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Preventing spread of SARS coronavirus-2 in humans

Göttingen infection researchers identify potential drug
Schematic representation of a coronavirus with surface proteins on the outer envelope. Illustration: Markus Hoffmann
Das Anheftungsprotein „Spike“ des neuen Coronavirus SARS-CoV-2 verwendet den gleichen zellulären Anheftungsfaktor (ACE2) wie das SARS-CoV und nutzt für seine Aktivierung die zelluläre Protease TMPRSS2. Vorhandene, klinisch freigegebene Medikamente, die gegen TMPRSS2 gerichtet sind, hemmen die SARS-CoV-2 Infektion von Lungenzellen. Abbildung: Markus Hoffmann
The attachment protein "spike" of the new coronavirus SARS-CoV-2 uses the same cellular attachment factor (ACE2) as SARS-CoV and uses the cellular protease TMPRSS2 for its activation. Existing, clinically approved drugs directed against TMPRSS2 inhibit SARS-CoV-2 infection of lung cells. Illustration: Markus Hoffmann
Ursprung und Übertragbarkeit humanpathogener Coronaviren. Abbildung: Markus Hoffmann
Origin and transmission of pathogenic coronaviruses. Illustration: Markus Hoffmann
Dr. Markus Hoffmann, Hannah Kleine-Weber und Prof. Dr. Stefan Pöhlmann, Infektionsforscher in der Abteilung Infektionsbiologie am Deutschen Primatenzentrum. Foto: Karin Tilch
Dr. Markus Hoffmann, Hannah Kleine-Weber and Prof. Dr. Stefan Pöhlmann, scientists at the infection biology unit of the German Primate Center – Leibniz Institute for Primate Research. Photo: Karin Tilch

Viruses must enter cells of the human body to cause disease. For this, they attach to suitable cells and inject their genetic information into these cells. Infection biologists from the German Primate Center - Leibniz Institute for Primate Research in Göttingen, together with colleagues at Charité – Universitätsmedizin Berlin, have investigated how the novel coronavirus SARS-CoV-2 penetrates cells. They have identified a cellular enzyme that is essential for viral entry into lung cells: the protease TMPRSS2. A clinically proven drug known to be active against TMPRSS2 was found to block SARS-CoV-2 infection and might constitute a novel treatment option (Cell).

Several coronaviruses circulate worldwide and constantly infect humans, which normally caused only mild respiratory disease. Currently, however, we are witnessing a worldwide spread of a new coronavirus with more than 90,000 confirmed cases and over 3,000 deaths. The new virus has been named SARS coronavirus-2 and has been transmitted from animals to humans. It causes a respiratory disease called COVID-19 that may take a severe course. The SARS coronavirus-2 has been spreading since December 2019 and is closely related to the SARS coronavirus that caused the SARS pandemic in 2002/2003. No vaccines or drugs are currently available to combat these viruses.

Stopping virus spread
A team of scientists led by infection biologists from the German Primate Centre and including researchers from Charité, the University of Veterinary Medicine Hannover Foundation, the BG-Unfallklinik Murnau, the LMU Munich, the Robert Koch Institute and the German Center for Infection Research, wanted to find out how the new coronavirus SARS-CoV-2 enters host cells and how this process can be blocked. The researchers identified a cellular protein that is important for the entry of SARS-CoV-2 into lung cells. "Our results show that SARS-CoV-2 requires the protease TMPRSS2, which is present in the human body, to enter cells," says Stefan Pöhlmann, head of the Infection Biology Unit at the German Primate Center. "This protease is a potential target for therapeutic intervention."

Promising drug
Since it is known that the drug camostat mesilate inhibits the protease TMPRSS2, the researchers have investigated whether it can also prevent infection with SARS-CoV-2. "We have tested SARS-CoV-2 isolated from a patient and found that camostat mesilate blocks entry of the virus into lung cells," says Markus Hoffmann, the lead author of the study. Camostat mesilate is a drug approved in Japan for use in pancreatic inflammation. "Our results suggest that camostat mesilate might also protect against COVID-19," says Markus Hoffmann. "This should be investigated in clinical trials."

Original publication
Hoffmann, M et al. (2020). SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically-proven protease inhibitor. Cell, DOI: 10.1016/j.cell.2020.02.052