Ezrin Peptide Therapy from HIV to COVID: Inhibition of Inflammation and Amplification of Adaptive Anti-Viral Immunity.

Human Ezrin Peptides (HEPs) are inhibitors of expression of IL-6 and other inflammatory cytokines, amplifiers of adaptive B cell and T cell immunity and enhancers of tissue repair. The mutation stable C-terminus of HIV gp120, mimics 69% of the "Hep-receptor", a zipped α-helical structure in the middle of the α domain of human ezrin protein. Synthetic peptides homologous to the Hep-receptor of ezrin of five to fourteen amino acids, activate anti-viral immunity against a wide range of viruses (HIV, HCV, herpes, HPV, influenza and other human respiratory viruses). Human Ezrin Peptide One (HEP1) TEKKRRETVEREKE (brand name Gepon, registered for human use in Russia from 2001) is a successful treatment for opportunistic infections in HIV-infected patients. That treats HEP1and prevents mucosal candidiasis, herpes zoster outbreaks and infection-induced chronic diarrhea. There are clinical publications in Russian on the successful treatments of chronic recurrent vaginal candidiasis, acute and chronic enterocolitis and dysbacteriosis, which are accompanied by normalization of the mucosal microbiome, and the decline or disappearance of inflammation. HEP1 is also an effective treatment and prevention for recurrent inflammation and ulceration in the stomach, duodenum and colon. HEP1 and RepG3 GEKKRRETVEREGG (a derivative of HEP1) have been used successfully as an inhaled spray peptide solution to treat a small number of human volunteers with mild-to-moderate COVID, resulting from SARS-CoV-2 infection, based on earlier successes in treating acute viral respiratory disease with inflammatory complications. Ezrin peptides seem to correct a dysregulation of innate immune responses to SARS-CoV-2. They are also adjuvants of B cell adaptive immunity and increase antibody titres, resulting in protection from lethal virus infection of mice. In a clinical study in Moscow, orally administered HEP1 was shown to enhance antibody-titres produced in response to hepatitis-B vaccination. These very preliminary but promising results with ezrin peptide treatment of COVID must be replicated in large-scale randomised placebo controlled clinical studies, to be verified.

Treatment of hepatitis C virus infection with human ezrin peptide one (HEP1) in HIV infected patients.

This report shows the therapeutic benefit of HEP1 (human ezrin peptide 324-337; TEKKRRETVEREKE) monotherapy of hepatitis C virus (HCV) infection in HIV infected patients in two clinical studies. In the Pilot Study I, 16 of 18 patients responded well to the treatment with significant reductions of HCV viral load and a normalization of serum liver enzymes. In 8 of 18 patients, HCV RNA became undetectable, and 3 of 8 interferon/ribavirin treatment failure patients showed undetectable HCV load following HEP1 treatment. In the second study, 8 of 10 patients responded well to the treatment with a pronounced reduction of the HCV viral load and a normalization of serum liver enzymes. Three of 15 patients (20%) showed an undetectable viral load 30 days after the end of a 30-day course of HEP1 treatment. In both studies, all genotypes of HCV were sensitive to HEP1 treatment. Analysis of the combined data from both studies showed the overall efficacy of HEP1 therapy: in 37 HCV+HIV patients, HEP1 therapy gave the following results: 10 of 37 (27%) HCV+HIV patients showed a reduction of viral load between -7 log (-10,000,000x) and -3 log (-1000x); 4 of 37 (11%) a reduction of -3 log (-1000x); 6 of 37 (16%) a reduction of -2 log (-100x); 11 of 37 (30%) a reduction of -1 log (-10x); 6 of 37 (16%) a reduction of less than -1 log (-10x); 0 of 37 (0%) had an increase in viral load, and the average reduction in viral load for all 37 patients was -2 log (-100x). No adverse reactions or side effects were detected and the improving CD4/CD8 ratio showed that the therapy had no negative impact on the immunological status. Thus, oral HEP1 therapy matches the efficacy results for injectable peginterferon/oral ribavirin therapy with the advantages of more rapid action and less side effects. HEP1 therapy should be used in patients where either peginterferon/ribavirin therapy fails or is contraindicated.