The TLR4 antagonist Eritoran protects mice from lethal influenza infection

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Abstract
TLR4 stimulation is known to contribute to acute lung injury after administration of inactivated influenza virus; here, the synthetic TLR4 antagonist Eritoran is shown to protect mice from death after infection with a lethal dose of the virus. With the influenza virus continually evolving, and resistance to existing antiviral therapies spreading, there is a pressing need for new anti-influenza therapies. Previous work has shown that TLR4 signalling mediates influenza-induced acute lung injury, cytokine production and systemic effects in mice. Stefanie Vogel and colleagues now report that Eritoran, a synthetic TLR4 antagonist, can protect mice from death when administered up to six days after infection with the influenza virus. Existing antivirals must be administered within three days of infection to be effective. This work suggests that TLR4 antagonists may be effective against influenza and could usefully extend the period during which the infection can be effectively treated. There is a pressing need to develop alternatives to annual influenza vaccines and antiviral agents licensed for mitigating influenza infection. Previous studies reported that acute lung injury caused by chemical or microbial insults is secondary to the generation of host-derived, oxidized phospholipid that potently stimulates Toll-like receptor 4 (TLR4)-dependent inflammation1. Subsequently, we reported that Tlr4−/− mice are highly refractory to influenza-induced lethality2, and proposed that therapeutic antagonism of TLR4 signalling would protect against influenza-induced acute lung injury. Here we report that therapeutic administration of Eritoran (also known as E5564)—a potent, well-tolerated, synthetic TLR4 antagonist3,4—blocks influenza-induced lethality in mice, as well as lung pathology, clinical symptoms, cytokine and oxidized phospholipid expression, and decreases viral titres. CD14 and TLR2 are also required for Eritoran-mediated protection, and CD14 directly binds Eritoran and inhibits ligand binding to MD2. Thus, Eritoran blockade of TLR signalling represents a novel therapeutic approach for inflammation associated with influenza, and possibly other infections.