Ultrapotent miniproteins targeting the SARS-CoV-2 receptor-binding domain protect against infection and disease

Despite the introduction of public health measures and spike protein-based vaccines to mitigate the COVID-19 pandemic, SARS-CoV-2 infections and deaths continue to have a global impact. Previously, we used a structural design approach to develop picomolar range miniproteins targeting the SARS-CoV-2 spike receptor-binding domain. Here, we investigated the capacity of modified versions of one lead miniprotein, LCB1, to protect against SARS-CoV-2-mediated lung disease in mice. Systemic administration of LCB1-Fc reduced viral burden, diminished immune cell infiltration and inflammation, and completely prevented lung disease and pathology. A single intranasal dose of LCB1v1.3 reduced SARS-CoV-2 infection in the lung when given as many as 5 days before or 2 days after virus inoculation. Importantly, LCB1v1.3 protected in vivo against a historical strain (WA1/2020), an emerging B.1.1.7 strain, and a strain encoding key E484K and N501Y spike protein substitutions. These data support development of LCB1v1.3 for prevention or treatment of SARS-CoV-2 infection. [Display omitted] •SARS-CoV-2 RBD-specific miniproteins confer 100% survival against lethal challenge•Miniproteins prevent SARS-CoV-2-induced lung inflammation and pathology•One miniprotein dose protects when given between D-5 and D+3 relative to infection•Miniproteins inhibit historical, circulating, and emerging SARS-CoV-2 strains Case et al. show that de novo-designed SARS-CoV-2 RBD-specific miniproteins administered as prophylaxis or therapy protect mice against SARS-CoV-2-mediated disease, inflammation, and pathology. Injected or intranasal administration of miniproteins showed efficacy when given any time over an 8-day treatment window.