Patent Application
20240093173
The present disclosure generally relates to a method for treating or preventing infection of a subject by a virus that infects the subject through angiotensin converting enzyme 2 (ACE2).
Outbreaks of emerging infectious diseases continue to challenge human health. The reported incidence of emerging and re-emerging zoonotic disease is increasing in many parts of the world. The Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) first emerged 17 years ago (Drosten et al., Identification of a novel coronavirus in patients with severe acute respiratory syndrome, N Engl J Med (2003) 348, 1967-1976). In December of 2019, a novel coronavirus (Severe Acute Respiratory Syndrome Coronavirus 2, “SARS-CoV-2”) crossed species barriers to infect humans and was effectively transmitted from person to person, leading to a pneumonia outbreak. The SARS-CoV-2 causes coronavirus disease-19 (COVID-19) with influenza like symptoms ranging from mild disease to severe lung injury and multi-organ failure, eventually leading to death, especially in older patients with other co-morbidities.
SARS-CoV-2 is a positive-sense single-stranded RNA (+ssRNA) virus which belongs to the beta-coronavirus family and shares substantial genetic and functional similarity with other pathogenic human beta-coronaviruses, including Severe Acute Respiratory Syndrome Coronavirus (“SARS-CoV”, also called SARS-CoV-1) and Middle East Respiratory Syndrome Coronavirus (“MERS-CoV”). Like other coronaviruses, SARS-CoV-2 has four structural proteins, known as the S (spike), E (envelope), M (membrane), and N (nucleocapsid) proteins. The spike protein is the protein responsible for allowing the SARS-CoV-2 virus to attach to the membrane of a host cell, the receptor binding domain (“RBD”) of the spike protein of SARS-CoV-2 recognizes and attaches to the angiotensin-converting enzyme 2 (“ACE2”) receptor of host cells to use them as a mechanism of cell entry.
ACE2 is a key metalloprotease of the Renin Angiotensin System (RAS), primarily existing as a membrane anchored zinc metalloprotease, which acts in the blood circulation and induces local effects in affected organs, as well as systemic effects via the blood circulation. ACE2 is expressed in the vascular system as well as in most organs, but predominantly in the lungs, kidneys, liver, heart, intestine and testes. In a normal adult human lung, ACE2 is expressed primarily in alveolar epithelial type II cells, which can serve as a viral reservoir. These cells produce surfactant which reduces surface tension, thus preventing alveoli from collapsing, and hence are critical to the gas exchange function of the lung. The overexpression of human ACE2 was identified to enhance disease severity in mice infected with SARS-CoV, demonstrating that ACE2-dependent viral entry into cells is a critical step (Yang et al., 2007). It was also reported that injecting SARS-CoV spike into mice decreased ACE2 expression levels, thereby worsening lung injury (Imai et al., 2005; Kuba et al., 2005). Thus, ACE2 serves both as the entry receptor of SARS-CoV and to protect the lung from injury.
A few disruptive agents targeted to ACE2 disrupting the RBD and ACE2 interaction have been shown to inhibit SARS-CoV infection. However, given the important physiological roles of ACE2 in vivo, these agents may have undesired side effects. Disruptive agents targeted to the RBD, on the other hand, are therefore more favorable.
No SARS-CoV-2-specific treatments are currently available. Hence, an urgent need exists in the art to treat and/or prevent infection of a subject by a virus (especially Coronavirus).
Throughout the present disclosure, the articles “a,” “an,” and “the” are used herein to refer to one or to more than one (i.e., to at least one) of the grammatical object of the article.
In one aspect, the present disclosure provides a method for treating or preventing infection of a subject by a virus that infects the subject through ACE2, comprising administering an effective amount of a recombinant ACE2 (rACE2) to the subject.
In another aspect, the present disclosure provides use of ACE2 in the manufacture of a medicament for treating or preventing infection of a subject by a virus that infects the subject through ACE2.
In one yet another aspect, the present disclosure provides use of ACE2 for treating or preventing infection of a subject by a virus that infects the subject through ACE2.
In one aspect, the present disclosure provides an in vitro method for treating or preventing infection of cells or tissue by a virus that infects cells or tissue through ACE2, comprising administering an effective amount of a rACE2 to the cells or tissue. In some embodiments, the tissue is lung, blood vessel, intestine, kidney, liver, brain or heart. In some embodiments, the cells are lung cells, blood vessel cells, intestine cells, kidney cells, liver cells, brain cells or heart cells. In some embodiments, the cells are human cells or non-human mammalian cells.
In some embodiments, the present disclosure provides a method for treating infection of a subject by a virus that infects the subject through ACE2, comprising administering an effective amount of a rACE2 to the subject. In some embodiments, the present disclosure provides a method for preventing infection of a subject by a virus that infects the subject through ACE2, comprising administering an effective amount of a rACE2 to the subject.
In some embodiments, the virus is a member of the family of coronaviruses, influenza viruses, Ebola or Marburg virus, or pseudotyped viruses. In some embodiments, the virus is coronavirus. In some embodiments, the coronavirus is selected from the group consisting of SARS-CoV, SARS-CoV-2 and MERS-CoV. In another embodiments, the coronavirus is SARS-CoV-2.
