Hymecromone: A Clinical Prescription Hyaluronan Inhibitor for Efficiently Blocking COVID-19 Progression
Summary Background We previously found that human identical sequences (HIS) of SARS-CoV-2 promote the clinical progression of COVID-19 by upregulating hyaluronan (HA). As one of the drugs for hyaluronan inhibition, hymecromone was chosen for evaluating its therapeutic effects on COVID-19. Methods ELISA was performed to detect the level of HA in COVID-19 patients. We first analyzed the correlation between the level of plasma HA and clinical parameters (lymphocytes, C-reactive protein, D-dimer, and fibrinogen). We then assessed the correlation between the plasma HA level and pulmonary lesions, which were quantified by using artificial intelligence based on chest CT scans, including ground-glass opacity (GGO) and consolidation. Furthermore, we assessed the effect of hyaluronan treatment on the formation of pulmonary lesions in mice and evaluated the role of hymecromone on hyaluronan production in cultured cells. Finally, 94 of the 144 confirmed COVID-19 patients received oral hymecromone in addition to standard care, whereas the others with only standard care were treated as control. Abnormal serological markers in two groups were selected to determine the efficacy of hymecromone. Findings Plasma HA was closely relevant to clinical parameters, including lymphocytes (n = 158; r = -0.50; P<0.0001), CRP (n = 156; r = 0.55; P<0.0001), D-dimer (n = 154; r = 0.38; P<0.0001), and fibrinogen (n = 152; r = 0.37; P<0.0001), as well as the mass (n = 120; r = 0.30; P = 0.0008) and volume (n = 120; r = 0.30; P = 0.0009) of GGO, the mass (n = 120; r = 0.34; P = 0.0002) and volume (n = 120; r = 0.35; P<0.0001) of consolidation. Mice experiment further verified that hyaluronan could cause pulmonary lesions directly. Hymecromone remarkably reduced HA via downregulating HAS2/HAS3 expression. Accordingly, the number of lymphocytes recovered more quickly as the fold change of lymphocytes per day was higher in hymecromone-treated patients (n=8) than the control group (n=5) (P <0.01). Moreover, 89% patients with hymecromone treatment had pulmonary lesion absorption while only 42% patients in control group had pulmonary lesion absorption (P<0.0001). Interpretation Hyaluronan is closely correlated with COVID-19 progression and can serve as a plasma biomarker. As a promising treatment for COVID-19, hymecromone deserves our further efforts to determine its effect in a larger cohort of COVID-19 patients. Funding National Key R&D Program of China, Major Special Projects of Basic Research of Shanghai Science and Technology Commission, and Shanghai Science and Technology Innovation Action Plan, Medical Innovation Research Special Project, Research of early identification and warning of acute respiratory infectious diseases.