Highlights d NTD-targeting antibodies are a key part of immunity to SARS-CoV-2 d NTD neutralizing antibodies target a single antigenic site of vulnerability d Neutralizing NTD antibodies protect hamsters from SARS-CoV-2 challenge d Variants of concern have mutations in the NTD that escape neutralization

Efficient therapeutic options are needed to control the spread of SARS-CoV-2 that has caused more than 922,000 fatalities as of September 13th, 2020. We report the isolation and characterization of two ultrapotent SARS-CoV-2 human neutralizing antibodies (S2E12 and S2M11) that protect hamsters against SARS-CoV-2 challenge. Cryo-electron microscopy structures show that S2E12 and S2M11 competitively block ACE2 attachment and that S2M11 also locks the spike in a closed conformation by recognition of a quaternary epitope spanning two adjacent receptor-binding domains. Cocktails including S2M11, S2E12 or the previously identified S309 antibody broadly neutralize a panel of circulating SARS-CoV-2 isolates and activate effector functions. Our results pave the way to implement antibody cocktails for prophylaxis or therapy, circumventing or limiting the emergence of viral escape mutants.

An ideal anti-SARS-CoV-2 antibody would resist viral escape [1][2][3] , have activity against diverse SARS-related coronaviruses (sarbecoviruses) [4][5][6][7] , and be highly protective through viral neutralization [8][9][10][11] and effector functions 12,13 . Understanding how these properties relate to each other and vary across epitopes would aid development of antibody therapeutics and guide vaccine design. Here, we comprehensively characterize escape, breadth, and potency across a panel of SARS-CoV-2 antibodies targeting the receptor-binding domain (RBD). Despite a tradeoff between in vitro neutralization potency and breadth of sarbecovirus binding, we identify neutralizing antibodies with exceptional sarbecovirus breadth and a corresponding resistance to SARS-CoV-2 escape. One of these antibodies, S2H97, binds with high affinity across all sarbecovirus clades to a previously undescribed cryptic epitope and prophylactically protects hamsters from viral challenge. Antibodies targeting the ACE2 receptor binding motif (RBM) typically have poor breadth and are readily escaped by mutations despite high neutralization potency. Nevertheless, we characterize one potent RBM antibody (S2E12 8 ) with breadth across sarbecoviruses related to SARS-CoV-2 and a high barrier to viral escape. These data highlight principles underlying variation in escape, breadth, and potency among antibodies targeting the RBD, and identify epitopes and features to prioritize for therapeutic development against the current and potential future pandemics.The most potently neutralizing antibodies to SARS-CoV-2-including those in clinical use 14 and dominant in polyclonal sera 15,16 -target the spike receptor-binding domain (RBD). Mutations in the RBD that reduce binding by antibodies have emerged among SARS-CoV-2 variants [17][18][19][20][21] , highlighting the need for antibodies and vaccines that are robust to viral escape. We have previously described an antibody, S309 4 , that exhibits potent effector functions and neutralizes all current SARS-CoV-2 variants 22,23 and the divergent sarbecovirus SARS-CoV-1. S309 forms the basis for an antibody therapy (VIR-7831, recently renamed sotrovimab) that has received Emergency Use Authorization from the FDA for treatment of COVID-19 24 . Longer term, antibodies with broad activity across SARS-related coronaviruses (sarbecoviruses) would be useful to combat potential future spillovers 6 . These efforts would be aided by a systematic understanding of the relationships among antibody epitope,

The spillovers of β-coronaviruses in humans and the emergence of SARS-CoV-2 variants highlight the need for broad coronavirus countermeasures. We describe five monoclonal antibodies (mAbs) cross-reacting with the stem helix of multiple β-coronavirus spike glycoproteins isolated from COVID-19 convalescent individuals. Using structural and functional studies we show that the mAb with the greatest breadth (S2P6) neutralizes pseudotyped viruses from three different subgenera through inhibition of membrane fusion and delineate the molecular basis for its cross-reactivity. S2P6 reduces viral burden in hamsters challenged with SARS-CoV-2 through viral neutralization and Fc-mediated effector functions. Stem helix antibodies are rare, oftentimes of narrow specificity and can acquire neutralization breadth through somatic mutations. These data provide a framework for structure-guided design of pan-β-coronavirus vaccines eliciting broad protection.

