<?xml version="1.0" encoding="UTF-8"?><!DOCTYPE article PUBLIC "-//NLM//DTD JATS (Z39.96) Journal Archiving and Interchange DTD with MathML3 v1.3 20210610//EN"  "JATS-archivearticle1-3-mathml3.dtd"><?covid-19-tdm ?><article xmlns:ali="http://www.niso.org/schemas/ali/1.0/" xmlns:xlink="http://www.w3.org/1999/xlink" article-type="research-article" dtd-version="1.3"><front><journal-meta><journal-id journal-id-type="nlm-ta">elife</journal-id><journal-id journal-id-type="publisher-id">eLife</journal-id><journal-title-group><journal-title>eLife</journal-title></journal-title-group><issn publication-format="electronic" pub-type="epub">2050-084X</issn><publisher><publisher-name>eLife Sciences Publications, Ltd</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="publisher-id">108959</article-id><article-id pub-id-type="doi">10.7554/eLife.108959</article-id><article-id pub-id-type="doi" specific-use="version">10.7554/eLife.108959.3</article-id><article-version article-version-type="publication-state">version of record</article-version><article-categories><subj-group subj-group-type="display-channel"><subject>Research Article</subject></subj-group><subj-group subj-group-type="heading"><subject>Microbiology and Infectious Disease</subject></subj-group></article-categories><title-group><article-title>Bivalent mRNA booster encoding virus-like particles elicits potent polyclass receptor-binding domain antibodies in pre-vaccinated mice</article-title></title-group><contrib-group><contrib contrib-type="author" equal-contrib="yes"><name><surname>Fan</surname><given-names>Chengcheng</given-names></name><contrib-id authenticated="true" contrib-id-type="orcid">https://orcid.org/0000-0003-4213-5758</contrib-id><xref ref-type="aff" rid="aff1">1</xref><xref ref-type="fn" rid="equal-contrib1">†</xref><xref ref-type="fn" rid="con1"/><xref ref-type="fn" rid="conf1"/></contrib><contrib contrib-type="author" equal-contrib="yes"><name><surname>Cohen</surname><given-names>Alexander A</given-names></name><contrib-id authenticated="true" contrib-id-type="orcid">https://orcid.org/0000-0002-2818-656X</contrib-id><xref ref-type="aff" rid="aff1">1</xref><xref ref-type="fn" rid="equal-contrib1">†</xref><xref ref-type="fn" rid="con2"/><xref ref-type="fn" rid="conf1"/></contrib><contrib contrib-type="author" equal-contrib="yes"><name><surname>Dam</surname><given-names>Kim-Marie A</given-names></name><contrib-id authenticated="true" contrib-id-type="orcid">https://orcid.org/0000-0002-1416-4757</contrib-id><xref ref-type="aff" rid="aff2">2</xref><xref ref-type="fn" rid="equal-contrib1">†</xref><xref ref-type="fn" rid="con3"/><xref ref-type="fn" rid="conf1"/></contrib><contrib contrib-type="author"><name><surname>Rorick</surname><given-names>Annie V</given-names></name><xref ref-type="aff" rid="aff1">1</xref><xref ref-type="fn" rid="pa1">‡</xref><xref ref-type="fn" rid="con4"/><xref ref-type="fn" rid="conf1"/></contrib><contrib contrib-type="author"><name><surname>Priso Fils</surname><given-names>Ange-Célia I</given-names></name><xref ref-type="aff" rid="aff1">1</xref><xref ref-type="fn" rid="con5"/><xref ref-type="fn" rid="conf1"/></contrib><contrib contrib-type="author"><name><surname>Yang</surname><given-names>Zhi</given-names></name><contrib-id authenticated="true" contrib-id-type="orcid">https://orcid.org/0000-0001-8680-3784</contrib-id><xref ref-type="aff" rid="aff1">1</xref><xref ref-type="fn" rid="pa2">§</xref><xref ref-type="fn" rid="con6"/><xref ref-type="fn" rid="conf1"/></contrib><contrib contrib-type="author"><name><surname>Gnanapragasam</surname><given-names>Priyanthi NP</given-names></name><xref ref-type="aff" rid="aff1">1</xref><xref ref-type="fn" rid="con7"/><xref ref-type="fn" rid="conf1"/></contrib><contrib contrib-type="author"><name><surname>Segovia</surname><given-names>Luisa N</given-names></name><xref ref-type="aff" rid="aff1">1</xref><xref ref-type="fn" rid="con8"/><xref ref-type="fn" rid="conf1"/></contrib><contrib contrib-type="author"><name><surname>Huey-Tubman</surname><given-names>Kathryn E</given-names></name><xref ref-type="aff" rid="aff1">1</xref><xref ref-type="fn" rid="con9"/><xref ref-type="fn" rid="conf1"/></contrib><contrib contrib-type="author"><name><surname>Moon</surname><given-names>Woohyun J</given-names></name><xref ref-type="aff" rid="aff3">3</xref><xref ref-type="fn" rid="con10"/><xref ref-type="fn" rid="conf2"/></contrib><contrib contrib-type="author"><name><surname>Lin</surname><given-names>Paulo JC</given-names></name><xref ref-type="aff" rid="aff3">3</xref><xref ref-type="fn" rid="con11"/><xref ref-type="fn" rid="conf3"/></contrib><contrib contrib-type="author" corresp="yes"><name><surname>Bjorkman</surname><given-names>Pamela J</given-names></name><contrib-id authenticated="true" contrib-id-type="orcid">https://orcid.org/0000-0002-2277-3990</contrib-id><email>bjorkman@caltech.edu</email><xref ref-type="aff" rid="aff1">1</xref><xref ref-type="other" rid="fund7"/><xref ref-type="fn" rid="con12"/><xref ref-type="fn" rid="conf4"/></contrib><contrib contrib-type="author" corresp="yes"><name><surname>Hoffmann</surname><given-names>Magnus AG</given-names></name><contrib-id authenticated="true" contrib-id-type="orcid">https://orcid.org/0000-0003-4923-9568</contrib-id><email>magnus.hoffmann@gladstone.ucsf.edu</email><xref ref-type="aff" rid="aff2">2</xref><xref ref-type="aff" rid="aff4">4</xref><xref ref-type="other" rid="fund2"/><xref ref-type="fn" rid="con13"/><xref ref-type="fn" rid="conf5"/></contrib><aff id="aff1"><label>1</label><institution-wrap><institution-id institution-id-type="ror">https://ror.org/05dxps055</institution-id><institution>Division of Biology and Biological Engineering, California Institute of Technology</institution></institution-wrap><addr-line><named-content content-type="city">Pasadena</named-content></addr-line><country>United States</country></aff><aff id="aff2"><label>2</label><institution-wrap><institution-id institution-id-type="ror">https://ror.org/038321296</institution-id><institution>Gladstone Institutes</institution></institution-wrap><addr-line><named-content content-type="city">San Francisco</named-content></addr-line><country>United States</country></aff><aff id="aff3"><label>3</label><institution-wrap><institution-id institution-id-type="ror">https://ror.org/04eaec870</institution-id><institution>Acuitas Therapeutics</institution></institution-wrap><addr-line><named-content content-type="city">Vancouver</named-content></addr-line><country>Canada</country></aff><aff id="aff4"><label>4</label><institution-wrap><institution-id institution-id-type="ror">https://ror.org/043mz5j54</institution-id><institution>Department of Medicine, University of California, San Francisco</institution></institution-wrap><addr-line><named-content content-type="city">San Francisco</named-content></addr-line><country>United States</country></aff></contrib-group><contrib-group content-type="section"><contrib contrib-type="editor"><name><surname>Krzych</surname><given-names>Urszula</given-names></name><role>Reviewing Editor</role><aff><institution-wrap><institution-id institution-id-type="ror">https://ror.org/0145znz58</institution-id><institution>Walter Reed Army Institute of Research</institution></institution-wrap><country>United States</country></aff></contrib><contrib contrib-type="senior_editor"><name><surname>Kana</surname><given-names>Bavesh D</given-names></name><role>Senior Editor</role><aff><institution-wrap><institution-id institution-id-type="ror">https://ror.org/03rp50x72</institution-id><institution>University of the Witwatersrand</institution></institution-wrap><country>South Africa</country></aff></contrib></contrib-group><author-notes><fn fn-type="con" id="equal-contrib1"><label>†</label><p>These authors contributed equally to this work</p></fn><fn fn-type="present-address" id="pa1"><label>‡</label><p>Department of Biochemistry, University of Washington, Seattle, United States</p></fn><fn fn-type="present-address" id="pa2"><label>§</label><p>Department of Molecular and Cell Biology, University of California, Berkeley, Berkeley, United States</p></fn></author-notes><pub-date publication-format="electronic" date-type="publication"><day>30</day><month>04</month><year>2026</year></pub-date><volume>14</volume><elocation-id>RP108959</elocation-id><history><date date-type="sent-for-review" iso-8601-date="2025-09-09"><day>09</day><month>09</month><year>2025</year></date></history><pub-history><event><event-desc>This manuscript was published as a preprint.</event-desc><date date-type="preprint" iso-8601-date="2025-08-19"><day>19</day><month>08</month><year>2025</year></date><self-uri content-type="preprint" xlink:href="https://doi.org/10.1101/2025.08.18.670983"/></event><event><event-desc>This manuscript was published as a reviewed preprint.</event-desc><date date-type="reviewed-preprint" iso-8601-date="2025-12-01"><day>01</day><month>12</month><year>2025</year></date><self-uri content-type="reviewed-preprint" xlink:href="https://doi.org/10.7554/eLife.108959.1"/></event><event><event-desc>The reviewed preprint was revised.</event-desc><date date-type="reviewed-preprint" iso-8601-date="2026-03-20"><day>20</day><month>03</month><year>2026</year></date><self-uri content-type="reviewed-preprint" xlink:href="https://doi.org/10.7554/eLife.108959.2"/></event></pub-history><permissions><copyright-statement>© 2025, Fan, Cohen, Dam et al</copyright-statement><copyright-year>2025</copyright-year><copyright-holder>Fan, Cohen, Dam et al</copyright-holder><ali:free_to_read/><license xlink:href="http://creativecommons.org/licenses/by/4.0/"><ali:license_ref>http://creativecommons.org/licenses/by/4.0/</ali:license_ref><license-p>This article is distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License</ext-link>, which permits unrestricted use and redistribution provided that the original author and source are credited.</license-p></license></permissions><self-uri content-type="pdf" xlink:href="elife-108959-v1.pdf"/><self-uri content-type="figures-pdf" xlink:href="elife-108959-figures-v1.pdf"/><abstract><p>mRNA vaccines emerged as a leading vaccine technology during the COVID-19 pandemic. However, their sustained protective efficacies were limited by relatively short-lived antibody responses and the emergence of SARS-CoV-2 variants, necessitating frequent and variant-updated boosters. We recently developed the ESCRT- and ALIX-binding region (EABR) mRNA vaccine platform, which encodes engineered immunogens that induce budding of enveloped virus-like particles (eVLPs) from the plasma membrane, thereby resulting in presentation of immunogens on cell surfaces and eVLPs. Prior studies showed that spike (S)-EABR mRNA-LNP immunizations elicited enhanced neutralizing antibody responses against ancestral and variant SARS-CoV-2 compared with conventional S mRNA-LNP in naïve mice, but the effectiveness of S-EABR mRNA-LNP boosters in the context of pre-existing immunity has not been investigated. Here, we evaluated monovalent Wuhan-Hu-1 (Wu1) and bivalent (Wu1/BA.5) S-EABR mRNA-LNP boosters in mice pre-vaccinated with conventional Wu1 S mRNA-LNP. Compared to conventional S mRNA-LNP boosters, the EABR approach enhanced monovalent and bivalent mRNA-LNP booster-induced neutralizing responses against Omicron subvariants BA.1, BA.5, BQ.1.1, and XBB.1, with bivalent S-EABR mRNA-LNP consistently eliciting the highest titers. Epitope mapping of polyclonal antisera by deep mutational scanning revealed that bivalent S-EABR mRNA-LNP boosted diverse ‘polyclass’ anti-receptor-binding domain (RBD) responses, suggesting balanced targeting of multiple RBD epitope classes. In contrast, monovalent S, bivalent S, and monovalent S-EABR mRNA-LNP boosters elicited less diverse polyclonal serum responses primarily targeting immunodominant RBD epitopes. Cryo-electron microscopy (cryo-EM) structures demonstrated that bivalent mRNA immunizations promote S heterotrimer formation, potentially enhancing bivalent S-EABR mRNA-LNP booster-induced antibody breadth and polyclass epitope targeting by activating cross-reactive B cells through intra-S crosslinking. These findings support the future design of bivalent or multivalent S-EABR mRNA-LNP boosters as a promising strategy to confer broader, and therefore potentially more durable, protection against emerging SARS-CoV-2 variants and other rapidly evolving viruses.</p></abstract><kwd-group kwd-group-type="author-keywords"><kwd>mRNA vaccines</kwd><kwd>SARS-CoV-2</kwd><kwd>epitope targeting</kwd><kwd>immune imprinting</kwd></kwd-group><kwd-group kwd-group-type="research-organism"><title>Research organism</title><kwd>Mouse</kwd></kwd-group><funding-group><award-group id="fund1"><funding-source><institution-wrap><institution-id institution-id-type="ror">https://ror.org/01cwqze88</institution-id><institution>National Institutes of Health</institution></institution-wrap></funding-source><award-id>P01-AI165075</award-id><principal-award-recipient><name><surname>Bjorkman</surname><given-names>Pamela J</given-names></name></principal-award-recipient></award-group><award-group id="fund2"><funding-source><institution-wrap><institution-id institution-id-type="ror">https://ror.org/01cwqze88</institution-id><institution>National Institutes of Health</institution></institution-wrap></funding-source><award-id>DP5OD033362</award-id><principal-award-recipient><name><surname>Hoffmann</surname><given-names>Magnus AG</given-names></name></principal-award-recipient></award-group><award-group id="fund3"><funding-source><institution-wrap><institution-id institution-id-type="ror">https://ror.org/0456r8d26</institution-id><institution>Gates Foundation</institution></institution-wrap></funding-source><award-id>INV-034638</award-id><principal-award-recipient><name><surname>Bjorkman</surname><given-names>Pamela J</given-names></name></principal-award-recipient></award-group><award-group id="fund4"><funding-source><institution-wrap><institution-id institution-id-type="ror">https://ror.org/0456r8d26</institution-id><institution>Gates Foundation</institution></institution-wrap></funding-source><award-id>INV-056219</award-id><principal-award-recipient><name><surname>Hoffmann</surname><given-names>Magnus AG</given-names></name></principal-award-recipient></award-group><award-group id="fund5"><funding-source><institution-wrap><institution-id institution-id-type="ror">https://ror.org/05dxps055</institution-id><institution>Merkin Institute for Translational Research, California Institute of Technology</institution></institution-wrap></funding-source><principal-award-recipient><name><surname>Bjorkman</surname><given-names>Pamela J</given-names></name></principal-award-recipient></award-group><award-group id="fund6"><funding-source><institution-wrap><institution-id institution-id-type="ror">https://ror.org/02jqj7156</institution-id><institution>George Mason University</institution></institution-wrap></funding-source><principal-award-recipient><name><surname>Bjorkman</surname><given-names>Pamela J</given-names></name></principal-award-recipient></award-group><award-group id="fund7"><funding-source><institution-wrap><institution-id institution-id-type="ror">https://ror.org/029chgv08</institution-id><institution>Wellcome Leap</institution></institution-wrap></funding-source><principal-award-recipient><name><surname>Bjorkman</surname><given-names>Pamela J</given-names></name></principal-award-recipient></award-group><funding-statement>The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication. For the purpose of Open Access, the authors have applied a CC BY public copyright license to any Author Accepted Manuscript version arising from this submission.