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Fluoxetine inhibits enterovirus replication by targeting the viral 2C protein in a stereospecific manner

Bauer, Lisa, Manganaro, Roberto, Zonsics, Birgit, Strating, Jeroen R. P. M., El Kazzi, Priscila, Lorenzo Lopez, Moira, Ulferts, Rachel, van Hoey, Clara, Maté, Maria J., Langer, Thierry, Coutard, Bruno, Brancale, Andrea ORCID: and van Kuppeveld, Frank J. M. 2019. Fluoxetine inhibits enterovirus replication by targeting the viral 2C protein in a stereospecific manner. ACS Infectious Diseases 5 (9) , pp. 1609-1623. 10.1021/acsinfecdis.9b00179

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Enteroviruses (family Picornaviridae) comprise a large group of human pathogens against which no licensed antiviral therapy exists. Drug-repurposing screens uncovered the FDA-approved drug fluoxetine as a replication inhibitor of enterovirus B and D species. Fluoxetine likely targets the nonstructural viral protein 2C, but detailed mode-of-action studies are missing because structural information on 2C of fluoxetine-sensitive enteroviruses is lacking. We here show that broad-spectrum anti-enteroviral activity of fluoxetine is stereospecific concomitant with binding to recombinant 2C. (S)-Fluoxetine inhibits with a 5-fold lower 50% effective concentration (EC50) than racemic fluoxetine. Using a homology model of 2C of the fluoxetine-sensitive enterovirus coxsackievirus B3 (CVB3) based upon a recently elucidated structure of a fluoxetine-insensitive enterovirus, we predicted stable binding of (S)-fluoxetine. Structure-guided mutations disrupted binding and rendered coxsackievirus B3 (CVB3) resistant to fluoxetine. The study provides new insights into the anti-enteroviral mode-of-action of fluoxetine. Importantly, using only (S)-fluoxetine would allow for lower dosing in patients, thereby likely reducing side effects.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Pharmacy
Publisher: American Chemical Society
ISSN: 2373-8227
Date of First Compliant Deposit: 10 September 2019
Date of Acceptance: 15 July 2019
Last Modified: 05 Jan 2024 05:47

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