Potential Anti-Mpox Virus Activity of Atovaquone, Mefloquine, and Molnupiravir, and Their Potential Use As Treatments

Overview

Journal J Infect Dis

Publisher Oxford University Press

Specialty Infectious Diseases

Date 2023 Mar 9

PMID 36892247

Authors

Daisuke Akazawa

Hirofumi Ohashi

Takayuki Hishiki

Takeshi Morita

Shoya Iwanami

Kwang Su Kim

Yong Dam Jeong

Eun-Sil Park

Michiyo Kataoka

Kaho Shionoya

Junki Mifune

Kana Tsuchimoto

Shinjiro Ojima

Aa Haeruman Azam

Shogo Nakajima

Hyeongki Park

Tomoki Yoshikawa

Masayuki Shimojima

Kotaro Kiga

Shingo Iwami

Ken Maeda

Tadaki Suzuki

Hideki Ebihara

Yoshimasa Takahashi

Koichi Watashi

Affiliations

Soon will be listed here.

Abstract

Background: Mpox virus (MPXV) is a zoonotic orthopoxvirus and caused an outbreak in 2022. Although tecovirimat and brincidofovir are approved as anti-smallpox drugs, their effects in mpox patients have not been well documented. In this study, by a drug repurposing approach, we identified potential drug candidates for treating mpox and predicted their clinical impacts by mathematical modeling.

Methods: We screened 132 approved drugs using an MPXV infection cell system. We quantified antiviral activities of potential drug candidates by measuring intracellular viral DNA and analyzed the modes of action by time-of-addition assay and electron microscopic analysis. We further predicted the efficacy of drugs under clinical concentrations by mathematical simulation and examined combination treatment.

Results: Atovaquone, mefloquine, and molnupiravir exhibited anti-MPXV activity, with 50% inhibitory concentrations of 0.51-5.2 μM, which was more potent than cidofovir. Whereas mefloquine was suggested to inhibit viral entry, atovaquone and molnupiravir targeted postentry processes. Atovaquone was suggested to exert its activity through inhibiting dihydroorotate dehydrogenase. Combining atovaquone with tecovirimat enhanced the anti-MPXV effect of tecovirimat. Quantitative mathematical simulations predicted that atovaquone can promote viral clearance in patients by 7 days at clinically relevant drug concentrations.

Conclusions: These data suggest that atovaquone would be a potential candidate for treating mpox.

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