De novo designed inhibitor confers protection against lethal toxic shock

Paeniclostridium sordellii causes a toxic shock syndrome with a mortality rate of nearly 70%, primarily affecting postpartum and post-abortive women. This disease is driven by the production of the P. sordellii lethal toxin, TcsL, for which there are currently no effective treatments. We used a protein diffusion model, RFdiffusion, to design high affinity TcsL inhibitors. From a very small set of 48 starting designs and 48 additional sequence optimized designs, we developed a potent inhibitor with <100 pM affinity that protects mice prophylactically and therapeutically (post exposure) from lung edema and death in a stringent lethal challenge model. This inhibitor, which can be lyophilized without any loss of activity, is a promising therapeutic candidate for this rare but deadly disease, and our results highlight the ability of deep learning-based protein design to rapidly generate biologics with potential clinical utility.