In some embodiments, said organ failure is long-term or chronic organ failure, meaning organ failure that occurs over a period of about three months or more.

[022] MG53 can be administered acutely, chronically or a combination thereof. MG53 can be administered according to any dosing regimen that is clinically and/or therapeutically beneficial to a subject receiving it. It can be administered orally, by injection, intravenously, intratracheally, inhalation, nasal spray, aerosol delivery system, nebulizer, intraarterially, subcutaneously, intramuscularly, rectally, by infusion, directly to a target organ, and/or transdermally.

[023] MG53 can be included in any dosage form or kit suitable for administration to a subject in need thereof. Acceptable dosage forms include injectable, intratracheal , oral, peroral, rectal, spray, topical, transdermal, buccal, aerosol delivery system, and nebulizer. Such dosage forms exhibit one or more release profiles selected from the group consisting of immediate release, rapid release, extended release, sustained release, controlled release, enteric release, and a combination of any thereof. MG53 may be administered systemically or non-systemically.

[024] The methods of invention can further comprise administration of MG53 and one or more antiviral drug(s) to a subject infected with a virus that induces organ failure. Said antiviral drug(s) may be administered in combination with MG53 or separately from MG53. The administration of MG53 and said one or more antiviral drug(s) can be separate, simultaneous, overlapping or sequential. [025] The vims that induces organ failure and/or causes mortality can be selected from the group consisting of positive-sense single-stranded RNA vims ((+)-ss-envRNAV), negative- sense single-stranded RNA vims ((-)-ss-envRNAV), double-stranded DNA vims (ds- DNAV), or positive-sense RNA via DNA vims. In some embodiments, the viral infection is caused by any of the following vims families: Arenaviridae, Arterviridae, Bunyaviridae, Filoviridae, Flaviviridae, Orthomyxoviridae, Paramyxoviridae, Rhabdoviridae, Retroviridae (in particular, Deltaretrovims genus), Coronaviridae, Togaviridae, Herpesviridae, Poxviridae or Hepadnaviridae.

[026] In some embodiments, the (+)-ss-envRNAV is a vims selected from the group consisting of Coronaviridae family, Flaviviridae family, Togaviridae family, and Arterviridae family. In some embodiments, the (+)-ss-envRNAV is a coronavims that is pathogenic to humans. In some embodiments, the coronavims is selected from the group consisting of SARS-CoV, MERS-CoV, COVID-19 (SARS-CoV-2), CoV 229E, CoV NL63, CoV OC43, CoV HKU1, and CoV HKU20.

[027] In some embodiments, the (+)-ss-envRNAV is a vims selected from the group consisting flavivims, Yellow Fever vims, Dengue Fever vims, Japanese Enchephalitis vims, West Nile vims, Zikavims, Tick-borne Encephalitis vims, Kyasanur Forest Disease vims, Alkhurma Disease vims, Omsk Hemorrhagic Fever vims, and Powassan vims.

[028] In some embodiments, the (+)-ss-envRNAV is a Togaviridae family vims selected from the group consisting arborvims, eastern equine encephalomyelitis vims (EEEV), western equine encephalomyelitis vims (WEEV), Venezuelan equine encephalomyelitis vims (VEEV), Chikungunya vims (CHIKV), O’nyong’nvirus (ONNV), Pogosta disease vims, Sindbis vims, Ross River fever vims (RRV) and Semliki Forest vims.

[029] The invention includes embodiments wherein the viral infection is CoV that is pathogenic to humans, e.g. SARS-CoV, MERS-CoV, COVID-19 (SARS-CoV-2), CoV 229E, CoV NL63, CoV OC43, CoV HKU1, and CoV HKU20.

[030] In some embodiments, the (-)-(ss)-envRNAV is a vims selected from the Arenaviridae family, Bunyaviridae family (Bunyavirales order), Filoviridae family, Orthomyxoviridae family, Paramyxoviridae family, or Rhabdoviridae family. [031] In some embodiments, Arenaviridae family vims is selected from the group consisting of Lassa vims, aseptic mengitis, Guanarito vims, Junin vims, Lujo vims, Machupo vims, Sabia vims and Whitewater Arroyo vims.

[032] In some embodiments, Bunyaviridae family vims is selected from the group consisting of Hantavims, and Crimean-Congo hemorrhagic fever orthonairovims.

[033] In some embodiments, Paramyxoviridae family vims is selected from the group consisting of Mumps vims, Nipah vims, Hendra vims, respiratory syncytial vims (RSV), human parainfluenza vims (HPIV), and NDV.

[034] In some embodiments, Orthomyxoviridae family vims is selected from the group consisting of influenza vims (A through C), Isavims, Thogotovims, Quaranjavims, H1N1 vims, H2N2 vims, H3N2 vims, H1N2 vims, Spanish flu vims, Asian flu vims, Hong Kong Flu vims, and Russian flu vims.

[035] In some embodiments, Rhabdoviridae family vims is selected from the group consisting of rabies vims, vesiculovims, Lyssavims, and Cytorhabdovims.

[036] The organ that undergoes vims infection-induced organ failure can be the respiratory system, heart, lung, kidney, gastrointestinal system and/or liver.

[037] In some embodiments, the composition further comprises one or more zinc salts present in an amount sufficient to stabilize MG53 present in the composition. In a composition of the invention, the molar ratio of Zn ions present to MG53 molecules present is at least 2:1, when considering the two zinc ion binding sites present on each MG53 molecule. In some embodiments, the composition comprises a molar ratio of >2: 1 for the moles of Zn to moles of MG53.

[038] In some embodiments, the method of the invention further comprises adjunct administration of with at least one antioxidant, whereby said at least one antioxidant is administered prior to, along with, or after administration of MG53. Accordingly, the method of the invention can further comprise the step of administering at least one antioxidant to a subject. The molar ratio ofMG53 to antioxidant can be in the range of 0.01:1 to 10:1.

[039] In some embodiments, a subject is chronically administered MG53, at least one antioxidant, and at least one zinc salt. The invention also provides a composition comprising MG53, at least one antioxidant, and at least one zinc salt. The molar ratio of MG53 to antioxidant can be in the range of 0.01 : 1 to 10: 1. [040] A composition of the invention can be administered one, two, three or more times per day. It can be administered daily, weekly, monthly, bimonthly, quarterly, semiannually, annually or even longer as needed. It can be administered every other day, five times per week, four times per week, three times per week, two times per week, once daily, twice daily, one to four times daily, continuously, or as frequently or infrequently as needed. The unit dose of each administration is independently selected upon each occurrence from the doses described in this specification or as determined to be therapeutically effective. All combinations of the dosing regimens described are contemplated to be within the scope of the invention.

[041] The composition may be administered one or more times over a treatment period of at least one week. The composition may be administered acutely or chronically. In some embodiments, the chronic administration is at least one weekly, at least once daily, two or more times daily, two or more times per week, or as needed at a dose of about 0.01 mg of MG53/kg of bodyweight to about 10 mg of MG53 /kg of bodyweight.

