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Unfractionated heparin inhibits live wild type SARS-CoV-2 cell infectivity at therapeutically relevant concentrations

Unfractionated heparin inhibits live wild type SARS-CoV-2 cell infectivity at therapeutically relevant concentrations
Unfractionated heparin inhibits live wild type SARS-CoV-2 cell infectivity at therapeutically relevant concentrations

BACKGROUND AND PURPOSE: Currently, there are no licensed vaccines and limited antivirals for the treatment of COVID-19. Heparin (delivered systemically) is currently used to treat anticoagulant anomalies in COVID-19 patients. Additionally, in the United Kingdom, Brazil and Australia, nebulised unfractionated heparin (UFH) is being trialled in COVID-19 patients as a potential treatment. A systematic comparison of the potential antiviral effect of various heparin preparations on live wild type SARS-CoV-2, in vitro, is needed.

EXPERIMENTAL APPROACH: Seven different heparin preparations including UFH and low MW heparins (LMWH) of porcine or bovine origin were screened for antiviral activity against live SARS-CoV-2 (Australia/VIC01/2020) using a plaque inhibition assay with Vero E6 cells. Interaction of heparin with spike protein RBD was studied using differential scanning fluorimetry and the inhibition of RBD binding to human ACE2 protein using elisa assays was examined.

KEY RESULTS: All the UFH preparations had potent antiviral effects, with IC50 values ranging between 25 and 41 μg·ml-1 , whereas LMWHs were less inhibitory by ~150-fold (IC50 range 3.4-7.8 mg·ml-1 ). Mechanistically, we observed that heparin binds and destabilizes the RBD protein and furthermore, we show heparin directly inhibits the binding of RBD to the human ACE2 protein receptor.

CONCLUSION AND IMPLICATIONS: This comparison of clinically relevant heparins shows that UFH has significantly stronger SARS-CoV-2 antiviral activity compared to LMWHs. UFH acts to directly inhibit binding of spike protein to the human ACE2 protein receptor. Overall, the data strongly support further clinical investigation of UFH as a potential treatment for patients with COVID-19.

Angiotensin-Converting Enzyme 2/metabolism, Animals, Antiviral Agents/pharmacology, COVID-19/drug therapy, Chlorocebus aethiops, Heparin, Low-Molecular-Weight/pharmacology, Heparin/metabolism, Protein Binding/drug effects, SARS-CoV-2/growth & development, Spike Glycoprotein, Coronavirus/metabolism, Viral Plaque Assay
0007-1188
626-635
Tree, Julia A.
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Turnbull, Jeremy E.
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Buttigieg, Karen R.
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Elmore, Michael J.
05aa3707-1371-4fad-a575-309f7678bacf
Coombes, Naomi
699ffcfe-0e4d-4098-9ddc-308dce0ce685
Hogwood, John
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Mycroft-West, Courtney J.
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Lima, Marcelo A.
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Skidmore, Mark A.
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Karlsson, Richard
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Chen, Yen-Hsi
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Zhang, Yang
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Spalluto, Cosma Mirella
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Staples, Karl J.
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Yates, Edwin A.
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Gray, Elaine
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Singh, Dave
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Wilkinson, Tom
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Page, Clive P.
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Carroll, Miles W.
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Tree, Julia A.
fc209b63-16a5-4363-a742-7dea154fecd4
Turnbull, Jeremy E.
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Buttigieg, Karen R.
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Elmore, Michael J.
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Coombes, Naomi
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Hogwood, John
c88b210e-280d-453c-ac2c-93f5d0658b39
Mycroft-West, Courtney J.
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Lima, Marcelo A.
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Skidmore, Mark A.
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Karlsson, Richard
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Chen, Yen-Hsi
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Zhang, Yang
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Spalluto, Cosma Mirella
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Staples, Karl J.
e0e9d80f-0aed-435f-bd75-0c8818491fee
Yates, Edwin A.
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Gray, Elaine
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Singh, Dave
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Wilkinson, Tom
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Page, Clive P.
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Carroll, Miles W.
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Tree, Julia A., Turnbull, Jeremy E., Buttigieg, Karen R., Elmore, Michael J., Coombes, Naomi, Hogwood, John, Mycroft-West, Courtney J., Lima, Marcelo A., Skidmore, Mark A., Karlsson, Richard, Chen, Yen-Hsi, Zhang, Yang, Spalluto, Cosma Mirella, Staples, Karl J., Yates, Edwin A., Gray, Elaine, Singh, Dave, Wilkinson, Tom, Page, Clive P. and Carroll, Miles W. (2021) Unfractionated heparin inhibits live wild type SARS-CoV-2 cell infectivity at therapeutically relevant concentrations. British Journal of Pharmacology, 178 (3), 626-635. (doi:10.1111/bph.15304).

Record type: Article

Abstract

BACKGROUND AND PURPOSE: Currently, there are no licensed vaccines and limited antivirals for the treatment of COVID-19. Heparin (delivered systemically) is currently used to treat anticoagulant anomalies in COVID-19 patients. Additionally, in the United Kingdom, Brazil and Australia, nebulised unfractionated heparin (UFH) is being trialled in COVID-19 patients as a potential treatment. A systematic comparison of the potential antiviral effect of various heparin preparations on live wild type SARS-CoV-2, in vitro, is needed.

