Open AccessHuman soluble ACE2 improves the effect of remdesivir in SARS‐CoV‐2 infection
Author(s) -
Monteil Vanessa,
Dyczynski Matheus,
Lauschke Volker M,
Kwon Hyesoo,
Wirnsberger Gerald,
Youhanna Sonia,
Zhang Haibo,
Slutsky Arthur S,
Hurtado del Pozo Carmen,
Horn Moritz,
Montserrat Nuria,
Penninger Josef M,
Mirazimi Ali
Publication year - 2020
Publication title -
embo molecular medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.923
H-Index - 107
eISSN - 1757-4684
pISSN - 1757-4676
DOI - 10.15252/emmm.202013426
Subject(s) - toxicity , pharmacology , vero cell , covid-19 , medicine , virology , biology , virus , disease , infectious disease (medical specialty)
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.