[042] The invention also provides the methods of treatment herein employing an enteric release composition comprising MG53, at least one enteric release material, and one or more pharmaceutical excipients. Following oral or peroral administration, the enteric release composition can be used to deliver MG53 to the gastrointestinal tract of a subject. The invention also provides a method of preventing, reversing or treating viral infection induced organ failure comprising administering to a subject an effective amount of said enteric release composition.

[043] The invention includes all combinations of the aspects, embodiments and sub embodiments disclosed herein. Other features, advantages and embodiments of the invention will become apparent to those skilled in the art by the following description, accompanying examples and appended claims.

BRIEF DESCRIPTION OF THE FIGURES

[044] The following drawings are part of the present specification and are included to further demonstrate certain aspects of the invention. The invention may be better understood by reference to one or more of these drawings in combination with the detailed description of the specific embodiments presented herein. [045] FIG. 1 depicts a chart of the relative expression of MG53 in THP1 cells. Quantification of reduction in MG53 protein expression following SeV infection (data representative of three independent experiments at the 24 h timepoint and two independent experiments at the 48 h timepoint; mean ± SD; *** p < 0.001, **** p < 0.0001; One sample t-tests).

[046] FIG. 2. depicts a photograph of a gel comparing the effect of Sendai virus (SeV) and influenza virus H1N1 strain PR8 infection upon MG53 expression in THP1 cells.

[047] FIG. 3 depicts a chart of the percentage of SeV-GFP (green fluorescent protein labelled SeV) positive cells. Quantification of percentage of SeV-GFP positive cells (data representative of 4 independent experiments; mean ± SD; unpaired t-test).

[048] FIG. 4A depicts a chart of the percentage of initial body weight over time for mice infected with influenza virus. Mice were infected intranasally with influenza virus PR8 (10 TCID50). MG53 KO mice lost more weight and took longer to recover following PR8 infection compared to controls (n = 12 mice / group, mean ± SE; * = p < 0.05; Multiple t- tests).

[049] FIG. 4B depicts a chart of the viral titer in lung and heart tissue of wild type (WT) and knockout (KO) mice five days after infection with influenza virus. Lung and heart tissues were harvested from mice 5 days post infection. There was no significant difference in viral burden, as shown by comparable viral titers between WT and KO mice (n = 9 WT mice and 10 KO mice; mean±SE; unpaired t-test). Lungs were isolated at 5 days post infection and either fixed for histology or homogenized for viral titer.

[050] FIG. 5 depicts a graph of percent body mass versus time (day) for WT C57BL/6J mice (8 week old Jackson laboratories) intranasally infected with 100 TCID50 Influenza A virus PR8 in 50 ul sterile saline, then intravenously treated with saline as control and rhMG53 (2mg/kg, in saline). See Example 5. Mice were monitored daily for (A) body mass and (B) survival. All untreated infected mice lost weight until death (see FIG. 6); whereas all treated infected mice lost weight during the first half of the 2-week study period but ultimately regained full body weight by the end of the 2-week study period.

[051] FIG. 6 depicts a graph of the survival rate of the mice of FIG. 5. All untreated infected mice died by day-8; whereas almost all treated infected mice survived beyond the 2- week endpoint of the study. [052] FIG. 7 depicts a chart of the viral titer of TCID50 in the lung tissue of the mice of FIG. 5 at day 7 post infection. There was no substantial difference in viral titer between treated and untreated infected mice.

[053] FIG. 8 depicts photographs of lung tissue after Trichrome staining after the mice of FIG. 5 were euthanized and lung tissues were collected. The Trichrome staining showed the extent of fibrosis (stained blue lesions) in the lungs. rhMG53 treatment (right) reduced the formation of viral infection-induced fibrosis as compared to saline control (left).

DETAILED DESCRIPTION OF THE INVENTION

[054] Hereinafter, preferred embodiments of the present invention will be described in detail with reference, as needed, to the accompanying figures.

[055] MG53 protein (also referred to as mitsugumin 53 or TRIM72) is known in the art. Unless specified otherwise, all embodiments of the invention comprising or employing “MG53” include all known forms of MG53. It also refers to recombinant human MG53 (rhMG53). As used herein and unless otherwise specified, the term MG53 (or MG53 protein) refers to the MG53 protein present as the native form, optimized form thereof, mutant thereof, derivative thereof or a combination of any two or more of said forms. Native MG53 contains 477 amino acids that are well conserved in different animal species. Methods of preparing and/or isolating MG53 are known: US 7981866, W02008/054561, W02009/073808, US2011/0202033, US2011/0287004, US2011/0287015, US2013/0123340,

WO20 11/142744, WO2012/061793, US 8420338, US 9139630, US 9458465, US 9494602, US2014/0024594, WO2012/134478, WO2012/135868, US2015/0110778, W02013/036610, US2012/0213737, WO2016/109638, the entire disclosures of which, including sequence information therein, are hereby incorporated by reference.

[056] The sequence listing information for native MG53, and variants or various forms thereof, is disclosed in US7981866 and US9139630, the entire disclosures of which, including sequence information therein, are hereby incorporated by reference. The sequence listing information for a cDNA that encodes optimized native human MG53, or a fragment thereof, is disclosed in US9139630, the entire disclosure of which, including sequence information therein, is hereby incorporated by reference.

[057] As used herein in reference to MG53, the term “mutant” means a recombinant form of MG53 having an amino acid change (replacement) of one, two, three or more amino acids in the amino acid sequence of native MG53. Mutant forms of MG53 and methods of preparing the same are known: US2015/0361146, EP3118317, WO2015/131728, US9139630, the entire disclosures of which, including sequence information therein, are hereby incorporated by reference.

[058] As used herein the term “endogenous MG53”, refers to MG53 present in a subject prior to treatment with a composition or method according to the invention. As used herein, exogenous MG53 is nonendogenous MG53.

[059] As used herein, a subject at risk of viral infection is: a) a subject living in a geographical area within which mosquitos, in particular Aedes species ( Aedes egypti, Aedes albopictus ) mosquitos, live; b) a subject living with or near a person or people having viral infection; c) a subject having sexual relations with a person having a viral infection; d) a subject living in a geographical area within which ticks, in particular Ixodes species {Ixodes marx, Ixodes scapularis, or Ixodes cooke species) ticks, live; e) a subject living in a geographical area within which fruit bats live; f) subj ects living in a tropical region; g) subj ects living in Africa; h) subjects in contact with bodily fluids of other subjects having a viral infection; i) a child; or j) a subject with a weakened immune system. In some embodiments, the subject is a female, a female capable of getting pregnant, or a pregnant female.

[060] As used herein, the term “subj ecf ’ is taken to mean warm blooded creatures such as mammals, for example, cats, dogs, mice, guinea pigs, horses, bovine cows, sheep, and humans.

