Human soluble ACE2 improves the effect of remdesivir in SARS‐CoV‐2 infection

Abstract There is a critical need for safe and effective drugs for COVID‐19. Only remdesivir has received authorization for COVID‐19 and has been shown to improve outcomes but not decrease mortality. However, the dose of remdesivir is limited by hepatic and kidney toxicity. ACE2 is the critical cell...

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Main Authors: Vanessa Monteil, Matheus Dyczynski, Volker M Lauschke, Hyesoo Kwon, Gerald Wirnsberger, Sonia Youhanna, Haibo Zhang, Arthur S Slutsky, Carmen Hurtado del Pozo, Moritz Horn, Nuria Montserrat, Josef M Penninger, Ali Mirazimi
Format: Article
Language:English
Published: Springer Nature 2020-12-01
Series:EMBO Molecular Medicine
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Online Access:https://doi.org/10.15252/emmm.202013426
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author Vanessa Monteil
Matheus Dyczynski
Volker M Lauschke
Hyesoo Kwon
Gerald Wirnsberger
Sonia Youhanna
Haibo Zhang
Arthur S Slutsky
Carmen Hurtado del Pozo
Moritz Horn
Nuria Montserrat
Josef M Penninger
Ali Mirazimi
author_facet Vanessa Monteil
Matheus Dyczynski
Volker M Lauschke
Hyesoo Kwon
Gerald Wirnsberger
Sonia Youhanna
Haibo Zhang
Arthur S Slutsky
Carmen Hurtado del Pozo
Moritz Horn
Nuria Montserrat
Josef M Penninger
Ali Mirazimi
author_sort Vanessa Monteil
collection DOAJ
description Abstract There is a critical need for safe and effective drugs for COVID‐19. Only remdesivir has received authorization for COVID‐19 and has been shown to improve outcomes but not decrease mortality. However, the dose of remdesivir is limited by hepatic and kidney toxicity. ACE2 is the critical cell surface receptor for SARS‐CoV‐2. Here, we investigated additive effect of combination therapy using remdesivir with recombinant soluble ACE2 (high/low dose) on Vero E6 and kidney organoids, targeting two different modalities of SARS‐CoV‐2 life cycle: cell entry via its receptor ACE2 and intracellular viral RNA replication. This combination treatment markedly improved their therapeutic windows against SARS‐CoV‐2 in both models. By using single amino‐acid resolution screening in haploid ES cells, we report a singular critical pathway required for remdesivir toxicity, namely, Adenylate Kinase 2. The data provided here demonstrate that combining two therapeutic modalities with different targets, common strategy in HIV treatment, exhibit strong additive effects at sub‐toxic concentrations. Our data lay the groundwork for the study of combinatorial regimens in future COVID‐19 clinical trials.
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institution Kabale University
issn 1757-4676
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publishDate 2020-12-01
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spelling doaj-art-07998970104b4c38b5f25f0f58d1b2212025-08-20T03:43:29ZengSpringer NatureEMBO Molecular Medicine1757-46761757-46842020-12-011311810.15252/emmm.202013426Human soluble ACE2 improves the effect of remdesivir in SARS‐CoV‐2 infectionVanessa Monteil0Matheus Dyczynski1Volker M Lauschke2Hyesoo Kwon3Gerald Wirnsberger4Sonia Youhanna5Haibo Zhang6Arthur S Slutsky7Carmen Hurtado del Pozo8Moritz Horn9Nuria Montserrat10Josef M Penninger11Ali Mirazimi12Department of Laboratory Medicine, Unit of Clinical Microbiology, Karolinska InstituteAcus Laboratories GmbHDepartment of Physiology and Pharmacology, Karolinska InstituteNational Veterinary InstituteAPEIRON Biologics AGDepartment of Physiology and Pharmacology, Karolinska InstituteKeenan Research Centre for Biomedical Science at Li Ka Shing Knowledge Institute of St. Michael’s Hospital, University of TorontoKeenan Research Centre for Biomedical Science at Li Ka Shing Knowledge Institute of St. Michael’s Hospital, University of TorontoPluripotency for Organ Regeneration, Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Technology (BIST)Acus Laboratories GmbHPluripotency for Organ Regeneration, Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Technology (BIST)Institute of Molecular Biotechnology of the Austrian Academy of SciencesDepartment of Laboratory Medicine, Unit of Clinical Microbiology, Karolinska InstituteAbstract There is a critical need for safe and effective drugs for COVID‐19. Only remdesivir has received authorization for COVID‐19 and has been shown to improve outcomes but not decrease mortality. However, the dose of remdesivir is limited by hepatic and kidney toxicity. ACE2 is the critical cell surface receptor for SARS‐CoV‐2. Here, we investigated additive effect of combination therapy using remdesivir with recombinant soluble ACE2 (high/low dose) on Vero E6 and kidney organoids, targeting two different modalities of SARS‐CoV‐2 life cycle: cell entry via its receptor ACE2 and intracellular viral RNA replication. This combination treatment markedly improved their therapeutic windows against SARS‐CoV‐2 in both models. By using single amino‐acid resolution screening in haploid ES cells, we report a singular critical pathway required for remdesivir toxicity, namely, Adenylate Kinase 2. The data provided here demonstrate that combining two therapeutic modalities with different targets, common strategy in HIV treatment, exhibit strong additive effects at sub‐toxic concentrations. Our data lay the groundwork for the study of combinatorial regimens in future COVID‐19 clinical trials.https://doi.org/10.15252/emmm.202013426clinical trialcombination therapyCOVID‐19treatment
spellingShingle Vanessa Monteil
Matheus Dyczynski
Volker M Lauschke
Hyesoo Kwon
Gerald Wirnsberger
Sonia Youhanna
Haibo Zhang
Arthur S Slutsky
Carmen Hurtado del Pozo
Moritz Horn
Nuria Montserrat
Josef M Penninger
Ali Mirazimi
Human soluble ACE2 improves the effect of remdesivir in SARS‐CoV‐2 infection
EMBO Molecular Medicine
clinical trial
combination therapy
COVID‐19
treatment
title Human soluble ACE2 improves the effect of remdesivir in SARS‐CoV‐2 infection
title_full Human soluble ACE2 improves the effect of remdesivir in SARS‐CoV‐2 infection
title_fullStr Human soluble ACE2 improves the effect of remdesivir in SARS‐CoV‐2 infection
title_full_unstemmed Human soluble ACE2 improves the effect of remdesivir in SARS‐CoV‐2 infection
title_short Human soluble ACE2 improves the effect of remdesivir in SARS‐CoV‐2 infection
title_sort human soluble ace2 improves the effect of remdesivir in sars cov 2 infection
topic clinical trial
combination therapy
COVID‐19
treatment
url https://doi.org/10.15252/emmm.202013426
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