Rapid Emergence of Potentially Transmissible Severe Acute Respiratory Syndrome Coronavirus 2 With Resistance to Combination Monoclonal Antibody Therapy

Jana L Jacobs; Ghady Haidar; Asma Naqvi; Kevin D McCormick; Michele Sobolewski; Benjamin R Treat; Amy L Heaps; Jordan Simpson; Kailey Hughes Kramer; Erin McCreary; J Ryan Bariola; Cynthia Klamar-Blain; Bernard J C Macatangay; Dimiter Dimitrov; Wei Li; Christopher C Marino; Anastasios Raptis; Rahil Sethi; Uma Chandran; Simon Barratt-Boyes; Urvi M Parikh; John W Mellors

doi:10.1093/ofid/ofad278

Rapid Emergence of Potentially Transmissible Severe Acute Respiratory Syndrome Coronavirus 2 With Resistance to Combination Monoclonal Antibody Therapy

Open Forum Infect Dis. 2023 May 17;10(5):ofad278. doi: 10.1093/ofid/ofad278. eCollection 2023 May.

Authors

Jana L Jacobs¹, Ghady Haidar¹, Asma Naqvi¹, Kevin D McCormick¹, Michele Sobolewski¹, Benjamin R Treat², Amy L Heaps¹, Jordan Simpson¹, Kailey Hughes Kramer¹, Erin McCreary¹, J Ryan Bariola¹, Cynthia Klamar-Blain¹, Bernard J C Macatangay¹, Dimiter Dimitrov¹, Wei Li¹, Christopher C Marino³, Anastasios Raptis³, Rahil Sethi⁴, Uma Chandran⁴, Simon Barratt-Boyes², Urvi M Parikh¹, John W Mellors¹

Affiliations

¹ Division of Infectious Diseases, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
² Department of Infectious Diseases and Microbiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA.
³ Department of Medicine, Division of Hematology and Oncology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
⁴ Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

Abstract

Prolonged coronavirus disease 2019 may generate new viral variants. We report an immunocompromised patient treated with monoclonal antibodies who experienced rebound of viral RNA and emergence of an antibody-resistant (>1000-fold) variant containing 5 mutations in the spike gene. The mutant virus was isolated from respiratory secretions, suggesting the potential for secondary transmission.