[061] The present inventors have unexpectedly discovered that virus infection-induced organ failure can be prevented, reversed or treated by administration of MG53 to a subject having a virus infection that causes organ failure.

[062] An in vitro viral assay was developed (Example 1) to determine whether MG53 expression is altered in THP1 cells upon infection with SeV (Sendai virus). We observed that SeV infection reduced MG53 protein expression by more than 50% (FIG. 1). This suggests that MG53 levels in cells are decreased during certain viral infections.

[063] We then compared the effects of SeV and influenza H1N1 strain PR8 infection on MG53 expression in THP1 cells (Example 2). We observed that SeV infection consistently led to reduced MG53 protein levels in THP1 cells, but influenza infection did not appear to induce a significant decrease in MG53 in THP1 cells (FIG. 2). This demonstrates that alterations in MG53 levels is virus-specific and suggests that certain viruses may manipulate MG53 levels.

[064] We then determined whether endogenous MG53 affects the infection rate of cells by SeV (Example 3). shRNA was used to knock down the expression of MG53 in THP1 cells and, in doing so, confirmed that MG53 is also expressed in undifferentiated THP1 cells. Control shRNA (sh-control) and sh-MG53 knockdown THP1 cells were infected with SeV expressing GFP for 24 h. Cells were collected and examined by flow cytometry for GFP fluorescence, indicative of virus infection and virus protein production. We observed that knockdown of MG53 did not significantly affect the percentage of cells infected with virus as compared to sh-control cells, thereby indicating similar infection rates of sh-MG53 and sh- control THP1 cells (FIG. 3). This is indicative of the absence of a direct antiviral effect by MG53.

[065] We then determined whether MG53 plays a physiological role during in vivo viral infection, MG53 wild type (WT) and knockout (KO) mice were intranasally infected with influenza virus strain PR8 at a dose of 10 tissue culture infectious dose 50 (TCID50) (Example 4). This dose causes weight loss in WT mice, peaking around day 10, followed by a full recovery of body weight. Even though MG53 has no direct antiviral activity, we observed in MG53 KO mice a more severe decrease in weight following infection and a delayed recovery compared to WT mice (FIG. 4A). This suggests that MG53 provides defense against morbidity during respiratory infection with influenza virus.

[066] We then determined whether differences in virus replication and dissemination were responsible for worsened morbidity in KO mice. Virus titers were measured from lung and heart tissues 5 days post infection. WT and KO mice showed no significant difference in virus titers across tissues (FIG. 4B), suggesting comparable levels of viral replication and dissemination at this time point post infection. This is further evidence that MG53 does not possess a direct antiviral effect.

[067] We then determined whether exogenously administered MG53 might decrease mortality in mice infected with a lethal dose of influenza virus (Example 5). The mice were divided into two groups with each group receiving the same dose of influenza virus (100 TCID50 influenza A virus H1N1 strain PR8. The control group was not administered MG53, and the test group was administered exogenous MG53 (dose: 2mg/kg). The body weight of the mice was monitored (FIG. 5). [068] After 8 days, all of the untreated mice had died, and all of the treated mice survived (FIG. 6). By day-14, all of the treated mice had completely recovered. Bodyweight of those mice was also recorded (FIG. 5). The treated mice were then euthanized. Post-mortem examination of the lung and heart of control and test mice was conducted. It was determined that the untreated control mice died of organ failure.

[069] The viral TCID50 titer for the lung tissue of all mice was calculated using the classic Reed & Muench method. Data demonstrated that saline and rhMG53 treated mice exhibited the same viral titer in the lung tissue (FIG. 7). This indicates that MG53 does not possess direct antiviral activity.

[070] Lungs were collected from the euthanized mice and stored in 4% PFA for histological analysis. Lung tissue Trichrome staining (Example 13) showed the lungs derived from mice treated with rhMG53 (FIG. 8: right) have less viral infection-induced fibrosis as compared to untreated saline control mice (FIG. 8: left).

[071] Since viral infection may induce long-term (chronic) organ failure by fibrosis, the invention also provides a method of mitigating viral infection-induced organ fibrosis, which might or might not be fatal. Contrary to what is suggested in the art, administration of exogenous MG53 is useful for preventing, reversing or treating long-term organ failure, in particular for mitigating viral infection induced organ fibrosis. A subject having a viral infection that induces organ fibrosis is administered MG53 according to a dosing regimen as described herein. As a result, virus infection-induced fibrosis in the subject’s organ is reduced (reversed) or progression of fibrosis is slowed or delayed compared to what might be expected (based upon comparison to an average population of subjects having said viral infection) had the subject not been administered MG53.

[072] The invention thus provides a method of preventing, reversing or treating organ failure, in particularly short-term or acute organ failure, in a subject infected with a virus that causes said organ failure. It also provides a method reducing the mortality rate in a population of subjects infected with a virus that causes said organ failure. It also provides a method of mitigating or reducing viral infection-induced organ fibrosis in a subject infected with a virus that causes organ fibrosis.

[073] If a clinician intends to treat a subject with a combination of MG53 (MG53- containing composition) and one or more other antiviral agents, and it is known that the organ failure-inducing viral infection, which the subject has, is at least partially therapeutically responsive to treatment with said one or more other antiviral agents, then the present method invention comprises: administering to the subject in need thereof a therapeutically relevant dose of MG53 (MG53-containing composition or MG-53-expressing composition) and a therapeutically relevant dose of said one or more other antiviral agents, wherein the MG53 is administered according to a first dosing regimen and the one or more other antiviral agents is administered according to a second dosing regimen. In some embodiments, the first and second dosing regimens are the same. In some embodiments, the first and second dosing regimens are different.

[074] Methods of the invention include separate administration or coadministration of the MG53 with at least one other known antiviral composition, meaning the MG53 can be administered before, during or after administration of a known antiviral composition. In some embodiments, a composition for treating symptoms associated with the viral infection can also be administered to the subject to which MG53 is being administered. For example, medications used to treat inflammation, vomiting, nausea, headache, fever, diarrhea, nausea, hives, conjunctivitis, malaise, muscle pain, joint pain, seizure, or paralysis can be administered with or separately from the antiviral composition of the invention.

[075] The one or more other antiviral agents can be administered at doses and according to dosing regimens that are clinician-recognized as being therapeutically effective or at doses that are clinician-recognized as being sub-therapeutically effective. The clinical benefit and/or therapeutic effect provided by administration of a combination of MG53 and one or more other antiviral agents can be additive or synergistic, such level of benefit or effect being determined by comparison of administration of the combination to administration of the individual MG53 and one or more other antiviral agents. The one or more other antiviral agents can be administered at doses and according to dosing regimens as suggested or described by the Food and Drug Administration, World Health Organization, European Medicines Agency (E.M.E.A.), Therapeutic Goods Administration (TGA, Australia), Pan American Health Organization (PAHO), Medicines and Medical Devices Safety Authority (Medsafe, New Zealand) or the various Ministries of Health worldwide.