EXPERIMENTAL APPROACH: Seven different heparin preparations including UFH and low MW heparins (LMWH) of porcine or bovine origin were screened for antiviral activity against live SARS-CoV-2 (Australia/VIC01/2020) using a plaque inhibition assay with Vero E6 cells. Interaction of heparin with spike protein RBD was studied using differential scanning fluorimetry and the inhibition of RBD binding to human ACE2 protein using elisa assays was examined.

KEY RESULTS: All the UFH preparations had potent antiviral effects, with IC50 values ranging between 25 and 41 μg·ml-1 , whereas LMWHs were less inhibitory by ~150-fold (IC50 range 3.4-7.8 mg·ml-1 ). Mechanistically, we observed that heparin binds and destabilizes the RBD protein and furthermore, we show heparin directly inhibits the binding of RBD to the human ACE2 protein receptor.

CONCLUSION AND IMPLICATIONS: This comparison of clinically relevant heparins shows that UFH has significantly stronger SARS-CoV-2 antiviral activity compared to LMWHs. UFH acts to directly inhibit binding of spike protein to the human ACE2 protein receptor. Overall, the data strongly support further clinical investigation of UFH as a potential treatment for patients with COVID-19.

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Tree et al 2020 BJP - Accepted Manuscript
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Accepted/In Press date: 18 October 2020
e-pub ahead of print date: 30 October 2020
Published date: February 2021
Additional Information: Funding Information: We thank Professor Jan Shute (University of Portsmouth) for helpful comments on nebulised heparin. We add thanks to Dr Julian Druce, Doherty Institute, Melbourne, Australia, for donating the virus used in this study. We thank Dr Kevin Bewley, Public Health England, for designing and optimising the PRNT assay used in this study. We thank Mrs Elizabeth Penn for preparing the cell cultures, Mrs Harriet Garlant and Mrs Joanna McGlashan for technical assistance. We are grateful for receiving MERS convalescent sera from Dr Mark Page and Dr Giada Mattiuzzo, NIBSC, UK. D.S. is supported by the National Institute for Health Research (NIHR) Manchester Biomedical Research Centre (BRC). J.E.T. acknowledges the support of University of Liverpool, and M.A.S. the support of Keele University. Z.Y. acknowledges the Danish National Research Foundation (DNRF107) and the Lundbeck Foundation, Y.-H.C. the Innovation Fund Denmark and R.K. the European Commission (GlycoImaging H2020-MSCA-ITN-721297). This work was funded by Public Health England, the University of Liverpool and the University of Keele. Funding Information: We thank Professor Jan Shute (University of Portsmouth) for helpful comments on nebulised heparin. We add thanks to Dr Julian Druce, Doherty Institute, Melbourne, Australia, for donating the virus used in this study. We thank Dr Kevin Bewley, Public Health England, for designing and optimising the PRNT assay used in this study. We thank Mrs Elizabeth Penn for preparing the cell cultures, Mrs Harriet Garlant and Mrs Joanna McGlashan for technical assistance. We are grateful for receiving MERS convalescent sera from Dr Mark Page and Dr Giada Mattiuzzo, NIBSC, UK. D.S. is supported by the National Institute for Health Research (NIHR) Manchester Biomedical Research Centre (BRC). J.E.T. acknowledges the support of University of Liverpool, and M.A.S. the support of Keele University. Z.Y. acknowledges the Danish National Research Foundation (DNRF107) and the Lundbeck Foundation, Y.‐H.C. the Innovation Fund Denmark and R.K. the European Commission (GlycoImaging H2020‐MSCA‐ITN‐721297). This work was funded by Public Health England, the University of Liverpool and the University of Keele. Publisher Copyright: © 2020 The Authors. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society
Keywords: Angiotensin-Converting Enzyme 2/metabolism, Animals, Antiviral Agents/pharmacology, COVID-19/drug therapy, Chlorocebus aethiops, Heparin, Low-Molecular-Weight/pharmacology, Heparin/metabolism, Protein Binding/drug effects, SARS-CoV-2/growth & development, Spike Glycoprotein, Coronavirus/metabolism, Viral Plaque Assay

Identifiers

Local EPrints ID: 444485
URI: http://eprints.soton.ac.uk/id/eprint/444485
ISSN: 0007-1188
PURE UUID: 7cdc326e-1418-4f7f-a048-b56cb3db52f5
ORCID for Cosma Mirella Spalluto: ORCID iD orcid.org/0000-0001-7273-0844
ORCID for Karl J. Staples: ORCID iD orcid.org/0000-0003-3844-6457

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Date deposited: 21 Oct 2020 16:31
Last modified: 17 Mar 2024 06:00

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Contributors

Author: Julia A. Tree
Author: Jeremy E. Turnbull
Author: Karen R. Buttigieg
Author: Michael J. Elmore
Author: Naomi Coombes
Author: John Hogwood
Author: Courtney J. Mycroft-West
Author: Marcelo A. Lima
Author: Mark A. Skidmore
Author: Richard Karlsson
Author: Yen-Hsi Chen
Author: Yang Zhang
Author: Cosma Mirella Spalluto ORCID iD
Author: Karl J. Staples ORCID iD
Author: Edwin A. Yates
Author: Elaine Gray
Author: Dave Singh
Author: Tom Wilkinson
Author: Clive P. Page
Author: Miles W. Carroll

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