In some embodiments, the ACE2 is recombinant ACE2. In some embodiments, the ACE2 is recombinant human ACE2. In another embodiment, the ACE2 is soluble ACE2. In yet another embodiment, the ACE2 is soluble recombinant human ACE2. In some embodiments, the ACE2 is glycosylated. In some embodiments, at least 85%, 88%, 90%, 92%, 95% or 99% of the possible N-glycosylation sites of the ACE2 are glycosylated. In some embodiments, the glycosyl groups of ACE2 are present in a total of at least 10, 11, 12, 13, 14, 15 or at least 16 sialic acid residues, preferably at least 14 sialic acid residues. In some embodiments, the rhACE2 comprising amino acid sequence of amino acid 18-740 of SEQ ID NO: 1. In some embodiments, the rhACE2 is at least 90%, 92%, 95%, 98%, or 99% identical to the amino acid sequence of SEQ ID NO: 2.
In some embodiments, the ACE2 is present in monomeric, dimeric form, or multimeric forms. In some embodiments, the ACE2 is present in dimeric form. In some embodiments, the ACE2 is present in homo-dimeric form. In another embodiments, the ACE2 is present in multimeric form. In some embodiments, a linker is used to dimerize or multimerize rhACE2. In some embodiments, the linker is Fc region. In some embodiments, the rhACE2 is GSK2586881.
In some embodiments, the subject is human.
In some embodiments, the method is for treating or preventing infection of a tissue in the subject by viruses. In some embodiments, the method is for treating or preventing infection of a tissue in the subject by coronavirus. In some embodiments, the method is for treating or preventing infection of a tissue in the subject by SARS-CoV-2. In some embodiments, the tissue is lung, blood vessel, intestine, kidney, liver, brain, or heart. In some embodiments, the infection of lung, blood vessel, intestine, liver, heart, brain, or kidney in the subject is prevented or treated by administering an effective amount of ACE2 to the subject.
In some embodiments, the virus infects a subject through ACE2 expressed on lung cells. In another embodiment, the virus infects a subject through ACE2 expressed on alveolar epithelial type II cells. In some embodiments, the virus infects a subject through ACE2 expressed on blood vessel cells. In another embodiments, the virus infects a subject through ACE2 expressed on capillary cells. In some embodiments, the virus infects a subject through ACE2 expressed on cardiac cells. In some embodiments, the virus infects a subject through ACE2 expressed on kidney cells. In some embodiments, the virus infects a subject through ACE2 expressed on intestine cells. In some embodiments, the virus infects a subject through ACE2 expressed on liver cells. In some embodiments, the virus infects a subject through ACE2 expressed on brain cells. In some embodiments, the virus infects a subject through ACE2 expressed on testis cells.
In some embodiment, the ACE2 is administered in a pharmaceutical composition to the subject. In some embodiment, the ACE2 is administered in a pharmaceutically acceptable formulation to the subject.
In some embodiment, the ACE2 is administered through intravenous, intradermal, intramuscular injection, oral administration, or inhalation.
In some embodiment, the rACE2 is administered at a dosage of 0.01-10 mg/kg. In some embodiment, the rACE2 is administered at a dosage of 0.01-1 mg/kg. In another embodiment, the rACE2 is administered at a dosage of 0.4 mg/kg. In some embodiments, the ACE2 is administered twice a day. In another embodiment, the ACE2 is administered once a day. In some embodiments, the ACE2 is administered consecutively for at least 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14 or 15 days. In another embodiment, the ACE2 is administered consecutively for no more than 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14 or 15 days.
In some embodiment, the method further comprises administering to the subject a second therapeutic agent. In some embodiment, the method further comprises administering to the subject a second therapeutic agent for treating infections or complications. In some embodiment, the second therapeutic agent is an anti-viral agent or anti-inflammatory. In some embodiment, the anti-viral agent is hydroxychloroquine. In some embodiments, the second therapeutic agent is an RNA dependent RNA polymerase inhibitor, a non-nucleoside reverse transcriptase inhibitor (NNRTI), nucleoside reverse transcriptase inhibitor (NRTI), purine nucleoside, antiviral interferon, adamantine antiviral compound, or any other suitable antiviral agent. In some embodiments, the second therapeutic agent is remdesivir, chloroquine, hydroxychloroquine, lopinavir, ritonavir, APN01, favilavir, mesalazine, toremifene, eplerenone, paroxetine, sirolimus, dactinomycin, irbesartan, emodin, mercaptopurine, melatonin, quinacrine, carvedilol, colchicine, camphor, equilin, oxymetholone, nafamosta, camostat, derivatives thereof, or any combination thereof.
The following drawings form part of the present specification and are included to further demonstrate certain aspects of the present disclosure. The disclosure may be better understood by reference to one or more of these drawings in combination with the detailed description of specific embodiments presented herein.
The following description of the disclosure is merely intended to illustrate various embodiments of the disclosure. As such, the specific modifications discussed are not to be construed as limitations on the scope of the disclosure. It will be apparent to a person skilled in the art that various equivalents, changes, and modifications may be made without departing from the scope of the disclosure, and it is understood that such equivalent embodiments are to be included herein. All references cited herein, including publications, patents and patent applications are incorporated herein by reference in their entirety.
In one aspect, the present disclosure provides a method for treating or preventing infection of a subject by a virus that infects the subject through Angiotensin converting enzyme 2 (ACE2), comprising administering an effective amount of a recombinant Angiotensin converting enzyme 2 (rACE2) to the subject.
The terms “infection” used herein refers to the invasion of an organism's tissues or cells by viruses and related agents such as viroids and prions, their multiplication and reaction with host cells, as well as the resulted conditions and diseases.
