Christos A. Kyratsous

CD8+ T Cells and Macrophages Regulate Pathogenesis in a Mouse Model of Middle East Respiratory Syndrome.

ABSTRACT Middle East respiratory syndrome coronavirus (MERS-CoV) is an important emerging pathogen that was first described in 2012. While the cell surface receptor for MERS-CoV has been identified as dipeptidyl peptidase 4 (DPP4), the mouse DPP4 homologue does not allow virus entry into cells. Therefore, development of mouse models of MERS-CoV has been hampered by the fact that MERS-CoV does not replicate in commonly available mouse strains. We have previously described a mouse model in which mDPP4 was replaced with hDPP4 such that hDPP4 is expressed under the endogenous mDPP4 promoter. In this study, we used this mouse model to analyze the host response to MERS-CoV infection using immunological assays and transcriptome analysis. Depletion of CD4+ T cells, CD8+ T cells, or macrophages has no effect on MERS-CoV replication in the lungs of infected mice. However, we found that depletion of CD8+ T cells protects and depletion of macrophages exacerbates MERS-CoV-induced pathology and clinical symptoms of disease. Overall, we demonstrate an important role for the inflammatory response in regulating MERS-CoV pathogenesis in vivo. IMPORTANCE The Middle East respiratory syndrome coronavirus (MERS-CoV) is a highly pathogenic respiratory virus that emerged from zoonotic sources in 2012. Human infections are still occurring throughout Saudi Arabia at a 38% case fatality rate, with the potential for worldwide spread via air travel. In this work, we identify the host response to the virus and identify inflammatory pathways and cell populations that are critical for protection from severe lung disease. By understanding the immune response to MERS-CoV we can develop targeted therapies to inhibit pathogenesis in the future.

Alirocumab, a Therapeutic Human Antibody to PCSK9, Does Not Affect CD81 Levels or Hepatitis C Virus Entry and Replication into Hepatocytes.

Background Proprotein convertase subtilisin/kexin type 9 (PSCK9) is secreted mainly from the liver and binds to the low-density lipoprotein receptor (LDLR), reducing LDLR availability and thus resulting in an increase in LDL-cholesterol. While the LDLR has been implicated in the cell entry process of the hepatitis C virus (HCV), overexpression of an artificial non-secreted, cell membrane-bound form of PCSK9 has also been shown to reduce surface expression of CD81, a major component of the HCV entry complex, leading to concerns that pharmacological inhibition of PCSK9 may increase susceptibility to HCV infection by increasing either CD81 or LDLR availability. Here, we evaluated effects of PCSK9 and PCSK9 blockade on CD81 levels and HCV entry with a physiologically relevant model using native secreted PCSK9 and a monoclonal antibody to PCSK9, alirocumab. Methods and Results Flow cytometry and Western blotting of human hepatocyte Huh-7 cells showed that, although LDLR levels were reduced when cells were exposed to increasing PCSK9 concentrations, there was no correlation between total or surface CD81 levels and the presence and amount of soluble PCSK9. Moreover, inhibiting PCSK9 with the monoclonal antibody alirocumab did not affect expression levels of CD81. In an in vitro model of HCV entry, addition of soluble PCSK9 or treatment with alirocumab had no effect on the ability of either lentiviral particles bearing the HCV glycoproteins or JFH-1 based cell culture virus to enter hepatocytes. Consistent with these in vitro findings, no differences were observed in hepatic CD81 levels using in vivo mouse models, including Pcsk9-/- mice compared with wild-type controls and hyperlipidemic mice homozygous for human Pcsk9 and heterozygous for Ldlr deletion, treated with either alirocumab or isotype control antibody. Conclusion These results suggest that inhibition of PCSK9 with alirocumab has no effect on CD81 and does not result in increased susceptibility to HCV entry.

Heat-shock protein fusion vectors for improved expression of soluble recombinant proteins in Escherichia coli.

Molecular chaperones or heat-shock proteins (HSPs) are protein machines that interact with unfolded or partially folded polypeptides and assist them in attaining their proper conformation. The folding reaction relies on a complex array of scaffolding effects and ATP-driven conformational changes that mediate the temporary unfolding and subsequent refolding of protein substrates. DnaK and GroEL are the two major Escherichia coli chaperones. They belong to the HSP70 and HSP60 families of proteins, respectively, and play a major role in protein folding. Here, we describe a set of bacterial expression vectors that permits the fusion of a protein of interest to DnaK or GroEL and its subsequent quantitative expression in a soluble, easily purifiable form. We also provide a set of compatible co-chaperone expression constructs that permit the simultaneous co-expression of the DnaK and GroEL physiological partners to further increase protein solubility. The system was successfully tested using the murine prion protein (PrP). Although PrP is normally insoluble when expressed in E. coli, we show that utilizing our vectors it can be produced in a soluble form as a DnaK or GroEL fusion. This system is useful for the production of a large array of proteins that fail to fold properly when expressed in E. coli.

