@article {Starr2020.11.30.405472, author = {Tyler N. Starr and Allison J. Greaney and Amin Addetia and William W. Hannon and Manish C. Choudhary and Adam S. Dingens and Jonathan Z. Li and Jesse D. Bloom}, title = {Prospective mapping of viral mutations that escape antibodies used to treat COVID-19}, elocation-id = {2020.11.30.405472}, year = {2020}, doi = {10.1101/2020.11.30.405472}, publisher = {Cold Spring Harbor Laboratory}, abstract = {Antibodies are becoming a frontline therapy for SARS-CoV-2, but the risk of viral evolutionary escape remains unclear. Here we map how all mutations to SARS-CoV-2{\textquoteright}s receptor-binding domain (RBD) affect binding by the antibodies in Regeneron{\textquoteright}s REGN-COV2 cocktail and Eli Lilly{\textquoteright}s LY-CoV016. These complete maps uncover a single amino-acid mutation that fully escapes the REGN-COV2 cocktail, which consists of two antibodies targeting distinct structural epitopes. The maps also identify viral mutations that are selected in a persistently infected patient treated with REGN-COV2, as well as in lab viral escape selections. Finally, the maps reveal that mutations escaping each individual antibody are already present in circulating SARS-CoV-2 strains. Overall, these complete escape maps enable immediate interpretation of the consequences of mutations observed during viral surveillance.Competing Interest StatementJonathan Li has consulted for Abbvie and Jan Biotech. The other authors declare no competing interests.}, URL = {https://www.biorxiv.org/content/early/2020/12/01/2020.11.30.405472}, eprint = {https://www.biorxiv.org/content/early/2020/12/01/2020.11.30.405472.full.pdf}, journal = {bioRxiv} }