The term “virus” as used herein refers to virus particles including the parental virus and its progeny virus, which may be infectious or noninfectious. The multiplication of the virus depend both on its destructive tendencies toward a specific host cell and on environmental conditions. In the vegetative cycle of viral infection, multiplication of progeny viruses can be rapid. This cycle of infection often results in the death of the cell and the release of many virus progeny.
The term “a virus that infects the subject through Angiotensin converting enzyme 2” as used herein refers to any virus, of which infection involves ACE2. In some embodiments, the virus uses ACE2 as receptor. In some embodiments, the virus uses ACE2 as receptor. In some embodiments, the virus uses ACE2 as receptor to enter into host cells. In some embodiments, the virus that infects the subject through ACE2 is a member of the family of coronaviruses, influenza viruses, Ebola or Marburg virus, or pseudotyped viruses. In some embodiments, the virus that infects the subject through ACE2 is Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2).
The term “ACE2” as used herein refers to a zinc metalloenzyme and carboxypeptidase located as an ectoenzyme on the surface of endothelial and other cells. While its primary substrate appears to be Ang II, it can hydrolyze a number of other physiological substrates. The human ACE2 (UniProt sequence data base entry: Q9BYF1) comprises a signal peptide (amino acids 1 to 17), an extracellular domain (amino acids 18 to 740), a helical transmembrane domain (amino acids 741 to 761) and a cytoplasmic domain (amino acids 762 to 805). In present invention, the ACE2 may be a full-length ACE2 polypeptide or a fragment thereof.
The term “recombinant” when used with reference to a polypeptide or a polynucleotide, refers to a polypeptide or polynucleotide that is produced by a recombinant method. A recombinant polypeptide includes any polypeptide expressed from a recombinant polynucleotide. A recombinant polynucleotide includes any polynucleotide which has been modified by the introduction of at least one exogenous (i.e., foreign, and typically heterologous) nucleotide or the alteration of at least one native nucleotide component of the polynucleotide, and need not include all of the coding sequence or the regulatory elements naturally associated with the coding sequence. A recombinant vector refers to a non-naturally occurring vector, including, e.g., a vector comprising a recombinant polynucleotide sequence.
In some embodiments, the rACE2 is a soluble rACE2. In one embodiment, the soluble rACE2 has no trans-membrane domains. In some embodiments, the soluble rACE2 comprises or consists of the amino acid sequence of the extracellular domain of ACE2 or any fragment thereof. In one embodiment, the soluble ACE2 comprises amino acids 374 to 378 of SEQ ID No: 2. In some embodiments, the soluble ACE2 comprises or consists of amino acids 18-740 of SEQ ID No: 2. In some embodiments, the soluble ACE2 consists of amino acids 18 to 615 of SEQ ID No: 2. In some embodiments, the soluble ACE2 is present in monomeric, dimeric, or multimeric forms.
The rACE2 used herein may optionally be glycosylated. The soluble domain of native human ACE2 has seven N-glycosylation sites. In one embodiment, 3, 4, 5, 6 or 7 of the possible N-glycosylation positions of the ACE2 polypeptides which correspond to Asn53, Asn90, Asn103, Asn322, Asn432, Asn546, Asn690 of SEQ ID NO: 2, are glycosylated and/or the ACE2 polypeptide has a sugar content of greater than 10% (percent by weight of the total ACE2 polypeptide) or 11%, 12%, 13%, 14%, 15%, 16%, 17%, 18%, 19%, in particular greater than 20%, 21%, 22%, 23%, 24%, or 25% by weight. In some embodiments, at least 85%, 88%, 90%, 92%, 95% or 99% of the possible N-glycosylation sites of the rhACE2 polypeptide are glycosylated.
The term “sialic acid residues” as used herein, refers to residues of the N-acetylneuraminic acid type (Neu5Ac), especially N-glycosylation or O-glycosylation.
The rACE2 can be prepared by conventional methods well known in the art. The exemplary method for producing ACE2 polypeptides are described in WO2008/151347, the entire contents of which are incorporated herein by reference. The rACE2 could also be commercially available. In some embodiments, the rACE2 is GSK2586881.
The term “polypeptide” or “protein” means a string of at least two amino acids linked to one another by peptide bonds. Polypeptides and proteins may include moieties in addition to amino acids (e.g., may be glycosylated) and/or may be otherwise processed or modified. Those of ordinary skill in the art will appreciate that a “polypeptide” or “protein” can be a complete polypeptide chain as produced by a cell (with or without a signal sequence), or can be a functional portion thereof. Those of ordinary skill will further appreciate that a polypeptide or protein can sometimes include more than one polypeptide chain, for example a dimer. The dimer is preferably a homo-dimer, in particular, its monomer units have an identical sequence and glycosylation. In general, the monomer units of the dimer are non-covalently bound. The term also includes amino acid polymers in which one or more amino acids are chemical analogs of a corresponding naturally-occurring amino acid and polymers.
The term “nucleic acid” or “polynucleotide” as used herein refers to deoxyribonucleic acids (DNA) or ribonucleic acids (RNA) and polymers thereof in either single- or double-stranded form. Unless otherwise indicated, a particular polynucleotide sequence also implicitly encompasses conservatively modified variants thereof (e.g. degenerate codon substitutions), alleles, orthologs, SNPs, and complementary sequences as well as the sequence explicitly indicated. Specifically, degenerate codon substitutions may be achieved by generating sequences in which the third position of one or more selected (or all) codons is substituted with mixed-base and/or deoxyinosine residues (see Batzer et al., Nucleic Acid Res. 19:5081 (1991); Ohtsuka et al., J. Biol. Chem. 260:2605-2608 (1985); and Rossolini et al., Mol. Cell. Probes 8:91-98 (1994)).