</funding-statement></funding-group><custom-meta-group><custom-meta specific-use="meta-only"><meta-name>Author impact statement</meta-name><meta-value>Bivalent EABR mRNA boosters broaden neutralizing responses to Omicron subvariants by promoting diverse receptor-binding domain epitope targeting, although antibody responses remain partially shaped by immune imprinting from prior vaccination.</meta-value></custom-meta><custom-meta specific-use="meta-only"><meta-name>publishing-route</meta-name><meta-value>prc</meta-value></custom-meta></custom-meta-group></article-meta></front><body><sec id="s1" sec-type="intro"><title>Introduction</title><p>mRNA vaccines emerged as a leading platform for the rapid and scalable development of effective vaccines during the COVID-19 pandemic (<xref ref-type="bibr" rid="bib18">Corbett et al., 2020</xref>). Currently approved mRNA vaccines encode the SARS-CoV-2 spike (S) trimer (<xref ref-type="bibr" rid="bib75">Zheng et al., 2022</xref>), the main target for neutralizing antibodies (Abs) produced during natural infection (<xref ref-type="bibr" rid="bib12">Chen et al., 2023</xref>). S-encoding mRNAs formulated in lipid nanoparticles (LNPs) are taken up by cells, which promotes translation and cell surface expression of S trimers to activate B cells (<xref ref-type="bibr" rid="bib29">Hogan and Pardi, 2022</xref>). Translation of mRNA-encoded S protein within host cells also provides viral peptides for presentation on MHC class I molecules, which are recognized by cytotoxic T cells (<xref ref-type="bibr" rid="bib46">Painter et al., 2021</xref>; <xref ref-type="bibr" rid="bib45">Oberhardt et al., 2021</xref>).</p><p>Initial two-shot COVID-19 mRNA vaccination series became available in December 2020 after clinical studies demonstrated protection from severe disease after SARS-CoV-2 infection (<xref ref-type="bibr" rid="bib52">Polack et al., 2020</xref>; <xref ref-type="bibr" rid="bib4">Baden et al., 2021</xref>). However, the durability of mRNA vaccine-induced immune protection was limited by two factors. First, serum Ab levels contracted over several months (<xref ref-type="bibr" rid="bib74">Zhang et al., 2022</xref>). Second, SARS-CoV-2 variants acquired mutations in the S protein, which reduced their sensitivity to vaccine-induced neutralizing Abs (<xref ref-type="bibr" rid="bib51">Planas et al., 2021</xref>). As a result, a third dose of the original mRNA vaccine encoding the ancestral Wuhan-Hu-1 (Wu1) S protein was offered starting in fall 2021 (<xref ref-type="bibr" rid="bib3">Andrews et al., 2022b</xref>).</p><p>The emergence of the Omicron BA.1 variant in November 2021 (<xref ref-type="bibr" rid="bib71">WHO, 2021</xref>) sparked concern because of its levels of substitution in S, especially in the receptor-binding domain (RBD), resulting in effective evasion of Ab-mediated immunity (<xref ref-type="bibr" rid="bib39">Liu et al., 2022</xref>; <xref ref-type="bibr" rid="bib10">Cele et al., 2022</xref>) and increased rates of symptomatic infections in previously vaccinated individuals (<xref ref-type="bibr" rid="bib2">Andrews et al., 2022a</xref>; <xref ref-type="bibr" rid="bib64">Tseng et al., 2022</xref>). Although undetectable after the initial mRNA vaccine series, a third dose of the original mRNA vaccine elicited neutralizing Abs against BA.1, but BA.1 neutralizing titers were lower compared to titers against the ancestral Wu1 variant (<xref ref-type="bibr" rid="bib26">Gruell et al., 2022</xref>). The subsequent emergence of Omicron subvariants such as BA.5, BQ.1.1, and XBB.1, which exhibited progressively reduced sensitivities to vaccine-induced neutralizing Abs (<xref ref-type="bibr" rid="bib69">Wang et al., 2023c</xref>), prompted the development of bivalent mRNA boosters, which included mRNAs encoding both the Wu1 and the BA.5 S proteins (<xref ref-type="bibr" rid="bib58">Scheaffer et al., 2023</xref>). Preclinical and clinical studies found that bivalent boosters elicited modestly improved neutralizing Ab responses against Omicron subvariants compared to a fourth dose of the original monovalent vaccine (<xref ref-type="bibr" rid="bib58">Scheaffer et al., 2023</xref>; <xref ref-type="bibr" rid="bib35">Khoury et al., 2023</xref>; <xref ref-type="bibr" rid="bib11">Chalkias et al., 2022</xref>; <xref ref-type="bibr" rid="bib17">Collier et al., 2023</xref>; <xref ref-type="bibr" rid="bib20">Davis-Gardner et al., 2023</xref>), although some studies found no differences between monovalent and bivalent boosters following initial vaccination with the original Wu1 S-encoding mRNA vaccine (<xref ref-type="bibr" rid="bib67">Wang et al., 2023a</xref>; <xref ref-type="bibr" rid="bib68">Wang et al., 2023b</xref>). Several studies (<xref ref-type="bibr" rid="bib11">Chalkias et al., 2022</xref>; <xref ref-type="bibr" rid="bib17">Collier et al., 2023</xref>; <xref ref-type="bibr" rid="bib68">Wang et al., 2023b</xref>; <xref ref-type="bibr" rid="bib1">Alsoussi et al., 2023</xref>; <xref ref-type="bibr" rid="bib49">Park et al., 2022</xref>; <xref ref-type="bibr" rid="bib9">Carreño et al., 2023</xref>) showed that the effectiveness of bivalent boosters was limited by immune imprinting, which occurs when prior exposure to an antigen shapes immunological responses to related antigens during subsequent exposures (<xref ref-type="bibr" rid="bib13">Cobey and Hensley, 2017</xref>). Instead of generating de novo Omicron-specific immune responses, bivalent boosters primarily activated pre-existing cross-reactive memory B cells from previous vaccinations and/or infections (<xref ref-type="bibr" rid="bib1">Alsoussi et al., 2023</xref>; <xref ref-type="bibr" rid="bib49">Park et al., 2022</xref>; <xref ref-type="bibr" rid="bib9">Carreño et al., 2023</xref>), leading to lower neutralizing activity against Omicron subvariants compared to the ancestral variant (<xref ref-type="bibr" rid="bib11">Chalkias et al., 2022</xref>; <xref ref-type="bibr" rid="bib17">Collier et al., 2023</xref>; <xref ref-type="bibr" rid="bib68">Wang et al., 2023b</xref>).</p><p>Continued development of updated boosters in response to emerging variants was slowed by the need for additional clinical testing, regulatory approvals, and adjustments to the manufacturing process. As a result, bivalent boosters became available in fall 2022, almost 1 year after the emergence of Omicron (<xref ref-type="bibr" rid="bib59">Song et al., 2024</xref>). These challenges highlight the urgent need for innovative vaccine strategies that achieve more lasting immune protection against rapidly evolving viruses such as SARS-CoV-2, thereby reducing the need for frequent and updated boosters.</p><p>We recently developed the ESCRT- and ALIX-binding region (EABR) mRNA vaccine platform that combines features of mRNA and protein nanoparticle (NP) vaccines through delivery of mRNA-encoded self-assembling enveloped virus-like particles (eVLPs) (<xref ref-type="bibr" rid="bib28">Hoffmann et al., 2023</xref>). eVLP assembly is achieved by fusing a short EABR sequence to the cytoplasmic tail of viral surface proteins, which recruits proteins from the <underline>E</underline>ndosomal <underline>S</underline>orting <underline>C</underline>omplex <underline>R</underline>equired for <underline>T</underline>ransport (ESCRT) pathway. Thus, EABR mRNA vaccines promote dual presentation of S trimers on cell surfaces and eVLPs that bud from the plasma membrane. Immunizations in mice showed that an EABR mRNA vaccine encoding a Wu1 SARS-CoV-2 S elicited superior neutralizing Ab potency and breadth against ancestral and Omicron SARS-CoV-2 variants compared to conventional mRNA and protein NP vaccines (<xref ref-type="bibr" rid="bib28">Hoffmann et al., 2023</xref>). Similar to conventional mRNA vaccines, the EABR mRNA vaccine also induced potent T cell responses, consistent with the presence of S-specific cytotoxic T cells (<xref ref-type="bibr" rid="bib28">Hoffmann et al., 2023</xref>). These findings suggest that the EABR mRNA vaccine approach has the potential to enhance monovalent or bivalent booster-induced Ab responses against Omicron subvariants in the context of pre-existing immunity induced by prior vaccination, infection, or both.</p><p>Here, we evaluated the ability of EABR mRNA boost immunogens to elicit potent and broad humoral immune responses against SARS-CoV-2 variants in pre-vaccinated mice. We demonstrate that the EABR mRNA vaccine approach improves monovalent and bivalent booster-mediated neutralizing Ab responses against Omicron subvariants compared to conventional mRNA boosters. Epitope mapping of polyclonal antisera further showed that a bivalent EABR mRNA booster elicited a more diversified anti-RBD IgG response than other tested boosting immunogens. These findings support the use of the EABR mRNA vaccine platform for the design of effective boosters that could confer more lasting protection against SARS-CoV-2 variants and potentially other rapidly evolving viruses. In addition, our work provides structural evidence that bivalent mRNA immunizations promote heterotrimer formation, which could enhance activation of cross-reactive B cells through intra-S crosslinking. These insights inform the future design of bivalent or multivalent COVID-19 boosters and highlight the need for further investigation into potentially beneficial effects of S heterotrimer formation on vaccine-induced immune responses against trimeric viral Ss.</p></sec><sec id="s2" sec-type="results"><title>Results</title><p>To expand upon our previous characterizations of a monovalent SARS-CoV-2 S-EABR mRNA vaccine (<xref ref-type="bibr" rid="bib28">Hoffmann et al., 2023</xref>), we evaluated the potential of the EABR mRNA vaccine approach for monovalent and bivalent SARS-CoV-2 immunizations in pre-vaccinated mice. Four cohorts of 10 BALB/c mice each initially received prime-boost intramuscular (IM) vaccinations on days 0 and 28 with 2 µg of a conventional mRNA vaccine encoding the ancestral S protein from the Wu1 variant, similar to the immunogens used in initially approved COVID-19 mRNA vaccines (Wu1 S mRNA-LNP) (<xref ref-type="fig" rid="fig1">Figure 1A–C</xref>). To simulate the timing of the third available COVID-19 mRNA vaccine dose in humans, booster immunizations were administered on day 230, nearly 7 months after the primary vaccination series, with each cohort receiving a different boost immunogen (<xref ref-type="fig" rid="fig1">Figure 1A–C</xref>). Consistent with the COVID-19 booster that became available in fall 2021 (<xref ref-type="bibr" rid="bib3">Andrews et al., 2022b</xref>), cohort 1 received a third dose of 2 µg Wu1 S mRNA-LNP (<xref ref-type="fig" rid="fig1">Figure 1B and C</xref>). To evaluate whether formation of mRNA-encoded S-EABR eVLPs enhances booster immunogenicity in pre-vaccinated mice, cohort 2 received 2 µg Wu1 S-EABR mRNA-LNP (<xref ref-type="fig" rid="fig1">Figure 1B and C</xref>). Cohort 3 received a bivalent Wu1/BA.5 S mRNA-LNP booster (1 µg Wu1 S mRNA-LNP combined with 1 µg BA.5 S mRNA-LNP), which resembled the COVID-19 booster that became available in fall 2022 (<xref ref-type="bibr" rid="bib59">Song et al., 2024</xref>; <xref ref-type="fig" rid="fig1">Figure 1B and C</xref>). Lastly, cohort 4 received a bivalent Wu1/BA.5 S-EABR mRNA-LNP booster (1 µg Wu1 S-EABR mRNA-LNP combined with 1 µg BA.5 S-EABR mRNA-LNP) to promote the formation of eVLPs that co-display Wu1 and BA.5 S trimers (<xref ref-type="fig" rid="fig1">Figure 1B and C</xref>). The Wu1 and BA.5 S-EABR constructs were designed as previously described by fusing an endocytosis-preventing motif (EPM), a short Gly-Ser linker, and an EABR sequence to the end of the cytoplasmic domain of Wu1 and BA.5 S trimers (<xref ref-type="bibr" rid="bib28">Hoffmann et al., 2023</xref>; <xref ref-type="fig" rid="fig1s1">Figure 1—figure supplement 1A</xref>). The Wu1 and BA.5 S-EABR constructs induced similar levels of eVLP budding in transiently transfected HEK293T cells (<xref ref-type="fig" rid="fig1s1">Figure 1—figure supplement 1B</xref>).</p><fig-group><fig id="fig1" position="float"><label>Figure 1.</label><caption><title>Monovalent and bivalent boosters elicit similar antibody (Ab) binding responses against variant S trimers in pre-vaccinated mice.</title><p>(<bold>A</bold>) Immunization schedule in BALB/c mice. Blood samples were collected on days 14, 56, 154, and 244. This panel was created using <ext-link ext-link-type="uri" xlink:href="https://BioRender.com/xrvixmq">BioRender.com</ext-link>. (<bold>B</bold>) Immunization regimens for each cohort. All cohorts were initially vaccinated with 2 µg of Wu1 S mRNA-LNP on days 0 and 28 by intramuscular (IM) injection. Pre-vaccinated mice received different boost immunogens on day 230 by IM injection. Cohorts 1–4 received 2 µg of monovalent Wu1 S mRNA-LNP (cyan), monovalent Wu1 S-EABR mRNA-LNP (orange), bivalent Wu1/BA.5 S mRNA-LNP (blue), or bivalent Wu1/BA.5 S-EABR mRNA-LNP (maroon), respectively. (<bold>C</bold>) Schematic showing the different boost immunogens that were administered on day 230. Wu1 S mRNA-LNP immunization results in cell surface presentation of membrane-anchored Wu1 S trimers. Wu1 S-EABR mRNA-LNP immunization results in dual presentation of Wu1 S trimers on cell surfaces and on enveloped virus-like particles (eVLPs) that are secreted after budding from the plasma membrane. eVLP formation is induced by EABR-mediated recruitment of host cell proteins from the ESCRT pathway. Bivalent Wu1/BA.5 S mRNA-LNP immunization results in cell surface presentation of membrane-anchored Wu1 and BA.5 S trimers. Wu1/BA.5 S-EABR mRNA-LNP immunization results in dual presentation of Wu1 and BA.5 S trimers on cell surfaces and eVLPs that bud from the plasma membrane. S trimers are shown as homotrimers for both monovalent and bivalent boost immunogens. This panel was created using <ext-link ext-link-type="uri" xlink:href="https://BioRender.com/t4gbbc7">BioRender.com</ext-link>. (<bold>D–G</bold>) Enzyme-linked immunosorbent assay (ELISA) data from indicated time points for antisera from individual mice (colored circles) presented as the geometric mean (bars) and standard deviation (horizontal lines) of area under the curve (AUC) values. ELISAs evaluated binding of purified Ss from the (<bold>D</bold>) Wu1, (<bold>E</bold>) BA.5, (<bold>F</bold>) BQ.1.1, and (<bold>G</bold>) XBB.1 variants. The log<sub>10</sub>-fold change in binding titers from day 154 to day 244 is also shown for each S (plotted as mean [bars] and standard deviation [horizontal lines]).