Category: Corona Virus Vaccine

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Influence of employment during COVID-19 on cognitive and motor … – News-Medical.Net

November 2, 2023

In a recent study published in Scientific Reports, researchers examined the effects of employment on geriatric health during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak.

Study:Impact of employment on the elderly in a super-aging society during the COVID-19 pandemic in Japan. Image Credit:Cryptographer/Shutterstock.com

Due to the aging population and the necessity to complement the working-age population, Japan's older population is becoming more employed. This occupation is viewed as a means of preventing cognitive deterioration and lowering the chance of mortality.

The COVID-19 pandemic, on the other hand, has underlined the necessity to research the impact of work on the health of elderly individuals. Elders have avoided going out due to the severity of COVID-19 and the related mortality risk.

A fear has arisen that if individuals do not go out, their activity levels will decline, and their health may deteriorate. Maintaining high levels of physical and mental activity can lower the likelihood of frailty, and being active in social engagements such as work may benefit geriatric health throughout the SARS-CoV-2 outbreak.

However, it is uncertain whether continuing to work during COVID-19 improved cognitive and motor abilities compared to regular periods.

In the present analysis, researchers explored the cognitive and motor functional implications of employment during COVID-19 among elderly individuals.

The study included 144 individuals aged65 years and older who undertook medical examinations at three centers (i.e., Hamate District Public Hall, Yamate District Public Hall, and Health and Welfare Center) in the Kaizuka city of Osaka Prefecture over six days between August and September 2021. The individuals were divided into employed and non-employed groups.

A one-to-one survey was conducted, querying the employment status and income of the participants. The motor function was assessed based on the skeletal muscle index (SMI), 2.4-meter walking speed (m/s), bone mineral density, and a two-step test.

General cognitive function was assessed using the Mini-Mental State Examination-Japanese edition (MMSE-J), and attention function (selection, persistence, distribution, and transfer) was assessed using the Trail Making Test-Parts A and B (TMT-A/B).

In addition, frailty (weakness, weight loss, exhaustion, slowness, and low activity level) was assessed using the modified Japanese edition of the Cardiovascular Health Study (J-CHS) criteria. Univariate analysis and logistic regression models were used to determine the odds ratios (ORs), adjusting for gender and age. The team excluded individuals restricted from exercising by health professionals and those with inadequate data.

The mean walking speed was determined based on the duration of completing a 2.0-meter walk at regular speed. The dominant hands grip strength was measured by grip strength meters, and the SMI values were determined based on body composition, height, and bio-impedance. The heel bone density (right side) was determined ultrasonically and compared to the corresponding bone density values for young adults.

Among the study participants, the mean age was 76 years; 33 (23%) were employed, and 111 (77%) were unemployed. Among employed individuals, 16 (49%) were female, whereas among those unemployed, 87 (78%) were female.

Concerning employment reasons, ten individuals (30%) worked for health, five (15%) for social connections, five (15%) for income, four (12%) for survival, three (nine percent) for additional income, two (six percent) for having plenty of time to spare, and four (12%) for other reasons.

Concerning employment type, one individual (three percent) worked full-time, 18 (55%) worked part-time, eight (24%) were self-employed, and six (18%) were categorized as other employment types.

The univariate analysis showed significantly higher SMI values and grip strength among employed individuals, likely due to the skewed gender ratio among the groups.

Concerning motor function, non-significant differences were observed in the locomotive two-step test, frailty, and walking speed between the groups.TMT-A was an independent factor for employed individuals (OR, 0.96). Working individuals were significantly more attentive than non-working individuals, as indicated by significantly less time on the TMT-A.

Overall, the study findings showed significantly higher attention among employed individuals than their unemployed counterparts during COVID-19, likely because attention is required to execute job-related tasks.

In addition, an individual needs to process visual data and write while performing jobs. Future studies must investigate the component of the attention function impacted by employment, considering underlying medical conditions affecting motor and cognitive functions and including larger sample sizes to improve the generalizability of the study findings.

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Influence of employment during COVID-19 on cognitive and motor ... - News-Medical.Net

Paxlovid shown not effective against long COVID in veterans – University of Minnesota Twin Cities

November 2, 2023

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From 46% to 61% of adults receiving mpox vaccination at two US public health clinics reported a decrease in sexual behaviors tied to viral transmission, including one-time encounters, sex partners, dating app or sex venuebased sex, and group sex, according to a study published late last week in Sexually Transmitted Diseases.

The study, led by Centers for Disease Control and Prevention (CDC) researchers, involved 711 adults seeking mpox vaccination at two clinics in Washington, DC, who completed questionnaires from August to October 2022.

Median participant age was 32 years, 52.0% were White, 20.5% were Black, 14.6% were Hispanic, 7.9% were Asian, 2.0% were multiracial, 0.3% were American Indian/Alaska Native, and 9% had HIV. Most participants were men who have sex with men (MSM) (61.0%), 27.0% were women, and 3.8% were men who have sex with only women.

During the 2022 multicountry mpox outbreak, more than 30,000 mpox cases were reported, mainly among MSM. "Decreases in U.S. mpox cases were likely accelerated by a combination of vaccination and modifications to sexual behaviors associated with mpox virus transmission," the researchers wrote.

Many participants reported fewer one-time sexual encounters (60.8%), sex partners (54.3%), less dating app or sex venuefacilitated sex (53.4%), and less group sex (45.6%). A total of 39% to 54% reported no change in these behaviors, and 0.4% reported an increase.

While reported cases of mpox continue to be low, individuals may return to behaviors and practices that they engaged in prior to the outbreak. In turn, behavior mitigation strategies may only be implemented as temporary protective measures, underscoring the importance of mpox vaccination for continued protection.

A greater proportion of Black participants reported decreases in all four behaviors since learning about mpox (61% to 76%), compared with White participants (41% to 54%). Also, a higher percentage of participants with HIV than those without HIV said they were engaging less in these activities (72% to 82% vs 43% to 59%).

"While reported cases of mpox continue to be low, individuals may return to behaviors and practices that they engaged in prior to the outbreak," the authors wrote. "In turn, behavior mitigation strategies may only be implemented as temporary protective measures, underscoring the importance of mpox vaccination for continued protection."

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Paxlovid shown not effective against long COVID in veterans - University of Minnesota Twin Cities

Family remembers Fort Worth police officer who died of COVID-19 complications – NBC 5 Dallas-Fort Worth

November 2, 2023

On Monday, the department posted a message on Facebook, announcing that Sgt. Jenson died over the weekend surrounded by family, friends, and colleagues.

Sergeant Jon Jenson was part of Fort Worth Police for 26 years, but his family didn't know a lot about his day-to-day there.

When he was home, it was all about family," said Vickie Jenson, his wife.

So, she was surprised when he came home one day with a Lifesaving Award.

"I said, What is this? He goes, Oh, they had a banquet, I didnt go,'" she laughed.

Turns out, he had helped rescue an older man who thought he was back in World War II.

"He called commandsWorld War II commands, and was able to get the man out of the tunnel and into safety," Vickie recalled.

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One of her fondest memories is getting married in the rain in March of 2001.

There was a certain song that was playing that we danced to," she said.

All moments she and her kids are now holding onto after COVID-19 shattered their lives.

I started to get better after a week, he did not. He started getting worse," said Vickie.

They contracted the virus in mid-August, and she said her husband was in and out of the hospital from then on.

Vickie said her husband got the virus while on the job.

I was always scared of him getting COVID because he already had lung problems, he hashes an asthmatic," she said.

She said after being on an ECMO, Jenson's liver and kidney started failing. An ECMO machine pumps blood outside the body, allowing the patient's heart and lungs to rest.

"He went from...breathing oxygen, to a mask, to the highest form of ventilator, like within 24 hours or so," Vickie said.

They said their goodbyes to the 57-year-old on Saturday.

We were there to hold his hand whenever he passed and it was very hard," she said, looking at her two kids.

I think the things that really made him great was the things that everyone has been saying for forever," said Jenson's son, William, "Hes just a loving, caring father and husband, and very honest, very thoughtful.

Vickie said he loved babies and animals and was a caring person.

Anytime anybody needed anything, he was the first one to jump up and help or whip out his wallet if anybody needed something-- to pay for flowers or anything. He just, he was always the first one to jump up and say, Ill do it," Vickie said.

She said he always wanted to take care of his team, too-- buying Christmas presents for them every year and, she found out over the last few days, sometimes surprising his staff with food.

