Abstract 1483: Sugar analogs inhibit KSHV replication by blocking N-glycosylation and inducing the unfolded protein response
Authors: Schlesinger Mariana , McDonald Christian , Ahuja Anuj , Alvez-Canete Carolina , Prado Zelmira Nunez Del , Naipauer Julian , Lampidis Theodore , Mesri Enrique , Shembade Noula 
Published: March 2024

Abstract
Background: Kaposi´s Sarcoma (KS) herpesvirus (KSHV) is one of the seven known human oncogenic viruses. KSHV infection precedes the development of KS, an AIDS-associated malignancy. While the incidence of AIDS-KS globally has seen a decline, this endothelial cancer is refractory to treatment. The standard of care for AIDS-KS has gone virtually unchanged for over 20 years and effective treatments against the oncovirus KSHV have yet to be developed. 2-DG (2-deoxy-D-glucose), 2-FDG (2-fluoro-deoxy-D-glucose), and2-DFM (2-deoxy-2-fluoro-D-mannose) are sugar analogs. 2-DG and 2-FDG are D-glucose analogs and strong glycolysis inhibitors. 2-DG is also a D-mannose analog so that can inhibit N-glycosylation. In this work we aimed to further characterize and compare the inhibition of the three drug analogs on KSHV replication and pathogenesis.
Design/Methods: We determined the ability of each drug to inhibit KSHV reactivation and infection by flow cytometry using the KSHV producer cell line iSLK.219 Virus titers were measured by de novo infection of naïve AdHEK293 cells and quantifying the number of AdHEK293 infected cells. We further characterized sugar analog inhibition assessing viral glycoprotein expression by western blot and quantifying virion production by qPCR. To show that N-glycosylation impairment is the main contributor of virus replication inhibition, we carried out D-mannose rescue experiments and analyzed activation of the unfolded protein response (UPR). When UPR cannot be resolved, it leads to either apoptosis or autophagy. For this reason, we analyzed the cellular fate of reactivated sugar analog-treated cells by western blot using apoptotic and autophagic markers. Additionally, we calculated the cell death index using the IncuCyte® machine.
Results: All three sugar analogs negatively affected KSHV replication and virion infectivity, but 2-DFM displayed the strongest inhibition. Viral glycoproteins K8.1 and gB were down-regulated and virion production was diminished especially with 2-FDG and 2-DFM sugar analogs. D-mannose could rescue viral glycoprotein expression and virion infectivity, but could not reverse the number of reactivated cells, indicating that N-glycosylation is the main target of the drugs. In line with this, all analogs triggered UPR and even overcame KSHV-induced suppression of the PERK pathway. Finally, 2-DG, 2-FDG, and 2-DFM played a protective role in reactivated cells, displaying the autophagic marker instead of the apoptotic signature observed in the untreated cells.
Conclusion: Collectively, this work identifies the non-toxic inhibition of N-glycosylation by sugar analogs as an important viral target and reinforces the potential of 2-DG as an antiviral for KSHV and other enveloped viruses. We also found that 2-DFM is a more potent and target-oriented compound and a promising therapeutic antiviral agent against an oncogenic virus.
Citation Format: Mariana Schlesinger, Christian McDonald, Anuj Ahuja, Carolina Alvez-Canete, Zelmira Nunez Del Prado, Julian Naipauer, Theodore Lampidis, Enrique Mesri, Noula Shembade. Sugar analogs inhibit KSHV replication by blocking N-glycosylation and inducing the unfolded protein response [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1483.