</p></caption><graphic mimetype="image" mime-subtype="tiff" xlink:href="elife-108959-fig1-v1.tif"/></fig><fig id="fig1s1" position="float" specific-use="child-fig"><label>Figure 1—figure supplement 1.</label><caption><title>Wu1 and BA.5 S-EABR constructs induce efficient enveloped virus-like particle (eVLP) budding.</title><p>(<bold>A</bold>) Design and sequence information for SARS-CoV-2 S-EABR constructs. Top: The Wu1 and BA.5 S (including a furin cleavage site, 2P stabilizing substitutions, the D614G substitution, and ∆CT, a cytoplasmic tail deletion) were fused to an EPM sequence, a (Gly)<sub>3</sub>Ser (GS) spacer, and an EABR sequence. EPM = endocytosis prevention motif. GS = (Gly)<sub>3</sub>Ser linker. EABR = ESCRT- and ALIX-binding region. Bottom: EPM and EABR sequence information. (<bold>B</bold>) DNA plasmids encoding Wu1 S-EABR (red) or BA.5 S-EABR (orange) constructs were transfected into HEK293T cells. 48 hr post-transfection, transfected cell culture supernatants were harvested, and eVLPs were purified by ultracentrifugation on a 20% sucrose cushion. Purified eVLP samples were serially diluted, directly coated onto 96-well plates, and eVLP-associated S protein levels were quantified by enzyme-linked immunosorbent assay (ELISA).</p></caption><graphic mimetype="image" mime-subtype="tiff" xlink:href="elife-108959-fig1-figsupp1-v1.tif"/></fig><fig id="fig1s2" position="float" specific-use="child-fig"><label>Figure 1—figure supplement 2.</label><caption><title>Sarbecovirus receptor-binding domain (RBD) sequence conservation.</title><p>(<bold>A</bold>) Sequence conservation of 16 sarbecovirus RBDs calculated with ConSurf (<xref ref-type="bibr" rid="bib37">Landau et al., 2005</xref>) and plotted on a surface representation of a SARS-CoV-2 RBD (PDB 7BZ5). Anti-RBD class 1, 2, 3, 4, 1/4, and 5 antibody (Ab) epitopes are outlined with dotted lines in different colors using structural information from representative structures of mAb bound to SARS-CoV-2 S or RBD (C102: PDB 7K8M; C002: PDB 7K8T, S309: PDB 7JX3; CR3022: PDB 7LOP; C118: PDB 7RKV; WRAIR-2063: PDB 8EOO). SARS-CoV-2 RBD substitutions (colored in red) in Omicron (<bold>B</bold>) BA.1, (<bold>C</bold>) BA.5, (<bold>D</bold>) BQ.1.1, and (<bold>E</bold>) XBB.1 variants plotted on the RBD sequence conservation plot.</p></caption><graphic mimetype="image" mime-subtype="tiff" xlink:href="elife-108959-fig1-figsupp2-v1.tif"/></fig><fig id="fig1s3" position="float" specific-use="child-fig"><label>Figure 1—figure supplement 3.</label><caption><title>Primary vaccinations and booster immunizations elicit potent anti-S2 binding responses.</title><p>S2 binding titers for antisera from pre-vaccinated mice that received booster immunizations with 2 µg of monovalent Wu1 S mRNA-LNP (cyan), 2 µg of monovalent Wu1 S-EABR mRNA-LNP (orange), 2 µg of bivalent Wu1/BA.5 S mRNA-LNP (blue), or 2 µg of bivalent Wu1/BA.5 S-EABR mRNA-LNP (maroon). Enzyme-linked immunosorbent assay (ELISA) data for binding of Wu1 S2 are shown for indicated time points for antisera from individual mice (colored circles) presented as the geometric mean (bars) and standard deviation (horizontal lines) of area under the curve (AUC) values. The log<sub>10</sub>-fold change in binding titers from day 154 to day 244 is also shown (plotted as mean [bars] and standard deviation [horizontal lines]).</p></caption><graphic mimetype="image" mime-subtype="tiff" xlink:href="elife-108959-fig1-figsupp3-v1.tif"/></fig></fig-group><p>Serum binding Ab responses were measured by enzyme-linked immunosorbent assay (ELISA) 4 and 18 weeks after the primary vaccination series (days 56 and 154) and 2 weeks after the booster immunizations (day 244). As previously observed, the initial Wu1 S mRNA-LNP vaccinations elicited high binding Ab titers against soluble Wu1 S-6P trimers (contain 6 proline substitutions to enhance expression and stability) (<xref ref-type="bibr" rid="bib30">Hsieh et al., 2020</xref>), and as expected, these titers were similar for all cohorts on day 56 (<xref ref-type="fig" rid="fig1">Figure 1D</xref>). Robust binding Ab responses were also detected for all cohorts against Omicron BA.5, BQ.1.1, and XBB.1 S-6P trimers on day 56 (<xref ref-type="fig" rid="fig1">Figure 1E–G</xref>). On day 154, binding Ab levels against all variants dropped slightly, which was consistent between cohorts (<xref ref-type="fig" rid="fig1">Figure 1D–G</xref>). On day 244, all boost immunogens increased binding Ab titers against Wu1, BA.5, BQ.1.1, and XBB.1 S-6P trimers compared to titers measured on days 56 and 154, but no differences were observed between cohorts for all time points (<xref ref-type="fig" rid="fig1">Figure 1D–G</xref>).</p><sec id="s2-1"><title>Bivalent S-EABR mRNA-LNP booster elicits potent Ab responses targeting Omicron RBDs</title><p>We next evaluated the impact of the different boost immunizations on Ab responses against the RBD, the primary target of neutralizing Abs (<xref ref-type="bibr" rid="bib12">Chen et al., 2023</xref>). The initial Wu1 S mRNA-LNP prime-boost vaccinations elicited robust and similar Ab responses against the Wu1 RBD for all cohorts on day 56 (<xref ref-type="fig" rid="fig2">Figure 2A</xref>). The BA.5, BQ.1.1, and XBB.1 variants harbor multiple RBD substitutions, particularly within the class 1 and 2 epitopes at the tip of the RBD (<xref ref-type="bibr" rid="bib6">Barnes et al., 2020</xref>; <xref ref-type="fig" rid="fig1s2">Figure 1—figure supplement 2</xref>), promoting effective escape from neutralizing Abs (<xref ref-type="bibr" rid="bib69">Wang et al., 2023c</xref>). Compared to Wu1 RBD binding, Ab binding titers were weaker against the BA.5, BQ.1.1, and XBB.1 RBDs on day 56 (<xref ref-type="fig" rid="fig2">Figure 2B–D</xref>). The robust Ab binding against the BA.5, BQ.1.1, and XBB.1 S trimers (<xref ref-type="fig" rid="fig1">Figure 1E–G</xref>) in the absence of strong RBD responses was at least in part driven by potent responses against the S2 stem region of S (residues 686–1213) (<xref ref-type="fig" rid="fig1s3">Figure 1—figure supplement 3</xref>), which is relatively conserved in SARS-CoV-2 variants (<xref ref-type="bibr" rid="bib38">Li and Chang, 2023</xref>; <xref ref-type="fig" rid="fig1s2">Figure 1—figure supplement 2</xref>). Similar to binding titers against S-6P trimers (<xref ref-type="fig" rid="fig1">Figure 1D–G</xref>), Wu1, BA.5, BQ.1.1, and XBB.1 RBD binding slightly dropped on day 154 without statistically significant differences between cohorts (<xref ref-type="fig" rid="fig2">Figure 2A–D</xref>). The booster immunizations increased Wu1 RBD binding on day 244 compared to day 56 and 154 levels, but no differences were detected between the four boosting immunogens (<xref ref-type="fig" rid="fig2">Figure 2A</xref>). In contrast, the bivalent Wu1/BA.5 S-EABR mRNA-LNP booster elicited the highest BA.5, BQ.1.1, and XBB.1 RBD responses on day 244 (<xref ref-type="fig" rid="fig2">Figure 2B–D</xref>), which were significantly higher than Wu1 S mRNA-LNP booster-induced responses against BQ.1.1 RBD (p=0.0499) (<xref ref-type="fig" rid="fig2">Figure 2C</xref>) and narrowly failed to reach statistical significance compared to Wu1 S mRNA-LNP booster-induced responses against BA.5 RBD (p=0.07) (<xref ref-type="fig" rid="fig2">Figure 2B</xref>). Compared to baseline titers measured prior to boost immunizations on day 154, the bivalent Wu1/BA.5 S-EABR mRNA-LNP immunization elicited significantly larger increases in BA.5 RBD binding than the monovalent Wu1 S mRNA-LNP (p=0.02) and the bivalent Wu1/BA.5 S mRNA-LNP boosters (p=0.01) (<xref ref-type="fig" rid="fig2">Figure 2B</xref>), as well as significantly larger increases in BQ.1.1 RBD binding than the Wu1 S mRNA-LNP booster (p=0.002) (<xref ref-type="fig" rid="fig2">Figure 2C</xref>). While overall titers were similar on day 244, the monovalent Wu1 S-EABR mRNA-LNP booster consistently induced larger increases in Ab binding to the BA.5, BQ.1.1, and XBB.1 RBDs than the monovalent Wu1 S mRNA-LNP booster (<xref ref-type="fig" rid="fig2">Figure 2B–D</xref>), although these differences failed to reach statistical significance. The monovalent Wu1 and bivalent Wu1/BA.5 S mRNA-LNP boosters elicited similar binding titers against the BA.5 and XBB.1 RBDs (<xref ref-type="fig" rid="fig2">Figure 2B and D</xref>), but the bivalent booster induced slightly higher responses and a larger increase compared to day 154 titers against BQ.1.1 RBD (not statistically significant) (<xref ref-type="fig" rid="fig2">Figure 2C</xref>). Overall, these results demonstrate that booster immunizations with the bivalent Wu1/BA.5 S-EABR mRNA-LNP elicited the highest Ab responses against Omicron RBDs in pre-vaccinated mice. Notably, post-boost Ab binding against Omicron RBDs remained lower than binding titers against Wu1 RBD in all cohorts, suggesting that booster responses were affected by immune imprinting induced by the primary vaccination series.</p><fig id="fig2" position="float"><label>Figure 2.</label><caption><title>Bivalent S-EABR mRNA-LNP booster elicits potent antibody (Ab) responses targeting Omicron receptor-binding domains (RBDs).</title><p>(<bold>A–D</bold>) RBD binding titers for antisera from pre-vaccinated mice that received booster immunizations with 2 µg of monovalent Wu1 S mRNA-LNP (cyan), 2 µg of monovalent Wu1 S-EABR mRNA-LNP (orange), 2 µg of bivalent Wu1/BA.5 S mRNA-LNP (blue), or 2 µg of bivalent Wu1/BA.5 S-EABR mRNA-LNP (maroon) (immunization schedule in <xref ref-type="fig" rid="fig1">Figure 1A and B</xref>). Enzyme-linked immunosorbent assay (ELISA) data are shown for indicated time points for antisera from individual mice (colored circles) presented as the geometric mean (bars) and standard deviation (horizontal lines) of area under the curve (AUC) values. ELISAs evaluated binding of RBDs from the (<bold>A</bold>) Wu1, (<bold>B</bold>) BA.5, (<bold>C</bold>) BQ.1.1, and (<bold>D</bold>) XBB.1 SARS-CoV-2 variants. The log<sub>10</sub>-fold change in binding titers from day 154 to day 244 is also shown for each RBD (plotted as mean [bars] and standard deviation [horizontal lines]). Significant differences between cohorts linked by horizontal lines are indicated by asterisks: p&lt;0.05 = *, p&lt;0.01 = **.</p></caption><graphic mimetype="image" mime-subtype="tiff" xlink:href="elife-108959-fig2-v1.tif"/></fig></sec><sec id="s2-2"><title>Bivalent S-EABR mRNA-LNP booster elicits higher neutralizing responses against Omicron variants</title><p>The ability of boost immunogens to elicit neutralizing Ab responses in pre-vaccinated mice was evaluated by in vitro pseudovirus neutralization assays (<xref ref-type="bibr" rid="bib19">Crawford et al., 2020</xref>; <xref ref-type="bibr" rid="bib54">Robbiani et al., 2020</xref>). The primary vaccination series with Wu1 S mRNA-LNP elicited potent and consistent autologous geometric mean neutralizing titers as assessed by half-maximal serum inhibitory dilution (ID<sub>50</sub>) values against Wu1 pseudovirus in all cohorts on day 56 (<xref ref-type="fig" rid="fig3">Figure 3A</xref>; <xref ref-type="supplementary-material" rid="supp1">Supplementary file 1</xref>). Neutralizing activity was &gt;100-fold lower against the BA.5 variant and undetectable in most animals against the BQ.1.1 and XBB.1 variants on day 56 for all cohorts (<xref ref-type="fig" rid="fig3">Figure 3B–D</xref>; <xref ref-type="supplementary-material" rid="supp1">Supplementary file 1</xref>). On day 154, neutralizing titers against the Wu1 and BA.5 variants were consistent in all cohorts and slightly lower compared to day 56 titers (<xref ref-type="fig" rid="fig3">Figure 3A and B</xref>; <xref ref-type="supplementary-material" rid="supp1">Supplementary file 1</xref>). Neutralizing activity against the BQ.1.1 and XBB.1 variants was undetectable in all but one animal on day 154 (<xref ref-type="fig" rid="fig3">Figure 3C and D</xref>; <xref ref-type="supplementary-material" rid="supp1">Supplementary file 1</xref>). Booster immunizations on day 230 increased autologous neutralizing titers against Wu1 pseudovirus on day 244 compared to day 154 in all cohorts (<xref ref-type="fig" rid="fig3">Figure 3A</xref>; <xref ref-type="supplementary-material" rid="supp1">Supplementary file 1</xref>). Monovalent Wu1 S mRNA-LNP and S-EABR mRNA-LNP immunizations elicited the smallest and largest increases in Wu1 neutralization (4.2-fold versus 6.6-fold), respectively. All boost immunogens elicited increased BA.5 neutralizing activity on day 244 compared to day 56 and 154 titers (<xref ref-type="fig" rid="fig3">Figure 3B</xref>; <xref ref-type="supplementary-material" rid="supp1">Supplementary file 1</xref>). Boosting with monovalent Wu1 S-EABR mRNA-LNP induced 4.8-fold higher BA.5 neutralizing titers than a third Wu1 S mRNA-LNP immunization, but this difference did not reach statistical significance. Using the respective day 154 titers as baseline, the Wu1 S-EABR mRNA-LNP booster induced a 23.8-fold increase in BA.5 neutralization on day 244 compared to only a 6.3-fold increase detected after boosting with Wu1 S mRNA-LNP (not statistically significant) (<xref ref-type="fig" rid="fig3">Figure 3B</xref>; <xref ref-type="supplementary-material" rid="supp1">Supplementary file 1</xref>). Compared to day 56 baseline titers, the Wu1 S-EABR mRNA-LNP booster induced a significantly higher increase in BA.5 neutralization on day 244 than the conventional Wu1 S mRNA-LNP booster (16.2-fold versus 3.1-fold; p=0.048) (<xref ref-type="fig" rid="fig3s1">Figure 3—figure supplement 1</xref>; <xref ref-type="supplementary-material" rid="supp1">Supplementary file 1</xref>). The Wu1 S-EABR mRNA-LNP booster also elicited 3.4-fold higher neutralizing responses than the Wu1 S mRNA-LNP booster against the Omicron BA.1 variant on day 244 (p=0.03) (<xref ref-type="fig" rid="fig3s2">Figure 3—figure supplement 2</xref>). Based on day 154 titers, boosting with monovalent Wu1 S-EABR mRNA-LNP induced significantly higher increases in BA.1 neutralization compared to monovalent Wu1 S mRNA-LNP (8.8-fold versus 2.5-fold; p=0.009) (<xref ref-type="fig" rid="fig3s2">Figure 3—figure supplement 2</xref>). Interestingly, the monovalent Wu1 S-EABR mRNA-LNP and the bivalent Wu1/BA.5 S mRNA-LNP boosters elicited similar BA.5 neutralizing responses on day 244 (<xref ref-type="fig" rid="fig3">Figure 3B</xref>; <xref ref-type="supplementary-material" rid="supp1">Supplementary file 1</xref>), suggesting that the EABR mRNA vaccine approach might reduce the need for updating boost immunogens to achieve robust Ab responses against emerging SARS-CoV-2 variants. The highest BA.5 neutralizing titers were elicited by the bivalent Wu1/BA.5 S-EABR mRNA-LNP booster, which were 12.3-fold higher than titers induced by the monovalent Wu1 S mRNA-LNP booster (p=0.02) and 2.4-fold higher than titers induced by the bivalent Wu1/BA.5 S mRNA-LNP booster (not statistically significant). Based on titers measured on day 154, the Wu1/BA.5 S-EABR mRNA-LNP booster induced a 67-fold increase in BA.5 neutralization, which was significantly higher than the increase elicited by boosting with monovalent Wu1 S mRNA-LNP (p=0.003).