AZD3152 neutralizes SARS-CoV-2 historical and contemporary variants and is protective in hamsters and well tolerated in adults.

The evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in variants that can escape neutralization by therapeutic antibodies. Here, we describe AZD3152, a SARS-CoV-2–neutralizing monoclonal antibody designed to provide improved potency and coverage against emerging variants. AZD3152 binds to the back left shoulder of the SARS-CoV-2 spike protein receptor binding domain and prevents interaction with the human angiotensin-converting enzyme 2 receptor. AZD3152 potently neutralized a broad panel of pseudovirus variants, including the currently dominant Omicron variant JN.1 but has reduced potency against XBB subvariants containing F456L. In vitro studies confirmed F456L resistance and additionally identified T415I and K458E as escape mutations. In a Syrian hamster challenge model, prophylactic administration of AZD3152 protected hamsters from weight loss and inflammation-related lung pathologies and reduced lung viral load. In the phase 1 sentinel safety cohort of the ongoing SUPERNOVA study (ClinicalTrials.gov: NCT05648110), a single 600-mg intramuscular injection of AZD5156 (containing 300 mg each of AZD3152 and cilgavimab) was well tolerated in adults through day 91. Observed serum concentrations of AZD3152 through day 91 were similar to those observed with cilgavimab and consistent with predictions for AZD7442, a SARS-CoV-2–neutralizing antibody combination of cilgavimab and tixagevimab, in a population pharmacokinetic model. On the basis of its pharmacokinetic characteristics, AZD3152 is predicted to provide durable protection against symptomatic coronavirus disease 2019 caused by susceptible SARS-CoV-2 variants, such as JN.1, in humans. Editor's summary: Monoclonal antibody (mAb) therapies for SARS-CoV-2 were an essential component of the treatment toolbox for the first few years of the pandemic. Unfortunately, contemporary SARS-CoV-2 variants have evolved to escape these previously approved mAb therapies, leading to suspension of their use. For most individuals, this is acceptable, because we have our own antibodies generated by vaccination and prior infection. However, for immunocompromised individuals who were receiving mAb prophylaxis, this once again increases their risk of severe COVID-19. To address this gap in patient care, Cai et al. developed and tested AZD3152, a SARS-CoV-2 mAb capable of neutralizing contemporary strains of the virus. The authors found that prophylactic administration of AZD3152 was protective in a hamster model and had favorable pharmacokinetic profiles in humans. These data support further development of AZD3152 and next-generation SARS-CoV-2 mAbs. —Courtney Malo [ABSTRACT FROM AUTHOR]