[076] Exemplary other antiviral agents that can be included in the method (and/or composition) of the invention for the treatment of viral infection-induced organ failure include antiretroviral agent, interferon alpha (IFN-a), zidovudine, lamivudine, cyclosporine A, CHOP with arsenic trioxide, sodium valproate, methotrexate, azathioprine, one or more symptom alleviating dmg(s), steroid sparing drug, corticosteroid, cyclophosphamide, immunosuppressant, anti-inflammatory agent, Janus kinase inhibitor, tofacitinib, calcineurin inhibitor, tacrolimus, mTOR inhibitor, sirolimus, everolimus, IMDH inhibitor, azathioprine, leflunomide, my cophenol ate, biologic, abatacept, adalimumab, anakinra, certolizumab, etanercept, golimumab, infliximab, ixekizumab, natalizumab, rituximab, secukinumab, tocilizumab, ustekinumab, vedolizumab, monoclonal antibody, basiliximab, daclizumab, polyclonal antibody, nucleoside analogs, reverse transcriptase inhibitor, emtricitabine, telbivudine, abacavir, adefovir, didanosine, emtricitabine, entecavir, stavudine, tenofovir, azithromycin, macrolide-type antibiotic, protease inhibitor, interferon, immune response modifier, mRNA synthesis inhibitor, protein synthesis, inhibitor, thiazolide, CYP3A4 inhibitor, heterocyclic biguanidine, CCR5 receptor inhibitor, and combinations thereof. Therapies studied also include plasmapheresis and/or radiation. Antibodies to specific viruses may also be administered to a subject treated with the antiviral composition of the invention. Plasma obtained from the blood of survivors of a first viral infection can be administered to other subjects having the same type of viral infection, said other subjects also being administered the antiviral composition of the invention. For example, the plasma from a survivor of COVID-19 infection may be administered to another subject having a COVID-19 infection, said other subject also being administered the MG53 composition of the invention. [077] MG53 may be administered to a subject in many different forms.

[078] Since MG53 can be degraded by proteases in the GI tract or by the acidic conditions of the stomach, MG53 may be administered a probiotic composition whereby a safe microbe is engineered to express MG53. The probiotic composition is then administered orally (perorally) to a subject such that the microbe expresses MG53 in the GI tract of a subject. Exemplary probiotic compositions are disclosed in international application No. PCT/US2019/060684 to Ma, the entire disclosure of which is hereby incorporated by reference.

[079] As another means of providing MG53 to the intestinal tract downstream of the stomach, an enteric release (ER) composition comprising MG53 was developed. The ER composition comprises MG53, an enteric release pharmaceutical excipient, and a cyclodextrin. In particular embodiments, the ER composition comprises MG53, at least one enteric release polymer, and at least one cyclodextrin derivative. [080] In particular embodiments, the enteric release polymer is a copolymer of methacrylic acid and methyl methacrylate. In particular embodiments, the enteric release polymer has a dissolution pH of > about 5, > about 5.5, > about 6, > about 6.5, or > about 7.

[081] In particular embodiments, the cyclodextrin derivative is water soluble. In particular embodiments, the cyclodextrin derivative is hydroxypropyl-beta-cyclodextrin.

[082] The amount of therapeutic compound (MG53) incorporated in each dosage form will be at least one or more unit doses and can be selected according to known principles of pharmacy. An effective amount of therapeutic compound is specifically contemplated. By the term "effective amount", it is understood that, with respect to, for example, pharmaceuticals, a pharmaceutically (therapeutically) effective amount is contemplated. A pharmaceutically effective amount is the amount or quantity of a drug or pharmaceutically active substance which is sufficient to elicit the required or desired therapeutic response, or in other words, the amount which is sufficient to elicit an appreciable biological response when administered to a patient.

[083] Suitable concentrations of MG53 in a liquid dosage form include at least 1 ng of MG53/ml, at least 5 ng of MG53/ml, at least 10 ng of MG53/ml, at least 25 ng of MG53/ml, at least 50 ng of MG53/ml, at least 75 ng of MG53/ml, at least 100 ng of MG53/ml, at least 250 ng of MG53/ml, at least 500 ng of MG53/ml, at least 750 ng of MG53/ml, at least 1 Dg of MG53/ml, at least 5 Dg of MG53/ml, at least 10 Dg of MG53/ml, at least 15 Dg of MG53/ml, atleast20 DgofMG53/ml, atleast25 DgofMG53/ml, atleast30 DgofMG53/ml, at least 50 Dg of MG53/ml, or at least 100 Dg of MG53/ml. Higher concentrations are also acceptable, particularly in view the efficacy dose-response trend observed for MG53. These doses can be administered on a frequency as described herein or as determined to be most effective.

[084] A dosing regimen includes a therapeutically relevant dose (or effective dose) of MG53 administered according to a dosing schedule. A therapeutically relevant dose, therefore, is a therapeutic dose at which a therapeutic response of the organ failure to treatment with a composition as described is observed and at which a subject can be administered said composition without an excessive amount of unwanted or deleterious side effects. A therapeutically relevant dose is non-lethal to a subject, even though it may cause some side effects in the patient. It is a dose at which the level of clinical benefit to a subject being administered said composition exceeds the level of deleterious side effects experienced by the subject due to administration of said composition or component(s) thereof. A therapeutically relevant dose will vary from subject to subject according to a variety of established pharmacologic, pharmacodynamic and pharmacokinetic principles.

[085] A therapeutically relevant dose can be administered according to any dosing regimen typically used in the treatment of viral infection. A therapeutically relevant dose can be administered once, twice, thrice or more daily. It can be administered every other day, every third day, every fourth day, every fifth day, semiweekly, weekly, biweekly, every three weeks, every four weeks, monthly, bimonthly, semimonthly, every three months, every four months, semiannually, annually, or according to a combination of any of the above to arrive at a suitable dosing schedule. For example, a therapeutically relevant dose can be administered one or more times daily (up to 10 times daily for the highest dose) for one or more weeks.

[086] Suitable doses of MG53 that can be administered to a subject in one or more dosage forms include at least 1 ng of MG53, at least 5 ng of MG53, at least 10 ng of MG53, at least 25 ng of MG53, at least 50 ng of MG53, at least 75 ng of MG53, at least 100 ng of MG53, at least 250 ng of MG53, at least 500 ng of MG53, at least 750 ng of MG53, at least 1 Dg of MG53, at least 5 Dg of MG53, at least 10 Dg of MG53, at least 15 Dg of MG53, at least 20 □ g of MG53, at least 25 Dg of MG53, at least 30 Dg of MG53, at least 50 Dg of MG53, or at least 100 Dg of MG53. Such doses can be on a total body weight basis or a per kg of body weight basis.

[087] The dose of exogenous MG53 can be as low as about 1 microg per kg of body weight up to about 1000 microg per kg of body weight.