“Percent (%) sequence identity” with respect to amino acid sequence (or nucleic acid sequence) is defined as the percentage of amino acid (or nucleic acid) residues in a candidate sequence that are identical to the amino acid (or nucleic acid) residues in a reference sequence, after aligning the sequences and, if necessary, introducing gaps, to achieve the maximum number of identical amino acids (or nucleic acids). Conservative substitution of the amino acid residues may or may not be considered as identical residues. Alignment for purposes of determining percent amino acid (or nucleic acid) sequence identity can be achieved, for example, using publicly available tools such as BLASTN, BLASTp (available on the website of U.S. National Center for Biotechnology Information (NCBI), see also, Altschul S. F. et al., J. Mol. Biol., 215:403-410 (1990); Stephen F. et al., Nucleic Acids Res., 25:3389-3402 (1997)), ClustalW2 (available on the website of European Bioinformatics Institute, see also, Higgins D. G. et al., Methods in Enzymology, 266:383-402 (1996); Larkin M. A. et al., Bioinformatics (Oxford, England), 23(21): 2947-8 (2007)), and ALIGN or Megalign (DNASTAR) software. A person skilled in the art may use the default parameters provided by the tool, or may customize the parameters as appropriate for the alignment, such as for example, by selecting a suitable algorithm.
As used herein, the term “sample” used herein refers to a biological specimen that is obtained or derived from a subject of interest. The sample contains a cellular and/or other molecular entity that is to be characterized and/or identified, for example based on physical, biochemical, chemical and/or physiological characteristics.
The term “subject” as used herein refers to human and non-human animals infected or at a risk of being infected by a virus which infects the subject through ACE2. In some embodiments, the subject is human. Except when noted, the terms “patient” or “subject” are used herein interchangeably.
The term “pharmaceutically acceptable” indicates that the designated carrier, vehicle, diluent, excipient(s), and/or salt is generally chemically and/or physically compatible with the other ingredients comprising the formulation, and physiologically compatible with the recipient thereof.
The term “therapeutic effect” as used herein refers to a local or systemic effect in a subject, particularly humans, caused by a pharmacologically active substance. The term thus means any substance intended for use in the treatment or prevention of infection or disease, or in the enhancement of desirable physical or mental development and conditions in a subject.
The term “therapeutically effective amount” or “effective amount” used herein refers to an amount of an ACE2 that is effective for preventing, ameliorating and/or treating a condition resulting from infection with virus (preferably, SARS-CoV-2). “Amelioration” as used herein may refer to the reduction of visible or perceptible disease symptoms, viremia, or any other measurable manifestation of virus (preferably, SARS-CoV-2) infection. In one embodiment, a therapeutically effective amount of the ACE2 (i.e., an effective dosage) ranges from about 0.01-10 mg/kg body weight, preferably about 0.01-5 mg/kg body weight, more preferably about 0.1-1 mg/kg body weight, and even more preferably about 0.1-0.8 mg/kg, 0.2-0.7 mg/kg, 0.3-0.6 mg/kg or 0.4-0.5 mg/kg. The skilled artisan will appreciate that certain factors may influence the dosage required to effectively treat a subject, including but not limited to the severity of the infection, disease or disorder, previous treatments, the general health and/or age of the subject, and other diseases present.
Moreover, treatment of a subject with a therapeutically effective amount of ACE2 can include a single treatment or, preferably, can include a series of treatments. In some embodiments, a subject is treated with ACE2 in the range of between about 0.01-10 mg/kg body weight, one time per day or twice a day for between about 1 to 30 days. In some embodiments, the ACE2 is administered consecutively for at least 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14 or 15 days. In some embodiments, the ACE2 is administered consecutively for no more than 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14 or 15 days. It will also be appreciated that the effective dosage of ACE2 or the regimen used for treatment may be changed over the course of a particular treatment. Changes in dosage and/or regimen may result from the results of diagnostic assays.
The term “inhibit”, “inhibiting” or “inhibition” include the decrease, limitation, or blockage, of, for example a particular action, function, or interaction. In some embodiments, infection is “inhibited” if at least one symptom of the infection is alleviated, terminated, slowed, or prevented. As used herein, infection is also “inhibited” if replication of the virus is reduced, slowed, delayed, or prevented.
The term “interaction”, when referring to an interaction between two molecules, refers to the physical contact (e.g., binding) of the molecules with one another. Generally, such an interaction results in an activity (which produces a biological effect) of one or both of said molecules. The interaction between a rhACE2 and the RBD of spike protein of coronavirus (preferably SARS-CoV-2) may inhibit the binding interaction between the RBD of spike protein of coronavirus and its binding partner, such as the ACE receptor expressed on cells in a subject.
The term “treating” or “treatment” of an infection, disease, disorder or condition as used herein includes preventing or alleviating an infection, disease, disorder or condition, slowing the onset or rate of development of an infection, disease, disorder or condition, reducing the risk of developing an infection, disease, disorder or condition, preventing or delaying the development of symptoms associated with an infection, disease, disorder or condition, reducing or ending symptoms associated with an infection, disease, disorder or condition, generating a complete or partial regression of a disease, disorder or condition, curing a disease, disorder or condition, or some combination thereof. Those in need of treatment include those already inflicted with a condition resulting from infection of virus (preferably, SARS-CoV-2) as well as those in which infection with virus (preferably, SARS-CoV-2) is to be prevented. Subjects partially or totally recovered from infection of virus (preferably, SARS-CoV-2) might also be in need of treatment. Prevention encompasses inhibiting or reducing the spread of virus (preferably, SARS-CoV-2) or inhibiting or reducing the onset, development or progression of one or more of the symptoms associated with infection with virus (preferably, SARS-CoV-2).
