Spike Gene Evolution and Immune Escape Mutations in Patients with Mild or Moderate Forms of COVID-19 and Treated with Monoclonal Antibodies Therapies

Viruses. 2022 Jan 24;14(2):226. doi: 10.3390/v14020226.

Abstract

We explored the molecular evolution of the spike gene after the administration of anti-spike monoclonal antibodies in patients with mild or moderate forms of COVID-19. Four out of the 13 patients acquired a mutation during follow-up; two mutations (G1204E and E406G) appeared as a mixture without clinical impact, while the Q493R mutation emerged in two patients (one receiving bamlanivimab and one receiving bamlanivimab/etesevimab) with fatal outcomes. Careful virological monitoring of patients treated with mAbs should be performed, especially in immunosuppressed patients.

Keywords: COVID-19; Q493R; SARS-CoV-2; immune escape mutation; monoclonal antibodies therapy; spike gene.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Antibodies, Monoclonal / therapeutic use*
  • Antibodies, Monoclonal, Humanized / therapeutic use
  • Antibodies, Neutralizing / therapeutic use
  • COVID-19 / immunology
  • COVID-19 / therapy*
  • Drug Combinations
  • Evolution, Molecular*
  • Female
  • Humans
  • Immune Evasion*
  • Immunotherapy / statistics & numerical data
  • Male
  • Middle Aged
  • Mutation*
  • SARS-CoV-2 / genetics*
  • SARS-CoV-2 / immunology*
  • Spike Glycoprotein, Coronavirus / genetics*
  • Spike Glycoprotein, Coronavirus / immunology

Substances

  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Antibodies, Neutralizing
  • Drug Combinations
  • Spike Glycoprotein, Coronavirus
  • bamlanivimab and etesevimab drug combination
  • spike protein, SARS-CoV-2
  • bamlanivimab
  • etesevimab