In-vitro and in-vivo assessment of nirmatrelvir penetration into CSF, central nervous system cells, tissues, and peripheral blood mononuclear cells

• Published in: Scientific reports Vol. 14; no. 1; pp. 10709 - 13
• Main Authors: Avedissian, Sean N., Malik, Johid R., Podany, Anthony T., Neely, Michael, Rhodes, Nathaniel J., Scarsi, Kimberly K., Scheetz, Marc H., Duryee, Michael J., Modebelu, Ukamaka O., Mykris, Timothy M., Winchester, Lee C., Byrareddy, Siddappa N., Fletcher, Courtney V.
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 10.05.2024; Nature Publishing Group; Nature Portfolio
• Subjects: 631/154/436/108; 631/154/436/1729; 631/154/436/2388; 692/699/255/2514; Animals; Antiviral Agents - pharmacokinetics; Antiviral Agents - pharmacology; Blood–brain-barrier; Brain - metabolism; Brain - virology; Central nervous system; Central Nervous System - metabolism; Central Nervous System - virology; Cerebrospinal fluid; COVID-19; COVID-19 - cerebrospinal fluid; COVID-19 - virology; COVID-19 Drug Treatment; Humanities and Social Sciences; Humans; Leukocytes (mononuclear); Leukocytes, Mononuclear - metabolism; Leukocytes, Mononuclear - virology; Male; multidisciplinary; Neurological complications; Nirmatrelvir/ritonavir; NMR; Nuclear magnetic resonance; Peripheral blood mononuclear cells; Pharmacodynamics; Pharmacokinetics; Pharmacology; Rats; Rats, Sprague-Dawley; Ritonavir; Ritonavir - pharmacokinetics; Rodents; SARS-CoV-2 - drug effects; Science; Science (multidisciplinary); Severe acute respiratory syndrome coronavirus 2; Blood–brain-barrier; Central nervous system; Nirmatrelvir/ritonavir
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-024-60935-5

Three years after SARS-CoV-2 emerged as a global infectious threat, the virus has become endemic. The neurological complications such as depression, anxiety, and other CNS complications after COVID-19 disease are increasing. The brain, and CSF have been shown as viral reservoirs for SARS-CoV-2, yielding a potential hypothesis for CNS effects. Thus, we investigated the CNS pharmacology of orally dosed nirmatrelvir/ritonavir (NMR/RTV). Using both an in vitro and an in vivo rodent model, we investigated CNS penetration and potential pharmacodynamic activity of NMR. Through pharmacokinetic modeling, we estimated the median CSF penetration of NMR to be low at 18.11% of plasma with very low accumulation in rodent brain tissue. Based on the multiples of the 90% maximal effective concentration (EC 90 ) for SARS-CoV-2, NMR concentrations in the CSF and brain do not achieve an exposure level similar to that of plasma. A median of only 16% of all the predicted CSF concentrations in rats were > 3xEC 90 (unadjusted for protein binding). This may have implications for viral persistence and neurologic post-acute sequelae of COVID-19 if increased NMR penetration in the CNS leads to decreased CNS viral loads and decreased CNS inflammation.