[Source: Lancet Respiratory Medicine, full page: (LINK). Summary, edited.]
Human recombinant soluble ACE2 in severe COVID-19
Alexander Zoufaly, MD, Marko Poglitsch, MD, Judith H Aberle, MD, Wolfgang Hoepler, MD, Tamara Seitz, MD, Marianna Traugott, MD, Alexander Grieb, BSc, Erich Pawelka, MD, Hermann Laferl, MD, Christoph Wenisch, MD, Stephanie Neuhold, MD, Doris Haider, MMBA, Karin Stiasny, PhD, Andreas Bergthaler, PhD, Prof Elisabeth Puchhammer-Stoeckl, MD, Ali Mirazimi, PhD, Nuria Montserrat, PhD, Haibo Zhang, MD, Prof Arthur S Slutsky, MD, Prof Josef M Penninger, MD
Published: September 24, 2020 | DOI: https://doi.org/10.1016/S2213-2600(20)30418-5
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Angiotensin converting enzyme 2 (ACE2) is the crucial severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) receptor and protects multiple tissues, including the lung, from injury as a regulator of the renin–angiotensin system.1 Therefore, ACE2 has become the focus of COVID-19 research and a plethora of drug development efforts. Among the novel compounds under development is human recombinant soluble ACE2 (hrsACE2 [APN01; Apeiron Biologics, Vienna, Austria]), which has two mechanisms of action that theoretically should be of benefit in COVID-19.2 The first involves binding the viral spike protein and thereby neutralising SARS-CoV-2,3 and the second is minimising injury to multiple organs, including the lungs, kidneys, and heart, because of unabated renin–angiotensin system hyperactivation and increased angiotensin II concentrations.4 , 5, 6 hrsACE2 has been tested in 89 patients, namely in healthy volunteers in phase 1 studies and in patients with acute respiratory distress syndrome (ARDS) in phase 2 clinical studies, with a good safety profile.7, 8 Moreover, hrsACE2 can reduce SARS-CoV-2 load by a factor of 1000–5000 in in-vitro cell-culture experiments and engineered organoids, directly demonstrating that ACE2 can effectively neutralise SARS-CoV-2.3 We describe in this Case Report the first course of treatment with hrsACE2 of a patient with severe COVID-19.
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Keywords: SARS-CoV-2; COVID-19; ACE2.
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