Thats just the things that he did. And he didnt ask for anything in return," she said.

Vickie said she felt one last moment as they transported Jenson's casket, and their song started playing over the radio.

"As soon as we got out of the car, it started raining. And then as soon as we got in the car, it stopped," she said. "Its like I knew he was there."

Members of the Fort Worth Police Department are remembering Jenson for being "a great husband, father, friend and leader."

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Family remembers Fort Worth police officer who died of COVID-19 complications - NBC 5 Dallas-Fort Worth

CDC weighs in on JN.1 COVID-19 variant developments – University of Minnesota Twin Cities

November 2, 2023

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More than 50% of long-COVID patients failed to improve 1.5 years after their initial diagnosis, according to a new study based on cases seen at a Danish post-COVID clinic, both before and after the Omicron variant period. The study was published yesterday in the International Journal of Infectious Diseases.

The analysis included 806 patients who were infected with the wild-type strain, Alpha, Delta, or Omicron strain. All case-patients had been referred to a long COVID clinic with symptoms persisting at least 12 weeks from onset of COVID-19. Seventy percent of participants were female, with a median age of 48.

Patients were given a post-COVID symptom questionnaire (PCQ), and standard health scores, four times between enrollment and 18 months of follow-up. The first clinic visit for long COVID occurred an average of 7 months after acute infection. Patients were grouped according to the period of transmission of predominant SARS-CoV-2 variants, with 69% of patients infected during the wild-type period and 9%, 7%, and 15% infected in the Alpha, Delta, and Omicron periods, respectively.

The authors found that patients infected in the Delta period had significantly more severe long COVID initially, with a mean PCQ score of 43, compared with 38 for patients infected in the wild-type period.

Patients infected in the Omicron period did not differ in PCQ score (median 40) compared to wild-type patients (median 38) or to pre-Omicron patients (median 38). However, patients infected with Omicron had a lower health-related quality of life compared to patients infected with wild-type strain.

At 1.5 year after infection, patients had no clinically meaningful decline in severity of long COVID.

"At 1.5 year after infection, patients had no clinically meaningful decline in severity of long COVID, and 57% (245/429) of patients failed to improve 1.5 years after infection, with no differences between variants," the authors wrote.

Overall, PCQ scores fell 7 to 10 months post-infection, then plateaued between 10 and 18 months, Overall median PCQ score declined from 38 at 7 months to 33 at 18-month follow-up.

"In some patients, long COVID may last for more than 2 years after infection, which is supported by our data," the authors concluded.

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CDC weighs in on JN.1 COVID-19 variant developments - University of Minnesota Twin Cities

HEPA filters cut covid-19 sick days but we’ve been slow proving this – New Scientist

November 2, 2023

Matthew Horwood/Getty Images

TEMPERATURES have recently taken a dip in London, where I live, and, at home, I have been digging out my jumpers. At work, the winter feel is reinforced by a surge of interest in covid-19, with rising reported UK cases leading to familiar concerns over pressures on hospitals.

Because there is now much more population immunity to covid-19, it seems unlikely we would go back to restrictions on public mixing and so on. But in hospitals, where people are more vulnerable, there are questions over whether they should be reintroducing measures like staff wearing masks and having stricter isolation policies.

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HEPA filters cut covid-19 sick days but we've been slow proving this - New Scientist

Antibiotic use declined among people hospitalized with COVID-19 … – Healio

November 2, 2023

November 01, 2023

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Antibiotic use among critically ill patients hospitalized with COVID-19 declined between 2020 and 2022, researchers found.

Antibiotics are commonly prescribed to patients who have COVID -19 even though they do not treat viral infections, Christine Kim, PhD, MSPH, senior health scientist at CDC, told Healio.

We updated a previous analysis of hospital discharge records in PINC AI Healthcare Data through June 2022 to characterize inpatient antibiotic use in patients hospitalized with COVID-19. The main objective of this analysis was to evaluate changes in antibiotic use and identify opportunities for improving prescribing practices, she said.

To do so, Kim and colleagues conducted a retrospective analysis of adults aged 18 years and older who were hospitalized in the U.S. and included in the PINC AI Healthcare Data (PHD) Special Release COVID-19 edition (PHD-SR COVID-19) a hospital-based, all-payer database that contains inpatient discharge records from participating general acute-care, nonfederal U.S. hospitals.

Researchers used this cohort to calculate the monthly proportion of hospital discharges in which patients received at least one dose of an antibiotic during their hospital stay and stratified by critical care status, days of therapy (DOT)/1,000 patient days (PDs) and length of therapy/1000 PDs, according to the study.

In total, 1,142,752 adults were hospitalized and discharged with a COVID-19 diagnosis between March 2020 and June 2022, with most patients (69.9%) receiving an antibiotic during their hospital stay 88.1% of which were started at admission.

According to the study, antibiotic use rates were higher among critically ill patients compared with those among noncritically ill patients (903 DOT/1,000 PDs vs. 763 DOT/1,000 PDs). These patients were more likely to be older, critically ill, have longer hospital stays and higher in-hospital mortality.

Overall, the study showed that among noncritically ill patients discharged in 2020, 71.1% received an antibiotic of whom 92.3% were started on admission vs. 62.1% in 2022, of whom 88.2% were started on admission. The largest decreases in antibiotics were observed for azithromycin (40.2% to 30.9%) and ceftriaxone (46.6% to 39.9%).

Hospital antimicrobial stewardship programs are critical in leading efforts to decrease early initiation of unnecessary antibiotics among patients hospitalized with COVID-19, Kim said. With increasing cases of respiratory viruses this season, stewardship programs also support optimizing the use of diagnostic testing and appropriate antimicrobial treatment, including antiviral therapy, to improve the evaluation and treatment of patients hospitalized with respiratory infections.

Kim added, Clinicians should follow national or hospital treatment guidelines for patients with COVID-19.

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Prior COVID infection lowers risk of multisystem inflammatory … – University of Minnesota Twin Cities

November 2, 2023

A pair of studies sheds new light on the SARS-CoV-2related multisystem inflammatory syndrome in children (MIS-C), with Dutch researchers finding that previous COVID-19 infection helps protect children against the condition, and a US study showing that low-dose corticosteroids and intravenous immunoglobulin (IVIG) were tied to shorter hospital stays and less severe disease.

Both studies were published in the Pediatric Infectious Disease Journal.

For the first study, a team led by Leiden University researchers conducted an international study involving 564 hospitalized pediatric COVID-19 or MIS-C patients from March 2020 to December 2022. The children were from the Netherlands, Curacao, and Surinam.

Most children hospitalized for COVID-19 (239/375; 64%) had a respiratory tract infection. About one third of admitted children (136/375; 36%) had primarily nonrespiratory COVID-19 symptoms (eg, fever, gastrointestinal symptoms).

Of the 375 COVID-19 patients, 36% required supplemental oxygen, and 9.3% were admitted to an intensive care unit (ICU). Risk factors for severe disease were age older than 12 years, a history of neurocognitive developmental abnormalities, and underlying chronic lung conditions.

Over one third (36%) of COVID-19 patients were severely ill. Of these patients, 26% were admitted to an ICU, 15 needed mechanical ventilation, 2 received extracorporeal membrane oxygenation (ECMO), and 1 patient with severe underlying conditions died.

Of the 189 MIS-C patients, 43% had severe illness. All severely ill patients were admitted to the ICU. Five patients required mechanical ventilation, and none died. The gastrointestinal (90%) and cardiac (75%) systems were most often involved.

Our data supports the notion that, similar to adults, prior immunity protects against severe sequelae of SARS-CoV-2 infections in children.

Most COVID-19 cases were from wild-type variant predominance (34%), followed by the Delta period (25%). The incidence of MIS-C was highest during Delta predominance (4.0 cases per 1 million people), with a steep fall-off when Omicron emerged (1.2 per million). No MIS-C cases were documented after July 2022. MIS-C patients younger than 5 years had milder illness than their older counterparts.

Children had less severe infections during the Omicron than during preceding variant periods. After population immunity rose due to COVID-19 vaccine rollouts and previous infections, the incidence of COVID declined except for in infants younger than 1 year, in whom the rate remained stable.

"Our data supports the notion that, similar to adults, prior immunity protects against severe sequelae of SARS-CoV-2 infections in children," the study authors wrote. "Real-time reporting of accurate and high-quality data is feasible and impacts clinical and public health decision-making."

