Antibodies powerless against new Omicron variants

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Monoclonal antibodies and antibody cocktails have been unable to neutralise new sublineages under lab conditions.

Emerging covid variants could pose an increased risk to immunocompromised individuals, research suggests.

A recent study in The Lancet Infectious Diseases revealed that several emerging Omicron sublineages, especially BQ.1.1, demonstrate complete or partial resistance to clinically used monoclonal antibodies (mAbs).

The researchers compared the neutralisation of Omicron sublineages BA.1, BA.4-5, BA.4.6, BA.2.75.2, BJ.1 and BQ.1.1 by single mAbs and mAb cocktails.

They found that the sublineages BA.1, BA.4-5, BA.4.6, BA.2.75.2 and BJ.1 exhibited variable resistance (efficient, moderate and poor neutralisation) to the mAbs tested, while none of the tested mAbs or mAb cocktails were able to neutralise BQ.1.1.

“Our data reveal that emerging Omicron sublineages are resistant to most (i.e. BA.4.6, BA.2.75.2 and BJ.1) or all (BQ.1.1) clinically used mAbs,” the authors wrote.

“As a consequence, in patients at high risk, treatment with mAbs alone might not provide a therapeutic benefit in regions of the globe in which BQ.1.1 is spreading.”

This suggests that additional treatment options (e.g. Paxlovid or molnupiravir) should be considered. “Furthermore, novel, broadly active mAbs are urgently needed for prophylactic or therapeutic treatment, or both, in patients at high risk.”

Treatment with mAbs has been crucial for immunocompromised patients who are more likely to get severely ill from covid due to comorbidities, age, immunosuppressive treatment or other factors.  

The Lancet Infectious Diseases 2022, online 18 November

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