The terms “prevent,” “preventing,” “prevention,” “prophylactic treatment,” and the like refer to reducing the probability of developing an infection, disease, disorder, or condition in a subject, who does not have, but is at risk of or susceptible to developing an infection, disease, disorder, or condition.
The present disclosure provides a method for treating or preventing infection of a subject by a virus that infects the subject through ACE2, comprising administering an effective amount of a rACE2 in a pharmaceutical composition to the subject. In some embodiments, the pharmaceutical compositions comprising an effective amount of a rACE2 and one or more pharmaceutically acceptable carriers.
Pharmaceutical acceptable carriers for use in the pharmaceutical compositions disclosed herein may include, for example, pharmaceutically acceptable liquid, gel, or solid carriers, aqueous vehicles, non-aqueous vehicles, antimicrobial agents, isotonic agents, buffers, tonicity-adjusting agents, antioxidants, anesthetics, suspending/dispending agents, sequestering or chelating agents, diluents, adjuvants, excipients, or non-toxic auxiliary substances, other components known in the art, or various combinations thereof.
Suitable components may include, for example, fillers, binders, disintegrants, buffers, preservatives, lubricants, flavorings, thickeners, coloring agents, emulsifiers or stabilizers such as sugars and cyclodextrins. In some embodiments, the suitable buffers may include, for example, a phosphate buffer or a MES (2-(N-morpholino)ethane sulfonic acid) buffer.
To further illustrate, pharmaceutical acceptable carriers may include, for example, aqueous vehicles such as sodium chloride injection, Ringer's injection, isotonic dextrose injection, sterile water injection, or dextrose and lactated Ringer's injection, nonaqueous vehicles such as fixed oils of vegetable origin, cottonseed oil, corn oil, sesame oil, or peanut oil, antimicrobial agents at bacteriostatic or fungistatic concentrations, isotonic agents such as sodium chloride or dextrose, buffers such as phosphate or citrate buffers or MES (2-(N-morpholino)ethane sulfonic acid buffers, antioxidants such as sodium bisulfate, local anesthetics such as procaine hydrochloride, suspending and dispersing agents such as sodium carboxymethylcelluose, hydroxypropyl methylcellulose, or polyvinylpyrrolidone, emulsifying agents such as Polysorbate 80 (TWEEN-80), sequestering or chelating agents such as EDTA (ethylenediaminetetraacetic acid) or EGTA (ethylene glycol tetraacetic acid), ethyl alcohol, polyethylene glycol, propylene glycol, sodium hydroxide, hydrochloric acid, citric acid, or lactic acid. Antimicrobial agents utilized as carriers may be added to pharmaceutical compositions in multiple-dose containers that include phenols or cresols, mercurials, benzyl alcohol, chlorobutanol, methyl and propyl p-hydroxybenzoic acid esters, thimerosal, benzalkonium chloride and benzethonium chloride. Suitable excipients may include, for example, water, saline, dextrose, glycerol, or ethanol. Suitable non-toxic auxiliary substances may include, for example, wetting or emulsifying agents, pH buffering agents, stabilizers, solubility enhancers, or agents such as sodium acetate, sorbitan monolaurate, triethanolamine oleate, or cyclodextrin.
The pharmaceutical compositions can be a liquid solution, suspension, emulsion, pill, capsule, tablet, sustained release formulation, or powder. Oral formulations can include standard carriers such as pharmaceutical grades of mannitol, lactose, starch, magnesium stearate, polyvinyl pyrollidone, sodium saccharine, cellulose, magnesium carbonate, etc.
The form of pharmaceutical compositions depends on a number of criteria, including, but not limited to, route of administration, extent of disease, or dose to be administered. The pharmaceutical compositions can be formulated for intravenous, oral, nasal, rectal, percutaneous, or intramuscular administration. For example, dosage forms for intravenous administration, may be formulated as lyophilized powder or fluid formulation; dosage forms for nasal administration may conveniently be formulated as aerosols, solutions, drops, gels or dry powders. In accordance to the desired route of administration, the pharmaceutical compositions can be formulated in the form of tablets, capsule, pill, dragee, powder, granule, sachets, cachets, lozenges, suspensions, emulsions, solutions, syrups, aerosols (as a solid or in a liquid medium), spray, inhalant, or suppository.
In certain embodiments, the pharmaceutical compositions are formulated into an injectable composition. The injectable pharmaceutical compositions may be prepared in any conventional form, such as for example liquid solution, suspension, emulsion, or solid forms suitable for generating liquid solution, suspension, or emulsion. Preparations for injection may include sterile and/or non-pyretic solutions ready for injection, sterile dry soluble products, such as lyophilized powders, ready to be combined with a solvent just prior to use, including hypodermic tablets, sterile suspensions ready for injection, sterile dry insoluble products ready to be combined with a vehicle just prior to use, and sterile and/or non-pyretic emulsions. The solutions may be either aqueous or nonaqueous.
In certain embodiments, unit-dose parenteral preparations are packaged in an ampoule, a vial or a syringe with a needle. All preparations for parenteral administration should be sterile and not pyretic, as is known and practiced in the art.
