An engineered ACE2 decoy receptor can be administered by inhalation and potently targets the BA.1 and BA.2 omicron variants of SARS-CoV-2

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Abstract

Monoclonal antibodies targeting the SARS-CoV-2 spike (S) glycoprotein neutralize infection and are efficacious for the treatment of mild-to-moderate COVID-19. However, SARS-CoV-2 variants have emerged that partially or fully escape monoclonal antibodies in clinical use. Notably, the BA.2 sublineage of B.1.1.529/omicron escapes nearly all monoclonal antibodies currently authorized for therapeutic treatment of COVID-19. Decoy receptors, which are based on soluble forms of the host entry receptor ACE2, are an alternative strategy that broadly bind and block S from SARS-CoV-2 variants and related betacoronaviruses. The high-affinity and catalytically active decoy sACE2 2 .v2.4-IgG1 was previously shown to be effective in vivo against SARS-CoV-2 variants when administered intravenously. Here, the inhalation of sACE2 2 .v2.4-IgG1 is found to increase survival and ameliorate lung injury in K18-hACE2 transgenic mice inoculated with a lethal dose of the virulent P.1/gamma virus. Loss of catalytic activity reduced the decoy’s therapeutic efficacy supporting dual mechanisms of action: direct blocking of viral S and turnover of ACE2 substrates associated with lung injury and inflammation. Binding of sACE2 2 .v2.4-IgG1 remained tight to S of BA.1 omicron, despite BA.1 omicron having extensive mutations, and binding exceeded that of four monoclonal antibodies approved for clinical use. BA.1 pseudovirus and authentic virus were neutralized at picomolar concentrations. Finally, tight binding was maintained against S from the BA.2 omicron sublineage, which differs from S of BA.1 by 26 mutations. Overall, the therapeutic potential of sACE2 2 .v2.4-IgG1 is further confirmed by inhalation route and broad neutralization potency persists against increasingly divergent SARS-CoV-2 variants.

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  1. SciScore for 10.1101/2022.03.28.486075: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    RandomizationAnimals with sex- and age-matched littermates were randomly included in experiments.
    BlindingAnimal experiments were carried out in a blinded fashion whenever feasible.
    Power AnalysisFor the number of animals needed to achieve statistically significant results, we conducted an a priori power analysis.
    Cell Line Authenticationnot detected.

    Table 2: Resources

    Antibodies
    SentencesResources
    For assays examining the avid binding of dimeric sACE22-IgG1 and monoclonal antibodies, cells were resuspended in PBS-BSA containing 1:150 polyclonal chicken anti-MYC-FITC (Immunology Consultants Laboratory) and 1:300 anti-human IgG-APC (clone HP6017, BioLegend).
    anti-MYC-FITC (Immunology Consultants Laboratory)
    suggested: None
    anti-human IgG-APC
    suggested: None
    Experimental Models: Cell Lines
    SentencesResources
    HeLa-hACE2-11 (a stable human ACE2 HeLa clone) were grown in Dulbecco’s Modified Eagle’s Medium (DMEM) high glucose (4500 mg/l) with 10% fetal bovine serum (FBS), 100 units/ml penicillin, and 100 μg/ml streptomycin at 37 °C, 5% CO2.
    HeLa clone
    suggested: None
    Calu-3 (ATCC HTB-55) cells were grown in Modified Eagle’s Medium high glucose (4500 mg/l) with 10% FBS, 4 mM L-Glutamine, 1 mM sodium pyruvate, 100 units/ml penicillin, and 100 μg/ml streptomycin at 37 °C with 5% CO2.
    Calu-3
    suggested: ATCC Cat# HTB-55, RRID:CVCL_0609)
    Monoclonal antibodies, sACE2-8his proteins, and RBD-8his were expressed in Expi293F cells transfected using Expifectamine (Thermo Fisher) according to the manufacturer’s instructions.
    Expi293F
    suggested: RRID:CVCL_D615)
    Virus titers were quantitated by a plaque forming assay using Vero E6 cells.
    Vero E6
    suggested: RRID:CVCL_XD71)
    Pseudovirions were created following a polyethylenimine (PEI)-based transient co-transfection on 293T cells.
    293T
    suggested: KCB Cat# KCB 200744YJ, RRID:CVCL_0063)
    Pseudovirus Inhibition Assay: HeLa-hACE2-11 cells were seeded (5×103 cells/well) onto white-bottomed 96-well tissue culture plates (100 μL/well) and incubated for 16 h, 37 °C, 5% CO2.
    HeLa-hACE2-11
    suggested: None
    Experimental Models: Organisms/Strains
    SentencesResources
    HeLa-hACE2-11 (a stable human ACE2 HeLa clone) were grown in Dulbecco’s Modified Eagle’s Medium (DMEM) high glucose (4500 mg/l) with 10% fetal bovine serum (FBS), 100 units/ml penicillin, and 100 μg/ml streptomycin at 37 °C, 5% CO2.
    HeLa-hACE2-11
    suggested: None
    Hemizygous K18-hACE2 mice (strain 034860: B6.Cg-Tg(K18-ACE2)2Prlmn/J) were purchased from The Jackson Laboratory.
    K18-hACE2
    suggested: RRID:IMSR_GPT:T037657)
    B6.Cg-Tg(K18-ACE2)2Prlmn/J
    suggested: RRID:IMSR_JAX:034860)
    Recombinant DNA
    SentencesResources
    Plasmids for sACE22-IgG1 (Addgene #154104), sACE22.v2.4-IgG1 (#154106), sACE2(18-615)-8his (#149268), sACE2(18-615).
    sACE22-IgG1
    suggested: None
    Mutations for the CDY14 decoy receptor were introduced into the wild type sACE2 plasmids using extension overlap PCR and confirmed by Sanger sequencing.
    sACE2
    suggested: None
    S Binding Assay: Human codon-optimized genes encoding N-terminal myc-tagged S proteins of BA.1 and BA.2 omicron were synthesized (Integrated DNA Technologies) and cloned into the NheI-XhoI sites of pcDNA3.1(+) (Invitrogen).
    pcDNA3.1(+)
    suggested: RRID:Addgene_129020)
    Pseudovirion Production: Pseudoviruses were created using plasmids for SARS-CoV-2 Omicron B.1.1.529 (BA.1) S and HIV-1 proviral vector pNL4-3.
    pNL4-3
    suggested: None
    Software and Algorithms
    SentencesResources
    Images were taken by Aperio ImageScope 12.4.3 and analyzed by Zen software (Zeiss).
    ImageScope
    suggested: (ImageScope, RRID:SCR_014311)
    Zen
    suggested: None
    IC50 values were determined by fitting dose-response curves with four-parameter logistic regression in GraphPad Prism 8 software.
    GraphPad Prism
    suggested: (GraphPad Prism, RRID:SCR_002798)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).


    Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    Results from TrialIdentifier: We found the following clinical trial numbers in your paper:

    IdentifierStatusTitle
    NCT04335136CompletedRecombinant Human Angiotensin-converting Enzyme 2 (rhACE2) a…


    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.


    Results from JetFighter: We did not find any issues relating to colormaps.


    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.


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