In the second study, a team led by Centers for Disease Control and Prevention (CDC) researchers obtained data on 233 MIS-C patients at four children's hospitals in Florida, Georgia, Arizona, and Missouri from March 2020 to March 2021. Median age at MIS-C onset was 9 years.

Patients who received high-dose steroids and aspirin had increased rates of severe outcomes and longer duration of treatment, indicating that patients with severe illness may have been selected for these treatments.

The most commonly administered treatments were corticosteroids (88.4%), aspirin (81.1%), IVIG (77.7%), and anticoagulants (71.2%). Compared with patients without respiratory symptoms, those with respiratory involvement were less likely to be given IVIG and steroids on the same day (44.1%).

After adjustment for confounding variables, patients given IVIG within 1 day of hospitalization were less likely to have a hospital stay of 8 days or longer (relative risk [RR], 0.53). Patients given low-dose steroids on their first day of hospitalization were less likely to develop ventricular dysfunction (RR, 0.45), have increasingly elevated troponin levels (an indication of heart damage; RR, 0.55), or remain hospitalized for at least 8 days (RR, 0.46).

"Patients who received high-dose steroids and aspirin had increased rates of severe outcomes and longer duration of treatment, indicating that patients with severe illness may have been selected for these treatments," the researchers wrote. "Furthermore, treatment with IVIG and low-dose steroids within 1 day of hospitalization lowered the risk of severe outcomes, illustrating that prompt treatment is essential for better outcomes among patients with MIS-C."

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Prior COVID infection lowers risk of multisystem inflammatory ... - University of Minnesota Twin Cities

DeSantis campaigns in NH with Florida surgeon general who rejected CDC COVID-19 guidance – WMUR Manchester

November 2, 2023

DeSantis campaigns in NH with Florida surgeon general who rejected CDC COVID-19 guidance

Updated: 6:33 PM EDT Nov 1, 2023

Republican presidential candidate Ron DeSantis campaigned in New Hampshire on Wednesday with the Florida surgeon general, touting their sometimes controversial response to the COVID-19 pandemic.During the COVID-19 pandemic, DeSantis and Dr. Joseph Ladapo weren't afraid to steer Florida away from certain guidelines set by the Centers for Disease Control and Prevention."They decided that healthy people should be quarantined, and that had never been done before," DeSantis said. "And you had schools the CDC pushed this; Joe and I rejected it but they would say if one kid got positive for COVID, then anyone in the class, even if they were healthy, had to go home and isolate for two weeks. It was terrible for families."Ladapo became a controversial figure in the medical community during the pandemic when he said healthy children should not be vaccinated against COVID-19, which went against recommendations from the CDC and the American Academy of Pediatrics. He said the negative impacts of the COVID-19 response should have been balanced against the danger of the virus."Record rates of alcohol abuse, drug abuse, overdoses, kids. I mean, it's crazy," Ladapo said. "Can you imagine that double-digit percentages of children have thought about suicide?"DeSantis is targeting a certain kind of primary voter, but talking about the pandemic also helps him draw a contrast with the GOP frontrunner, former President Donald Trump."The CDC director under Trump at one point said I think holding up a mask 'If we do this for six weeks, the pandemic will be over," DeSantis said. "That was false."

Republican presidential candidate Ron DeSantis campaigned in New Hampshire on Wednesday with the Florida surgeon general, touting their sometimes controversial response to the COVID-19 pandemic.

During the COVID-19 pandemic, DeSantis and Dr. Joseph Ladapo weren't afraid to steer Florida away from certain guidelines set by the Centers for Disease Control and Prevention.

"They decided that healthy people should be quarantined, and that had never been done before," DeSantis said. "And you had schools the CDC pushed this; Joe and I rejected it but they would say if one kid got positive for COVID, then anyone in the class, even if they were healthy, had to go home and isolate for two weeks. It was terrible for families."

Ladapo became a controversial figure in the medical community during the pandemic when he said healthy children should not be vaccinated against COVID-19, which went against recommendations from the CDC and the American Academy of Pediatrics. He said the negative impacts of the COVID-19 response should have been balanced against the danger of the virus.

"Record rates of alcohol abuse, drug abuse, overdoses, kids. I mean, it's crazy," Ladapo said. "Can you imagine that double-digit percentages of children have thought about suicide?"

DeSantis is targeting a certain kind of primary voter, but talking about the pandemic also helps him draw a contrast with the GOP frontrunner, former President Donald Trump.

"The CDC director under Trump at one point said I think holding up a mask 'If we do this for six weeks, the pandemic will be over," DeSantis said. "That was false."

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DeSantis campaigns in NH with Florida surgeon general who rejected CDC COVID-19 guidance - WMUR Manchester

Simulation study shows best air exchange for cruise ships – University of Minnesota Twin Cities

November 2, 2023

The Michigan Department of Natural Resource (DNR) yesterday reported the first detection of chronic wasting disease (CWD) in a deer in Ogemaw County, which is in the north central part of the lower peninsula.

The deer was a 4-year-old doe that was skinny, drooled, and showed no fear of people. The University of Wisconsin Veterinary Diagnostic Laboratory in Madison confirmed the findings. CWD has now been found in 13 of Michigans 83 counties.

Chad Stewart, MS, the DNRs deer and elk specialist, said intensive surveillance had been done. "In light of this new detection, we are offering additional opportunities for those interested in getting their deer tested for CWD in Ogemaw County," he said. Officials said a drop box for CWD testing will be available in the area starting November 3.

Stewart said CWD isnt common in Michigan deer, and the hunting community continues to play a key role in helping with testing efforts. The DNR said it regularly tests around areas where CWD is detected as a way to detect the disease early. In 2021, it started a rotational approach, selecting a group of counties for testing each year with a longer-term goal of testing all Michigan counties.

The focus this year is counties in the northwestern lower peninsula and a few counties where more herd information is needed.

Michigans first CWD detection occurred in 2015, and, since then, more than 137,000 wild deer have been tested. The deer in Ogemaw County is the 251st to test positive.

CWD is a prion disease that causes neurodegeneration, similar to "mad cow disease," in several cervid species, or members of the deer family. The disease hasnt been shown to jump to people, but health officials urge people to avoid eating infected animals and to use precautions, such as wearing rubber gloves and minimizing contact with brain and spinal tissues, when processing deer.

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Simulation study shows best air exchange for cruise ships - University of Minnesota Twin Cities

Defining neutralization and allostery by antibodies against COVID … – Nature.com

November 2, 2023

Varying binding affinities and neutralization efficacies of Spike by antibodies

We performed biophysical characterization of nine human monoclonal IgG antibodies (HuMAbs), namely LSI-CoVA-014, LSI-CoVA-015, LSI-CoVA-016, LSI-CoVA-017 which were discovered in this study, along with 4A833, 5A634, CR302235, CoVA-0236, and CoVA-3936. These monoclonal antibodies were principally discovered from convalescent patients of COVID-19 with the exception of CR3022 that was derived from a SARS-CoV-1 patient35, and 5A6 which was derived from a nave human phage-FAB library. The binding activity of each antibody to SARS-CoV-2 Spike trimer (Spike) and isolated RBD (RBD) from the Wuhan-Hu-1 strain was determined using Quartz Crystal Microbalance (QCM) and enzyme-linked immunosorbent assay (ELISA). As indicated by the half-maximal effective concentration (EC50) values, seven of the nine antibodies bound strongly to both Spike trimer and RBD (Fig.1b). Antibody LSI-CoVA-017 binds strongly to Spike but not RBD, suggestive of an epitope outside RBD. Antibody 4A8 binds weakly to Spike and showed negligible binding to RBD, consistent with previous studies that show 4A8 binds NTD33. Next, we determined the binding kinetics of these HuMAbs against Spike and observed high affinity binding with slow off-rates (Supplementary Fig.1 and Supplementary Table1). The affinity constants (KD) were in the sub-nM range, with LSI-CoVA-017 being the lowest (0.088nM). The association-dissociation kinetics clearly indicate stable binding of the HuMAbs to the Spike trimer.

We next investigated their neutralization efficacies using a pseudotyped virus neutralization test (PVNT). A neutralization capacity of >50% was considered significant in accordance with WHO standards. Correspondingly, we observed differential levels of neutralization, wherein LSI-CoVA-014, LSI-CoVA-015, LSI-CoVA-016, and CR3022 showed less than 50% efficacy. On the other hand, 4A8, LSI-CoVA-017, and CoVA2-04 showed significant neutralization capacities, while the highest neutralization was observed for CoVA2-39 and 5A6. On this basis, the antibodies were classified as (i) weak, (ii) moderate, and (iii) strong neutralizing HuMAbs (Fig.1ce).

