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Sci Transl Med . An inhaled ACE2 decoy confers protection against SARS-CoV-2 infection in preclinical models

tetano

Editor, Senior Moderator
Sci Transl Med


. 2023 Aug 30;15(711):eadi2623.
doi: 10.1126/scitranslmed.adi2623. Epub 2023 Aug 30. An inhaled ACE2 decoy confers protection against SARS-CoV-2 infection in preclinical models

Emiko Urano[SUP] 1 [/SUP], Yumi Itoh[SUP] 2 3 [/SUP], Tatsuya Suzuki[SUP] 2 3 [/SUP], Takanori Sasaki[SUP] 4 [/SUP], Jun-Ichi Kishikawa[SUP] 5 [/SUP], Kanako Akamatsu[SUP] 6 [/SUP], Yusuke Higuchi[SUP] 7 [/SUP], Yusuke Sakai[SUP] 8 [/SUP], Tomotaka Okamura[SUP] 1 [/SUP], Shuya Mitoma[SUP] 9 [/SUP], Fuminori Sugihara[SUP] 10 [/SUP], Akira Takada[SUP] 2 [/SUP], Mari Kimura[SUP] 2 [/SUP], Shuto Nakao[SUP] 2 [/SUP], Mika Hirose[SUP] 5 [/SUP], Tadahiro Sasaki[SUP] 11 [/SUP], Ritsuko Koketsu[SUP] 11 [/SUP], Shunya Tsuji[SUP] 12 [/SUP], Shota Yanagida[SUP] 13 [/SUP], Tatsuo Shioda[SUP] 11 14 [/SUP], Eiji Hara[SUP] 12 14 [/SUP], Satoaki Matoba[SUP] 7 [/SUP], Yoshiharu Matsuura[SUP] 14 [/SUP], Yasunari Kanda[SUP] 13 [/SUP], Hisashi Arase[SUP] 14 15 16 [/SUP], Masato Okada[SUP] 6 14 16 17 [/SUP], Junichi Takagi[SUP] 14 18 [/SUP], Takayuki Kato[SUP] 5 14 16 [/SUP], Atsushi Hoshino[SUP] 7 [/SUP], Yasuhiro Yasutomi[SUP] 1 19 [/SUP], Akatsuki Saito[SUP] 9 20 21 [/SUP], Toru Okamoto[SUP] 2 3 14 [/SUP]



Affiliations
Abstract

The Omicron variant continuously evolves under the humoral immune pressure exerted by vaccination and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and the resulting Omicron subvariants display further immune evasion and antibody escape. An engineered angiotensin-converting enzyme 2 (ACE2) decoy composed of high-affinity ACE2 and an IgG1 Fc domain could offer an alternative modality to neutralize SARS-CoV-2. We previously reported its broad spectrum and therapeutic potential in rodent models. Here, we demonstrate that the engineered ACE2 decoy retains neutralization activity against Omicron subvariants, including the currently emerging XBB and BQ.1 strains, which completely evade antibodies currently in clinical use. SARS-CoV-2, under the suboptimal concentration of neutralizing drugs, generated SARS-CoV-2 mutants escaping wild-type ACE2 decoy and monoclonal antibodies, whereas no escape mutant emerged against the engineered ACE2 decoy. Furthermore, inhalation of aerosolized decoys improved the outcomes of rodents infected with SARS-CoV-2 at a 20-fold lower dose than that of intravenous administration. Last, the engineered ACE2 decoy exhibited therapeutic efficacy for cynomolgus macaques infected with SARS-CoV-2. These results indicate that this engineered ACE2 decoy represents a promising therapeutic strategy to overcome immune-evading SARS-CoV-2 variants and that liquid aerosol inhalation could be considered as a noninvasive approach to enhance the efficacy of COVID-19 treatments.


 
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