[088] The term "unit dosage form" is used herein to mean a dosage form containing a quantity of the MG53, said quantity being such that one or more predetermined units may be provided as a single therapeutic administration.

[089] The dosage form is independently selected at each occurrence from the group consisting of liquid solution, suspension, tablet, pill, vial, powder, granule, bead, caplet, capsule, sachet or powder.

[090] Compositions and dosage forms of the invention can further comprise one or more pharmaceutically acceptable excipients. Dosage forms can comprise one or more excipients independently selected at each occurrence from the group consisting of acidic agent, alkaline agent, buffer, tonicity modifier, osmotic agent, water soluble polymer, water-swellable polymer, thickening agent, complexing agent, chelating agent, penetration enhancer. Suitable excipients include U.S.F.D.A. inactive ingredients approved for use in parenteral or oral formulations (dosage forms), such as those listed in the U.S.F.D.A.’s “Inactive Ingredients Database (available on the following website: https://www.fda.gov/Drugs/InformationOnDrugs/ucml l3978.htm: Oct. 2018), the entire disclosure of which is hereby incorporated by reference.

[091] As used herein, an acidic agent is a compound or combination of compounds that comprises an acidic moiety. Exemplary acidic agents include organic acid, inorganic acid, mineral acid and a combination thereof. Exemplary acids include hydrochloric acid, hydrobromic acid, sulfuric acid, sulfonic acid, sulfamic acid, phosphoric acid, or nitric acid or others known to those of ordinary skill; and the salts prepared from organic acids such as amino acids, acetic acid, propionic acid, succinic acid, glycolic acid, stearic acid, lactic acid, malic acid, tartaric acid, citric acid, ascorbic acid, pamoic acid, maleic acid, hydroxymaleic acid, phenylacetic acid, glutamic acid, benzoic acid, salicylic acid, sulfanilic acid, 2- acetoxybenzoic acid, fumaric acid, toluenesulfonic acid, methanesulfonic acid, ethane disulfonic acid, oxalic acid, isethionic acid, others acids known to those of ordinary skill in the art, or combinations thereof.

[092] As used herein, an alkaline agent is a compound or combination of compounds that comprises an alkaline moiety. Exemplary alkaline agents include primary amine, secondary amine, tertiary amine, quaternary amine, hydroxide, alkoxide, and a combination thereof. Exemplary alkaline agents include ammonia solution, ammonium carbonate, diethanolamine, monoethanolamine, potassium hydroxide, sodium borate, sodium carbonate, sodium bicarbonate, sodium hydroxide, triethanolamine, diethanolamine, monobasic phosphate salt, dibasic phosphate salt, organic amine base, alkaline amino acids and trolamine, others known to those of ordinary skill in the art, or combinations thereof.

[093] Exemplary excipients (inactive ingredients as defined by the U.S.F.D.A.) that can be included in dosage forms of the invention include, by way of example and without limitation, water, benzalkonium chloride, glycerin, sodium hydroxide, hydrochloric acid, boric acid, hydroxyalkylphosphonate, sodium alginate, sodium borate, edetate disodium, propylene glycol, polysorbate 80, citrate, sodium chloride, polyvinylalcohol, povidone, copovidone, carboxymethylcellulose sodium, Dextrose, Dibasic Sodium Phosphate, Monobasic Sodium Phosphate, Potassium Chloride, Sodium Bicarbonate, Sodium Citrate, Calcium Chloride, Magnesium Chloride, stabilized oxychloro complex, Calcium Chloride Dihydrate, Erythritol, Levocamitine, Magnesium Chloride Hexahydrate, Sodium Borate Decahydrate, Sodium Citrate Dihydrate, Sodium Lactate, Sodium Phosphate (Mono- and Dibasic-), Polyethylene Glycol 400, Hydroxypropyl Guar, Polyquatemium-1, Zinc Chloride, white petrolatum, mineral oil, hyaluronic acid, artificial tear, or combinations thereof.

[094] One or more antioxidants can be included in a composition or dosage form of the invention. Exemplary antioxidants include SS-31, NAC, glutathione, selenium, vitamin A, vitamin C, vitamin E, co-enzyme Q10, resveratrol, other GRAS antioxidant, or a combination of two or more thereof.

[095] One or more zinc salts can be included in a composition or dosage form of the invention. Such zinc salt(s) may also be administered to a subj ect receiving exogenous MG53 or expressed MG53. Pharmaceutically acceptable zinc salts include Zinc gluconate, Zinc acetate, Zinc sulfate, Zinc picolinate, Zinc orotate, Zinc citrate, and other such salts comprising a zinc cation and organic or inorganic anion(s).

[096] It should be understood, that compounds used in the art of pharmaceutical formulations generally serve a variety of functions or purposes. Thus, if a compound named herein is mentioned only once or is used to define more than one term herein, its purpose or function should not be construed as being limited solely to that named purpose(s) or function(s).

[097] As used herein, "pharmaceutically acceptable salts" refer to derivatives of the disclosed compounds wherein the compound is modified by making an acid or base salt thereof. Examples of pharmaceutically acceptable salts include, but are not limited to, mineral or organic acid salts of basic residues such as amines; alkali or organic salts of acidic residues such as carboxylic acids; and others known to those of ordinary skill. The pharmaceutically acceptable salts can be synthesized from the parent therapeutic compound which contains a basic or acidic moiety by conventional chemical methods. Lists of suitable salts are found in Remington's Pharmaceutical Sciences, 17th ed., Mack Publishing Company, Easton, PA, 1985, p. 1418, the disclosure of which is hereby incorporated by reference.

[098] The phrase "pharmaceutically acceptable" is employed herein to refer to those compounds, materials, compositions, and/or dosage forms which are, within the scope of sound medical judgment, suitable for use in contact with the tissues of human beings and animals without excessive toxicity, irritation, allergic response, or other problem or complication, commensurate with a reasonable benefit/risk ratio.

[099] The therapeutically acceptable dose, maximum tolerated dose (MTD), and minimally effective dose (MED) for each of said active ingredients is well known and set forth in the respective U.S.F.D.A. approved product package insert for each said active ingredients. [0100] A composition, dosage form or formulation of the invention can include one, two or more active ingredients in combination with MG53. The dose of each said active ingredient in said composition, dosage form or formulation of the invention will be a therapeutically effective dose including and above the MED and including and below the MTD.

[0101] In some embodiments, the combination treatment of MG53 with another active ingredient provides at least additive therapeutic efficacy. In some embodiments, said combination provides synergistic therapeutic efficacy. In some embodiments, MG53 reduces the occurrence of, reduces the level of, or eliminates adverse events caused by the other active ingredient.

[0102] The acceptable concentrations of said excipients are well known in the art and specific concentrations (amounts) thereof are set forth in the package insert or package label of known commercial products containing the same.

[0103] It should be understood that compounds used in the art of pharmaceutics may serve a variety of functions or purposes. Thus, if a compound named herein is mentioned only once or is used to define more than one term herein, its purpose or function should not be construed as being limited solely to that named purpose(s) or function(s).