</p><fig-group><fig id="fig3" position="float"><label>Figure 3.</label><caption><title>Bivalent Wu1/BA.5 S-EABR mRNA-LNP booster elicits higher neutralizing responses against Omicron subvariants.</title><p>(<bold>A–D</bold>) Neutralization titers for antisera from pre-vaccinated mice that received booster immunizations with 2 µg of monovalent Wu1 S mRNA-LNP (cyan), 2 µg of monovalent Wu1 S-EABR mRNA-LNP (orange), 2 µg of bivalent Wu1/BA.5 S mRNA-LNP (blue), or 2 µg of bivalent Wu1/BA.5 S-EABR mRNA-LNP (maroon) (immunization schedule in <xref ref-type="fig" rid="fig1">Figure 1A and B</xref>). Neutralization data are shown for indicated time points for antisera from individual mice (colored circles) presented as the geometric mean (bars) and standard deviation (horizontal lines) of ID<sub>50</sub> values. Results are shown for (<bold>A</bold>) Wu1, (<bold>B</bold>) BA.5, (<bold>C</bold>) BQ.1.1, and (<bold>D</bold>) XBB.1 pseudoviruses. Dashed horizontal lines correspond to the background values representing the limit of detection for neutralization assays (ID<sub>50</sub>=1:50). The log<sub>10</sub>-fold change in neutralization titers from day 154 to day 244 is also shown for each pseudovirus (plotted as mean [bars] and standard deviation [horizontal lines]). Significant differences between cohorts linked by horizontal lines are indicated by asterisks: p&lt;0.05 = *, p&lt;0.01 = **. (<bold>E</bold>) Number of mice in each cohort that reached an ID<sub>50</sub> ≤ 1:100 against each variant on days 56 (left), 154 (middle), and 244 (right).</p></caption><graphic mimetype="image" mime-subtype="tiff" xlink:href="elife-108959-fig3-v1.tif"/></fig><fig id="fig3s1" position="float" specific-use="child-fig"><label>Figure 3—figure supplement 1.</label><caption><title>Monovalent and bivalent S-EABR mRNA-LNP boosters elicit higher increases in BA.5 neutralization compared to conventional S mRNA-LNP boosters.</title><p>Neutralization titers for antisera from pre-vaccinated mice that received booster immunizations with 2 µg of monovalent Wu1 S mRNA-LNP (cyan), 2 µg of monovalent Wu1 S-EABR mRNA-LNP (orange), 2 µg of bivalent Wu1/BA.5 S mRNA-LNP (blue), or 2 µg of bivalent Wu1/BA.5 S-EABR mRNA-LNP (maroon) (immunization schedule in <xref ref-type="fig" rid="fig1">Figure 1A and B</xref>). BA.5 neutralization data are shown for indicated time points for antisera from individual mice (colored circles) presented as the geometric mean (bars) and standard deviation (horizontal lines) of ID<sub>50</sub> values. Dashed horizontal lines correspond to the background values representing the limit of detection for neutralization assays (ID<sub>50</sub>=1:50). The log<sub>10</sub>-fold change in neutralization titers from day 56 to day 244 is also shown (plotted as mean [bars] and standard deviation [horizontal lines]). Significant differences between cohorts linked by horizontal lines are indicated by asterisks: p&lt;0.05 = *, p&lt;0.01 = **.</p></caption><graphic mimetype="image" mime-subtype="tiff" xlink:href="elife-108959-fig3-figsupp1-v1.tif"/></fig><fig id="fig3s2" position="float" specific-use="child-fig"><label>Figure 3—figure supplement 2.</label><caption><title>Monovalent Wu1 S-EABR mRNA-LNP booster elicits improved neutralizing responses against BA.1 variant.</title><p>Neutralization titers for antisera from pre-vaccinated mice that received booster immunizations with 2 µg of monovalent Wu1 S mRNA-LNP (cyan) or monovalent Wu1 S-EABR mRNA-LNP (orange). Neutralization data are shown for indicated time points for antisera from individual mice (colored circles) presented as the geometric mean (bars) and standard deviation (horizontal lines) of ID<sub>50</sub> values against BA.1 pseudovirus. Dashed horizontal lines correspond to the limit of detection for neutralization assays (ID<sub>50</sub>=1:50). The log<sub>10</sub>-fold change in neutralization titers from day 154 to day 244 is also shown (plotted as mean [bars] and standard deviation [horizontal lines]). Significant differences between cohorts linked by horizontal lines are indicated by asterisks: p&lt;0.05 = *.</p></caption><graphic mimetype="image" mime-subtype="tiff" xlink:href="elife-108959-fig3-figsupp2-v1.tif"/></fig><fig id="fig3s3" position="float" specific-use="child-fig"><label>Figure 3—figure supplement 3.</label><caption><title>Depleting bivalent booster-induced antisera with Wu1 receptor-binding domain (RBD) reduces BA.5 neutralizing activity.</title><p>Day 244 serum samples obtained from pre-vaccinated mice that received booster immunizations with 2 µg of bivalent Wu1/BA.5 S mRNA-LNP (blue) or 2 µg of bivalent Wu1/BA.5 S-EABR mRNA-LNP (maroon) were depleted using a mock protein (HIV-1 gp120; left) or Wu1 RBD (right). The neutralizing activity of the depleted antisera was measured against BA.5 pseudovirus. Neutralization data are shown as ID<sub>50</sub> values for individual mice (colored circles). Data points for individual mice following mock or Wu1 RBD depletions are connected by colored lines. Dashed horizontal lines correspond to the limit of detection for neutralization assays (ID<sub>50</sub>=1:50).</p></caption><graphic mimetype="image" mime-subtype="tiff" xlink:href="elife-108959-fig3-figsupp3-v1.tif"/></fig></fig-group><p>While the BA.5 neutralizing activity induced by the monovalent Wu1 S and S-EABR mRNA-LNP boosters can likely be attributed to cross-neutralizing Abs that neutralize both the Wu1 and BA.5 variants, it is possible that the bivalent Wu1/BA.5 S and S-EABR mRNA-LNP boosters also elicited de novo strain-specific Abs that neutralize BA.5 but not Wu1. Day 244 serum samples from mice that received bivalent Wu1/BA.5 S or S-EABR mRNA-LNP boosters were depleted of Abs that bind to Wu1 RBD. Sera were passaged over a column presenting either a mock protein (HIV-1 gp120) as a control or the Wu1 RBD to remove cross-neutralizing anti-RBD Abs while retaining BA.5 RBD-specific Abs. Following depletions, residual neutralization activity was measured against the BA.5 variant. Interestingly, Wu1 RBD depletion resulted in 17- and 36-fold lower geometric mean neutralizing titers compared to mock depletion for the bivalent Wu1/BA.5 S and S-EABR mRNA-LNP boosters, respectively (<xref ref-type="fig" rid="fig3s3">Figure 3—figure supplement 3</xref>). In both cohorts, BA.5 neutralizing titers in all but two mice dropped below ID<sub>50</sub> values of 1:120 following Wu1 RBD depletion, consistent with the neutralizing activity in these samples being primarily driven by cross-neutralizing Abs targeting the RBD induced by the primary vaccination series. The potent residual neutralizing activity observed in two mice in each cohort after Wu1 RBD depletion implies either the presence of boost-induced de novo BA.5-specific RBD Abs or neutralizing non-RBD Abs that target another region of S, e.g., the N-terminal domain (<xref ref-type="bibr" rid="bib66">Wang et al., 2022</xref>) or S2 (<xref ref-type="bibr" rid="bib38">Li and Chang, 2023</xref>).</p><p>Booster immunizations had less pronounced effects on neutralization activity against the BQ.1.1 and XBB.1 variants. Against BQ.1.1 pseudovirus, the bivalent Wu1/BA.5 S-EABR mRNA-LNP booster elicited the most potent neutralizing activity on day 244, which was significantly higher than responses induced by a third immunization with the monovalent Wu1 S mRNA-LNP booster (p=0.0495) (<xref ref-type="fig" rid="fig3">Figure 3C</xref>; <xref ref-type="supplementary-material" rid="supp1">Supplementary file 1</xref>). The monovalent Wu1 S-EABR mRNA-LNP and bivalent Wu1/BA.5 S mRNA-LNP boosters elicited 1.8- and 2.5-fold higher BQ.1.1 titers than the monovalent Wu1 S mRNA-LNP booster, respectively, the latter of which narrowly failed to reach statistical significance (p=0.07). Based on day 154 BQ.1.1 neutralizing titers, the monovalent Wu1 S mRNA-LNP and bivalent Wu1/BA.5 S-EABR mRNA-LNP boosters induced the smallest and largest increases in neutralizing activity on day 244, respectively (1.4-fold versus 4.7-fold; p=0.0495). The monovalent Wu1 S-EABR mRNA-LNP and bivalent Wu1/BA.5 S mRNA-LNP boosters elicited 2.4- and 3.4-fold increases in neutralizing BQ.1.1 titers, respectively. Notably, day 244 neutralizing titers against BQ.1.1 were substantially lower than BA.5 neutralizing titers for all boost immunogens (<xref ref-type="fig" rid="fig3">Figure 3B and C</xref>; <xref ref-type="supplementary-material" rid="supp1">Supplementary file 1</xref>), consistent with previous reports (<xref ref-type="bibr" rid="bib69">Wang et al., 2023c</xref>; <xref ref-type="bibr" rid="bib43">Miller et al., 2023</xref>). Notably, Ab binding responses against the BA.5 and BQ.1.1 RBDs were similar (<xref ref-type="fig" rid="fig2">Figure 2B and C</xref>), implying that RBD binding responses are not always predictive of neutralizing activity against Omicron subvariants.</p><p>Neutralizing responses against the XBB.1 variant were slightly lower than titers against BQ.1.1 pseudovirus (<xref ref-type="fig" rid="fig3">Figure 3D</xref>; <xref ref-type="supplementary-material" rid="supp1">Supplementary file 1</xref>). Once again, the bivalent Wu1/BA.5 S-EABR mRNA-LNP booster elicited the highest XBB.1 neutralizing titers, which were 2.1-fold higher than titers induced by the monovalent Wu1 S mRNA-LNP booster (not statistically significant). Based on day 154 titers, the monovalent Wu1 and bivalent Wu1/BA.5 S-EABR mRNA-LNP boosters increased XBB.1 neutralization by 2.5- and 3.2-fold, respectively, while conventional monovalent and bivalent S mRNA-LNP boosters only induced 1.5- and 2.2-fold increases, respectively.</p><p>Notable differences were also observed in the number of mice in each cohort that reached robust neutralizing titers (defined as ID<sub>50</sub>s exceeding 1:100) against Omicron subvariants following booster immunizations, titers that are likely important for the prevention of symptomatic infections (<xref ref-type="bibr" rid="bib23">Feng et al., 2021</xref>). The primary vaccination series with Wu1 S mRNA-LNP elicited robust neutralizing titers against the Wu1 variant in all mice on day 56 (<xref ref-type="fig" rid="fig3">Figure 3E</xref>). However, the initial Wu1 S mRNA-LNP vaccinations elicited robust titers in only 6–8, 1–3, and 0–2 of 10 mice against the BA.5, BQ.1.1, and XBB.1 variants on day 56, respectively. On day 154, ID<sub>50</sub>s over 1:100 were measured for 3–5 mice in each cohort against BA.5, but for none of the animals against BQ.1.1 and XBB.1. While a third immunization with Wu1 S mRNA-LNP induced robust titers against BA.5 in only 8 of 10 mice on day 244, the monovalent Wu1 S-EABR mRNA-LNP booster induced robust titers against BA.5 in all 10 mice, including the 4 mice that did not have detectable BA.5 neutralizing activity on day 56 (<xref ref-type="fig" rid="fig3">Figure 3E</xref>). As expected, robust neutralizing titers against the BA.5 variant were also observed in all mice that received the bivalent Wu1/BA.5 S or S-EABR mRNA-LNP boosters. Against the BQ.1.1 and XBB.1 variants, a third immunization with Wu1 S mRNA-LNP induced robust neutralizing titers in only 2 and 3 mice, respectively (<xref ref-type="fig" rid="fig3">Figure 3E</xref>). In comparison, the bivalent Wu1/BA.5 S-EABR mRNA-LNP booster induced ID<sub>50</sub>s over 1:100 in 7 and 6 mice against the BQ.1.1 and XBB.1 variants, respectively.</p><p>Overall, these results demonstrate that the EABR mRNA vaccine approach improves the neutralizing activity against Omicron subvariants induced by monovalent and bivalent boost immunogens in pre-vaccinated mice.</p></sec><sec id="s2-3"><title>Bivalent S-EABR mRNA-LNP booster induces polyclass Ab responses</title><p>Several distinct Ab-binding epitopes have been defined on RBDs, including the variable class 1 and 2 RBD epitopes and the more conserved class 3, 4, 1/4, and 5 RBD epitopes (<xref ref-type="bibr" rid="bib6">Barnes et al., 2020</xref>; <xref ref-type="bibr" rid="bib21">Fan et al., 2022</xref>; <xref ref-type="bibr" rid="bib22">Fan et al., 2025</xref>; <xref ref-type="fig" rid="fig1s2">Figure 1—figure supplement 2</xref>). We determined which RBD epitopes were targeted by booster-induced Abs in pre-vaccinated mice using deep mutational scanning (DMS) of yeast display libraries derived from Wu1 (<xref ref-type="bibr" rid="bib60">Starr et al., 2020</xref>) and XBB.1.5 RBDs (<xref ref-type="bibr" rid="bib63">Taylor and Starr, 2023</xref>). In previous studies, we showed that equimolar mixtures of monoclonal Abs targeting distinct RBD epitopes produced less pronounced DMS escape peaks, which we defined as a polyclass Ab response (<xref ref-type="bibr" rid="bib16">Cohen et al., 2024</xref>). This suggests that polyclonal serum that includes roughly equal distributions of Abs targeting multiple classes of RBD epitopes would exhibit relatively flat DMS profiles, while more defined DMS escape peaks would be observed for less diverse polyclonal serum responses containing Abs that primarily target particular RBD epitopes (<xref ref-type="bibr" rid="bib16">Cohen et al., 2024</xref>). For this study, we used DMS escape fractions to define polyclass responses. Escape fractions for each RBD mutation range from 0 (no cells with this mutation are sorted into the serum Ab escape bin) to 1 (all cells with this mutation are sorted into the serum Ab escape bin) (<xref ref-type="bibr" rid="bib25">Greaney et al., 2021b</xref>). Total escape peaks represent the sum of escape fractions for all mutations at a specific site (<xref ref-type="bibr" rid="bib25">Greaney et al., 2021b</xref>). DMS profiles with total escape peaks below 0.5 at all sites were classified as polyclass responses. In contrast, DMS profiles with total escape peaks of 0.5–1, 1–2, or above 2 at one or more sites were classified as weak, moderate, or strong escape profiles, respectively, indicating weak, moderate, or strong targeting of particular RBD epitopes (<xref ref-type="supplementary-material" rid="supp2">Supplementary file 2</xref>). DMS was performed for 6 serum samples for each cohort, which were selected based on XBB.1 neutralization activity (1st, 2nd, 3rd, 5th, 6th, and 10th best neutralizer from each cohort). For the Wu1 RBD library, only 5 DMS profiles were obtained due to poor sequencing quality for one sample in each cohort.</p><p>Against the Wu1 RBD library, immunizations with the monovalent Wu1 S and S-EABR mRNA-LNP boosters or the bivalent Wu1/BA.5 S mRNA-LNP booster resulted in DMS profiles consistent with moderate targeting of the variable class 2 epitope primarily inducing escape at RBD residue 484 (<xref ref-type="fig" rid="fig4">Figure 4A and B</xref>). The bivalent Wu1/BA.5 S mRNA-LNP booster also elicited weak to moderate responses that mapped to the variable class 1 and class 3 RBD epitopes. In contrast, the bivalent Wu1/BA.5 S-EABR mRNA-LNP booster DMS profiles were consistent with polyclass Ab induction, suggesting a more diverse response targeting multiple RBD epitopes (<xref ref-type="fig" rid="fig4">Figure 4A and B</xref>). Notably, samples from 4 out of 5 mice in this cohort exhibited polyclass DMS profiles, whereas moderate to strong escape fractions for class 1, 2, or 3 epitopes were observed in 3–4 mice in each of the other cohorts (<xref ref-type="fig" rid="fig4s1">Figure 4—figure supplement 1</xref>; <xref ref-type="supplementary-material" rid="supp2">Supplementary file 2</xref>).