The epitopes of the HuMAbs were mapped by comparative HDXMS analysis of complexes with Spike and RBD. We observed extensive protection against deuterium exchange across peptides spanning RBD of Spike and isolated RBD, in the presence of LSI-CoVA-014, LSI-CoVA-015, LSI-CoVA-016. This indicates binding to eitherthereceptor-binding motif (RBM) or at a site distal to RBM (Fig.2af). Overlapping peptides covering residues 361395 showed large-scale protection against deuterium exchange in both Spike (Fig.2h, i) and RBD complexes with LSI-CoVA-014, LSI-CoVA-015, and LSI-CoVA-016, indicating that these three antibodies bind RBD at a site distal to the RBM site. In the trimeric Spike, the region spanning residues 361395 becomes accessible only when the RBD adopts an up-position. These changes indicate that the epitope sites identified for LSI-CoVA-014, LSI-CoVA-015, and LSI-CoVA-016 are similar to the site observed for the CR3022 antibody (Supplementary Fig.2a), previously characterized as a cryptic site binder37. Alongside antibodies discovered in the current study, we mapped the binding interfaces of known RBD-binding IgGsCoVA2-04, CoVA2-39, and CR3022 (Supplementary Fig.2). The binding hotspots mapped using HDXMS agree with reported cryo-EM structures38. Consistent with our expectations, increased deuterium exchange was observed across the peptides spanning the RBM/ACE2 binding site upon binding of either of these three antibodies (Fig.2af and Supplementary Fig.2a). This correlates to increased conformational dynamics at the ACE2 binding site, suggesting that binding of LSI-CoVA-014, LSI-CoVA-015, or LSI-CoVA-016 locks the RBD in the up- position resulting in higher solvent exposure (Fig.2g). Also, binding of LSI-CoVA 014, 015, 016 may induce allosteric destabilization at RBM, which further needs to be probed (Fig.2g).

Difference plots showing changes in deuterium exchange (D) for a LSI-CoVA-014, b LSI-CoVA-015, and c LSI-CoVA-016 antibody complexes with isolated RBD compared to free RBD, at different labelling times as indicated. Pepsin-proteolyzed fragment peptides are represented by a dot and their residue numbers are indicated. Average values (n=3 independent experiments) and the standard deviations are plotted using Microsoft Excel. A significant value of 0.5D was considered as threshold and is indicated by red-dashed line. Epitope sites are highlighted in yellow. Differences in deuterium exchange values at 1min labeling time for d LSI-CoVA-014, e LSI-CoVA-015, and f LSI-CoVA-016 antibody complexes are mapped on to the structure of RBD shown in surface representation, as per key. g The effects of ACE2 binding to RBDWuhan are mapped and shown for reference, with the RBM-site highlighted in pink box. Comparative HDXMS analysis of Spike trimer (purified from insect cell culture) in the presence and absence of h LSI-CoVA-014 and i LSI-CoVA-015 and LSI-CoVA-016 highlighting S1 subunit (left), S2 subunit (centre), and Spike monomer (right, 11208 residues), with the other two monomers shown in grey. Peptides spanning key regions are highlighted by arrows. Epitopes on RBD (345361, 375390, 471495) are indicated in yellow. Inset highlights a close-up view of Spike trimer (cartoon representation) along the transverse axis. Differences are mapped onto all the three monomers of Spike. RBD-binding antibodies (LSI-CoVA-014, LSI-CoVA-015, and LSI-COVA-016) induce destabilizing effects at the inter-protomer contacts. Peptides spanning residues 304317, fusion peptide (FP), and heptad repeat 1 (HR1) constituting a part of intermonomer interaction interface are indicated. Source data is provided as Source data file.

Similar effects were observed across the other regions of Spike upon binding of LSI-CoVA-014, LSI-CoVA-015, and LSI-CoVA-016 (Supplementary Fig.2bd). Notably, peptides spanning residues 516533 showed increased deuterium exchange (Fig.2h, i, left panels), confirming that antibody-binding stabilized RBD in an up-conformation. This is accompanied by the loss of inter- and intra-monomer contacts between RBD and NTD, with residues 166182 which interact with RBD, and 289305 that connect NTD to the central Spike core showing the most significant changes (Fig.2h, i, left panels). In the presence of LSI-CoVA-014, LSI-CoVA-015, and LSI-CoVA-016, an overall increased deuterium exchange was observed for peptides spanning the NTD regions of the Spike trimer. Further, multiple regions of the S2 subunit including the fusion peptide (FP), heptad repeats (HR1 and HR2) and residues 902916 also showed increased deuterium exchange in the presence of these three HuMAbs (Fig.2h, i, centre panels and Supplementary Fig.3ac), except the S1/S2 cleavage site which was associated with a decreased deuterium exchange. These sites are essential for intermonomer interactions (Fig.2h, i, right panels). Taken together, the conformational changes observed at the NTD and the S2 subunit suggest antibody-binding at RBD induces allosteric changes across the Spike trimer, resulting in its global destabilization that may lead to dissociation of adjacent monomers.

These observations were further supported by the HDX changes at the paratope sites of LSI-CoVA-014, LSI-CoVA-015, and LSI-CoVA-016 (Supplementary Figs.3d, e and4). Peptides spanning CDRL1-3 and CDRH1-3 showed greater differences in deuterium exchange in the RBD-bound complex, as compared to Spike-bound antibody complexes (Supplementary Table2). The epitope sites are not hidden in the isolated RBD construct but are readily accessible to stably bind the paratope sites. On the other hand, in the Spike trimer, the RBDs must move from a down- to an up- position, and antibody binding is further hindered spatially by the NTD and the S2 subunit, leading to less stable antibody binding.

We next investigated the effects of LSI-CoVA-017, which shows moderate neutralization. In the LSI-CoVA-017-bound state, protection against deuterium exchange was observed across the Spike trimer, with only a few peptides showing deprotection (Fig.3a and Supplementary Fig.5a). Upon closer examination, peptides spanning residues 92110, 136143 (N3 loop), and 243265 (N5 loop) showed large-scale decreases in deuterium exchange in the LSI-CoVA-017-bound state (Fig.3a). These peptides are positioned towards the outer edge of NTD, and are likely the epitope sites bound by LSI-CoVA-017. This region also corresponds to the NTD antigenic supersite20,39. Reduction in deuterium exchange at short labeling times was observed across residues 3648, 166182, and 303318, while increased deuterium exchange was observed for residues 6083, 107117, 213228, and 266276. These differences, mapped onto the structure of NTD (Fig.3a, right panels), revealed that peptides encompassing the epitope site are clustered closely to form a structural epitope and facilitate complexation of Spike with LSI-CoVA-017. These peptides also showed a reduction in deuterium exchange in our comparative HDX analysis of free Spike and its complex with 4A8, which has been previously characterized as an NTD-binding antibody40 (Fig.3b and Supplementary Fig.5b). Thus, our binding assays and HDX data identify LSI-CoVA-017 as an NTD-binding antibody, with both LSI-CoVA-017 and 4A8 being moderate neutralizers.

Difference plots for NTD showing changes in deuterium exchange for a LSI-CoVA-017 and b 4A8 antibody complexes with Spike (purified from insect cell culture) compared to apo Spike, at different labelling times as indicated. Pepsin-proteolyzed fragment peptides spanning NTD of the Spike are represented by a dot and their residue numbers are indicated on the x axis. Average values (n=3 independent experiments each for two biological replicates) and the standard deviations (error bars) are plotted using Microsoft Excel. A significant value of 0.5D was considered as threshold and is indicated by red-dashed line. Epitope sites are highlighted in yellow. Right panels: Differences at 1min labeling time mapped on to NTD of Spike is shown in cartoon representation. Comparative HDXMS analysis of Spike trimer in the presence and absence of c LSI-CoVA-017 and d 4A8 mapped onto the S1 subunit (left) and trimeric Spike protein (right), as indicated. Peptides spanning key regions are highlighted by arrows with epitopes on NTD (92110, 136143, 243265) indicated by yellow ellipse. Inset highlights a close-up view of Spike trimer along the transverse axis. Differences are mapped onto all the three monomers of Spike. NTD-binding LSI-CoVA-017 reduce overall conformational dynamics (shades of blue). Peptides spanning residues 304317, fusion peptide (FP), and heptad repeat 1 (HR1) constituting a part of intermonomer interaction interface are indicated. Source data is provided as Source data file.

