Computationally restoring the potency of a clinical antibody against Omicron.

The COVID-19 pandemic underscored the promise of monoclonal antibody-based prophylactic and therapeutic drugs1-3 and revealed how quickly viral escape can curtail effective options4,5. When the SARS-CoV-2 Omicron variant emerged in 2021, many antibody drug products lost potency, including Evusheld and its constituent, cilgavimab4-6. Cilgavimab, like its progenitor COV2-2130, is a class 3 antibody that is compatible with other antibodies in combination4 and is challenging to replace with existing approaches. Rapidly modifying such high-value antibodies to restore efficacy against emerging variants is a compelling mitigation strategy. We sought to redesign and renew the efficacy of COV2-2130 against Omicron BA.1 and BA.1.1 strains while maintaining efficacy against the dominant Delta variant. Here we show that our computationally redesigned antibody, 2130-1-0114-112, achieves this objective, simultaneously increases neutralization potency against Delta and subsequent variants of concern, and provides protection in vivo against the strains tested: WA1/2020, BA.1.1 and BA.5. Deep mutational scanning of tens of thousands of pseudovirus variants reveals that 2130-1-0114-112 improves broad potency without increasing escape liabilities. Our results suggest that computational approaches can optimize an antibody to target multiple escape variants, while simultaneously enriching potency. Our computational approach does not require experimental iterations or pre-existing binding data, thus enabling rapid response strategies to address escape variants or lessen escape vulnerabilities.

Computationally restoring the potency of a clinical antibody against SARS-CoV-2 Omicron subvariants.

The COVID-19 pandemic underscored the promise of monoclonal antibody-based prophylactic and therapeutic drugs1-3, but also revealed how quickly viral escape can curtail effective options4,5. With the emergence of the SARS-CoV-2 Omicron variant in late 2021, many clinically used antibody drug products lost potency, including Evusheld™ and its constituent, cilgavimab4,6. Cilgavimab, like its progenitor COV2-2130, is a class 3 antibody that is compatible with other antibodies in combination4 and is challenging to replace with existing approaches. Rapidly modifying such high-value antibodies with a known clinical profile to restore efficacy against emerging variants is a compelling mitigation strategy. We sought to redesign COV2-2130 to rescue in vivo efficacy against Omicron BA.1 and BA.1.1 strains while maintaining efficacy against the contemporaneously dominant Delta variant. Here we show that our computationally redesigned antibody, 2130-1-0114-112, achieves this objective, simultaneously increases neutralization potency against Delta and many variants of concern that subsequently emerged, and provides protection in vivo against the strains tested, WA1/2020, BA.1.1, and BA.5. Deep mutational scanning of tens of thousands pseudovirus variants reveals 2130-1-0114-112 improves broad potency without incurring additional escape liabilities. Our results suggest that computational approaches can optimize an antibody to target multiple escape variants, while simultaneously enriching potency. Because our approach is computationally driven, not requiring experimental iterations or pre-existing binding data, it could enable rapid response strategies to address escape variants or pre-emptively mitigate escape vulnerabilities.

A simulation model of intraherd transmission of foot and mouth disease with reference to disease spread before and after clinical diagnosis.

Intraherd transmission of foot and mouth disease virus (FMDV) was examined using a simulation model for a hypothetical 1,000-cow dairy, assuming clinical diagnosis was made when at least 1% (10 cows) or 5% (50 cows) had clinical signs of FMD, I index case cow, and transition state distributions for the latent, subclinically infectious, and clinically infectious periods of FMD calculated from published data. Estimates assumed for the number of animal-to-animal contacts (k) adequate for transmission ranged from 0.6 to 9.0 per hour (13.7-216.0 per day). A total of 40,000 iterations (5,000 for each scenario, assessing 4 adequate contact rates and 2 detection criteria) were run. The model predicted that FMD would not be diagnosed in the herd until 10.0-13.5 days after the index case cow had become infected, at which time between 65% and 97% of the cows (646-967 cows) to nearly 100% (978-996 cows) would already have become infected with the virus, if the number of cows showing clinical signs of FMD at the time of diagnosis were 10 or 50, respectively. At the time of diagnosis, the simulated number of infectious cattle varied substantially from 82-472 to 476-537 cows, depending on adequate contact rate and whether the diagnosis was made when 10 or 50 animals were showing clinical signs, respectively. The simulated number of infectious cows increased rapidly during the first few days after diagnosis. In the scenario where at least 10 cows showing clinical signs was necessary before a clinical diagnosis was made, each day after diagnosis, the number of infectious animals increased by nearly 100 to more than 200 cases per day up to day 5, assuming 0.57-9.0 animal-to-animal contacts per hour, respectively. Results obtained when it was assumed that at least 50 clinical cases were present at the time of diagnosis showed smaller relative increases because nearly one-half of the herd was projected to be infected at the time of diagnosis. From these results, it is clear that once an individual in a herd becomes infected with FMDV, herd infectivity is not static, rather it accelerates as would be expected as long as there are sufficient susceptible animals to sustain the increasing transmission rate, after which time the rate at which new infections occurs will diminish. Results indicate that biosecurity strategies aimed at minimizing both intraherd and interherd contact will be critical in minimizing the spread of FMD before the initial diagnosis is made. In addition, simulations suggest that very early clinical diagnosis of FMD and effective isolation or depopulation and disposal will be critical in limiting the number of infectious animals capable of transmitting the virus to other herds and thus in timely control of an epidemic. Early diagnosis will rely on early virus detection from animals in the preclinical phase of infection, rather than waiting for clinical signs to manifest in sufficient numbers to be noticed and to warrant investigation.