</p><fig-group><fig id="fig4" position="float"><label>Figure 4.</label><caption><title>Bivalent S-EABR mRNA-LNP booster induces polyclass antibody (Ab) responses.</title><p>Sera for deep mutational scanning (DMS) studies were derived from pre-vaccinated mice that received booster immunizations with 2 µg of monovalent Wu1 S mRNA-LNP, monovalent Wu1 S-EABR mRNA-LNP, bivalent Wu1/BA.5 S mRNA-LNP, or bivalent Wu1/BA.5 S-EABR mRNA-LNP (immunization schedule in <xref ref-type="fig" rid="fig1">Figure 1A and B</xref>). DMS was performed for 6 serum samples for each cohort, which were selected based on XBB.1 neutralization activity (1st, 2nd, 3rd, 5th, 6th, and 10th best neutralizer from each cohort). For the Wu1 receptor-binding domain (RBD) library, only five DMS profiles were obtained for each cohort. (<bold>A</bold>) Line plots for DMS results using Wu1 (top) or XBB.1.5 (bottom) RBD libraries for sera from pre-vaccinated mice that received the indicated boost immunogens. The x axes display the RBD residue numbers, and the y axes show the sum of the Ab escape of all mutations at a site (larger numbers indicating increased Ab escape). Each faint line shows one antiserum with heavy lines representing the average across the n=5 (top) or n=6 (bottom) sera in each cohort. Lines are colored differently for RBD epitopes within different RBD epitope classes (<xref ref-type="bibr" rid="bib6">Barnes et al., 2020</xref>; <xref ref-type="bibr" rid="bib21">Fan et al., 2022</xref>) (color definitions shown in legend above line plots; epitopes are shown in <xref ref-type="fig" rid="fig1s2">Figure 1—figure supplement 2</xref>; gray color for residues not assigned to an epitope). (<bold>B</bold>) The average site-total Ab escape for the Wu1 (top) or XBB.1.5 (bottom) RBD libraries for pre-vaccinated mice that received the indicated boost immunogens mapped to the Wu1 RBD surface (PDB: 6M0J). Gray coloring indicates no escape, and red coloring indicates escape. Lines with numbers colored according to epitope class indicate RBD positions with the most escape.</p></caption><graphic mimetype="image" mime-subtype="tiff" xlink:href="elife-108959-fig4-v1.tif"/></fig><fig id="fig4s1" position="float" specific-use="child-fig"><label>Figure 4—figure supplement 1.</label><caption><title>Bivalent S-EABR mRNA-LNP booster induces polyclass antibody (Ab) responses against Wu1 receptor-binding domain (RBD).</title><p>Sera for deep mutational scanning (DMS) studies were derived from pre-vaccinated mice that received booster immunizations with 2 µg of monovalent Wu1 S mRNA-LNP, monovalent Wu1 S-EABR mRNA-LNP, bivalent Wu1/BA.5 S mRNA-LNP, or bivalent Wu1/BA.5 S-EABR mRNA-LNP (immunization schedule in <xref ref-type="fig" rid="fig1">Figure 1A and B</xref>). Line (left) and logo plots (right) are shown for DMS results for individual sera from pre-vaccinated mice that received the indicated boost immunogens. DMS was performed using a Wu1 RBD library. The x axes of the line and logo plots display the RBD residue numbers. The y axis of the line plots shows the sum of the Ab escape of all mutations at a site (larger numbers indicating increased Ab escape). Sites with the strongest Ab escape are shown in logo plots, with tall letters representing the most frequent mutations at a site. Logo plots are colored differently for RBD epitopes within different classes (<xref ref-type="bibr" rid="bib6">Barnes et al., 2020</xref>; <xref ref-type="bibr" rid="bib21">Fan et al., 2022</xref>; <xref ref-type="bibr" rid="bib22">Fan et al., 2025</xref>) (epitopes are shown in <xref ref-type="fig" rid="fig1s2">Figure 1—figure supplement 2</xref>; gray color for residues not assigned to an epitope).</p></caption><graphic mimetype="image" mime-subtype="tiff" xlink:href="elife-108959-fig4-figsupp1-v1.tif"/></fig><fig id="fig4s2" position="float" specific-use="child-fig"><label>Figure 4—figure supplement 2.</label><caption><title>Bivalent S-EABR mRNA-LNP booster induces less pronounced class 3 Ab responses against XBB.1.5 receptor-binding domain (RBD).</title><p>Sera for deep mutational scanning (DMS) studies were derived from pre-vaccinated mice that received booster immunizations with 2 µg of monovalent Wu1 S mRNA-LNP, monovalent Wu1 S-EABR mRNA-LNP, bivalent Wu1/BA.5 S mRNA-LNP, or bivalent Wu1/BA.5 S-EABR mRNA-LNP (immunization schedule in <xref ref-type="fig" rid="fig1">Figure 1A and B</xref>). Line (left) and logo plots (right) are shown for DMS results for individual sera from pre-vaccinated mice that received the indicated boost immunogens. DMS was performed using an XBB.1.5 RBD library. The x axes of the line and logo plots display the RBD residue numbers. The y axis of the line plots shows the sum of the Ab escape of all mutations at a site (larger numbers indicating increased Ab escape). Sites with the strongest Ab escape are shown in logo plots, with tall letters representing the most frequent mutations at a site. Logo plots are colored differently for RBD epitopes within different classes (<xref ref-type="bibr" rid="bib6">Barnes et al., 2020</xref>; <xref ref-type="bibr" rid="bib21">Fan et al., 2022</xref>) (epitopes are shown in <xref ref-type="fig" rid="fig1s2">Figure 1—figure supplement 2</xref>; gray color for residues not assigned to an epitope).</p></caption><graphic mimetype="image" mime-subtype="tiff" xlink:href="elife-108959-fig4-figsupp2-v1.tif"/></fig></fig-group><p>As expected, no class 1 and 2 DMS profiles were observed against the XBB.1.5 RBD library (<xref ref-type="bibr" rid="bib63">Taylor and Starr, 2023</xref>) since these epitopes are highly substituted in Omicron subvariants (<xref ref-type="fig" rid="fig1s2">Figure 1—figure supplement 2</xref>). All booster immunizations induced strong class 5 escape peaks targeting RBD residues 352, 357, 396, and 468 (<xref ref-type="fig" rid="fig4">Figure 4C and D</xref>). Importantly, the bivalent Wu1/BA.5 S-EABR mRNA-LNP booster induced a less pronounced overall class 5 profile than the other boost immunogens, which was primarily driven by a strong class 5 response observed in a single animal in this cohort (<xref ref-type="fig" rid="fig4s2">Figure 4—figure supplement 2</xref>; <xref ref-type="supplementary-material" rid="supp2">Supplementary file 2</xref>). The other mice that received the bivalent Wu1/BA.5 S-EABR mRNA-LNP booster exhibited polyclass or weak to moderate responses against class 4 and 5 epitopes. In contrast, strong class 5 profiles were detected in 4–5 mice in cohorts that received the monovalent Wu1 S or S-EABR mRNA-LNP boosters or the bivalent Wu1/BA.5 S mRNA-LNP booster (<xref ref-type="fig" rid="fig4s2">Figure 4—figure supplement 2</xref>; <xref ref-type="supplementary-material" rid="supp2">Supplementary file 2</xref>). Overall, these results suggest that the bivalent Wu1/BA.5 S-EABR mRNA-LNP booster induced a more diversified polyclass Ab response that likely contributed to the higher neutralizing activity observed against Omicron subvariants, which could result in more effective recognition of future variants.</p></sec><sec id="s2-4"><title>Co-expression of Wu1 and BA.5 S results in heterotrimer formation</title><p>The results from this and previous studies <xref ref-type="bibr" rid="bib58">Scheaffer et al., 2023</xref>; <xref ref-type="bibr" rid="bib35">Khoury et al., 2023</xref>; <xref ref-type="bibr" rid="bib11">Chalkias et al., 2022</xref>; <xref ref-type="bibr" rid="bib17">Collier et al., 2023</xref> demonstrated that bivalent booster immunizations improve the potency and breadth of Ab responses against Omicron subvariants compared to monovalent boosters. Serum depletion assays also showed that the BA.5 neutralizing activity elicited by the bivalent Wu1/BA.5 S and S-EABR mRNA-LNP boosters was primarily driven by cross-reactive Abs that bind to the Wu1 and BA.5 RBDs (<xref ref-type="fig" rid="fig3s3">Figure 3—figure supplement 3</xref>). Preferential activation of cross-reactive B cells could be achieved through co-display of Wu1 and BA.5 S trimers on the surface of a cell and/or an eVLP (<xref ref-type="fig" rid="fig1">Figure 1C</xref>), which could result in inter-S crosslinking between cross-reactive B cell receptors (BCRs) and neighboring homotrimeric Wu1 and BA.5 S trimers (<xref ref-type="fig" rid="fig5s1">Figure 5—figure supplement 1</xref>). As an additional mechanism for bivalent booster-induced activation of cross-reactive B cells, we hypothesized that co-expression of ancestral Wu1 and Omicron S in the same cell could result in the formation of S heterotrimers consisting of Wu1 and Omicron S protomers and could promote intra-S crosslinking, i.e., simultaneous binding of cross-reactive BCRs to two neighboring RBDs within the same S trimer (<xref ref-type="fig" rid="fig5s1">Figure 5—figure supplement 1</xref>). We previously postulated that intra-S crosslinking is possible for several anti-RBD IgGs based on modeling of intact IgG coordinates into single-particle cryo-electron microscopy (cryo-EM) structures of fragment antigen-binding (Fab)-S complexes (<xref ref-type="bibr" rid="bib6">Barnes et al., 2020</xref>; <xref ref-type="bibr" rid="bib21">Fan et al., 2022</xref>), and intra-S crosslinking was observed in EM studies of IgG-S trimer complexes (<xref ref-type="bibr" rid="bib8">Callaway et al., 2023</xref>). However, it is currently unknown whether co-expression of Wu1 and Omicron Ss induces heterotrimerization, and if so, whether heterotrimer formation affects the overall structure of the S ectodomain and influences bivalent booster-induced immune responses.</p><p>To investigate whether S heterotrimers could form with different S protomers, we designed 6P versions (containing 6 proline substitutions to enhance expression and stability) (<xref ref-type="bibr" rid="bib30">Hsieh et al., 2020</xref>) of Wu1/BA.1 and Wu1/BA.1/Delta soluble heterotrimer Ss (HT2 and HT3, respectively) by co-transfection with specific C-terminally-tagged constructs. HT2 was generated by co-transfecting StrepII-tagged Wu1 S and His-tagged BA.1 S, while HT3 was generated using StrepII-tagged Wu1 S, His-tagged BA.1 S, and D7324 (<xref ref-type="bibr" rid="bib56">Sanders et al., 2013</xref>)-tagged Delta S (<xref ref-type="fig" rid="fig5">Figure 5A</xref>). Each heterotrimer was subsequently purified using sequential affinity purification specific to each tag, confirming the inclusion of distinct protomers in the purified heterotrimers (<xref ref-type="fig" rid="fig5">Figure 5A</xref>).</p><fig-group><fig id="fig5" position="float"><label>Figure 5.</label><caption><title>Heterotrimer S formation occurs for soluble constructs.</title><p>(<bold>A</bold>) Schematic for the generation and purification of soluble SARS-CoV-2 Wu1/BA.1 (HT2) and Wu1/BA.1/Delta (HT3) S heterotrimers. HT2 heterotrimers were generated by co-transfection of StrepII-tagged Wu1 S and His-tagged BA.1 S constructs at a 1:1 DNA ratio, while HT3 heterotrimers were produced by co-transfecting StrepII-tagged Wu1 S, His-tagged BA.1 S, and D7324-tagged Delta S constructs at a 1:1:1 ratio. Each heterotrimer was sequentially purified using affinity chromatography specific for each tag (StrepII, His, or JR-52) to ensure incorporation of distinct protomers. This panel was created using <ext-link ext-link-type="uri" xlink:href="https://BioRender.com/qv97gxb">BioRender.com</ext-link>. (<bold>B</bold>) Cryo-electron microscopy (cryo-EM) density maps for Wu1/BA.1 HT2 S class I with 3 ‘down’ receptor-binding domains (RBDs) (3.8 Å resolution) and class II with 1 ‘up’ RBD (3.8 Å resolution). (<bold>C</bold>) 4.0 Å and 3.9 Å resolution cryo-EM density maps for Wu1/BA.1/Delta HT3 S with 3 ‘down’ RBDs and 1 ‘up’ RBD. (<bold>D</bold>) Table summarizing S heterotrimer and control homotrimer conformational states.</p></caption><graphic mimetype="image" mime-subtype="tiff" xlink:href="elife-108959-fig5-v1.tif"/></fig><fig id="fig5s1" position="float" specific-use="child-fig"><label>Figure 5—figure supplement 1.</label><caption><title>Cartoon diagram illustrating inter- and intra-S crosslinking.</title><p>Left: model showing potential inter-S crosslinking through the interactions between both Fabs of a single IgG and two receptor-binding domains (RBDs) of adjacent viral S proteins. Right: model showing intra-S crosslinking through the interaction between both Fabs of a single IgG and two RBDs on the same viral S trimer. The hinge regions between the Fabs and Fc are modeled with flexible linkers, shown as dotted lines, as these regions were not resolved in the crystal structure of an intact IgG (<xref ref-type="bibr" rid="bib57">Saphire et al., 2001</xref>). Disulfide bonds in the hinge region are shown as black lines. These diagrams are modeled based on the cryo-electron microscopy (cryo-EM) structure of SARS-CoV-2 S complexed with human C118 Fab (PDB ID 7RKV) and the crystal structure of human Fc (PDB ID 1FC1). IgGs shown in this figure represent either circulating antibodies (Abs) or membrane-bound B cell receptors (BCRs).</p></caption><graphic mimetype="image" mime-subtype="tiff" xlink:href="elife-108959-fig5-figsupp1-v1.tif"/></fig><fig id="fig5s2" position="float" specific-use="child-fig"><label>Figure 5—figure supplement 2.</label><caption><title>Cryo-electron microscopy (cryo-EM) data collection and processing for heterotrimeric and control SARS-CoV-2 S structures.</title><p>Representative micrographs, workflow for single-particle data processing, and final reconstructions are shown for SARS-CoV-2 (<bold>A</bold>) Wu1/BA.1 S HT2 heterotrimer, (<bold>B</bold>) Wu1/BA.1/Delta S HT3 heterotrimer, and homotrimer S controls, including (<bold>C</bold>) Wu1 His/StrepII double-tag control, (<bold>D</bold>) StrepII-tagged Wu1, (<bold>E</bold>) His-tagged BA.1, and (<bold>F</bold>) D7324-tagged Delta constructs.