Depending on the route of administration, the rACE2 can be coated with or disposed in a selected material to protect it from natural conditions which may detrimentally affect its ability to perform its intended function. It may be administered alone, or in conjunction with a pharmaceutically acceptable carrier. It also may be administered as a prodrug, which is converted to its active form in vivo.
The present disclosure provides methods for treating or preventing infection of a subject by a virus that infects the subject through ACE2, comprising administering to the subject an effective amount of a rACE2, or the pharmaceutical composition comprising an effective amount of a rACE2.
In certain embodiment, the infection being treated or prevented is or is caused by coronavirus. In certain embodiment, the infection being treated or prevented is caused by SARS-CoV-2. In certain embodiments, the subject is human.
The rACE2, or the pharmaceutical composition comprising an effective amount of a rACE2 may be administered by any route known in the art, such as for example parenteral (e.g. subcutaneous, intraperitoneal, intravenous, including intravenous infusion, intramuscular, or intradermal injection) or non-parenteral (e.g. oral, intranasal, intraocular, sublingual, rectal, or topical) routes.
In certain embodiments, the rACE2 may be administered alone or in combination an effective amount of a second therapeutic agent. In some embodiments, the second therapeutic agent is an anti-viral agent. In one embodiment, the anti-viral agent is hydroxychloroquine. In some embodiments, the second therapeutic agent is an RNA dependent RNA polymerase inhibitor, a non-nucleoside reverse transcriptase inhibitor (NNRTI), nucleoside reverse transcriptase inhibitor (NRTI), purine nucleoside, antiviral interferon, adamantine antiviral compound, or any other suitable antiviral agent. In certain embodiments, the second therapeutic agent is selected from the group consisting of remdesivir, chloroquine, hydroxychloroquine, lopinavir, ritonavir, APN01, favilavir, mesalazine, toremifene, eplerenone, paroxetine, sirolimus, dactinomycin, irbesartan, emodin, mercaptopurine, melatonin, quinacrine, carvedilol, colchicine, camphor, equilin, oxymetholone, nafamosta, camostat, derivatives thereof, or any combination thereof.
In certain of these embodiments, rACE2 may be administered simultaneously with the one or more additional therapeutic agents, and in certain of these embodiments the rACE2 and the additional therapeutic agent(s) may be administered as part of the same pharmaceutical composition. However, a rACE2 administered “in combination” with another therapeutic agent does not have to be administered simultaneously with or in the same composition as the agent. A rACE2 administered prior to or after another agent is considered to be administered “in combination” with that agent as the phrase is used herein, even if the rACE2 and the second agent are administered via different routes. Where possible, additional therapeutic agents administered in combination with the rACE2 are administered according to the schedule listed in the product information sheet of the additional therapeutic agent, or according to the Physicians' Desk Reference 2003 (Physicians' Desk Reference, 57th Ed; Medical Economics Company; ISBN: 1563634457; 57th edition (November 2002)) or protocols well known in the art.
In certain of these embodiments, a rACE2 may be administrated to a subject at a dosage of about 0.01-10 mg/kg body weight, preferably about 0.01-5 mg/kg body weight, more preferably about 0.1-1 mg/kg body weight, and even more preferably about 0.1-0.8 mg/kg, 0.2-0.7 mg/kg, 0.3-0.6 mg/kg or 0.4-0.5 mg/kg. In certain of these embodiments, a rACE2 may be administrated to a subject consecutively for at least 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14 or 15 days. In another embodiments, a rACE2 may be administrated to a subject consecutively for no more than 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14 or 15 days. In certain of these embodiments, a rACE2 may be administrated to a subject twice a day.
The following examples are provided to better illustrate the claimed invention and are not to be interpreted as limiting the scope of the invention. All specific compositions, materials, and methods described below, in whole or in part, fall within the scope of the present invention. These specific compositions, materials, and methods are not intended to limit the invention, but merely to illustrate specific embodiments falling within the scope of the invention. One skilled in the art may develop equivalent compositions, materials, and methods without the exercise of inventive capacity and without departing from the scope of the invention. It will be understood that many variations can be made in the procedures herein described while still remaining within the bounds of the present invention. It is the intention of the inventors that such variations are included within the scope of the invention.
a. Isolation and Culture of SARS-CoV-2 Particles
SARS-CoV-2 was isolated from a nasopharyngeal sample of a patient in Sweden with confirmed COVID-19 and cultured on Vero-E6 cells. The virus was titered using a plaque assay with fixation of cells 72 hours post infection as previously described (Becker et al., Synthetic recombinant bat SARS-like coronavirus is infectious in cultured cells and in mice, Proc Natl Acad Sci USA 105, (2008) 19944-19949). The isolated SARS-CoV-2 was sequenced by Next-Generation Sequencing (Genbank accession number MT093571). The cultured SARS-CoV-2 particles showed a prototypic coronal shape in electron microscopy (
b. Recombinant Human ACE2 and Murine ACE2
The clinical-grade recombinant human ACE2 (amino acids 1-740) was produced by Polymun Scientific (contract manufacturer) from CHO cells according to Good Manufacturing Practice guidelines and formulated as a physiologic aqueous solution. The equivalent domain of murine ACE2 was similarly overexpressed in CHO cells under serum free conditions and purified by sequentially performing a capture step on DEAE-Sepharose, ammonium sulfate precipitation, purification via a HIC-Phenyl Sepharose column, followed by purification via a Superdex 200 gel filtration column. The purity of the murine protein was determined via HPLC, concentrations were determined with 280 nm photometric measurements.
