Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, 1205 Geneva, Switzerland; Laboratory of Virology, Division of Laboratory Medicine, Geneva University Hospitals & Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland.
Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, 1205 Geneva, Switzerland; Laboratory of Virology, Division of Laboratory Medicine, Geneva University Hospitals & Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland.
Clin Microbiol Infect. 2021 Aug;27(8):1109-1117. doi: 10.1016/j.cmi.2021.05.022. Epub 2021 May 17.
Many new variants of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been termed variants of concern/interest (VOC/I) because of the greater risk they pose due to possible enhanced transmissibility and/or severity, immune escape, diagnostic and/or treatment failure, and reduced vaccine efficacy.
We sought to review the current knowledge of emerging SARS-CoV-2 variants, particularly those deemed VOC/Is: B.1.351, B.1.1.7, and P.1.
MEDLINE and BioRxiv databases, as well as the grey literature, were searched for reports of SARS-CoV-2 variants since November 2020. Relevant articles and their references were screened.
Mutations on the spike protein in particular may affect both affinity for the SARS-CoV-2 cell receptor ACEII and antibody binding. These VOC/Is often share similar mutation sets. The N501Y mutation is shared by the three main VOCs: B.1.1.7, first identified in the United Kingdom, P.1, originating from Brazil, and B.1.351, first described in South Africa. This mutation likely increases transmissibility by increasing affinity for ACEII. The B.1.351 and P.1 variants also display the E484K mutation which decreases binding of neutralizing antibodies, leading to partial immune escape; this favours reinfections, and decreases the in vitro efficacy of some antibody therapies or vaccines. Those mutations may also have phenotypical repercussions of greater severity. Furthermore, the accumulation of mutations poses a diagnostic risk (lowered when using multiplex assays), as seen for some assays targeting the S gene. With ongoing surveillance, many new VOC/Is have been identified. The emergence of the E484K mutation independently in different parts of the globe may reflect the adaptation of SARS-CoV-2 to humans against a background of increasing immunity.
These VOC/Is are increasing in frequency globally and pose challenges to any herd immunity approach to managing the pandemic. While vaccination is ongoing, vaccine updates may be prudent. The virus continues to adapt to transmission in humans, and further divergence from the initial Wuhan sequences is expected.
许多严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）的新变体因其可能具有更高的传染性和/或严重性、免疫逃逸、诊断和/或治疗失败以及降低疫苗效力的风险而被称为关注/感兴趣的变体（VOC/I）。
我们旨在回顾新兴 SARS-CoV-2 变体的现有知识，特别是被认为是 VOC/I 的变体：B.1.351、B.1.1.7 和 P.1。
自 2020 年 11 月以来，我们在 MEDLINE 和 BioRxiv 数据库以及灰色文献中搜索了关于 SARS-CoV-2 变体的报告。筛选了相关文章及其参考文献。
刺突蛋白上的突变可能会影响 SARS-CoV-2 细胞受体 ACEII 的亲和力和抗体结合。这些 VOC/I 通常具有相似的突变集。三个主要 VOC 都有 N501Y 突变：首先在英国发现的 B.1.1.7、源自巴西的 P.1 和首先在南非描述的 B.1.351。这种突变可能通过增加与 ACEII 的亲和力来增加传染性。B.1.351 和 P.1 变体还显示 E484K 突变，该突变降低了中和抗体的结合，导致部分免疫逃逸；这有利于再次感染，并降低了一些抗体疗法或疫苗的体外疗效。这些突变也可能具有更大严重程度的表型影响。此外，随着突变的积累，会出现诊断风险（使用多重分析时会降低），如针对 S 基因的一些分析。随着持续监测，已经发现了许多新的 VOC/I。E484K 突变在全球不同地区的独立出现可能反映了 SARS-CoV-2 在人类中的适应，因为免疫力在不断增强。
这些 VOC/I 在全球范围内的频率不断增加，对任何通过群体免疫来管理大流行的方法都构成了挑战。虽然疫苗接种仍在进行中，但更新疫苗可能是明智之举。病毒继续适应在人类中的传播，预计会与最初的武汉序列进一步分化。