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The zoonotic spillover of SARS-CoV-2 has resulted in a global pandemic causing over 266 million infections and more than 5.2 million fatalities as of December 2021. Continued SARS-CoV-2 evolution leads to the emergence of variants of concern (VOC) that are characterized by higher transmissibility, immune evasion or disease severity. For pandemic preparedness, we need pan-sarbecovirus countermeasures, such as vaccines and therapeutics that are effective against all SARS-CoV-2 variants and divergent zoonotic sarbecoviruses (1).The coronavirus spike glycoprotein (S) promotes viral entry into host cells and is the main target of neutralizing antibodies elicited by infection or vaccination (2-7). S comprises an S1 subunit, which recognizes host cell receptors, and an S 2 subunit that drives viral-cell membrane fusion. The S 1 subunit includes the N-terminal domain and the receptor-binding domain (RBD) and two additional domains designated C and D (6). For SARS-CoV and SARS-CoV-2, the RBD interacts with angiotensin-converting enzyme 2 (ACE2) to allow virus entry into host cells (4,(8)(9)(10)(11)(12)(13)(14)(15)(16). The RBD is also the main target of serum neutralizing activity elicited by infection (17) and vaccination (7, 18) and exposes multiple antigenic sites that are recognized by broadly neutralizing sarbecovirus antibodies (Abs) (19-25) (fig. S1). However, a large fraction of Abs in polyclonal sera ( 17) and most monoclonal Abs (mAbs) selected for therapeutic development ( 26) target a subset of epitopes that overlap the ACE2-contact surface [designated the receptor-binding motif (RBM)]. The marked genetic divergence and plasticity of the RBM among SARS-CoV-2 variants and sarbecoviruses has thus far limited the breadth of Abs recognizing this region and they are readily escaped by mutations (20,(27)(28)(29)(30)(31)(32).To identify broadly neutralizing sarbecovirus Abs, we isolated SARS-CoV-2 S-specific (IgG) memory B cells from one symptomatic COVID-19 convalescent individual (who was not hospitalized) 35 days after symptoms onset. We identified one mAb, designated S2K146 (IGHV3-43; IGL1-44), which did not compete with S309 (site IV) (21) or S2X259 (site II) (19) but competed with S2E12 (site I), a potent RBM mAb with neutralization breadth against SARS-CoV-2-related

Background: Favipiravir and Molnupiravir, orally available antivirals, have been reported to exert antiviral activity against SARS-CoV-2. First efficacy data have been recently reported in COVID-19 patients. Methods: We here report on the combined antiviral effect of both drugs in a SARS-CoV-2 Syrian hamster infection model. The infected hamsters were treated twice daily with the vehicle (the control group) or a suboptimal dose of each compound or a combination of both compounds. Findings: When animals were treated with a combination of suboptimal doses of Molnupiravir and Favipiravir at the time of infection, a marked combined potency at endpoint is observed. Infectious virus titers in the lungs of animals treated with the combination are reduced by »5 log10 and infectious virus are no longer detected in the lungs of >60% of treated animals. When start of treatment was delayed with one day a reduction of titers in the lungs of 2.4 log10 was achieved. Moreover, treatment of infected animals nearly completely prevented transmission to co-housed untreated sentinels. Both drugs result in an increased mutation frequency of the remaining viral RNA recovered from the lungs of treated animals. In the combotreated hamsters, an increased frequency of C-to-T mutations in the viral RNA is observed as compared to the single treatment groups which may explain the pronounced antiviral potency of the combination. Interpretation: Our findings may lay the basis for the design of clinical studies to test the efficacy of the combination of Molnupiravir/Favipiravir in the treatment of COVID-19. Funding: stated in the acknowledgment.

Background: Within one year after its emergence, more than 108 million people acquired SARS-CoV-2 and almost 2¢4 million succumbed to COVID-19. New SARS-CoV-2 variants of concern (VoC) are emerging all over the world, with the threat of being more readily transmitted, being more virulent, or escaping naturally acquired and vaccine-induced immunity. At least three major prototypic VoC have been identified, i.e. the United Kingdom, UK (B.1.1.7), South African (B.1.351) and Brazilian (B.1.1.28.1) variants. These are replacing formerly dominant strains and sparking new COVID-19 epidemics. Methods: We studied the effect of infection with prototypic VoC from both B.1.1.7 and B.1.351 variants in female Syrian golden hamsters to assess their relative infectivity and virulence in direct comparison to two basal SARS-CoV-2 strains isolated in early 2020. Findings: A very efficient infection of the lower respiratory tract of hamsters by these VoC is observed. In line with clinical evidence from patients infected with these VoC, no major differences in disease outcome were observed as compared to the original strains as was quantified by (i) histological scoring, (ii) micro-computed tomography, and (iii) analysis of the expression profiles of selected antiviral and pro-inflammatory cytokine genes. Noteworthy however, in hamsters infected with VoC B.1.1.7, a particularly strong elevation of proinflammatory cytokines was detected. Interpretation: We established relevant preclinical infection models that will be pivotal to assess the efficacy of current and future vaccine(s) (candidates) as well as therapeutics (small molecules and antibodies) against two important SARS-CoV-2 VoC.