Large-magnitude decreases in deuterium exchange were observed across all peptides (including residues 320-350, 516533) spanning the RBD of Spike bound to LSI-CoVA-017 (Supplementary Fig.5a and Supplementary Table2). This indicates significantly reduced conformational dynamics across RBD, suggesting restricted domain motions in the LSI-CoVA-017-bound state. HDXMS analysis of LSI-CoVA-017 and 4A8 with isolated RBD, revealed no significant changes in deuteration levels of RBD (Supplementary Fig.5a). Hence, it is clear that the antibodies binding at NTD induce distinct conformational changes across RBD and the S2 subunit compared to RBD-binding antibodies. Decreased deuterium exchange was observed for peptides spanning the S2 subunit of the Spike-LSI-CoVA-017 complex (Fig.3c, d and Supplementary Fig.5b). Upon LSI-CoVA-017 binding, notable changes in conformational dynamics were observed at the S1/S2 cleavage site, FP, central helix, and HR (Fig.3c, inset). While both LSI-CoVA-017 and 4A8 binding resulted in similar effects on the Spike trimer, the changes induced by 4A8 HuMAb were less prominent. Overall, these HDXMS results reveal that LSI-CoVA-017 binding at NTD induces global stabilization of the Spike trimer.

HDXMS analysis of the LSI-CoVA-017 antibody showed significant changes across both heavy and light chains in the presence of Spike (Supplementary Fig.5c and Supplementary Table2). Peptides overlapping CDRH2 (residues 4870), CDRH3 (96103), and CDRL2 (4871) showed protection against deuterium exchange, while CDRL3 (101129) showed increased deuterium exchange. Interestingly, similar changes were observed for 4A8 complexed to Spike. No significant changes were observed for the light chain of 4A8 with or without Spike, consistent with available high-resolution structures33.

The commonalities in effects of 4A8 and LSI-CoVA-017 upon Spike suggest similar modes of neutralization, as reflected in their neutralization capacities. However, our biophysical data showed LSI-CoVA-017 binds Spike trimer with an affinity much greater than 4A8 (Fig.1b). To rationalize this, we determined the stoichiometry of the Spike-LSI-CoVA-017 complex by size-exclusion chromatography (Supplementary Fig.6 and Supplementary Table3). Three chromatographic peaks were detected and analyzed by denaturing polyacrylamide electrophoresis. Densitometry analysis of different amounts of peak B suggested a binding stoichiometry of three LSI-CoVA-017 antibodies per Spike trimer. With a 1:3 Spike:IgG stoichiometry, two models are plausible where: (i) Fab arms from three LSI-CoVA-017 antibodies bind to three monomers of a single Spike trimer; or (ii) two Fab arms of the same LSI-CoVA-017 bind monomers of two different Spike trimers. This is similar to the model predicted for the Spike:4A8 complex33. We further probed this computationally, as discussed below.

Multiple studies have reported high-resolution structures of HuMAbs bound to RBM, including CoVA2-04, 5A6, and CoVA2-39, showing direct competition with ACE2 binding38. However, given that these HuMAbs display varying neutralization potencies in inhibiting viral entry while binding to overlapping epitopes, a mechanistic explanation for their contrasting behavior remains elusive, particularly for CoVA2-04, a moderate neutralizer, as opposed to 5A6 and CoVA2-39 that are strong neutralizers. We therefore monitored the binding of CoVA2-04, 5A6, and CoVA2-39 to the Spike trimer and observed a distinct impact on its conformational dynamics (Fig.4 and Supplementary Fig.7). A large-magnitude decrease in deuterium exchange was observed across RBD, particularly the peptide clusters spanning RBM (485-502) of Spike complexes with 5A6, CoVA2-04 and CoVA2-39 (Fig.4d, e and Supplementary Fig.7a). Interestingly, HDXMS analysis of CoVA2-04 and CoVA2-39 complexes with the isolated RBD construct showed lower deuterium exchange across RBM, and only minor changes at other regions (Fig.4a). These results indicate that binding of HuMAbs at RBM induces localized changes that lead to a significant reduction in the structural dynamics of RBD, including the peptides spanning the base and linker regions that connect RBD to the Spike trimer. Notably, the Spike variants contain mutations at different sites including E484K, N501Y- or K417N/E484K/N501 that are localized at RBM, and are reported to reduce the neutralization efficacy of antibodies1,26,41.

Difference plots showing changes in deuterium exchange for a CoVA2-39 and b CoVA2-04 antibody complexes with isolated RBD, and c 5A6 antibody with RBD of Spike compared to apo RBD, at 1- and 10-min labelling times. Pepsin-proteolyzed fragment peptides spanning NTD of the Spike are represented by a dot and their residue numbers are indicated. Average values (n=3 independent experiments each for two biological replicates) and their standard deviations (error bars) are plotted using Microsoft Excel. A significant value of 0.5D was considered as threshold and is indicated by red-dashed line. Epitope sites are highlighted in yellow. (right panels) Differences at 1min labeling time mapped on to NTD of Spike is shown. Comparative HDXMS analysis of Spike trimer (purified from insect cell culture) in the presence and absence of d CoVA2-39 and e 5A6 mapped onto the S1 subunit (left), and Spike monomer (right), as indicated. Peptides spanning RBM epitope site are highlighted in yellow. Inset highlights a close-up view of Spike trimer along the transverse axis. Differences are mapped onto all the three monomers of Spike. Peptides spanning residues 304317, fusion peptide (FP), and heptad repeat 1 (HR1) constituting a part of intermonomer interaction interface are indicated. Source data is provided as Source data file.

Binding of CoVA2-04, 5A6, and CoVA2-39 to Spike resulted in increased deuterium exchange across peptide clusters covering residues 3142, 92110, 177191, 265276 of NTD (Fig.4d, e and Supplementary Fig.7a). Some of these peptides span the interface interacting with the RBD and the C-terminal region of NTD. As binding of these HuMAbs leads to RBD domain movement, it induces NTD movement as well, disrupting their interaction. Significant protection against deuterium exchange was observed at the S1/S2 cleavage site (residues 672695), regions flanking the FP (residues 770782, 878898), HR1 (residues 927962), central helix (10031031), and 11031117 of the S2 subunit (Fig.4d, e, right panels, Supplementary Fig.7b). These sites are essential for the Spike trimer to transition from its pre-fusion state to post-fusion state. Decreased deuterium exchange across the S2 subunit suggests that binding of these strong neutralizing HuMAbs leads to global reduction in the conformational dynamics of the Spike trimer, which may prevent the transition to the fusogenic intermediate. Collectively, the HDXMS results provide detailed insights into the mechanism of action of CoVA2-04, 5A6, and CoVA2-39, wherein they compete with ACE2 binding and induce stabilization throughout the Spike trimer to restrict its mobility.

