The Fc-mediated effector functions of a potent SARS-CoV-2 neutralizing antibody, SC31, isolated from an early convalescent COVID-19 patient, are essential for the optimal therapeutic efficacy of the antibody

Chan, Conrad E.Z.; Seah, Shirley G.K.; Chye, De Hoe; Massey, Shane; Torres, Maricela; Lim, Angeline P.C.; Wong, Steven K.K.; Neo, Jacklyn J.Y.; Wong, Pui San; Lim, Jie Hui; Loh, Gary S.L.; Wang, Dong Ling; Boyd-Kirkup, Jerome D.; Guan, Siyu; Thakkar, Dipti; Teo, Guo Hui; Purushotorman, Kiren; Hutchinson, Paul E.; Young, Barnaby E.; Lye, David C.; Low, Jenny G.; MacAry, Paul A.; Hentze, Hannes; Prativadibhayankara, Venkateshan S.; Ethirajulu, Kantharaj; O’Connell, Damian; Comer, Jason; Tseng, Chien-Te K.; Barrett, Alan D.T.; Ingram, Piers J.; Brasel, Trevor; Hanson, Brendon J.

SARS-CoV-2-neutralizing antibodies are promising therapeutics for COVID-19. However, little is known about the mechanisms of action of these antibodies or their effective dosing windows. We report the discovery and development of SC31, a potent SARS-CoV-2 neutralizing IgG1 antibody, originally isolated from a convalescent patient at day 27 after the onset of symptoms. Neutralization occurs via a binding epitope that maps within the ACE2 interface of the SARS-CoV-2 Spike protein, conserved across all common circulating SARS-CoV-2 mutants. In SARS-CoV-2 infected K18-human ACE2 transgenic mice, SC31 demonstrated potent survival benefit by dramatically reducing viral load concomitant with attenuated pro-inflammatory responses linked to severe systemic disease, such as IL-6. Comparison with a Fc-null LALA variant of SC31 demonstrated that optimal therapeutic efficacy of SC31 requires intact Fc-mediated effector functions that can further induce an IFNγ-driven anti-viral immune response. Dose-dependent efficacy for SC31 was observed down to 5mg/kg when dosed before the activation of lung inflammatory responses. Importantly, despite FcγR binding, no evidence of antibody dependent enhancement was observed with the Fc-competent SC31 even at sub-therapeutic doses. Therapeutic efficacy was confirmed in SARS-CoV-2-infected hamsters, where SC31 again significantly reduced viral load, decreased lung lesions and inhibited progression to severe disease manifestations. This study underlines the potential for significant COVID-19 patient benefit for the SC31 antibody that justifies rapid advancement to the clinic, as well as highlighting the importance of appropriate mechanistic and functional studies during development. One Sentence Summary Anti-SARS-CoV-2 IgG1 antibody SC31 controls infection in vivo by blocking SP:ACE2 binding and triggering a Fc-mediated anti-viral response.