TOP1 inhibition therapy protects against SARS-CoV-2-induced lethal inflammation

The ongoing pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is currently affecting millions of lives worldwide. Large retrospective studies indicate that an elevated level of inflammatory cytokines and pro-inflammatory factors are associated with both increased disease severity and mortality. Here, using multidimensional epigenetic, transcriptional, in vitro, and in vivo analyses, we report that topoisomerase 1 (TOP1) inhibition suppresses lethal inflammation induced by SARS-CoV-2. Therapeutic treatment with two doses of topotecan (TPT), an FDA-approved TOP1 inhibitor, suppresses infection-induced inflammation in hamsters. TPT treatment as late as 4 days post-infection reduces morbidity and rescues mortality in a transgenic mouse model. These results support the potential of TOP1 inhibition as an effective host-directed therapy against severe SARS-CoV-2 infection. TPT and its derivatives are inexpensive clinical-grade inhibitors available in most countries. Clinical trials are needed to evaluate the efficacy of repurposing TOP1 inhibitors for severe coronavirus disease 2019 (COVID-19) in humans. [Display omitted] •TOP1 activates inflammatory gene expression during SARS-CoV-2 infection•Topotecan (TPT), a TOP1 FDA-approved drug, suppresses inflammatory gene expression•Inflammatory genes suppressed by TPT are overexpressed in COVID-19 lung autopsies•TPT therapy protects from hyper-inflammation and death in preclinical models Inhibition of topoisomerase 1 through the FDA-approved molecule topotecan suppresses SARS-CoV-2-infection-associated lethal inflammation in hamster and mouse models without compromising antiviral immune responses.