Description of an epidemic simulation model for use in evaluating strategies to control an outbreak of foot-and-mouth disease.

OBJECTIVE: To develop a spatial epidemic model to simulate intraherd and interherd transmission of foot-and-mouth disease (FMD) virus. SAMPLE POPULATION: 2,238 herds, representing beef, dairy, swine, goats, and sheep, and 5 sale yards located in Fresno, Kings, and Tulare counties of California. PROCEDURE: Using Monte-Carlo simulations, a spatial stochastic epidemic simulation model was developed to identify new herds that would acquire FMD following random selection of an index herd and to assess progression of an epidemic after implementation of mandatory control strategies. RESULTS: The model included species-specific transition periods for FMD infection, locations of herds, rates of direct and indirect contacts among herds, and probability distributions derived from expert opinions on probabilities of transmission by direct and indirect contact, as well as reduction in contact following implementation of restrictions on movements in designated infected areas and surveillance zones. Models of supplemental control programs included slaughter of all animals within a specified distance of infected herds, slaughter of only high-risk animals identified by use of a model simulation, and vaccination of all animals within a 5- to 50-km radius of infected herds. CONCLUSIONS AND CLINICAL RELEVANCE: The FMD model represents a tool for use in planning biosecurity and emergency-response programs and in comparing potential benefits of various strategies for control and eradication of FMD appropriate for specific populations.

Results of epidemic simulation modeling to evaluate strategies to control an outbreak of foot-and-mouth disease.

OBJECTIVE: To assess estimated effectiveness of control and eradication procedures for foot-and-mouth disease (FMD) in a region of California. SAMPLE POPULATION: 2,238 herds and 5 sale yards in Fresno, Kings, andTulare counties of California. PROCEDURE: A spatial stochastic model was used to simulate hypothetical epidemics of FMD for specified control scenarios that included a baseline eradication strategy mandated by USDA and supplemental control strategies of slaughter or vaccination of all animals within a specified distance of infected herds, slaughter of only high-risk animals identified by use of a model simulation, and expansion of infected and surveillance zones. RESULTS: Median number of herds affected varied from 1 to 385 (17% of all herds), depending on type of index herd and delay in diagnosis of FMD. Percentage of herds infected decreased from that of the baseline eradication strategy by expanding the designated infected area from 10 to 20 km (48%), vaccinating within a 50-km radius of an infected herd (41%), slaughtering the 10 highest-risk herds for each infected herd (39%), and slaughtering all animals within 5 km of an infected herd (24%). CONCLUSIONS AND CLINICAL RELEVANCE: Results for the model provided a means of assessing the relative merits of potential strategies for control and eradication of FMD should it enter the US livestock population. For the study region, preemptive slaughter of highest-risk herds and vaccination of all animals within a specified distance of an infected herd consistently decreased size and duration of an epidemic, compared with the baseline eradication strategy.

Benefit-cost analysis of vaccination and preemptive slaughter as a means of eradicating foot-and-mouth disease.

OBJECTIVE: To assess relative costs and benefits of vaccination and preemptive herd slaughter to control transmission of foot-and-mouth disease (FMD) virus (FMDV). SAMPLE POPULATION: 2,238 herds and 5 sale yards located in Fresno, Kings, and Tulare counties of California. PROCEDURE: Direct costs associated with indemnity, slaughter, cleaning and disinfecting livestock premises, and vaccination were compared for various eradication strategies. Additional cost, total program cost, net benefit, and benefit-cost value (B/C) for each supplemental strategy were estimated, based in part on results of published model simulations for FMD. Sensitivity analyses were conducted. RESULTS: Mean herd indemnity payments were estimated to be dollars 2.6 million and dollars 110,359 for dairy and nondairy herds, respectively. Cost to clean and disinfect livestock premises ranged from dollars 18,062 to dollars 60,205. Mean vaccination cost was dollars 2,960/herd. Total eradication cost ranged from dollars 61 million to dollars 551 million. All supplemental strategies involving use of vaccination were economically efficient (B/C range, 5.0 to 10.1) and feasible, whereas supplemental strategies involving use of slaughter programs were not economically efficient (B-C, 0.05 to 0.8) or feasible. CONCLUSIONS AND CLINICAL RELEVANCE: Vaccination with a highly efficacious vaccine may be a cost-effective strategy for control of FMD if vaccinated animals are not subsequently slaughtered and there is no future adverse economic impact, such as trade restrictions. Although less preferable than the baseline eradication program, selective slaughter of highest-risk herds was preferable to other preemptive slaughter strategies. However, indirect costs can be expected to contribute substantially more than direct costs to the total cost of eradication programs.