Systematic Analysis of Monoclonal Antibodies against Ebola Virus GP Defines Features that Contribute to Protection

Antibodies are promising post-exposure therapies against emerging viruses, but which antibody features and inxa0vitro assays best forecast protection are unclear. Our international consortium systematically evaluated antibodies against Ebola virus (EBOV) using multidisciplinary assays. For each antibody, we evaluated epitopes recognized on the viral surface glycoprotein (GP) and secreted glycoprotein (sGP), readouts of multiple neutralization assays, fraction of virions left un-neutralized, glycan structures, phagocytic and natural killer cell functions elicited, and inxa0vivo protection in a mouse challenge model. Neutralization and induction of multiple immune effector functions (IEFs) correlated most strongly with protection. Neutralization predominantly occurred via epitopes maintained on endosomally cleaved GP, whereas maximal IEF mapped toxa0epitopes farthest from the viral membrane. Unexpectedly, sGP cross-reactivity did not significantly influence inxa0vivo protection. This comprehensive dataset provides a rubric to evaluate novel antibodies and vaccine responses and a roadmap for therapeutic development for EBOV and related viruses.

Development of Clinical-Stage Human Monoclonal Antibodies That Treat Advanced Ebola Virus Disease in Nonhuman Primates

Abstract Background For most classes of drugs, rapid development of therapeutics to treat emerging infections is challenged by the timelines needed to identify compounds with the desired efficacy, safety, and pharmacokinetic profiles. Fully human monoclonal antibodies (mAbs) provide an attractive method to overcome many of these hurdles to rapidly produce therapeutics for emerging diseases. Methods In this study, we deployed a platform to generate, test, and develop fully human antibodies to Zaire ebolavirus. We obtained specific anti-Ebola virus (EBOV) antibodies by immunizing VelocImmune mice that use human immunoglobulin variable regions in their humoral responses. Results Of the antibody clones isolated, 3 were selected as best at neutralizing EBOV and triggering FcγRIIIa. Binding studies and negative-stain electron microscopy revealed that the 3 selected antibodies bind to non-overlapping epitopes, including a potentially new protective epitope not targeted by other antibody-based treatments. When combined, a single dose of a cocktail of the 3 antibodies protected nonhuman primates (NHPs) from EBOV disease even after disease symptoms were apparent. Conclusions This antibody cocktail provides complementary mechanisms of actions, incorporates novel specificities, and demonstrates high-level postexposure protection from lethal EBOV disease in NHPs. It is now undergoing testing in normal healthy volunteers in preparation for potential use in future Ebola epidemics.

Prophylactic and therapeutic efficacy of mAb treatment against MERS-CoV in common marmosets

ABSTRACT The high case‐fatality rate of confirmed MERS‐CoV infections underlines the urgent need for an effective treatment to reduce the disease severity and mortality. REGN3051 and REGN3048 are two fully human neutralizing monoclonal antibodies (mAb) against MERS‐CoV that reduced virus replication in mice expressing human DPP4 upon prophylactic and therapeutic treatment. Here, we evaluated the prophylactic and therapeutic efficacy of REGN3048 and REGN3051 in the common marmoset model of MERS‐CoV infection. Intravenous administration of mAb resulted in high levels of MERS‐CoV‐neutralizing activity in circulating blood. When animals were treated with mAbs one day before challenge, respiratory disease was less severe and, in animals treated with both REGN3048 and REGN3051, viral loads in the lungs were reduced. However, therapeutic treatment on day one after challenge was less efficacious as it did not prevent the development of severe respiratory disease and all treated animals developed bronchointerstitial pneumonia of similar severity as the control animals. Thus, mAb administration may be more effective in a prophylactic treatment regimen rather than treatment of MERS. HIGHLIGHTSREGN3051 and REGN3048 are two human MERS‐CoV‐neutralizing monoclonal antibodies that reduced virus replication in mice.We evaluated the prophylactic and therapeutic efficacy of these mAbs in the common marmoset model of MERS‐CoV infection.Prophylactic treatment with REGN3048 and REGN3051 resulted in less severe respiratory disease and reduced viral lung loads.Therapeutic treatment was less efficacious as it did not prevent the development of severe respiratory disease.

Reply to Dimitrov et al.: VelociSuite technologies are a foundation for rapid therapeutic antibody development.

We appreciate the interest of Dimitrov et al. (1) in our work and welcome the opportunity to respond. The authors conclude that our report provides “No evidence for a superior platform to develop therapeutic antibodies rapidly…” and focus their points on our lead antibodies and mouse model developed using VelocImmune and VelociGene technologies. However, as indicated in our Significance statement (2), a platform approach should not only be based on rapid lead antibody discovery (for which several rapid methods exist), but should encompass the entire development process from discovery and preclinical validation through clinical material production. To this end, our report addresses all three components: (i) rapid discovery of potent lead antibodies; (ii) rapid generation of a small animal model; and (iii) antibody isolation compatible with rapid production for clinical use. Our antibody development process links “direct isolation of antibodies from B cells to development of isogenic cell lines,” which “can immediately be used for production of clinical-grade antibody material.” Given that the industry standard for manufacturing cell line development is 6–9 mo, we demonstrated gram quantity production of purified material weeks after lead selection. Such rapid identification, in vivo testing, and scale-up capacity are critical for a timely response to urgent public health threats.