Emergence of SARS-CoV-2 Spike Escape Mutation Q493r After Bamlanivimab/Etesevimab Treatment for COVID-19

Daniele Focosi; Federica Novazzi; Angelo Genoni; Francesco Dentali; Daniela Dalla gasperina; Andreina Baj; Fabrizio Maggi

Daniele Focosi, Federica Novazzi, Angelo Genoni, Francesco Dentali, Daniela Dalla Gasperina, Andreina Baj, Fabrizio Maggi

doi:10.21203/rs.3.rs-524959/v1

SARS-CoV-2 variants are usually a consequence of random mutations in humans or other hosts, but accelerated evolution can also occur under selective pressure from therapeutic interventions with neutralizing antibodies1. Bamlanivimab has been recently withdrawn from the vendor as a monotherapy because of failure against E484K-positive SARS-CoV-2 variants, but emergency use authorization remains in place for the bamlanivimab/etesevimab cocktail2, for which no completely resistant variant has been reported to date. We report here the rst in vivo case of a Spike escape mutation conferring combined resistance to both bamlanivimab and etesevimab.

Declarations We declare we have no con ict of interest related to this manuscript.

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Ortega, Pujol, Jastrzebska, Rangel, Mutations in the SARS-CoV-2 spike protein modulate the virus a nity to the human ACE2 receptor, an in silico analysis, EXCLI journal

Starr, Greaney, Dingens, Bloom, Complete map of SARS-CoV-2 RBD mutations that escape the monoclonal antibody LY-CoV555 and its cocktail with LY-CoV016, Cel Reports Medicine

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