Intensive selection pressure constrains the evolutionary trajectory of SARS-CoV-2 genomes and results in various novel variants with distinct mutation profiles. Point mutations, particularly those within the receptor binding domain (RBD) of SARS-CoV-2 spike (S) protein, lead to the functional alteration in both receptor engagement and monoclonal antibody (mAb) recognition. Here, we review the data of the RBD point mutations possessed by major SARS-CoV-2 variants and discuss their individual effects on ACE2 affinity and immune evasion. Many single amino acid substitutions within RBD epitopes crucial for the antibody evasion capacity may conversely weaken ACE2 binding affinity. However, this weakened effect could be largely compensated by specific epistatic mutations, such as N501Y, thus maintaining the overall ACE2 affinity for the spike protein of all major variants. The predominant direction of SARS-CoV-2 evolution lies neither in promoting ACE2 affinity nor evading mAb neutralization but in maintaining a delicate balance between these two dimensions. Together, this review interprets how RBD mutations efficiently resist antibody neutralization and meanwhile how the affinity between ACE2 and spike protein is maintained, emphasizing the significance of comprehensive assessment of spike mutations.

Background/Objectives: The antibody-dependent enhancement (ADE) of viral entry has been documented for SARS-CoV-2 infection both in vitro and in vivo. However, the potential for the SARS-CoV-2 vaccination to elicit similar ADE effects remains unclear. Methods: In this study, we assessed the in vitro ADE potential of monoclonal antibodies (mAbs) derived from individuals vaccinated with the inactivated SARS-CoV-2 vaccine and compared them to those from one convalescent donor. Results: Our analysis revealed no significant difference in binding affinity or neutralizing capacity between the vaccinated and convalescent mAbs. However, the inactivated SARS-CoV-2 vaccination induced fewer ADE-inducing mAbs, particularly those targeting the Class III epitope on the receptor-binding domain (RBD) compared to those from the convalescent individual. Moreover, no significant in vitro ADE was detected in either vaccinated or convalescent sera, indicating low levels of ADE-inducing antibodies in the sera. Conclusions: An inactivated SARS-CoV-2 vaccination induces fewer ADE-inducing antibodies compared to natural infection, further emphasizing the safety of inactivated SARS-CoV-2 vaccines.

Background: During the COVID-19 pandemic, three different types of inactivated SARS-CoV-2 vaccines, namely BBIBP-CorV, WIBP-CorV and CoronaVac, were manufactured and used for vaccination in China. However, as far as we know, no comparison of their induced serum neutralization has been carried out so far, possibly due to the regional difference in vaccine distribution, the difficulty in undertaking a comprehensive evaluation, and the intention to avoid unnecessary bias in populations for a certain type of inactivated vaccine.Methods: Since all three of these inactivated vaccines are no longer produced and used for vaccination, here, we retrospectively compared the serum neutralizing activities induced by these three different types of inactivated SARS-CoV-2 vaccines. Results: Compared with unvaccinated uninfected control donors, primary inactivated vaccination (232 donors) induced increased serum neutralizing titers against wildtype SARS-CoV-2 in around 70% of donors during the first 100 days. However, the neutralization effect waned quickly after 100 days, and significantly diminished against Delta and Omicron (B.1.1.529) variants. Moreover, the newly emerged Omicron variants, such as BA.2.75, BA.4/5, BF.7, BQ.1.1, and XBB, almost fully evaded the induced serum neutralization activity. Conclusions: These three distinct types of inactivated vaccines, namely BBIBP-CorV, WIBP-CorV, and CoronaVac, induced serum neutralization in most vaccinated populations but in a short-term and variant-evaded manner with no significant difference among these inactivated vaccines.

Antibody-dependent enhancement (ADE) of viral entry remains a mechanistically unresolved phenomenon in SARS-CoV-2 variants, with its variant-specificity and pathological consequences poorly defined. Through systematic profiling of 114 monoclonal antibodies (mAbs) across major variants of concern (VOCs), we discover that the Delta variant exhibits uniquely potent ADE mediated by mAbs targeting specific spike (S) epitopes. Crucially, ​​integrative single-cell RNA sequencing of Delta-infected patients provides direct in vivo evidence of ADE-associated immunopathology, revealing significant depletion of FcγR⁺ and C1qR⁺ immune cells (particularly CD16⁺ monocytes and dendritic cells) alongside pan-cellular cytokine hyperactivation, patterns that are absent in wildtype or Omicron infections. Functional dissection demonstrates epistatic interactions among Delta-specific S mutations (L452R, P681R, and D950N), wherein individual mutations enhance ADE in wildtype background but suppress it in Delta context. Longitudinal surveillance reveals fluctuating ADE patterns across variants, with BA.5 sub-lineage exhibiting L452R-mediated resurgence of enhancement. This study establishes ​​variant-specific ADE as an in vivo driver of immunopathology governed by epistatic constraints​​, necessitating continuous risk assessment in evolving variants.