[0104] As used herein, the terms “about” or “approximately” are taken to mean a variation or standard deviation of ±10%, ±5%, or ±1% of a specified value. For example, about 20 mg is taken to mean 20 mg ±10%, which is equivalent to 18-22 mg.

[0105] As used herein, the term “prodrug” is taken to mean a compound that, after administration, is converted within a subject’s body, e.g. by metabolism, hydrolysis, or biodegradation, into a pharmacologically active drug. The prodrug may be pharmacologically active or inactive. For example, a prodrug of MG53 (native or mutant) would be converted to the native form or mutant form, respectively, of MG53. The term “precursor” may also be used instead of the term “prodrug”. [0106] As used herein, the term “derivative” is taken to mean: a) a chemical substance that is related structurally to a first chemical substance and theoretically derivable from it; b) a compound that is formed from a similar first compound or a compound that can be imagined to arise from another first compound, if one atom of the first compound is replaced with another atom or group of atoms; c) a compound derived or obtained from a parent compound and containing essential elements of the parent compound; or d) a chemical compound that may be produced from first compound of similar structure in one or more steps. For example, a derivative may include a deuterated form, oxidized form, dehydrated, unsaturated, polymer conjugated or glycosilated form thereof or may include an ester, amide, lactone, homolog, ether, thioether, cyano, amino, alkylamino, sulfhydryl, heterocyclic, heterocyclic ring-fused, polymerized, pegylated, benzylidenyl, triazolyl, piperazinyl or deuterated form thereof. [0107] In the examples below, ranges are specified for the amount of each ingredient. Ranges including “0” as the lowest value indicate an optional ingredient. The lower limit “>0” indicates the respective material is present.

[0108] Compositions with quantities of ingredients falling within the compositional ranges specified herein were made. Compositions of the invention comprising quantities of ingredients falling within the compositional ranges specified herein operate as intended and as claimed.

[0109] In view of the above description and the examples below, one of ordinary skill in the art will be able to practice the invention as claimed without undue experimentation. The foregoing will be better understood with reference to the following examples that detail certain procedures for the preparation and use of compositions according to the present invention. All references made to these examples are for the purposes of illustration. The following examples should not be considered exhaustive, but merely illustrative of only a few of the many embodiments contemplated by the present invention. The methods described herein can be followed to prepare and use compositions of the invention and to practice methods of the invention.

[0110] MG53 was kindly provided by TRIM-edicine, Inc. (1275 Kinnear RD, Columbus OH 43212-1155, U.S.A.). We thank Dr. Wayne Chen for providing the doxycycline inducible RyR2 expressing HEK293 cells, Drs. Juan Moliva and Jordi Torrelles for providing the primary human blood monocyte-derived macrophage protein lysates, and Dr. Dominique Garcin for providing SeV-GFP. EXAMPLE 1

In vitro assay in THP1 cells: SeV

[0111] Sendai virus (SeV) expressing GFP, SeV strain Cantell, PR8 were propagated in embryonated chicken eggs and titered on LLCMK2 cells for SeV and MDCK cells for influenza virus. SeV-GFP and SeV infections were allowed to proceed for 24 or 48 hours using multiplicity of infections (MOIs) of 2 and 5 respectively. 24 hrs post SeV-GFP infection, THP1 cells were washed in PBS and fixed using 4% paraformaldehyde. Cells were washed, resuspended in PBS, and analyzed with a FACSCanto II flow cytometer (BD Biosciences) to determine the percentage of GFP positive cells. Data was analyzed using FlowJo software.

EXAMPLE 2

In vitro assay in THP1 cells: SeV and H1N1 influenza [0112] Sendai virus (SeV) expressing GFP, SeV strain Cantell, and influenza virus strain PR8 were propagated in embryonated chicken eggs and titered on LLCMK2 cells for SeV and MDCK cells for influenza virus. SeV-GFP and SeV infections were allowed to proceed for 24 or 48 hours using multiplicity of infections (MOIs) of 2 and 5 respectively. 24 hrs post SeV-GFP infection, THP1 cells were washed in PBS and fixed using 4% paraformaldehyde. Cells were washed, resuspended in PBS, and analyzed with a FACSCanto II flow cytometer (BD Biosciences) to determine the percentage of GFP positive cells. Data was analyzed using FlowJo software.

EXAMPLE 3

Knockdown of MG53 in THP1 cells

[0113] Control shRNA (SEQ ID 1: 5’-GACTGACATGTCAAGCTGTAC-3’) and MG53 shRNA (SEQ ID 2: 5'- GAAGAGTGTGGCTGTGCTGGAGCATCAGC-3 ’) were ligated into pKLO-mcherry-puro vector. In brief, HEK293-FT cells were transfected with packaging, envelope, and target plasmids. Media was changed 18 hours after transfection, followed by collection of virus-containing media 48 hours later. Virus-containing media was centrifuged at 1200 x g for 5 min and filtered with 0.45pm filters. THP1 cells were then incubated with viral media. After 24 hrs, media was replaced, and cells were allowed 48 hrs to recover. Following recovery, cells were selected for using puromycin (1.0 pg/mL), and subsequently cultured in RPMI-1640 media supplemented with puromycin (0.5 pg/mL), to generate sh- control and sh-MG53 THP1 cells. EXAMPLE 4

In vivo model: MG53 WT vs KO mice treated with influenza [0114] MG53 knockout mice were generated in the 129Sl/SvlmJ strain of mice. All mice were housed and handled following IACUC approved protocols. Murine intranasal influenza virus infections were carried out in 12-week-old male MG53 wild type and knockout mice. Animals were anesthetized using isoflurane and were intranasally infected with influenza virus strain A/PR/8/34 (H1N1) (PR8) at a dose of 10 tissue culture infectious dose 50 (TCID50) in 50 pL clinical grade saline. Mice were monitored daily and weights were recorded. Animals were euthanized at either day 5 post infection or at the experimental endpoint when they recovered to normal body weight. After animals were sacrificed, lungs and hearts were collected for viral titers, cytokine measurements, and histology.

EXAMPLE 5

Mortality in wt mice infected with influenza

[0115] Eight-week-old WT C57BL/6J mice (Jackson laboratories) were intranasally infected with 100 TCID50 Influenza A virus A/PR/8/34 (H1N1) in 50 ml sterile saline. Mice were monitored daily for body mass and survival. Mice reaching 30% body mass loss with hunched posture and lack of movement were considered moribund and removed from the study.