</p></caption><graphic mimetype="image" mime-subtype="tiff" xlink:href="elife-108959-fig5-figsupp2-v1.tif"/></fig></fig-group><p>HT2 and HT3 S proteins were then evaluated using single-particle cryo-EM to determine whether heterotrimeric Ss resembling their homotrimeric counterparts were formed. To ensure that C-terminal tags did not disrupt the formation of trimers, we included the following controls: (i) three homotrimers with single tags (StrepII-tagged Wu1 S, His-tagged BA.1 S, and D7324-tagged Delta S) and (ii) a homotrimer comprised of His- and StrepII-tagged protomers (Wu1-His/Wu1-StrepII). Single-particle cryo-EM analysis confirmed that all control S proteins formed trimers, indicating that C-terminal tags did not disrupt trimerization (<xref ref-type="fig" rid="fig5s2">Figure 5—figure supplement 2</xref>). Because most of the EM constructions for homotrimeric S controls exhibited preferred orientations, we determined overall conformational states (<xref ref-type="fig" rid="fig5">Figure 5</xref>) for the control structures but did not fit atomic models. Structural analysis also revealed trimerized HT2 and HT3 Ss (<xref ref-type="fig" rid="fig5">Figure 5B and C</xref>; <xref ref-type="fig" rid="fig5s2">Figure 5—figure supplement 2</xref>). Although atomic models could not be built for the HT2 and HT3 trimer reconstructions because the identities of individual protomers (Wu1 or BA.1 for HT2, and Wu1, BA.1, or Delta for HT3) could not be conclusively determined at relatively low resolution, the EM densities of S heterotrimers and control homotrimers showed no major conformational differences in domain organization (<xref ref-type="fig" rid="fig5">Figure 5B and C</xref>; <xref ref-type="fig" rid="fig5s2">Figure 5—figure supplement 2</xref>). As previously seen in SARS-CoV-2 S trimer structures (<xref ref-type="bibr" rid="bib65">Walls et al., 2020</xref>; <xref ref-type="bibr" rid="bib72">Wrapp et al., 2020</xref>), we observed two trimer populations in all datasets—one with all three RBDs in the ‘down’ conformation and one with a single RBD in an ‘up’ conformation (<xref ref-type="fig" rid="fig5">Figure 5D</xref>). These data demonstrate heterotrimeric S formation for soluble forms of SARS-CoV-2 S proteins. This result suggests that the bivalent S or S-EABR mRNA-LNP boost immunogens likely induce heterotrimerization, which could promote activation of cross-reactive B cells through intra-S crosslinking, a potential mechanism warranting further investigation.</p></sec></sec><sec id="s3" sec-type="discussion"><title>Discussion</title><p>The EABR mRNA vaccine platform delivers mRNA encoding engineered immunogens that induce budding of eVLPs from the plasma membrane to promote presentation of immunogens on cell surfaces and eVLPs (<xref ref-type="bibr" rid="bib28">Hoffmann et al., 2023</xref>). This approach elicited superior neutralizing Ab responses in naïve mice compared to a conventional mRNA vaccine against original and variant SARS-CoV-2 (<xref ref-type="bibr" rid="bib28">Hoffmann et al., 2023</xref>). However, the majority of the human population has already mounted immune responses against SARS-CoV-2 through prior vaccinations, natural infections, or a combination of both. Here, we demonstrate that the EABR mRNA vaccine approach improves humoral immune responses elicited by monovalent and bivalent mRNA-LNP booster immunizations against Omicron subvariants in pre-vaccinated mice.</p><p>The possibility of receiving a third dose of the original COVID-19 mRNA vaccine in fall 2021 (<xref ref-type="bibr" rid="bib3">Andrews et al., 2022b</xref>) coincided with the emergence of the Omicron variants in November 2021 (<xref ref-type="bibr" rid="bib71">WHO, 2021</xref>). These variants had acquired many substitutions, especially in the RBD, which allowed efficient evasion of Ab-mediated immunity (<xref ref-type="bibr" rid="bib39">Liu et al., 2022</xref>; <xref ref-type="bibr" rid="bib10">Cele et al., 2022</xref>) and rapid global spread. Similar to the effects of a third vaccination in humans (<xref ref-type="bibr" rid="bib26">Gruell et al., 2022</xref>), a third immunization in pre-vaccinated mice with a monovalent Wu1 S mRNA-LNP booster elicited modest neutralizing activity against the early Omicron variants BA.1 and BA.5. However, the addition of an EABR sequence (<xref ref-type="bibr" rid="bib28">Hoffmann et al., 2023</xref>) to the boosting immunogen resulted in higher Ab neutralizing titers against BA.1 and BA.5, suggesting that a monovalent Wu1 S-EABR booster could have promoted enhanced protection against early Omicron variants. Importantly, the monovalent Wu1 S-EABR mRNA-LNP booster elicited similar neutralizing responses against the BA.5, BQ.1.1, and XBB.1 subvariants compared to the conventional bivalent S mRNA-LNP booster that contained both Wu1 and BA.5 S immunogens.</p><p>While updating of mRNA vaccines can be done relatively quickly, the development, clinical testing, approval, and large-scale manufacturing of a bivalent booster that includes updated immunogens based on new circulating variants cannot be accomplished fast enough to keep up with viral evolution during a global pandemic such as COVID-19. Indeed, the Wu1/BA.5 bivalent booster became available in fall 2022, almost 1 year after the emergence of Omicron variants (<xref ref-type="bibr" rid="bib59">Song et al., 2024</xref>). The results reported here suggest that the EABR mRNA vaccine approach presents a potential solution that could reduce the need for frequent development of updated COVID-19 boosters and potentially future pandemic viruses. Combined with our previous finding that an initial two-shot vaccination series with a Wu1 S-EABR mRNA-LNP immunogen elicited substantially higher neutralizing activity against Omicron variants than conventional Wu1 S mRNA-LNP immunizations in naïve mice (<xref ref-type="bibr" rid="bib28">Hoffmann et al., 2023</xref>), our results demonstrate that the EABR mRNA vaccine approach has the potential to induce more effective and lasting humoral immunity against emerging SARS-CoV-2 variants and represents a promising platform for future pandemic preparedness.</p><p>Clinical studies showed that the bivalent COVID-19 mRNA booster outperformed the monovalent mRNA booster in terms of preventing symptomatic illness, hospitalizations, and deaths when administered as a fourth dose in humans (<xref ref-type="bibr" rid="bib59">Song et al., 2024</xref>; <xref ref-type="bibr" rid="bib62">Tan et al., 2023</xref>). Consistent with other studies (<xref ref-type="bibr" rid="bib58">Scheaffer et al., 2023</xref>; <xref ref-type="bibr" rid="bib35">Khoury et al., 2023</xref>; <xref ref-type="bibr" rid="bib11">Chalkias et al., 2022</xref>; <xref ref-type="bibr" rid="bib17">Collier et al., 2023</xref>; <xref ref-type="bibr" rid="bib20">Davis-Gardner et al., 2023</xref>), the bivalent conventional and EABR-based boosters evaluated in this study elicited higher neutralizing responses against Omicron subvariants than their monovalent counterparts in pre-vaccinated mice, although improvements were relatively modest. However, the bivalent Wu1/BA.5 S-EABR mRNA-LNP booster consistently elicited the highest RBD binding and neutralizing titers against all tested Omicron subvariants and induced robust neutralizing responses in the highest number of animals against the BQ.1.1 and XBB.1 variants that are particularly difficult to neutralize (<xref ref-type="bibr" rid="bib69">Wang et al., 2023c</xref>; <xref ref-type="bibr" rid="bib43">Miller et al., 2023</xref>). These results highlight that the EABR mRNA vaccine approach and the bivalent booster strategy work synergistically to induce more effective humoral immune responses.</p><p>In addition to eliciting the most potent neutralizing responses against Omicron subvariants, the bivalent Wu1/BA.5 S-EABR mRNA-LNP booster also induced distinct DMS signatures compared to the other boost immunogens, consistent with differences in epitope mapping of polyclonal anti-RBD Ab responses. While the monovalent Wu1 S and S-EABR mRNA-LNP and the bivalent Wu1/BA.5 S mRNA-LNP boosters elicited predominantly class 1 and class 2 responses against Wu1 RBD and strong class 5 responses against XBB.1.5 RBD, boost immunizations with bivalent Wu1/BA.5 S-EABR mRNA-LNP elicited polyclass serum Ab responses against Wu1 RBD and mostly polyclass or moderate polyclass class 4 and class 5 responses against XBB.1.5 RBD. These results imply that combining the bivalent booster strategy with the EARB mRNA vaccine approach elicited a more diversified Ab response, resulting in simultaneous and balanced targeting of multiple RBD epitopes. A more diverse anti-RBD Ab response might be desirable as viral immune evasion would require mutations in multiple sites, including the more conserved class 4 and 5 RBD epitopes. As a potential mechanism for the more frequent induction of polyclass-like Ab responses, we hypothesize that EABR eVLP formation promotes close proximity of Wu1 and BA.5 S trimers on densely coated eVLPs, consistent with cryo-electron tomography imaging of purified eVLPs showing that the density of S trimers was equivalent to or higher than that on SARS-CoV-2 virions (20–40 S trimers on 40–60 nm diameter eVLPs) (<xref ref-type="bibr" rid="bib28">Hoffmann et al., 2023</xref>). The high density of co-displayed Wu1 and BA.5 S trimers on eVLPs should facilitate inter-S crosslinking by BCRs that recognize epitopes that are conserved between Wu1 and BA.5 S trimers, leading to preferential activation of cross-reactive B cells. By comparison, conventional bivalent mRNA booster-mediated co-expression of Wu1 and BA.5 S trimers could result in lower S trimer density on cell surfaces that are crowded with endogenous membrane proteins, which could prevent efficient inter-S crosslinking.</p><p>As an additional mechanism for bivalent booster-induced preferential activation of cross-reactive B cells, we provide evidence that co-expression of ancestral and Omicron S results in heterotrimer formation that could promote intra-S crosslinking, i.e., simultaneous binding of both Fabs of a cross-reactive BCR to neighboring RBDs within the same S trimer. We previously postulated that intra-S crosslinking is possible for several anti-RBD Abs that target various RBD epitopes based on modeling of intact IgG structures onto cryo-EM structures of Fab-S complexes (<xref ref-type="bibr" rid="bib6">Barnes et al., 2020</xref>; <xref ref-type="bibr" rid="bib21">Fan et al., 2022</xref>). The conventional mRNA- and the EABR mRNA-based bivalent boost immunogens should promote similar degrees of heterotrimerization and intra-S crosslinking. While our RBD serum depletion assays showed that both bivalent boosters primarily elicited cross-neutralizing Abs that bind to the Wu1 and BA.5 RBDs, only the EABR mRNA-based bivalent booster induced predominantly polyclass DMS signatures. Thus, it is possible that the diversification of the anti-RBD Ab response observed for the bivalent EABR mRNA booster was primarily driven by inter-S crosslinking possibly in conjunction with intra-S crosslinking. Future studies are needed to investigate the impact of inter- and intra-S crosslinking on the activation of cross-reactive B cells and to evaluate whether the EABR mRNA vaccine approach can improve other types of bivalent and multivalent vaccines.</p><p>Although our results highlight the potential of the EABR mRNA vaccine approach in the context of pre-existing immunity, we observed that monovalent and bivalent EABR mRNA booster-induced humoral immune responses were still largely dictated by immunological imprinting resulting from the initial vaccination series. Post-boost BA.5 neutralizing responses were roughly an order of magnitude lower than Wu1 neutralization titers, even for bivalent boosters that included BA.5 S immunogens. In addition, despite eliciting consistent polyclass anti-RBD Ab responses, bivalent EABR mRNA booster-induced neutralizing activity against the BQ.1.1 and XBB.1 variants dropped over 10-fold compared to BA.5 neutralization. Notably, Ab binding responses to BQ.1.1 and XBB.1 RBDs were similar compared to BA.5 RBD binding for all boost immunogens. This discrepancy between RBD binding responses and neutralization titers indicates that only a relatively small fraction of binding Abs has neutralizing activity and/or the Abs still bind to the BQ.1.1 and XBB.1 RBDs, but fail to effectively prevent interactions with ACE2 on the surface of target cells. The initial two-shot COVID-19 mRNA vaccination series and all booster immunizations elicited potent binding responses against the S2 region, which is relatively conserved among SARS-CoV-2 variants (<xref ref-type="bibr" rid="bib38">Li and Chang, 2023</xref>). Consistent with previous reports (<xref ref-type="bibr" rid="bib7">Bowen et al., 2022</xref>), our depletion studies showed that anti-S2 Abs had little impact on virus neutralization, which was instead predominantly driven by anti-RBD Abs. However, anti-S2 Abs could still provide valuable immune protection against symptomatic Omicron infections through Fc-mediated effector functions (<xref ref-type="bibr" rid="bib5">Balinsky et al., 2023</xref>). In addition, mRNA vaccines induce potent cytotoxic T cell responses that cross-recognize Omicron variants (<xref ref-type="bibr" rid="bib34">Keeton et al., 2022</xref>) and reduce COVID-19 disease severity (<xref ref-type="bibr" rid="bib55">Rydyznski Moderbacher et al., 2020</xref>).</p><p>Taken together, our results demonstrate that the EABR mRNA vaccine approach improves monovalent and bivalent booster-mediated humoral immune responses against Omicron subvariants in pre-vaccinated mice. DMS epitope mapping studies further showed that the bivalent EABR mRNA booster elicited a more diversified anti-RBD Ab response than all other tested boost immunogens. Our work also provides evidence that bivalent mRNA booster immunizations promote heterotrimer formation, which could activate cross-reactive B cells through intra-S crosslinking. Despite these advances, future work is needed to develop booster strategies that overcome immunological imprinting more effectively and confer lasting immunity against emerging variants.</p><sec id="s3-1"><title>Limitations of the study</title><p>Due to the substantial time required to conduct immunization studies in pre-vaccinated mice, this proof-of-concept study to evaluate the potential of EABR-modified boosters in the context of pre-existing immunity was performed using outdated SARS-CoV-2 variants. Future studies are needed to assess EABR booster responses against currently circulating variants. While the monovalent Wu1 S-EABR mRNA-LNP booster elicited robust improvements in neutralization titers against BA.1 and BA.5 compared to the conventional Wu1 S mRNA-LNP booster, consistent with previously reported results in naïve mice (<xref ref-type="bibr" rid="bib28">Hoffmann et al., 2023</xref>), only modest and statistically nonsignificant increases were observed for later Omicron variants, such as BQ.1.1 and XBB.1. Moreover, although the bivalent Wu1/BA.5 S-EABR mRNA-LNP booster consistently induced the highest neutralizing titers across all tested variants, these increases were statistically significant only relative to the conventional monovalent Wu1 S mRNA-LNP and not the bivalent Wu1/BA.5 S mRNA-LNP booster. Larger mouse cohorts could have increased the statistical power of the study, such that the observed trends might have reached statistical significance. Another factor contributing to the relatively modest improvements elicited by the monovalent and bivalent EABR boosters against BQ.1.1 and XBB.1 was the generally low levels of neutralizing responses observed against these variants. Although the low neutralization activity against BQ.1.1 and XBB.1 was likely the result of immune imprinting caused by the initial vaccination series, addition of more cohorts might have excluded the possibility that the ancestral Wu1 S immunogen is more immunogenic than the Omicron BA.5 S immunogen, e.g., three immunizations with monovalent BA.5 S or bivalent Wu1/BA.5 S mRNA-LNP. However, this is unlikely since prior studies reported that ancestral and Omicron S immunogens are similarly immunogenic (<xref ref-type="bibr" rid="bib58">Scheaffer et al., 2023</xref>; <xref ref-type="bibr" rid="bib44">Muik et al., 2022</xref>; <xref ref-type="bibr" rid="bib73">Ying et al., 2022</xref>). Finally, it remains unclear why the polyclonal RBD epitope-targeting response elicited by the bivalent Wu1/BA.5 S-EABR mRNA-LNP booster translated into only modest gains in neutralizing activity against Omicron variants. It is possible that a longer post-boost follow-up period or an additional booster incorporating an XBB.1 S immunogen would have revealed further maturation and expansion of these responses, and thereby additional benefits of the bivalent EABR booster.