Breakthrough Gastrointestinal COVID-19 and Intrahost Evolution Consequent to Combination Monoclonal Antibody Prophylaxis

Breakthrough gastrointestinal COVID-19 was observed after experimental SARS-CoV-2 upper mucosal infection in a rhesus macaque undergoing low-dose monoclonal antibody prophylaxis. High levels of viral RNA were detected in intestinal sites contrasting with minimal viral replication in upper respiratory mucosa. Sequencing of virus recovered from tissue in 3 gastrointestinal sites and rectal swab revealed loss of furin cleavage site deletions present in the inoculating virus stock and 2 amino acid changes in spike that were detected in 2 colon sites but not elsewhere, suggesting compartmentalized replication and intestinal viral evolution. This suggests suboptimal antiviral therapies promote viral sequestration in these anatomies. Breakthrough COVID-19 was observed after experimental SARS-CoV-2 infection in a rhesus macaque undergoing low-dose monoclonal antibody prophylaxis that resulted in unique intrahost evolution of the virus within the gut of the infected animal.

Automated summary

Breakthrough gastrointestinal COVID-19 was observed in a rhesus macaque undergoing low-dose monoclonal antibody prophylaxis, indicating intrahost virus evolution within the gut.