EXAMPLE 6 THP1 cell culture

[0116] THP1 cells were purchased from ATCC and cultured in RPMI-1640 media supplemented with L-Glutamine and sodium pyruvate (Sigma R8758) in addition to 10% fetal bovine serum and 1% penicillin / streptomycin in a 5% C02 incubator. THP1 cells were differentiated using 100 ng/mL PMA (Sigma PI 585) for 48 hrs. HEK293 and HEK293FT cells were obtained from ATCC and cultured using Dulbecco’s modified Eagle’s medium (DMEM) supplemented with 10% fetal bovine serum and 1% penicillin/streptomycin in a 5% C02 incubator. HEK293-RyR2 cells were provided by Dr. Wayne Chen⁴⁷. These cells possess doxycycline-inducible RyR2 expression, which enables spontaneous calcium oscillation in response to elevated extracellular calcium via store-overload induced calcium release. Cells were cultured using DMEM supplemented with 10% fetal bovine serum and 1% penicillin/streptomycin in a 5% CO2 incubator. Treatment with doxycycline (lpg/mL) for 24 hrs was used to induce RyR expression.

EXAMPLE 7

Western Blot analyses

[0117] Cells and murine skeletal muscle were lysed in radio-immunoprecipitation assay lysis buffer (Alfa Aesar, J63306) containing protease and phosphatase inhibitors. Cellular debris was pelleted via centrifugation and supernatants were collected for protein quantification by Bradford assay. Samples were prepared in 2x Laemlli sample buffer and separated on SDS-PAGE gels via electrophoresis, followed by wet transfer onto PVDF membrane. Membranes were blocked in 5% milk in TBS-T and probed with antibodies against MG53 (custom-made rabbit monoclonal antibody), glyceraldehyde 3-phosphate dehydrogenase (GAPDH; Cell Signaling Technology (CST) catalog #2118), p65 (CST 8242), phospho-p65 (CST 3033), or RyR (Invitrogen MA3925).

EXAMPLE 8

Oral Dosage Form of rhMG53 and EUDRAGIT S-100 [0118] rhMG53 is provided by TRIM-edicine, Inc. (Columbus, OH). EUDRAGIT S-100 (Poly(methacylic acid-co-methyl methacrylate) 1:2) is provided by EVONIK (https://healthcare.evOnik.com/product/health-care/en/). The following procedure is used to prepare beads.

[0119] In a 100 mL beaker, add 35 mL water, and stir. While stirring add Eudragit S-100 powder (1.4 g), then and I2NNH4OH (0.82 mL). Add 2-hydroxypropyl)- -cyclodextrin (0.24 g) to a 10 mL water (CD: 24 mg/mL). Prepare a solution of MG53 (70 mg in -15.5 mL PBS) at a pH 8. To this solution, add 10 mL of the CD solution and 10 mL of water for a total volume of 35.55 mL. Mix the MG53/CD solution with the Eudragit solution while stirring. [0120] Spray dry the resulting suspension to form the powdered dosage form containing MG53 (70 mg), EUDRAGIT (1.4 g), salts (130 mg), and CD (0.24 g) for a total solids content of 1.77 g or a MG53-loading of 40 mg/g of solid (4% loading). Spray drying conditions used: nozzle size- 0.6 mm; air speed- 0.3 m³/min; air outlet temp: 38 C; room temperature: 24 C; room humidity: 53%.

[0121] The powder can be included in a capsule, caplet, tablet or other oral dosage form. EXAMPLE 9

Preparation of MG53 -containing Enteric Release Composition [0122] The enteric release formulation comprises MG53, hydroxypropyl-beta-cyclodextrin (HP-b-CD), and methacrylic acid / methyl methacrylate anionic copolymer (EUDRAGIT S 100; dissolution in water at pH above 7.0). The following procedure was used.

1. In a 100 mL beaker, added 35 mL water;

2. weighed 1.4 g Eudragit S-100 powder and added to the H2O above while stirring;

3. added 0.82 mL of 12N NH4OH and stirred continuously for half an hour while periodically checking pH;

4. weighed 0.24 g of 2-hydroxypropyl)-P-cyclodextrin and added to a vial containing 10 mL water (CD: 24 mg/mL);

5. added 70 mg MG53 to 15.5 mL PBS at pH 8;

6. mixed the HP-b-CD solution with the MG53 -containing solution and add water to a total volume of 35.55 mL;

7. added the MG53/CD solution to the 35 mL Eudragit-containing solution while stirring, and added 1 mL of water;

6. spray dried the MG53/CD/EUDRAGIT solution according to Example 11;

[0123] The resulting enteric release composition contained: MG53 70 mg; Eudragit 1.4 g; salts: 15.5/2*17 mg/mL=130 mg; CD 0.24 g.

EXAMPLE 10

Determination of In-vitro Release Profile

[0124] A known amount of powdered samples of MG53 containing enteric release composition (made according to Example 9) was dispersed in pH 2 (0.01N HC1) solution for 2 hrs, followed by addition of NasPCri solution (9.7 g in 112.8 mL H2O; to pH 6.5), then followed by addition of same NasPCri solution to pH 7.5. At different time points, the released MG53 solution was centrifuged at 17,000g for 20 min, filtered through 0.22 um filter, and the absorbance at 280 nm was measured (n=2 per time points). The release experiments were performed in an orbital shaker at 37 °C and 150 rpm.

EXAMPLE 11

Spraying drying of MG53/CD/EETDRAGIT mixture [0125] The MG53/CD/EEIDRAGIT mixture was produced by spray-drying using the laboratory scale ProCept 4M8-TriX spray-dryer (Zelzate, Belgium). Drug-polymer solutions were prepared in the binary solvent mixture of interest DCM/EtOH 2:1 (v/v) at 50 mg/mL. The feed solution flow rate was adjusted at 5 g/min. An atomizing air pressure of 0.65 bars was applied to a 1.2 mm bifluid nozzle to create a spray. The drying gas airflow was set at 0.35 m3/min and maintained at 65 °C. The lateral cooling air was kept constant at 100 L/min and dried particles were separated from the exhaust air within the medium cyclone (height/diameter of 242 mm/60 mm). After processing, the spray-dried material was stored in a vacuum oven for 48 h before analysis to eliminate the last traces of residual solvent.

EXAMPLE 12

Co-immunoprecipitation

[0126] Tissue and cells were lysed in radio-immunoprecipitation (IP) assay lysis buffer and assayed for protein concentration as stated above. 20 pL of magnetic protein G beads (per IP sample) were washed in PBS three times and conjugated to 2 pg (per IP sample) of antibody (MG53, RyR, Mouse and Rabbit IgG) for 2 hours at room temperature while rocking. Bead- antibody conjugates were then washed 2 times with PBS and once with lysis buffer. 1 mg of protein lysate was added to beads and then samples were incubated at 4°C overnight while rocking. The following day, samples were washed 3 times in PBS and protein was eluted with 4% SDS and 2x Laemlli sample buffer. IP samples were then analyzed following the western blotting protocol stated earlier.

EXAMPLE 13 Masson's Trichrome Staining

[0127] The following procedure was used to determine the level of fibrosis in lung tissue.

1. Deparaffmize the paraffin embedded lung tissue block and rehydrate through 100% alcohol, 95% alcohol 70% alcohol. Wash in distilled water.