Next, we performed molecular docking to model the Fab domains of LSI-CoVA-014, LSI-CoVA-015, LSI-CoVA-016, and LSI-CoVA-017 at their respective epitope sites of the Spike protein (RBD or NTD) using HDXMS footprints as restraints (Fig.5 and Supplementary Table4), followed by atomic-resolution MD simulations. Out of 100 Fab:RBD/NTD complexes generated, five top-scoring binding poses were selected for 200ns simulations (Fig.5ad). Among the simulated models of Fab:RBD/NTD complexes, multiple models were observed to either displace from the epitope site (Model 3, RBD-LSI-CoVA-014) or completely detach from RBD (Model 4, RBD-LSI-CoVA-014 and Model 3 of RBD-LSI-CoVA-016), and were not considered for further analysis(Supplemenary Fig. 8a). To select the best models from the stable complexes with each antibody, we next calculated the root mean square deviation (RMSD) of backbone atoms of the Fab domain (Supplementary Fig.8b) and the model with the lowest RMSD was selected for additional replicate simulations to improve the conformational sampling (Supplementary Table4 and Supplementary Fig.9). A stable Fab binding orientation from the most populated cluster was identified via cluster analysis, of each Fab:RBD/NTD complex (Supplementary Fig.9a) and the cluster analysis identified 34, 79, 52 and 65 clusters sampled for LSI-CoVA-014, LSI-CoVA-015, LSI-CoVA-016 and LSI-CoVA-017, respectively (Fig.5eh and Supplementary Fig.9). Further, contact frequencies were calculated between the glycan moieties and Fab from RBD/NTD simulations of the top 5 docking poses and triplicate MD trajectories of selected poses, revealing that N-glycans interact with residues across Fab arms of LSI-CoVA-014, LSI-CoVA-015, LSI-CoVA-016 and LSI-CoVA-017 (Fig.5il, Supplementary Fig.8b, and Supplementary Fig.9c). Interestingly, the glycan moieties at N343 of RBD and N74, N122 and N149 on NTD were observed to interact with the Fab (Fig.5c). For the residues interacting with the N-glycans at N331 and N343, contact frequency maps showed the highest number and magnitude of contact frequencies made by LSI-CoVA-014 Fab, as compared to those by LSI-CoVA-015 and LSI-CoVA-016 (Supplementary Fig.8b and Supplementary Fig.9c). Similarly, simulation trajectories of the NTD-LSI-CoVA-017 complex showed prominent interactions between the N74, N122 and N149 N-glycans and the Fab (Supplementary Fig.8b and Supplementary Fig.9c). The contact frequencies measured for the NTD-LSI-CoVA-017 Fab complex indicated stable interactions with a larger surface compared to any of the RBD-Fab complexes, suggesting a potential role for glycans in forming the antibody epitope.

Surface representation of central structures of the five most populated clusters from a RBD-LSI-CoVA-014, b RBD-LSI-CoVA-015, c RBD-LSI-CoVA-016, and d NTD-LSI-CoVA-017 complexes. RBD and NTD are in gray, with LSI-CoVA-014 (brown), LSI-CoVA-015 (green), LSI-CoVA-016 (orange), and LSI-CoVA-017 (yellow). Representative structures from the most populated cluster from MD simulation trajectories are depicted in two orientations for RBD (grey) complexes with Fab of e LSI-CoVA-014 (brown), f LSI-CoVA-015 (green), g LSI-CoVA-016 (orange); and NTD (grey) in complex with h LSI-CoVA-017 (yellow). Glycans are shown in ball-and-stick representation. il Maximum contact frequencies between glycan moieties and Fab from simulations of top five RBD/NTD:Fab docking poses are mapped onto the structure of each Fab. Plots showing the binding of varying concentrations of m LSI-CoVA-014, n LSI-CoVA-015, o LSI-CoVA-016, and p LSI-CoVA-017 antibodies with Spike (red circles) and deglycosylated Spike (blue squares) as determined by ELISA. Data is represented as mean SEM (n=3 independent experiments). Source data is provided as Source data file.

To verify this, we tested the binding of four novel HuMAbs (LSI-CoVA) with a deglycosylated Spike trimer. Binding of LSI-CoVA-017 was completely abolished with deglycosylated Spike, in contrast to the minor changes observed for LSI-CoVA-014, LSI-CoVA-015 and LSI-CoVA-016 (Fig.5mp and Supplementary Fig.10). Furthermore, significant reduction in binding kinetics of these four HuMAbs with deglycosylated Spike was observed, as compared to the glycosylated Spike trimer (Supplementary Fig.10b). To further validate the significance of glycosylation to RBD-binding HuMAbs, we tested 5A6 as a control, which showed a partial reduction. Collectively, these results demonstrate that the LSI-CoVA-017 epitope encompasses glycan moieties on the Spike protein surface. For other antibodies (LSI-CoVA-014/LSI-CoVA-015/LSI-CoVA-016/5A6) the primary binding sites were non-glycosylated epitopes, as identified by HDXMS, with only secondary interactions contributed by glycans. These results provide a view contrary to the prevailing notion that glycans only act as a shield for Spike protein to hide epitope sites from host immune recognition42,43 and suggest that non-specific interactions of glycans with the antibodies can play a substantial role in stabilizing Fab arm binding at the epitope site.

A competitive ELISA was performed to evaluate the extent of epitope site overlap among antibodies (Fig.6ad) and also to characterize the cooperative binding to Spike monomers in the trimeric Spike. This allowed us to distinguish the mechanisms of binding and neutralization of RBD-specific antibodies that share the same or highly overlapping epitopes, yet have different affinities and neutralization activities. Competitive binding ELISA results indicated similar OD450 values between LSI-CoVA-015 and LSI-CoVA-016 as detection or capture antibodies, suggesting a significant overlap in their binding orientation, which is in-line with our HDXMS-guided docking and MD simulations (Fig.6ej). On the other hand, LSI-CoVA-014 did not prevent binding of LSI-CoVA-015 or LSI-CoVA-016. Our simulation cluster analysisof trajectories showed that LSI-CoVA-014 bound to Spike in a different orientation than LSI-CoVA-015 or LSI-CoVA-016, and thus could, in principle, pair with either LSI-CoVA-015 or LSI-CoVA-016 (Fig.6eh). Competitive assays between RBD- and NTD- recognizing antibodies showed that the binding sites for these two antibody classes do not overlap with each other, as observed for LSI-CoVA-014 and LSI-CoVA-017 with LSI-CoVA-015/LSI-CoVA-016 antibodies (Fig.6ac).

Plots showing capture ELISA for pairs of selected antibodies. 0.1g SpikeWuhan (hexapro (purified from mammalian cell culture) was captured by a LSI-CoVA-014, LSI-CoVA-015, LSI-CoVA-016 and CR3022, b LSI-CoVA-017 and 4A8, and c 5A6, CoVA2-04 and CoVA2-39, detected using peroxidase-labelled monoclonal antibodies. A low OD450 value is indicative of impaired binding of the peroxidase-labelled detection antibody, as listed. Data (n=3 independent experiments) and represented as meanSEM. d Neutralization of pseudo SARS-CoV-2 virus using antibody cocktail (described in methods). Pair-mAb cocktail in the ratio of 1:9 to a final total concentration of 10g/ml or the single huMAb at a concentration of 10g/ml were incubated with pseudovirus lentiviral construct expressing the SARS-CoV-2 Spike protein. The chemiluminescence readout from the luciferase-tagged reporter in the lentiviral construct, is plotted and represented as percentage neutralization. The plots and one-way ANOVA statistical analysis were done using GraphPad prism 9.0. P values determined were 0.0026 (LSI-CoVA-017 vs LSI-CoVA-017+CoVA2-04) and 0.0339 (CoVA2-04 vs LSI-CoVA-017+CoVA2-04) using 6 degrees of freedom, as indicated in the figure. Different antibodies are indicated by alternative colors. Data is reported as meanSEM (n=3 independent experiments). Lateral (upper panel) and top (lower panel) views of surface representations showing Fab arms of e LSI-CoVA-014 (brown), f LSI-CoVA-015 (green), g LSI-CoVA-016 (orange), and h LSI-CoVA-017 (yellow) aligned onto a Spike trimer (grey, PDB 7A98). Representative structures from most populated cluster of Fab:RBD and Fab:NTD cluster analysis were used respectively. Predicted models showing two Spike trimers (grey and blue) bound to both Fab arms of i LSI-CoVA-014 (brown) and j LSI-CoVA-017 (yellow). Source data is provided as Source data file.

To infer stoichiometry and plausible mechanisms of neutralization, we then modelled the binding of full-length IgGs to Spike using a representative structure of Fab:RBD/NTD from the cluster analysis described above (Fig.6eh). Modelled full-length antibodies showed that RBD-binding antibodies specifically bind to RBD in the up-position. Models of LSI-CoVA-015 and LSI-CoVA-016 complexes with the Spike trimer indicate that IgG binding to a single RBD of a Spike monomer sterically hinders the binding of a second IgG to the same Spike trimer. In the case of LSI-CoVA-014 and LSI-CoVA-017, the predicted orientation allows the respective full-length antibody to bind all three RBDs or NTDs of the same Spike protein trimer. These results are consistent with our competitive ELISA and neutralization assays. Additionally, the second Fab arm of LSI-CoVA-017 and LSI-CoVA-014 can bind to a second Spike protein trimer, cross-linking two Spike trimers (Fig.6i, j and Supplementary Fig.6). Taken together, the Spike-IgG complex models suggest that the novel antibodies characterized in this study indirectly interfere with ACE2 binding by either cross-linking Spike trimers on the viral surface (LSI-CoVA-014 and LSI-CoVA-017), or by blocking RBD-ACE2 interaction on a single Spike trimer (LSI-CoVA-015 and LSI-CoVA-016).

