Haars Jonathan, Palanisamy Navaneethan, Wallin Frans, Mölling Paula, Lindh Johan, Sundqvist Martin, Ellström Patrik, Kaden René, Lennerstrand Johan
Department of Medical Sciences, Section for Clinical Microbiology and Hospital Hygiene Uppsala University, Akademiska Sjukhuset Entrance 40 Floor 5, 751 85 Uppsala, Sweden.
Chester Medical School, University of Chester, Chester CH2 1BR, UK.
Microorganisms. 2023 Sep 27;11(10):2417. doi: 10.3390/microorganisms11102417.
Monoclonal antibodies (mAbs) are an important treatment option for COVID-19 caused by SARS-CoV-2, especially in immunosuppressed patients. However, this treatment option can become ineffective due to mutations in the SARS-CoV-2 genome, mainly in the receptor binding domain (RBD) of the spike (S) protein. In the present study, 7950 SARS-CoV-2 positive samples from the Uppsala and Örebro regions of central Sweden, collected between March 2022 and May 2023, were whole-genome sequenced using amplicon-based sequencing methods on Oxford Nanopore GridION, Illumina MiSeq, Illumina HiSeq, or MGI DNBSEQ-G400 instruments. Pango lineages were determined and all single nucleotide polymorphism (SNP) mutations that occurred in these samples were identified. We found that the dominant sublineages changed over time, and mutations conferring resistance to currently available mAbs became common. Notable ones are R346T and K444T mutations in the RBD that confer significant resistance against tixagevimab and cilgavimab mAbs. Further, mutations conferring a high-fold resistance to bebtelovimab, such as the K444T and V445P mutations, were also observed in the samples. This study highlights that resistance mutations have over time rendered currently available mAbs ineffective against SARS-CoV-2 in most patients. Therefore, there is a need for continued surveillance of resistance mutations and the development of new mAbs that target more conserved regions of the RBD.
单克隆抗体(mAbs)是治疗由严重急性呼吸综合征冠状病毒2(SARS-CoV-2)引起的2019冠状病毒病(COVID-19)的重要选择,尤其是在免疫抑制患者中。然而,由于SARS-CoV-2基因组的突变,主要是刺突(S)蛋白的受体结合域(RBD)中的突变,这种治疗选择可能会变得无效。在本研究中,使用基于扩增子的测序方法,在牛津纳米孔GridION、Illumina MiSeq、Illumina HiSeq或MGI DNBSEQ-G400仪器上,对2022年3月至2023年5月期间从瑞典中部乌普萨拉和厄勒布鲁地区收集的7950份SARS-CoV-2阳性样本进行了全基因组测序。确定了谱系,并识别了这些样本中发生的所有单核苷酸多态性(SNP)突变。我们发现,优势亚谱系随时间变化,对现有mAbs产生抗性的突变变得常见。值得注意的是RBD中的R346T和K444T突变,它们对替沙格韦单抗和西加韦单抗mAbs具有显著抗性。此外,在样本中还观察到对贝替洛单抗具有高倍数抗性的突变,如K444T和V445P突变。这项研究强调,随着时间的推移,抗性突变已使现有mAbs对大多数患者的SARS-CoV-2无效。因此,需要持续监测抗性突变,并开发针对RBD更保守区域的新型mAbs。