c. Human Capillary Organoids
Human capillary organoids were engineered from induced pluripotent stem cells (iPSCs) and can be immunostained as previously described (see Wimmer et al., Generation of blood vessel organoids from human pluripotent stem cells, Nat Protoc 14, (2019) 3082-3100, the entire contents of which are incorporated herein by reference). The capillary organoids closely resemble human capillaries with a lumen, CD31+ endothelial lining, PDGFR+ pericyte coverage, as well as formation of a basal membrane (Wimmer et al., Human blood vessel organoids as a model of diabetic vasculopathy, Nature 565, (2019) 505-510). An exemplary image of vascular capillary organoids using light microscopy (magnifications×10) is shown in
g. Vero-E6 Cells Culture
Vero-E6 cells (ATCC) were grown in Dulbecco's Modified Eagle's Medium (DMEM, ThermoFisher Scientific) supplemented with 1% Non-Essential Amino-Acid (ThermoFisher Scientific), 10 mM Hepes (ThermoFisher Scientific) and 10% FBS at 37° C., 5% CO2.
i. qRT-PCR for SARS CoV-2 RNA
Samples were extracted using Direct-zol RNA MiniPrep kit (Zymo Research). qRT-PCR was performed using E-gene SARS-CoV-2 primers/probe following guidelines by the World Health Organization (https://www.who.int/docs/default-source/coronaviruse/wuhan-virus-assay-v1991527e5122341d99287a1b17c111902.pdf). RNase P was used as an endogenous gene control to normalize the levels of intracellular viral RNA.
Statistics
All statistical analyses were conducted using GraphPad Prism8 (GraphPad) and significance was determined by Students t-test.
1. The Soluble rhACE2 Blocks SARS-CoV-2 Infections of Cells
Vero E6 cells were seeded in 48-well plates (5×104 cells per well) (Sarstedt) in DMEM containing 10% FBS for 24 hours. Different concentrations of soluble rhACE2 (25 μg/ml, 50 μg/ml and 100 μg/ml) were mixed with SARS-CoV-2 (v/v=1:1) in a final volume of 100 μl per well in DMEM (0% FBS) at 37° C. The SARS-CoV-2 was mixed at the amount of 103 plaque forming units (PFUs, MOI 0.02), 105 PFUs (MOI 2) and 106 PFUs (MOI 20) respectively for each concentration. The mixture was then added to the culture medium of Vero-E6 cells. Cells were washed 3 times with PBS after 1 hour post-infection (h.p.i.) and incubated with fresh complete medium without soluble rhACE2. 15 hours post-infection, cells were washed 3 times with PBS and then lysed using Trizol™ (Thermofisher) before analysis by qRT-PCR for viral RNA detection. The SARS-CoV-2 RNA as a marker for replication was assayed by qRT-PCR. ** P<0.01; *** P<0.001. The results were shown in
Vero E6 cells were seeded in 48-well plates (5×104 cells per well) (Sarstedt) in DMEM containing 10% FBS for 24 hours. The equivalent soluble recombinant mouse ACE2 (soluble rmACE2, produced in the same way as soluble rhACE2) at a concentration of 6 μg/ml, 25 μg/ml, 50 μg/ml and 100 μg/ml respectively were mixed with SARS-CoV-2 (v/v=1:1) in a final volume of 100 μl per well in DMEM (0% FBS) at 37° C. for 30 mins. The SARS-CoV-2 was mixed at the amount of 103 PFUs (MOI 0.02), 105 PFUs (MOI 2) and 106 PFUs (MOI 20) respectively for each concentration. The mixture was then added to the culture medium of Vero-E6 cells. Cells were washed 3 times with PBS after 1 h.p.i and incubated with fresh complete medium without rmACE2. 15 hours post-infection, cells were washed 3 times with PBS and then lysed using Trizol™ (Thermofisher) before analysis by qRT-PCR for viral RNA detection. The viral RNA as a marker for replication was assayed by qRT-PCR. The results were shown in
2. The Soluble rhACE2 Reduces SARS-CoV-2 Infections
Vero E6 cells were seeded in 48-well plates (5×104 cells per well) (Sarstedt) in DMEM containing 10% FBS for 24 hours. Different concentrations of soluble rhACE2 (25 μg/ml, 50 μg/ml, 100 μg/ml and 200 μg/ml) were mixed with SARS-CoV-2 (v/v=1:1) in a final volume of 100 μl per well in DMEM (0% FBS) at 37° C. The SARS-CoV-2 was mixed at the amount of 103 PFUs (MOI 0.02), 105 PFUs (MOI 2) and 106 PFUs (MOI 20) respectively for each concentration. The mixture was then added to the culture medium of Vero-E6 cells. The inoculum was not removed. 15 hours post-infection, cells were washed 3 times with PBS and then lysed using Trizol™ (Thermofisher) before analysis by qRT-PCR for viral RNA detection. Viral RNA was assayed by qRT-PCR. The results were shown in
Vero E6 cells were seeded in 48-well plates (5×104 cells per well) (Sarstedt) in DMEM containing 10% FBS for 24 hours. The equivalent soluble rmACE2 at a concentration of 25 μg/ml, 50 μg/ml, 100 μg/ml and 200 μg/ml respectively were mixed with SARS-CoV-2 (v/v=1:1) in a final volume of 100 μl per well in DMEM (0% FBS) at 37° C. for 30 mins. The SARS-CoV-2 was mixed at the amount of 103 PFUs (MOI 0.02), 105 PFUs (MOI 2) and 106 PFUs (MOI 20) respectively for each concentration. The mixture was then added to the culture medium of Vero-E6 cells. The inoculum was not removed. 15 hours post-infection, cells were washed 3 times with PBS and then lysed using Trizol™ (Thermofisher) before analysis by qRT-PCR for viral RNA detection. Viral RNA was assayed by qRT-PCR. The results were shown in
3. Cytotoxicity Assay
To determine whether the recombinant human or mouse ACE2 are toxic to cells, 104 Vero E6 cells per well were seeded in a 96-well plate. 24 hours post-seeding, 25 μl of different concentrations (from 25 to 200 μg/ml) of rACE2 were added in triplicate and incubated for 15 hours. 15 hours post-treatment, cytotoxicity was determined using the CellTiter-Glo® Luminescent cell viability assay (Promega) following the manufacturer's protocol. The addition of human or mouse rACE2 was not toxic to the Vero-E6 cells (data not shown).