The four novel antibodies isolated here from convalescent patients showed suboptimal levels of neutralisation efficacy compared to RBM binding antibodies. However, considering the mutually exclusive epitope sites complemented by high affinity binding to Spike protein, it would be of interest to investigate their use in antibody cocktails. We explored the possibility to induce destabilisation in individual monomers or stabilization to reduce the hinge dynamics between the region connecting S1 and S2 subunits in order to effectively neutralise the SARS-CoV-2. Synergistic effects of selected HuMAbs used in this study were thus evaluated. The selected HuMAbs were used in a pairwise cocktail to study the potential synergistic enhancement of neutralization efficacy, amongst which the paired Mab cocktail of LSI-CoVA-017 and CoVA2-04 displayed a significantly higher percentage neutralization in comparison to the treatment of either of the single HuMAbs (Fig.6d). We did not observe any enhancement in the neutralization efficacies of the two potent HuMAbs (CoVA2-39, 5A6) with NTD-binding LSI-CoVA-017. This could possiblybe due to the limitation of the method and warrants alternative method for quantification purposes. Surprisingly, a combination of NTD- (LSI-CoVA-017) with RBD- (LSI-CoVA-014) antibodies resulted in lower neutralization, than when added alone.

Emergence of new variants as a result of mutations of the Spike protein, have led to many antibody-mediated therapies faltering. Therefore, we assessed the impact of defined variant-linked mutations on binding and neutralization of the novel antibodies characterized in this study with isolated RBD and Spike proteins of the two former variants Delta () and Omicron (o1 for BA.1 and o2 for BA.2 lineages). LSI-CoVA-014, LSI-CoVA-015, and LSI-CoVA-016 bind to Spike and isolated RBD of all strains tested, although the binding activities to Omicron variants were slightly lower (Fig.7), akin to CR3022 (Fig.7). Binding of these antibodies was preserved as the mutations among the variants are distant from the cryptic epitopes site. Interestingly, 4A8 bound to Spike of all strains tested, although the binding activity was drastically reduced among all variants compared to Wuhan-Hu-1 Spike. On the other hand, the other NTD-binding antibody LSI-CoVA-017 bound only to SpikeWuhan. This lack of binding of LSI-CoVA-017 and 4A8 to Spike or Spikeo is due to the deletions and mutations spanning the NTD antigenic supersite. Most importantly, 5A6, CoVA2-04, and CoVA2-39 which strongly bind and neutralize SpikeWuhan, bound only to Spike and RBD, but not the Omicron variants (Fig.7a, open symbol plots). We also observed that upon deglycosylation, the binding activity of LSI-CoVA-017 and 4A8 was lost for all Spike variants, while minimal reduction was detected for anti-RBD antibodies against the Spike variants (Supplementary Fig.10).

a Antibody binding activity to Delta and Omicron variants of Spike compared with Wuhan-Hu-1 strain (HexaPro, purified from mammalian cell culture). Antibodies at concentrations from 10pg/mL10g/mL were tested for binding to SARS-CoV-2 Spike and MBP-RBD by ELISA, shown with their EC50 values indicated. Data was collected (n=3 independent experiments) and represented as meanerror bars (SEM). Heat map of differences in deuterium exchange for bd LSI-CoVA-014 and eg LSI-CoVA-016 antibody complexes with isolated RBD variants (b, e) RBD (PDB: 7W98), c, f RBDo1 (PDB: 7WPA), and d, g RBDo2 (PDB: 7WPA) as compared to apo states. Cryptic epitope sites are highlighted in yellow. Source data is provided as Source data file.

Many studies have reported higher binding affinities of Spike variants with the ACE2 receptor44,45. We therefore set out to probe if any of the nine HuMAbs competed with ACE2 binding to Spike variants. We performed ACE2-binding inhibition assays and observed a lack of any inhibitory activity by the cryptic site binders or the NTD-binding antibodies (Fig.8a). Interestingly, LSI-CoVA-015 and LSI-CoVA-016 seemed to enhance ACE2 interaction with RBDo1, as indicated by the negative inhibition (Fig.8a, green arrows). These antibodies bind at the cryptic site, and maintain RBD in an up-position, making the RBM site accessible, which may lead to increased ACE2 binding. This is similar to the effects of antibodies (e.g., S309) recognizing epitopes outside the RBM locus, and show some efficacy against the Omicron variant46,47. Also, 5A6, CoVA2-04, and CoVA2-39 inhibited interactions between ACE2 and Spike Wuhan/Delta strains, but this was not the case for in Spikeo1 or RBDo1 (Fig.8a, bottom panels). For ACE2 inhibition assays, neutralizers that bind RBD often exhibit >40% inhibition. Therefore, the binding and ACE2-inhibition results suggest that only the cryptic-site binding antibodies retain binding to Spike and Spikeo2, and hence only their interactions were further explored.

a ACE2-binding inhibition assays for the nine antibodies at varying concentrations for Spike (purified from mammalian cell culture) and RBD constructs of Wuhan-Hu-1(HexaPro), Delta () and Omicron (o1, o2) variants. Negative values indicate enhanced ACE2 binding (green arrows), while positive values indicate inhibition of ACE2 binding by the antibody (Source data 8). Data was collected (n=3 independent experiments) and represented as meanerror bars (SEM). b Differences in HDX in the presence and absence of ACE2 for isolated RBD constructs of (left) Delta (PDB: 7W98), (centre) Omicron BA.1 (PDB: 7WPA), and (right) Omicron BA.2 (PDB: 7WPA) variants are mapped on to high-resolution structure of RBD, shown in cartoon. Shades of blue correspond to decreased deuterium exchange upon binding to ACE2. c Heat map of differences in deuterium exchange of (left) Spike Delta (PDB: 7W98) and (right) Spike Omicron BA.2 (PDB: 7WPA) in the presence and absence of ACE2 (yellow, cartoon) at 1min labeling time is shown. d, e Plots comparing differences in deuterium exchange (D) in the presence and absence of ACE2 for various peptides across the S1 subunit of Spike variants d Delta and e Omicron BA.2. Various labelling timepoints are indicated with peptide numbers are indicated in accompanying Source data. Data was collected (n=3 independent experiments) and represented as meanerror bars (standard deviation). Peptides covering NTD and RBD are grouped as per domain organization shown. ACE2-binding sites on RBM are highlighted in yellow. Source data is provided as Source data file.

We examined the effects of ACE2 binding on the conformational dynamics of the isolated RBD and trimeric Spike variants by HDXMS, and compared this with ACE2-binding footprints previously reported5,44,48. Binding of ACE2 elicited large-scale protection against deuterium uptake across all regions of isolated RBD, RBDo1 and RBDo2 (Fig.8b). This altered conformational dynamics of RBD variants upon ACE2 binding is reflective of their higher binding affinities44,48. Despite this, mutations of key residues of RBM disrupted specific contacts between the RBD and ACE2, as reflected by available cryo-electron microscopy structures45, and structural dynamics studies49. Upon closer examination of the HDX results, the ACE2 binding footprints were smaller for variants of RBD, as compared to RBDWuhan. Peptides spanning the mutation sites of the loop region (475-495) showed a lower degree of deuterium exchange, while residues 445-455 and 493-510 showed greater protection (Fig.8b and Supplementary Fig.11 ac). We further determined the effects of ACE2 bindingusing trimeric Spike and Spikeo2 (Fig.8c, d and Supplementary Fig.11d, e). Binding of ACE2 elicited conformational changes across RBD of Spike (Fig.8c, left, 8d) akin to those of isolated RBD (Fig.8b, left, 8d), as well as RBD of SpikeWuhan. Surprisingly, we observed marked differences between the ACE2-bound states of RBDo2 and Spikeo2 (Fig.8c, right, 8e). While domain-wide decreased deuterium exchange was observed for the RBDo2-ACE2 complex (Fig.8b, right and Supplementary Fig.11c), for RBD of the Spikeo2-ACE2 complex decreased deuterium exchange was observed only at residues 390417 and 450467 (Fig.8e), and at 1min labeling time for residues 488507, as observed in high-resolution structures. Peptides spanning residues 373384, 429446, and 468483 showed significantly increased deuterium exchange at all labeling time points, and residues 488507 showed increased deuterium exchange at longer labeling times. Peptides showing deprotection overlapped the RBD-specific mutation sites observed for the Omicron variant, while increased protection against HDX was observed for Wuhan-Hu-1and Delta variants (Fig.8c and Supplementary Fig.11d, e). These results describe the molecular mechanism of ACE2-binding by the Omicron variant, whereby the specific amino acid residues promote receptor-binding by maintaining the essential conformational dynamics, yet evade immune responses. Furthermore, these HDX findings also explain how ACE2 binding enhances the conformational sampling of variants, as observed by their high flexibility and fuzzy densities in cryo-EM maps44,45 as well as the comparative structural dynamics of Spike variants containing the D614G mutation.