</p></sec></sec><sec id="s4" sec-type="methods"><title>Methods</title><sec id="s4-1"><title>Design of EABR constructs</title><p>SARS-CoV-2 S-EABR constructs were designed as described (<xref ref-type="bibr" rid="bib28">Hoffmann et al., 2023</xref>). The EABR domain (residues 160–217) of the human CEP55 protein was fused to the C-terminus of the SARS-CoV-2 S protein obtained from the Wu1 (GenBank: QTA38991.1) or BA.5 (GenBank: UPP14409.1) variants separated by a 4-residue (Gly)<sub>3</sub>Ser (GS) linker (<xref ref-type="fig" rid="fig1s1">Figure 1—figure supplement 1A</xref>). These constructs contained the native furin cleavage site, 2P stabilizing mutations (<xref ref-type="bibr" rid="bib47">Pallesen et al., 2017</xref>), and the C-terminal 21 residues were truncated to remove an endoplasmic reticulum retention signal (<xref ref-type="bibr" rid="bib41">McBride et al., 2007</xref>). The D614G substitution (<xref ref-type="bibr" rid="bib36">Korber et al., 2020</xref>), naturally present in BA.5, was inserted into Wu1 S and S-EABR constructs. To prevent endocytosis and enhance the cell surface expression of S-EABR constructs, an EPM (residues 243–290 of mouse FcgRII-B1) (<xref ref-type="bibr" rid="bib28">Hoffmann et al., 2023</xref>; <xref ref-type="bibr" rid="bib42">Miettinen et al., 1989</xref>) was inserted upstream of the 4-residue Gly-Ser linker and the EABR domain as described (<xref ref-type="bibr" rid="bib28">Hoffmann et al., 2023</xref>; <xref ref-type="fig" rid="fig1s1">Figure 1—figure supplement 1A</xref>).</p></sec><sec id="s4-2"><title>In vitro transfection</title><p>To verify that the designed constructs induce eVLP budding, HEK293T cells were transiently transfected with DNA plasmids encoding Wu1 or BA.5 S-EABR using Fugene HD (Promega). After 48 hr, transfected cell supernatants were harvested, and eVLPs were purified by ultracentrifugation on a 20% sucrose cushion as described (<xref ref-type="bibr" rid="bib28">Hoffmann et al., 2023</xref>). The purified eVLP fractions were 3-fold serially diluted in 0.1 M NaHCO<sub>3</sub> pH 9.6, directly coated onto Costar high-binding 96-well plates (Corning), and eVLP-associated S protein levels were quantified by ELISA. After 1 hr blocking in Tris-buffered saline with 0.1% Tween 20 (TBS-T) and 3% bovine serum albumin (BSA) (TBS-T/3% BSA) at room temperature, the monoclonal anti-S2 Ab S2P6 (<xref ref-type="bibr" rid="bib50">Pinto et al., 2021</xref>) was diluted to a concentration of 5 µg/mL in TBS-T/3% BSA and added to plates for 1 hr at room temperature. After washing with TBS-T, HRP-conjugated goat anti-human IgG (2015-05; SouthernBiotech) was diluted 1:8000 in TBS-T/3% BSA and added to plates for 30 min at room temperature. After washing with TBS-T, plates were developed using 1-Step Ultra TMB-ELISA Substrate Solution (Thermo Fisher Scientific), and absorbance was measured at 450 nm.</p></sec><sec id="s4-3"><title>mRNA synthesis</title><p>Codon-optimized mRNAs encoding Wu1 S, Wu1 S-EABR, BA.5 S, and BA.5 S-EABR constructs were synthesized by RNAcore (<ext-link ext-link-type="uri" xlink:href="https://www.houstonmethodist.org/research-cores/rnacore/">https://www.houstonmethodist.org/research-cores/rnacore/</ext-link>) using proprietary manufacturing protocols as described (<xref ref-type="bibr" rid="bib28">Hoffmann et al., 2023</xref>). In brief, mRNAs were synthesized by T7 RNA polymerase-mediated in vitro transcription using DNA templates encoding the immunogen open reading frame flanked by 5′ and 3’ untranslated regions and terminated by an encoded polyA tail. CleanCap 5’ cap structures (TriLink) were co-transcriptionally incorporated into the 5′ end. Uridine was completely substituted with N1-methyl-pseudouridine to lower immunogenicity (<xref ref-type="bibr" rid="bib32">Karikó et al., 2008</xref>). mRNAs were purified by oligo-dT affinity purification and high-performance liquid chromatography to remove double-stranded RNA contaminants (<xref ref-type="bibr" rid="bib33">Karikó et al., 2011</xref>). Purified mRNAs were stored at –80°C.</p></sec><sec id="s4-4"><title>LNP encapsulation of mRNAs</title><p>Purified mRNAs were formulated in LNP as described (<xref ref-type="bibr" rid="bib28">Hoffmann et al., 2023</xref>; <xref ref-type="bibr" rid="bib48">Pardi et al., 2015</xref>). In brief, 1,2-distearoyl-<italic>sn</italic>-glycero-3-phosphocholine, cholesterol, a PEG lipid, and an ionizable cationic lipid dissolved in ethanol were rapidly mixed with an aqueous acidic solution containing the mRNAs using an in-line mixer. The ionizable lipid and LNP composition are described in the international patent application WO2017075531(2017). The post in-line solution was dialyzed with PBS to remove ethanol and displace the acidic solution. Subsequently, mRNA-LNPs were measured for size (60–65 nm) and polydispersity (PDI&lt;0.075) by dynamic light scattering (Malvern Nano ZS Zetasizer). The encapsulation efficiencies were &gt;97% as measured by the Quant-iT Ribogreen Assay (Invitrogen).</p></sec><sec id="s4-5"><title>Immunizations</title><p>All animal procedures in this study were performed in compliance with the U.S. Department of Agriculture’s (USDA) Animal Welfare Act (9 CFR Parts 1, 2, and 3), the Guide for the Care and Use of Laboratory Animals (Institute of Laboratory Animal Resources, National Academy Press, Washington, DC, 2011), and the National Institutes of Health, Office of Laboratory Animal Welfare. Whenever possible, procedures in this study were designed to avoid or minimize discomfort, distress, and pain to animals. Animals were observed for signs of morbidity and/or mortality at least once daily, in accordance with the Animal Welfare Act and the Association for Assessment and Accreditation of Laboratory Animal Care International (AAALACi). All mouse procedures were approved by the Labcorp Institutional Animal Care and Use Committee (IACUC).</p><p>7- to 8-week-old female BALB/c mice (Charles River Laboratories) were purchased and housed at Labcorp Drug Development, Denver, PA, for immunization studies. All animals were healthy upon receipt and were weighed and monitored during a 7-day acclimation period before the start of the study. Mice were randomly assigned to experimental cohorts of 10 animals. Up to 10 mice were co-housed together, and cages were kept in a climate-controlled room at 63–77°C at 50 ± 20% relative humidity. Mice were provided Rodent Diet #5001 (Purina Lab Diet) ad libitum.</p><p>2 µg of Wu1 S mRNA-LNP were administered to all cohorts of mice by IM injections on days 0 and 28. On day 230, pre-vaccinated mice received different boosters by IM injection: (i) 2 µg Wu1 S mRNA-LNP; (ii) 2 µg Wu1 S-EABR mRNA-LNP; (iii) 1 µg Wu1 S mRNA-LNP+1 µg BA.5 S mRNA-LNP; (iv) 1 µg Wu1 S-EABR mRNA-LNP+1 µg BA.5 S-EABR mRNA-LNP. For bivalent boosters (iii and iv), the Wu1 and BA.5 S or S-EABR mRNA-LNP were mixed prior to the IM injections. Serum samples for ELISAs and neutralization assays were obtained on indicated days by retro-orbital bleeding. One small drop of either 0.5% proparacaine hydrochloride ophthalmic solution or 0.5% tetracaine hydrochloride ophthalmic solution was applied in the eye of the mouse prior to performing retro-orbital blood collection. Eyes were alternated for each blood collection. Euthanasia was performed in accordance with the American Veterinary Medical Association (AVMA) guidelines for euthanasia. Mice were individually placed in a CO<sub>2</sub> chamber and rendered unconscious. Mice were verified as unconscious by lack of response when the toe was pinched. Unconscious mice were subjected to bilateral jugular vein severance for terminal exsanguination. Mice were placed back in the CO<sub>2</sub> chamber until death occurred. A double thoracotomy was performed as a second confirmation of death.</p></sec><sec id="s4-6"><title>Protein expression and purification</title><p>Soluble SARS-CoV-2 S trimers (Wu1/D614G, BA.5, BQ.1.1, XBB.1) (<xref ref-type="bibr" rid="bib30">Hsieh et al., 2020</xref>), RBDs (Wu1, BA.5, BQ.1.1, XBB.1), and a prefusion-stabilized S2 protein (<xref ref-type="bibr" rid="bib31">Hsieh et al., 2024</xref>) were expressed as described (<xref ref-type="bibr" rid="bib66">Wang et al., 2022</xref>; <xref ref-type="bibr" rid="bib15">Cohen et al., 2022</xref>). Briefly, Avi/His-tagged S trimers and His-tagged RBD and S2 proteins were purified from transiently transfected Expi293F cells (A14527; Thermo Fisher; authenticated by supplier; negative for mycoplasma) by nickel affinity chromatography (HisTrap, Cytiva) and size-exclusion chromatography (SEC) (Superose 6 Increase 10/300, Cytiva) (<xref ref-type="bibr" rid="bib6">Barnes et al., 2020</xref>; <xref ref-type="bibr" rid="bib66">Wang et al., 2022</xref>; <xref ref-type="bibr" rid="bib15">Cohen et al., 2022</xref>). Peak fractions corresponding to S, RBD, or S2 proteins were pooled, concentrated, and stored at 4°C. Biotinylated S trimers for ELISAs were generated by co-transfection of Avi/His-tagged S constructs with a plasmid encoding an endoplasmic reticulum-directed BirA enzyme (kind gift from Michael Anaya, Caltech).</p><p>For heterotrimeric constructs, Wu1/BA.1 (HT2) and Wu1/BA.1/Delta (HT3) heterotrimers were expressed via the addition of C-terminal tags and co-transfection of Expi293F cells (Gibco) with specific plasmid DNA ratios. HT2 heterotrimers were produced by co-transfecting a 1:1 plasmid DNA ratio of StrepII-tagged Wu1 S and His-tagged BA.1 S constructs. HT3 heterotrimers were produced by co-transfecting a 1:1:1 plasmid DNA ratio of StrepII-tagged Wu1 S, His-tagged BA.1 S, and D7324 (<xref ref-type="bibr" rid="bib56">Sanders et al., 2013</xref>)-tagged Delta S constructs. HT2 was sequentially purified using StrepTrap (Cytiva), HisTrap (Cytiva), and SEC, while HT3 also underwent immunoaffinity chromatography using the D7324-specific monoclonal Ab JR-52 (<xref ref-type="bibr" rid="bib56">Sanders et al., 2013</xref>) (kind gift from James Robinson, Tulane University) before SEC.</p><p>The Wu1-His/Wu1-StrepII S homotrimer was generated by co-transfecting Expi293F cells with a 1:1 plasmid DNA ratio of His-tagged Wu1 S and StrepII-tagged Wu1 S, followed by purification as described for the HT2 heterotrimer. Single-tagged S homotrimers included StrepII-tagged Wu1 S, His-tagged BA.1 S, and D7324-tagged Delta S, each purified using their respective affinity chromatography steps followed by SEC.</p></sec><sec id="s4-7"><title>Single-particle cryo-EM sample preparation</title><p>Grids of SARS-CoV-2 S homotrimers and heterotrimers were prepared at a protein concentration of 2 mg/mL. Prior to freezing, fluorinated octylmaltoside solution (Anatrace) was added to the S proteins at a final concentration of 0.02%(wt/vol). Three µL of S proteins were immediately applied to Quantifoil 300 mesh 1.2/1.3 grids (Electron Microscopy Sciences) that were freshly glow-discharged with the PELCO easiGLOW (Ted Pella) for 60 s at 20 mA. Grids were blotted for 3 s using Whatman No.1 filter paper with 0 blot force, 100% humidity, and room temperature, and vitrified in 100% liquid ethane using a Vitrobot Mark IV system (Thermo Fisher Scientific).</p></sec><sec id="s4-8"><title>Single-particle cryo-EM data collection and processing</title><p>Single-particle cryo-EM datasets for SARS-CoV-2 S homotrimers and heterotrimers were collected using SerialEM automatic data collection software (<xref ref-type="bibr" rid="bib40">Mastronarde, 2005</xref>) on a 300 keV Titan Krios (Thermo Fisher Scientific) cryo-electron microscope equipped with a K3 direct electron detector camera (Gatan). Movies were acquired in 40 frames with a defocus range of –1 to –3 µm and a total dosage of 60 electrons per Å<sup>2</sup> using the 3 by 3 beam image shift pattern with 3 exposures per hole in the super-resolution mode at a pixel size of 0.416 Å. Data processing workflows are outlined in <xref ref-type="fig" rid="fig5s2">Figure 5—figure supplement 2</xref>. For all datasets, motion correction was done with patch motion correction with a binning factor of 2, and contrast transfer function (CTF) parameters were estimated with Patch CTF in cryoSPARC (<xref ref-type="bibr" rid="bib53">Punjani et al., 2017</xref>). Particles with a diameter of 100–200 Å were picked with a blob picker, inspected, extracted, and finally classified with 2D classification in cryoSPARC (<xref ref-type="bibr" rid="bib53">Punjani et al., 2017</xref>). Ice particles, junk particles, and particles with preferred orientations were discarded, and the remaining particles were used for ab initio reconstruction of three to four volumes. These reconstructions were further refined with heterogeneous refinement in cryoSPARC (<xref ref-type="bibr" rid="bib53">Punjani et al., 2017</xref>). Depending on the state for the RBDs in the reconstructions, particles were combined for homogeneous and nonuniform refinements to obtain the final reconstructions in cryoSPARC (<xref ref-type="bibr" rid="bib53">Punjani et al., 2017</xref>).</p></sec><sec id="s4-9"><title>ELISAs</title><p>ELISAs were performed as described (<xref ref-type="bibr" rid="bib28">Hoffmann et al., 2023</xref>; <xref ref-type="bibr" rid="bib16">Cohen et al., 2024</xref>). To analyze serum binding to S trimers, pre-blocked streptavidin-coated Nunc MaxiSorp 384-well plates (Thermo Fisher Scientific) were coated with 5 µg/mL biotinylated S trimers in TBS-T/3% BSA for 1 hr at room temperature. To analyze serum binding to RBDs or S2, Nunc MaxiSorp 384-well plates (Sigma) were coated with 2.5 µg/mL RBD or S2 in 0.1 M NaHCO<sub>3</sub> pH 9.8 and incubated overnight at 4°C. Plates were blocked with TBS-T/3% BSA for 1 hr at room temperature followed by removal of the blocking buffer by aspiration. Serum samples from immunized mice were diluted 1:100, 4-fold serially diluted in TBS-T/3% BSA, and added to plates. After a 3 hr incubation at room temperature, plates were washed with TBS-T using an automated plate washer. HRP-conjugated goat anti-mouse IgG (715-035-150; Jackson ImmunoResearch) was diluted 1:100,000 in TBS-T/3% BSA and added to plates for 1 hr at room temperature. After washing with TBS-T, plates were developed using SuperSignal ELISA Femto Maximal Signal Substrate (Thermo Fisher Scientific), and absorbance was measured at 425 nm. Area under the curve calculations for binding curves were performed using GraphPad Prism 9.3.1 assuming a one-site binding model with a Hill coefficient as described (<xref ref-type="bibr" rid="bib14">Cohen et al., 2021</xref>).