SARS-CoV-2 Infects Human Blood Vessels Organoids
Groups of human blood vessel organoids were infected with 102, 104, or 106 SARS-CoV-2 infectious particles in StemPro complete media containing 15% FBS (Gibco cat.10500064), 100 ng/ml of VEGF-A (Peprotech cat. no. 100-2) and 100 ng/ml of FGF-2 (Milteny Biotech cat. no. 130-093-841) in a volume of 50 μl per well of a 96-well ultra-low attachment plate for 1 hour. One hour post-infection, blood vessels organoids were washed 3 times with PBS and kept in 100 μl of corresponding medium (StemPro complete media containing 15% FBS, 100 ng/ml of VEGF-A and 100 ng/ml of FGF-2) for 3 to 6 days. On day 3 post-infection (3 dpi), certain organoids were washed 3 times with PBS before being lysed with Trizol™ (Thermofisher). Samples were then analysed for the presence of SARS-CoV-2 RNA by qRT-PCR. On day 6 post-infection (6 dpi), other organoids were washed 3 times with PBS before to lysis with Trizol™ (Thermofisher). Samples were then analysed for the presence of SARS-CoV-2 RNA by qRT-PCR. We could detect viral RNA in the blood vessel organoids with viral RNA increasing from day 3 to day 6 post infection (see
On day 6 post-infection, supernatants of the blood vessels organoids were recovered. 100 μl of each supernatant were used to infect Vero E6 in 48-well plate plates. Cells were recovered 48 hours post-infection and pooled (5 blood vessels organoids/condition), and the level of infection was determined by viral RNA detection using qRT-PCR. The supernatant of infected organoids collected at day 6 post-infection efficiently infected Vero E6 cells (
Recombinant Human ACE2 Inhibits SARS-CoV-2 Infection of Human Blood Vessels Organoids
Different concentrations of soluble rhACE2 (50 μg/ml and 100 μg/ml) were mixed with 106 particles of SARS-CoV-2 for 30 mins at 37° C. in a final volume of 50 μl per well in STemPro 34 complete medium. The blood vessel organoids were then infected with the mixtures for 1 hour at 37° C. Organoids were then washed 3 times with PBS and 100 μl per well of new medium (StemPro complete media containing 15% FBS, 100 ng/ml of VEGF-A and 100 ng/ml of FGF-2) was added. Organoids were incubated for 3 days. To detect intracellular viral RNA, organoids were washed 3 times with PBS, pooled (5 organoids/condition) and lysed using Trizol™ (Thermofisher) before analysis. Then levels of SARS-CoV-2 RNA were assessed by qRT-PCR. The rhACE2 significantly decreased the level of SARS-CoV-2 infections in the vascular organoids (Student t test: ** P<0.01) as shown in
Those data evident that a primary site of SARS-CoV-2 infection appears to be the lung, and then SARS-CoV-2 infects blood vessels prior to local tissue (such as the kidney and intestine) infections.
Given the fact that the heart expresses high levels of ACE2 and heart alterations were the first phenotype observed in our ace2 mutant mice (see Crackower, M. A., Sarao, R., Oudit, G. Y., Yagil, C., Kozieradzki, I., Scanga, S. E., Oliveira-dos-Santos, A. J., da Costa, J., Zhang, L., Pei, Y., et al. (2002). Angiotensin-converting enzyme 2 is an essential regulator of heart function. Nature 417, 822-828), lung and heart organoids may be involved in the multi-organ dysfunction in patients with COVID-19. Similar method of the present disclosure can be used to test infection of human heart organoids and lung organoids by SARS-CoV-2.
All of the methods and uses disclosed and claimed herein can be made and executed without undue experimentation in light of the present disclosure. While the methods and uses of this invention have been described in terms of preferred embodiments, it will be apparent to those of skill in the art that variations may be applied to the methods and in the steps or in the sequence of steps of the method described herein without departing from the concept, spirit and scope of the invention. More specifically, it will be apparent that certain agents which are both chemically and physiologically related may be substituted for the agents described herein while the same or similar results would be achieved. All such similar substitutes and modifications apparent to those skilled in the art are deemed to be within the spirit, scope and concept of the invention as defined by the appended claims.
| Number | Date | Country | Kind |
|---|---|---|---|
| 20166052.9 | Mar 2020 | EP | regional |
| Filing Document | Filing Date | Country | Kind |
|---|---|---|---|
| PCT/EP2021/057989 | 3/26/2021 | WO |
