Characterisation of the antibody-mediated selective pressure driving intra-host evolution of SARS-CoV-2 in prolonged infection.

Schoefbaenker M; Günther T; Lorentzen EU; Romberg ML; Hennies MT; Neddermeyer R; Müller MM; Mellmann A; Bojarzyn CR; Lenz G; Stelljes M; Hrincius ER; Vollenberg R; Ludwig S; Tepasse PR; Kühn JE

Forschungsartikel (Zeitschrift) | Peer reviewed

Zusammenfassung

Neutralising antibodies against the SARS-CoV-2 spike (S) protein are major determinants of protective immunity, though insufficient antibody responses may cause the emergence of escape mutants. We studied the humoral immune response causing intra-host evolution in a B-cell depleted, haemato-oncologic patient experiencing clinically severe, prolonged SARS-CoV-2 infection with a virus of lineage B.1.177.81. Following bamlanivimab treatment at an early stage of infection, the patient developed a bamlanivimab-resistant mutation, S:S494P. After five weeks of apparent genetic stability, the emergence of additional substitutions and deletions within the N-terminal domain (NTD) and the receptor binding domain (RBD) of S was observed. Notably, the composition and frequency of escape mutations changed in a short period with an unprecedented dynamic. The triple mutant S:Delta141-4 E484K S494P became dominant until virus elimination. Routine serology revealed no evidence of an antibody response in the patient. A detailed analysis of the variant-specific immune response by pseudotyped virus neutralisation test, surrogate virus neutralisation test, and immunoglobulin-capture enzyme immunoassay showed that the onset of an IgM-dominated antibody response coincided with the appearance of escape mutations. The formation of neutralising antibodies against S:Delta141-4 E484K S494P correlated with virus elimination. One year later, the patient experienced clinically mild re-infection with Omicron BA.1.18, which was treated with sotrovimab and resulted in an increase in Omicron-reactive antibodies. In conclusion, the onset of an IgM-dominated endogenous immune response in an immunocompromised patient coincided with the appearance of additional mutations in the NTD and RBD of S in a bamlanivimab-resistant virus. Although virus elimination was ultimately achieved, this humoral immune response escaped detection by routine diagnosis and created a situation temporarily favouring the rapid emergence of various antibody escape mutants with known epidemiological relevance.

Details zur Publikation

FachzeitschriftPLoS Pathogens
Jahrgang / Bandnr. / Volume20
Ausgabe / Heftnr. / Issue10
Seitenbereiche1012624-e1012624
StatusVeröffentlicht
Veröffentlichungsjahr2024 (15.10.2024)
Sprache, in der die Publikation verfasst istEnglisch
DOI10.1371/journal.ppat.1012624
StichwörterHumans; SARS-CoV-2; COVID-19; Antibodies, Viral; Spike Glycoprotein, Coronavirus; Antibodies, Neutralizing; Antibodies, Monoclonal, Humanized; Mutation; Male; COVID-19 Drug Treatment; Immunity, Humoral; Middle Aged

Autor*innen der Universität Münster

Hennies, Marc Tim
Institut für Molekulare Virologie
Hrincius, Eike-Roman
Institut für Molekulare Virologie
Kühn, Joachim
Institut für Molekulare Virologie
Lenz, Georg
Medizinische Klinik A (Med A)
Lorentzen, Eva
Institut für Molekulare Virologie
Ludwig, Stephan
Institut für Molekulare Virologie
Mellmann, Alexander
Institut für Hygiene
Schöfbänker, Michael Eduard
Institut für Molekulare Virologie
Stelljes, Matthias
Medizinische Klinik A (Med A)
Tepasse, Phil-Robin
Medizinische Klinik B (Med B)
Vollenberg, Richard
Medizinische Klinik B (Med B)