2. For Formalin fixed tissue, re-fix in Bouin's solution for 1 hour at 56 C to improve staining quality although this step is not absolutely necessary. 3. Rinse in running tap water for 5-10 minutes to remove the yellow color. Stain in Weigerf s iron hematoxylin working solution for 10 minutes.

4. Rinse in running warm tap water for 10 minutes.

5. Wash in distilled water.

6. Stain in Biebrich scarlet-acid fuchsin solution for 10-15 minutes. Solution can be saved for future use.

7. Wash in distilled water.

8. Differentiate in phosphomolybdic-phosphotungstic acid solution for 10-15 minutes or until collagen is not red.

9. Transfer sections directly (without rinse) to aniline blue solution and stain for 5-10 minutes. Rinse briefly in distilled water and differentiate in 1% acetic acid solution for 2-5 minutes.

10. Wash in distilled water.

11. Dehydrate very quickly through 95% ethyl alcohol, absolute ethyl alcohol (these step will wipe off Biebrich scarlet-acid fuchsin staining) and clear in xylene.

12. Mount with resinous mounting medium.

EXAMPLE 14

Treatment of COVID-19 (SARS-COV-2) infection in a subject Method A. MG53 Composition therapy

A subject presenting with COVID-19 virus infection is prescribed MG53 composition, and therapeutically relevant doses are administered to the subject according to a prescribed dosing regimen for a period of time. The subject’s level of therapeutic response (in terms of performance of one or more organs) is determined periodically. If the level of therapeutic response is too low at one dose, then the dose is escalated according to a predetermined dose escalation schedule until the desired level of therapeutic response in the subject is achieved. Treatment of the subject with MG53 is continued as needed and the dose or dosing regimen can be adjusted as needed until the patient reaches the desired clinical endpoint. Method B. Combination therapy: MGS 3 and antiviral agent

Method A, above, is followed except that the subject is prescribed and administered one or more other antiviral agents for the treatment of COVID-19 virus infection or symptoms thereof. Then one or more other antiviral agents can be administered before, after or with the MG53. Dose escalation (or de-escalation) of the one or more other antiviral agents can also be done.

[0128] All data are expressed as mean ± S.D. Groups were compared by Student’ s t test and analysis of variance for repeated measures. A value of p<0.05 was considered significant. [0129] For any range herein, the upper and lower limits thereof are considered as being part of the range. Moreover, all integer and fractional values within said ranges are also considered as being within said range. Accordingly, all integers and fractional values within each specified range are hereby incorporated by reference.

[0130] All values disclosed herein may have standard technical measure error (standard deviation) of ± 10%. The term “about” or “approximately” is intended to mean ±10%, ±5%, ±2.5% or ±1% relative to a specified value, i.e. “about” 20% means 20±2%, 20±1%, 20±0.5% or 20±0.25%. The term “majority” or “major portion” is intended to mean more than half, when used in the context of two portions, or more than one-third, when used in the context of three portions. The term “minority” or “minor portion” is intended to mean less than half, when used in the context of two portions, or less than one-third, when used in the context of three portions. It should be noted that, unless otherwise specified, values herein concerning pharmacokinetic or dissolution parameters are typically representative of the mean or median values obtained.

[0131] The above is a detailed description of particular embodiments of the invention. It will be appreciated that, although specific embodiments of the invention have been described herein for purposes of illustration, various modifications may be made without departing from the spirit and scope of the invention. Accordingly, the invention is not limited except as by the appended claims. All of the embodiments disclosed and claimed herein can be made and executed without undue experimentation in light of the present disclosure.

Claims

1) A method of preventing viral infection-induced organ failure, the method comprising administering to a subject, infected with a virus that induces organ failure, one or more doses of MG53, thereby preventing said organ failure.

2) A method of preventing viral infection-induced organ failure, the method comprising administering to a subject, at risk of being infected with a virus that induces organ failure, one or more doses of MG53, thereby preventing said organ failure.

3) A method of reversing viral infection-induced organ failure, the method comprising administering to a subject, exhibiting (indicated with) viral infection-induced organ failure, one or more doses of MG53, thereby reversing said organ failure.

4) A method of reducing the mortality rate in a population of subjects having a viral infection that causes mortality due to organ failure, the method comprising administering to subjects of said population one or more doses of MG53, thereby reducing the mortality rate in said population of subjects.

5) A method of mitigating (e.g. ameliorating, treating, curing) virus-infection induced organ fibrosis, which may or may not be fatal, the method comprising administering to a subject, infected with a virus that induces organ fibrosis, one or more doses of MG53, thereby mitigating fibrosis of one or more organs of said subject.

6) The method according to any one of the above claims, wherein a) said organ failure is short-term or acute organ failure, meaning organ failure that occurs over a period of hours, days, weeks or up to about three months; or b) said organ failure is long-term or chronic organ failure, meaning organ failure that occurs over a period of about three months or more.

7) The method according to any one of the above claims, wherein said virus that induces organ failure and/or causes mortality is selected from the group consisting of positive-sense single-stranded RNA virus ((+)-ss-envRNAV), negative-sense single- stranded RNA virus ((-)-ss-envRNAV), double-stranded DNA virus (ds-DNAV), and positive-sense RNA via DNA virus.

8) The method according to any one of the above claims, wherein said organ is selected from the group consisting of the respiratory system, heart, lung, kidney, liver, gastrointestinal system.

9) The method according to any one of the above claims, wherein said MG53 is administered acutely, chronically, or a combination thereof. 10) The method according to any one of the above claims, wherein said MG53 is administered in one or more dosage forms exhibiting one or more release profiles selected from the group consisting of immediate release, rapid release, extended release, sustained release, controlled release, enteric release, and a combination of any thereof.

11) The method according to any one of the above claims, wherein said MG53 is administered orally, by injection, intravenously, intraarterially, subcutaneously, intramuscularly, rectally, by infusion, directly to a target organ, and/or transdermally.

12) The method according to any one of the above claims, wherein said MG53 is recombinant human MG53.

13) The method according to any one of the above claims, wherein said MG53 is exogenous MG53.

14) The method according to any one of the above claims, wherein MG53 is a native recombinant human MG53 or mutant recombinant human MG53.

15) The method according to any one of the above claims further comprising the step of administering one or more therapeutically relevant doses of one or more antiviral agents to said subject.

16) The method of claim 15, wherein administration of MG53 and said one or more antiviral agents is separate, overlapping, sequential, or simultaneous.

17) A method of preventing viral infection-induced organ failure as described herein.

18) A method of reversing viral infection-induced organ failure as described herein.

19) A method of reducing the mortality rate in a population of subjects having a viral infection that causes mortality due to organ failure as described herein.

20) A method of mitigating (e.g. ameliorating, treating, curing) virus-infection induced organ fibrosis, which may or may not be fatal, as described herein.

21) A composition as described herein.

22) A MG53 -containing composition as described herein.

23) A MG53 -containing and antiviral agent-containing composition as described herein.