Delta-Omicron recombinant escapes therapeutic antibody neutralization
Ralf Duerr, Hao Zhou, Takuya Tada, Dacia Dimartino, Christian Marier, Paul Zappile, Guiqing Wang, Jonathan Plitnick, Sara B. Griesemer, Roxie C. Girardin, Jessica Machowski, Sean Bialosuknia, Erica Lasek‐Nesselquist, Samuel L. Hong, Guy Baele, Meike Dittmann, Mila B. Ortigoza, Prithiv J. Prasad, Kathleen A. McDonough, Nathaniel R. Landau, Kirsten St. George, Adriana Heguy
Abstract
The emergence of recombinant viruses is a threat to public health, as recombination may integrate variant-specific features that together result in escape from treatment or immunity. The selective advantages of recombinant SARS-CoV-2 isolates over their parental lineages remain unknown. We identified a Delta-Omicron (AY.45-BA.1) recombinant in an immunosuppressed transplant recipient treated with monoclonal antibody Sotrovimab. The single recombination breakpoint is located in the spike N-terminal domain adjacent to the Sotrovimab binding site. While Delta and BA.1 are sensitive to Sotrovimab neutralization, the Delta-Omicron recombinant is highly resistant. To our knowledge, this is the first described instance of recombination between circulating SARS-CoV-2 variants as a functional mechanism of resistance to treatment and immune escape.