Emergence of Multiple SARS-CoV-2 Antibody Escape Variants in an Immunocompromised Host Undergoing Convalescent Plasma Treatment
Liang Chen, Michael C. Zody, Clara Di Germanio, Rachel Martinelli, José R. Mediavilla, Marcus H. Cunningham, Kaelea Composto, Kar Fai Chow, Milena Kordalewska, André Corvelo, Dayna M. Oschwald, Samantha Fennessey, Marygrace Zetkulic, Sophia Dar, Y.G. Kramer, Barun Mathema, Søren Germer, Mars Stone, Graham Simmons, Michael P. Busch, Tom Maniatis, David S. Perlin, Barry N. Kreiswirth
Abstract
Over a year of the COVID-19 pandemic, distinct severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) lineages have arisen in multiple geographic areas around the world. SARS-CoV-2 variants of concern (VOCs), i.e., B.1.1.7 (alpha), B.1.351 (beta), P.1 (gamma), and B.1.617.2 (delta), harboring mutations and/or deletions in spike protein N-terminal domain (NTD) or receptor-binding domain (RBD) regions showed evidence of increased transmissibility and disease severity and possible reduced vaccine efficacy. In this study, we report the emergence of five different NTD and RBD mutations in an uncommon SARS-CoV-2 B.1.369 lineage from an immunosuppressed patient undergoing steroid and convalescent plasma therapy. The observation highlighted that VOCs can independently arise in immunocompromised populations undergoing anti-SARS-CoV-2 therapy, and enhanced measures will be required to reduce the transmission.