Broad and potent neutralizing mAbs are elicited in vaccinated individuals following Delta/BA.1 breakthrough infection

Despite the success of COVID-19 vaccines in preventing infection and/or severe disease, with the emergence of SARS-CoV-2 variants of concern (VOC) which encode mutations in Spike, and the waning of vaccine induced immunity, there has been an increase in SARS-CoV-2 infections in vaccinated individuals which leads to increased serum neutralization breadth. However, how exposure to a heterologous Spike broadens the neutralizing response at the monoclonal antibody (mAb) level is not fully understood. Through isolation of 119 mAbs from three individuals receiving two-doses of BNT162b2 vaccine before becoming delta or omicron/BA.1-infected, we show that breadth arises from re-activation and maturation of B cells generated through previous COVID-19 vaccination rather than ade novoresponse specific to the VOC Spike. Isolated mAbs frequently show reduced neutralization of current circulating variants including BA.2.75.2, XBB, XBB.1.5 and BQ.1.1 confirming continuous selective pressure on Spike to evolve and evade neutralization. However, isolation of mAbs that display effective cross-neutralization against all variants indicate the presence of conserved epitopes on RBD and a lesser extent NTD. These findings have implications for selection of Spike antigens for next-generation COVID-19 vaccines.