Using HDXMS, we also mapped and characterized the interactions of LSI-CoVA-014, LSI-CoVA-015, LSI-CoVA-016 antibodies with Delta and Omicron variants. Firstly, we characterized the interactions of the cryptic site binding antibodies LSI-CoVA-014, LSI-CoVA-015, and LSI-CoVA-016 with isolated RBD constructs of Delta (Supplementary Fig.12), Omicron BA.1 (Supplementary Fig.13), and Omicron BA.2 (Supplementary Fig.14) variants. Consistent with our expectations, the most notable differences in deuterium exchange were observed for peptides covering the cryptic site, with LSI-CoVA-014, showing lower deuterium exchange values, compared to the LSI-CoVA-015 and LSI-CoVA-016 antibodies. These varying deuterium exchange values are reflective of the differences in conformations of RBD induced by variant-specific mutations. Further, we observed enhanced conformational dynamics for peptides spanning the ACE2-binding sites of the Delta and Omicron variants.

Next, we monitored the effects of these three antibodies binding to Spike and Spikeo2 variants, which showed similar deuterium exchange profiles across the S1 (Fig.9) and the S2 (Supplementary Fig.15) subunits. Peptides flanking the mutated sites of NTD showed no significant change in deuteration as compared to SpikeWuhan, which exhibited lower deuterium exchange upon binding to these three antibodies (Fig.2). Importantly, the linker regions of NTD and RBD showed large-scale protection against deuterium exchange, due to reduced conformational flexibility, indicating that their domain motions were severely restricted. Specifically, peptides spanning residues 365390 of RBD showed protection from deuterium exchange in the antibody-bound states of Spike (Fig.9a, b) and Spikeo2 (Fig.9c, d), indicating that these three HuMabs bind at the same epitopes, akin to SpikeWuhan. Upon closer examination, the magnitude of HDX changes across SpikeWuhan, Spike and Spikeo2 were different, owing to the differences in their binding affinities (Fig.9ad and Supplementary Fig.15). Overall LSI-CoVA-015 and LSI-CoVA-016 (Fig.9e, f, right panels) showed similar deuterium exchange values for peptides spanning the S1 subunit of Omicron Spike and were different compared to changes observed upon binding of LSI-CoVA-014 to Omicron Spike (Fig.9e, f, left panels). Furthermore, HDX kinetics observed across the epitope sites of individual RBD variants (RBD, RBDo1, and RBDo2) in the presence of LSI-CoVA-015, LSI-CoVA-016, and LSI-CoVA-014, were stronger than their corresponding Spike trimers. This indicates that variant-specific mutations on Spike induce subtle changes in the conformational dynamics, which alter the binding strengths of antibodies even though the epitope sites are conserved. This is further supported by the varying HDX effects observed across peptides spanning RBM in antibody-bound Spike and Spikeo2 (Fig.9). This effect was more prominent for RBD, RBDo1 and RBDo2, where binding of LSI-CoVA-014, LSI-CoVA-015, and LSI-CoVA-016 antibodies led to significant protection against deuterium exchange at the ACE2-binding sites (Fig.9d). Our results show destabilization of the RBD of Spike and Spikeo2upon antibody binding and explain why the up-position of RBD is favored in the variants50.

Plots comparing differences in deuterium exchange across the S1 subunit of a, b Spikeo2 and c, d Spike complexed to a, c LSI-CoVA-014 and b, d LSI-CoVA-016 versus the apo states are shown at various labelling times. Residue numbers for the peptides are labeled on x axis of the bottom plots of a, b Spikeo2 and c, d Spike, with domain organization shown. Average (n=3 independent experiments) values with standard deviations (error bars) were used to generate the plots (Microsoft Excel). Yellow zones highlight the peptides spanning the cryptic epitope site, as observed for SpikeWuhan. LSI-CoVA-016 showed larger decreases in deuterium exchange to the two variants. Differences in HDX of Spike variantse Delta and f Omicron BA.2 in the presence and absence of (left) LSI-CoVA-014 and (right) LSI-CoVA-016 antibody are mapped onto a monomer of delta Spike (PDB: 7W98) and Omicron Spike (PDB: 7WPA), shown in surface representation. The insets show a transverse view of the conformational changes across the trimer. Source data is provided as Source data file.

Within the S2 subunit of Spike, the LSI-CoVA-014/015/016 deuterium exchange profiles (Fig.9e, Supplementary Fig.15b) were similar to that of SpikeWuhan, but were significantly different from Spikeo2 (Fig.9f and Supplementary Fig.15a). Peptides spanning the S1/S2 cleavage site showed minor differences in deuterium exchange and were lower than those observed for SpikeWuhan. The reduced deuterium exchange indicates that the S1/S2 cleavage site is more concealed in Spike and Spikeo2, and is further occluded by antibody binding. These results also help to explain the reduced propensity for cleavage of variants and the inaccessibility to host proteases observed for the Omicron variant29,51. The most notable changes in conformation upon antibody binding were observed across peptide clusters spanning FP1, FP2 and HR1 (Supplementary Fig.15). Large-magnitude increases in deuterium exchange were observed across these sites for Spike and Spikeo2, as compared to the effects observed for SpikeWuhan. Higher deuterium uptake correlates with increased dynamics and/or solvent accessibility across regions which span peptide clusters including residues 539565 (subdomain 1), 757779, and 936974 (Fig.9e, f right panels,). Increased deuterium exchange at these sites reflects greater solvent accessibility accompanied by the loss of intermonomer contacts. This translates to a long-range effect induced effect by LSI-CoVA-014, LSI-CoVA-015, and LSI-CoVA-016 across the Spike and Spikeo2 trimers. Overall, these antibodies likely cause destabilization of the Spike trimers into antibody-bound monomers. This destabilization ofthe trimer, likely into individual monomers also reflects the altered interaction of ACE2 with Spikeo2 by LSI-CoVA-015/016, accompanied by weak neutralization efficacy.

Our binding assays indicated that 5A6, CoVA2-39, and CoVA2-04 bound to the Delta variant, but not the Omicron variant (Fig.7a). We then compared the effects of binding of 5A6 and CoVA2-04 to Spike and RBD, using HDXMS. Upon binding of these HuMAbs, significant protection against deuterium exchange was observed across the RBDs, both in isolated constructs (Supplementary Fig.16a) and in Spike (Supplementary Fig.16b, c). While the HDX changes observed across the RBM-sites of SpikeWuhan were about ~4Da, the average changes observed for the Delta variant were lower in magnitude (~2.5Da) with a relatively smaller antibody-binding footprint. As the Delta variant has two key mutations at the RBM-site26, the antibody footprint at the epitope site is reduced, affecting the overall conformational dynamics of the RBDs of Spike. Although 5A6, CoVA2-39 and CoVA2-04 directly compete with ACE2 binding, various studies have reported that both CoVA2-39 and CoVA2-04 are unable to neutralize Delta or Omicron variants52,53.

We further determined the effects of 5A6 (Supplementary Fig.16b) and CoVA2-04 on the S2 subunit of Spike. No significant change was observed for peptides covering the S1/S2 cleavage site. Decreased deuterium exchange was observed for peptides spanning FP2, HR1, connector domain (CD) and HR2. Importantly, peptides spanning the central helix (residues 9901010), showed increased deuterium exchange in the presence of these two antibodies, suggesting higher localized conformational dynamics. This is in contrast to the effects observed for SpikeWuhan (Fig.4). While the sites essential for trimerization of Spike showed increased conformational rigidity induced by 5A6 and CoVA2-04 HuMAbs, increased conformational mobility was observed across the central helix. Collectively, the binding assays and HDX results indicate that the HuMAbs recognizing the RBM antigenic supersite cannot bind Omicron at all, and bind Spike variant with reduced affinity, by allosterically reducing the conformational dynamics of the S1 and the S2 subunit, thereby mediating overall stabilization.

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