Cholesterol and COVID-19—therapeutic opportunities at the host/virus interface during cell entry

T Grewal, MKL Nguyen, C Buechler - Life Science Alliance, 2024 - life-science-alliance.org
T Grewal, MKL Nguyen, C Buechler
Life Science Alliance, 2024life-science-alliance.org
The rapid development of vaccines to combat severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2) infections has been critical to reduce the severity of COVID-19.
However, the continuous emergence of new SARS-CoV-2 subtypes highlights the need to
develop additional approaches that oppose viral infections. Targeting host factors that
support virus entry, replication, and propagation provide opportunities to lower SARS-CoV-2
infection rates and improve COVID-19 outcome. This includes cellular cholesterol, which is …
The rapid development of vaccines to combat severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections has been critical to reduce the severity of COVID-19. However, the continuous emergence of new SARS-CoV-2 subtypes highlights the need to develop additional approaches that oppose viral infections. Targeting host factors that support virus entry, replication, and propagation provide opportunities to lower SARS-CoV-2 infection rates and improve COVID-19 outcome. This includes cellular cholesterol, which is critical for viral spike proteins to capture the host machinery for SARS-CoV-2 cell entry. Once endocytosed, exit of SARS-CoV-2 from the late endosomal/lysosomal compartment occurs in a cholesterol-sensitive manner. In addition, effective release of new viral particles also requires cholesterol. Hence, cholesterol-lowering statins, proprotein convertase subtilisin/kexin type 9 antibodies, and ezetimibe have revealed potential to protect against COVID-19. In addition, pharmacological inhibition of cholesterol exiting late endosomes/lysosomes identified drug candidates, including antifungals, to block SARS-CoV-2 infection. This review describes the multiple roles of cholesterol at the cell surface and endolysosomes for SARS-CoV-2 entry and the potential of drugs targeting cholesterol homeostasis to reduce SARS-CoV-2 infectivity and COVID-19 disease severity.
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