Soluble forms of the human immunodeficiency virus type 1 (HIV-1) primary receptor CD4 (soluble CD4 [sCD4]) have been extensively characterized for a quarter of a century as promising HIV-1 inhibitors, but they have not been clinically successful. By combining a protein cavity-filling strategy and the power of library technology, we identified an engineered cavity-altered single-domain sCD4 (mD1.22) with a unique combination of excellent properties, including broad and potent neutralizing activity, high specificity, stability, solubility, and affinity for the HIV-1 envelope glycoprotein gp120, and small molecular size. To further improve its neutralizing potency and breadth, we generated bispecific multivalent fusion proteins of mD1.22 with another potent HIV-1 inhibitor, an antibody domain (m36.4) that targets the coreceptor-binding site on gp120. The fusion proteins neutralized all HIV-1 isolates tested, with potencies about 10-, 50-, and 200-fold higher than those of the broadly neutralizing antibody VRC01, the U.S. FDA-approved peptide inhibitor T20, and the clinically tested sCD4-Fc fusion protein CD4-Ig, respectively. In addition, they exhibited higher stability and specificity and a lower aggregation propensity than CD4-Ig. Therefore, mD1.22 and related fusion proteins could be useful for HIV-1 prevention and therapy, including eradication of the virus.
Soluble forms of human CD4 (sCD4) comprising all four (D1 to D4) or the first two (D1D2) extracellular domains are potent inhibitors of the human immunodeficiency virus type 1 (HIV-1) in vitro (1, 2). Several promising monomeric (3-5), dimeric (6-8), and tetrameric (9-11) sCD4 derivatives have been tested in animal models and in human clinical trials, but they exhibited modest and transient antiviral activities. Previously, we demonstrated that decreasing the molecular size of D1D2 to a single domain, D1, significantly increased its antiviral activity and reduce its nonspecificity, i.e., interactions with molecules other than the HIV-1 envelope glycoprotein (Env) gp120; a D1 variant (mD1.2) was identified that is also more soluble than D1D2 (12). However, mD1.2 still binds to human B cells and CD4 ϩ T cells without HIV-1 Env expression, although it binds more weakly than D1D2 and its stability is comparable to that of D1D2, which is relatively low (12).It has been shown previously that some proteins exhibit poor hydrophobic packing, leading to low stability and solubility due to the presence of cavities within or on the surfaces of proteins that are either empty or hydrated (13,14). Identification of such cavities and filling them with bulkier hydrophobic amino acid side chains have proven effective in improving stability and other properties of proteins (15). By combining this cavity-filling strategy with the power of library technology, we identified an mD1.2 mutant, designated mD1.22, that has significantly higher soluble expression, thermal stability, and specificity than mD1.2. Bispecific multivalent fusion proteins of mD1.22 with m36.4, an engineered ...