</p></sec><sec id="s4-10"><title>Neutralization assays</title><p>Lentivirus-based SARS-CoV-2 pseudoviruses were generated as described (<xref ref-type="bibr" rid="bib19">Crawford et al., 2020</xref>; <xref ref-type="bibr" rid="bib54">Robbiani et al., 2020</xref>) using S proteins from the Wu1/D614G, BA.1, BA.5, BQ.1.1, and XBB.1 variants in which the C-terminal 21 residues of the S cytoplasmic tails were removed (<xref ref-type="bibr" rid="bib19">Crawford et al., 2020</xref>). Serum samples from immunized mice were heat-inactivated for 30 min at 56°C. Three-fold serial dilutions of heat-inactivated samples were incubated with pseudoviruses for 1 hr at 37°C, followed by the addition of the serum-virus mixtures to pre-seeded HEK293T-ACE2 target cells. After 48 hr incubation at 37°C, BriteLite Plus substrate (Perkin Elmer) was added, and luminescence was measured. Half-maximal inhibitory dilutions (ID<sub>50</sub>s) were calculated using 4-parameter nonlinear regression analysis in AntibodyDatabase (<xref ref-type="bibr" rid="bib70">West et al., 2013</xref>), and ID<sub>50</sub> values were rounded to three significant figures.</p></sec><sec id="s4-11"><title>Ab depletions</title><p>HiTrap NHS-activated resin (Cytiva) was coupled to purified SARS-CoV-2 Wu1 RBD or a mock protein (HIV-1 gp120) at a 10 mg/mL concentration and stored in PBS supplemented with 0.02% sodium azide at 4°C. For Ab depletions, 50 µL dry worth of RBD-coupled resin were aliquoted into microcentrifuge tubes and spun down at 13,000 × <italic>g</italic> for 2 min. The supernatant was discarded. The resin was washed with 100 µL of sterile PBS to remove excess PBS-azide solution. The supernatant was again discarded. 10 µL of mouse serum was then diluted in 90 µL PBS and added to the resin. The tubes were mixed and incubated at room temperature for 10 min. The resin-serum mixture was spun down at 13,000 × <italic>g</italic> for 7 min to allow the resin to settle, and 90 µL of the supernatant was transferred into a fresh microcentrifuge tube. To ensure no resin was present in the final sample, the collection tube was spun down again, and supernatant was transferred to a fresh microcentrifuge tube. Sterile PBS was added for a final volume of 200 µL. Prior to neutralization assays, the Ab-depleted serum samples were heat-inactivated at 56°C for 30 min.</p></sec><sec id="s4-12"><title>Deep mutational scanning</title><p>DMS studies to map RBD epitopes recognized by serum Abs were performed in biological duplicates using independent mutant RBD yeast libraries (Wu1 [<xref ref-type="bibr" rid="bib60">Starr et al., 2020</xref>; <xref ref-type="bibr" rid="bib61">Starr et al., 2022</xref>] and XBB.1.5 RBD [<xref ref-type="bibr" rid="bib63">Taylor and Starr, 2023</xref>] libraries were generously provided by Tyler Starr, University of Utah) as described (<xref ref-type="bibr" rid="bib16">Cohen et al., 2024</xref>; <xref ref-type="bibr" rid="bib15">Cohen et al., 2022</xref>; <xref ref-type="bibr" rid="bib24">Greaney et al., 2021a</xref>; <xref ref-type="bibr" rid="bib27">Hills et al., 2024</xref>). Briefly, yeast libraries were stained with serum Abs, labeled with a secondary Ab (115-605-008, Jackson ImmunoResearch), and then processed using a Sony SH800 cell sorter. Cells were gated to capture RBD mutants that had reduced Ab binding for a relatively high degree of RBD expression. Ab-escaped cells were expanded for DNA extraction, and Illumina sequencing was done as described (<xref ref-type="bibr" rid="bib16">Cohen et al., 2024</xref>; <xref ref-type="bibr" rid="bib24">Greaney et al., 2021a</xref>; <xref ref-type="bibr" rid="bib27">Hills et al., 2024</xref>). Raw sequencing data are available on the NCBI SRA under BioProject PRJNA1067836. Escape fractions were computed using previously described processing steps (<xref ref-type="bibr" rid="bib16">Cohen et al., 2024</xref>; <xref ref-type="bibr" rid="bib24">Greaney et al., 2021a</xref>; <xref ref-type="bibr" rid="bib27">Hills et al., 2024</xref>) and implemented using a Swift DMS program available from authors upon request.</p><p>Escape map visualizations shown as static line plots, logo plots, and structural depictions were all created using Swift DMS as previously described (<xref ref-type="bibr" rid="bib22">Fan et al., 2025</xref>; <xref ref-type="bibr" rid="bib16">Cohen et al., 2024</xref>; <xref ref-type="bibr" rid="bib27">Hills et al., 2024</xref>). In some visualizations, RBD sites were categorized based on epitope region, which were defined as class 1 (pink) (RBD residues 403, 405, 406, 417, 420, 421, 453, 455–460, 473–478, 486, 487, 489, 503, 504), class 2 (purple) (residues 472, 479, 483–485, 490–495), class 3 (blue) (residues 341, 345, 346, 437–450, 496, 498–501), class 4 (orange) (residues 365–390, 408) (<xref ref-type="bibr" rid="bib6">Barnes et al., 2020</xref>), or class 5 (green) (352–357, 396, 462–468) (<xref ref-type="bibr" rid="bib22">Fan et al., 2025</xref>). Structural visualizations were performed using an RBD surface (PDB 6M0J) colored by the site-wise escape metric at each site as described (<xref ref-type="bibr" rid="bib16">Cohen et al., 2024</xref>).</p></sec><sec id="s4-13"><title>Statistical analysis</title><p>Statistically significant titer differences between immunized cohorts of BALB/c mice (10 mice per cohort) for ELISAs were determined using analysis of variance (ANOVA) test followed by Tukey’s multiple comparison post hoc test calculated using GraphPad Prism 9.3.1. Titer differences between immunized cohorts of BALB/c mice for Wu1, BA.5, BQ.1.1, and XBB.1 neutralization assays were determined using the non-parametric Kruskal-Wallis test followed by Dunn’s multiple comparison post hoc test calculated using GraphPad Prism 9.3.1. For BA.1 neutralization titers, statistically significant differences were determined using the non-parametric two-tailed Mann-Whitney test calculated using GraphPad Prism 9.3.1.</p></sec></sec></body><back><sec sec-type="additional-information" id="s5"><title>Additional information</title><fn-group content-type="competing-interest"><title>Competing interests</title><fn fn-type="COI-statement" id="conf1"><p>No competing interests declared</p></fn><fn fn-type="COI-statement" id="conf2"><p>employee of Acuitas Therapeutics, a company developing lipid nanoparticle delivery technology</p></fn><fn fn-type="COI-statement" id="conf3"><p>employee of Acuitas Therapeutics, a company developing lipid nanoparticle delivery technology; holds equity in Acuitas Therapeutics</p></fn><fn fn-type="COI-statement" id="conf4"><p>inventor on a US patent application filed by the California Institute of Technology that covers the EABR technology described in this work; is a scientific advisor for Vaccine Company, Inc</p></fn><fn fn-type="COI-statement" id="conf5"><p>inventor on a US patent application filed by the California Institute of Technology that covers the EABR technology described in this work; is a scientific consultant for Vaccine Company, Inc</p></fn></fn-group><fn-group content-type="author-contribution"><title>Author contributions</title><fn fn-type="con" id="con1"><p>Conceptualization, Data curation, Formal analysis, Validation, Investigation, Visualization, Methodology, Writing – original draft, Writing – review and editing</p></fn><fn fn-type="con" id="con2"><p>Conceptualization, Data curation, Formal analysis, Supervision, Validation, Investigation, Visualization, Methodology, Writing – original draft, Writing – review and editing</p></fn><fn fn-type="con" id="con3"><p>Conceptualization, Data curation, Formal analysis, Validation, Investigation, Visualization, Methodology, Writing – original draft, Writing – review and editing</p></fn><fn fn-type="con" id="con4"><p>Data curation, Formal analysis, Investigation, Methodology</p></fn><fn fn-type="con" id="con5"><p>Data curation, Formal analysis, Investigation, Methodology</p></fn><fn fn-type="con" id="con6"><p>Data curation, Formal analysis, Validation, Investigation, Methodology</p></fn><fn fn-type="con" id="con7"><p>Data curation, Formal analysis, Investigation, Methodology</p></fn><fn fn-type="con" id="con8"><p>Data curation, Investigation, Methodology</p></fn><fn fn-type="con" id="con9"><p>Data curation, Formal analysis, Investigation, Methodology</p></fn><fn fn-type="con" id="con10"><p>Resources, Methodology</p></fn><fn fn-type="con" id="con11"><p>Resources, Methodology, Writing – review and editing</p></fn><fn fn-type="con" id="con12"><p>Conceptualization, Resources, Formal analysis, Supervision, Funding acquisition, Investigation, Visualization, Methodology, Writing – original draft, Project administration, Writing – review and editing</p></fn><fn fn-type="con" id="con13"><p>Conceptualization, Resources, Data curation, Formal analysis, Supervision, Funding acquisition, Validation, Investigation, Methodology, Writing – original draft, Project administration, Writing – review and editing</p></fn></fn-group><fn-group content-type="ethics-information"><title>Ethics</title><fn fn-type="other"><p>All animal procedures in this study were performed in compliance with the U.S. Department of Agriculture's (USDA) Animal Welfare Act (9 CFR Parts 1, 2, and 3); the Guide for the Care and Use of Laboratory Animals (Institute of Laboratory Animal Resources, National Academy Press, Washington, D.C., 2011); and the National Institutes of Health, Office of Laboratory Animal Welfare. Whenever possible, procedures in this study were designed to avoid or minimize discomfort, distress, and pain to animals. Animals were observed for signs of morbidity and/or mortality at least once daily, according to animal welfare act and the Association for Assessment and Accreditation of Laboratory Animal Care International (AAALACi). All mouse procedures were approved by the Labcorp Institutional Animal Care and Use Committee (IACUC).</p></fn></fn-group></sec><sec sec-type="supplementary-material" id="s6"><title>Additional files</title><supplementary-material id="supp1"><label>Supplementary file 1.</label><caption><title>Geometric mean neutralization titers.</title><p>Day 56, 154, and 244 geometric mean neutralization titers for cohorts 1–4 against the Wu1, BA.5, BQ.1.1, and XBB.1 variants.</p></caption><media xlink:href="elife-108959-supp1-v1.xlsx" mimetype="application" mime-subtype="xlsx"/></supplementary-material><supplementary-material id="supp2"><label>Supplementary file 2.</label><caption><title>Bivalent S-EABR mRNA-LNP booster induces consistent polyclass anti-receptor-binding domain (RBD) antibody (Ab) responses.</title><p>The deep mutational scanning (DMS) profiles for antisera from individual mice against the Wu1 and XBB.1.5 RBD libraries shown in <xref ref-type="fig" rid="fig4s1">Figure 4—figure supplements 1–2</xref> were classified as polyclass (total escape peaks&lt;1 at all sites; green), moderate escape (total escape peaks between 1 and 2 at one or more sites; yellow), or strong escape (total escape peaks &gt;2 at one or more sites; red) profiles. Total escape peaks represent the sum of escape fractions for all mutations at a specific site (<xref ref-type="bibr" rid="bib25">Greaney et al., 2021b</xref>). For moderate and strong escape profiles, the RBD epitope classes with the highest total escape peaks are specified.</p></caption><media xlink:href="elife-108959-supp2-v1.xlsx" mimetype="application" mime-subtype="xlsx"/></supplementary-material><supplementary-material id="mdar"><label>MDAR checklist</label><media xlink:href="elife-108959-mdarchecklist1-v1.docx" mimetype="application" mime-subtype="docx"/></supplementary-material></sec><sec sec-type="data-availability" id="s7"><title>Data availability</title><p>Code used for data processing and visualization of DMS results is available at <ext-link ext-link-type="uri" xlink:href="https://data.caltech.edu/">data.caltech.edu</ext-link> (DOI: <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.22002/j4k4w-p8331">https://doi.org/10.22002/j4k4w-p8331</ext-link>). DMS raw sequencing data is available under an NCBI SRA (BioProject: PRJNA1067836; BioSample: SAMN56741139; SRA: SRX32770151). Cryo-EM density maps are deposited in the EMDB with accession codes: EMD-71513, EMD-71514, EMD-71515 and EMD-71516. Materials are available upon request to corresponding authors with a signed material transfer agreement, and other information required to analyze the data in this paper is available from the lead contacts upon request. This paper does not report original code.</p><p>The following datasets were generated:</p><p><element-citation publication-type="data" specific-use="isSupplementedBy" id="dataset1"><person-group person-group-type="author"><collab>California Institute of Technology</collab></person-group><year iso-8601-date="2026">2026</year><data-title>SARS-CoV-2 RBD mutational antig Illumina barcode sequencing for XBB15_22_gp8_81_250_abneg</data-title><source>NCBI Sequence Read Archive</source><pub-id pub-id-type="accession" xlink:href="https://www.ncbi.nlm.nih.gov/sra/SRX32770151">SRX32770151</pub-id></element-citation></p><p><element-citation publication-type="data" specific-use="isSupplementedBy" id="dataset2"><person-group person-group-type="author"><name><surname>Fan</surname><given-names>C</given-names></name><name><surname>Dam</surname><given-names>KA</given-names></name><name><surname>Bjorkman</surname><given-names>PJ</given-names></name></person-group><year iso-8601-date="2025">2025</year><data-title>SARS-CoV-2 Wuhan-Hu-1/BA.1 spike heterotrimer (HT2) with 3-'down' RBDs</data-title><source>EMDataBank</source><pub-id pub-id-type="accession" xlink:href="https://emdataresource.org/EMD-71513">EMD-71513</pub-id></element-citation></p><p><element-citation publication-type="data" specific-use="isSupplementedBy" id="dataset3"><person-group person-group-type="author"><name><surname>Fan</surname><given-names>C</given-names></name><name><surname>Dam</surname><given-names>KA</given-names></name><name><surname>Bjorkman</surname><given-names>PJ</given-names></name></person-group><year iso-8601-date="2025">2025</year><data-title>SARS-CoV-2 Wuhan-Hu-1/BA.1 spike heterotrimer (HT2) with 1-'up' RBD</data-title><source>EMDataBank</source><pub-id pub-id-type="accession" xlink:href="https://emdataresource.org/EMD-71514">EMD-71514</pub-id></element-citation></p><p><element-citation publication-type="data" specific-use="isSupplementedBy" id="dataset4"><person-group person-group-type="author"><name><surname>Fan</surname><given-names>C</given-names></name><name><surname>Dam</surname><given-names>KA</given-names></name><name><surname>Bjorkman</surname><given-names>PJ</given-names></name></person-group><year iso-8601-date="2025">2025</year><data-title>SARS-CoV-2 Wuhan-Hu-1/BA.1/Delta spike heterotrimer (HT3) with 3-'down' RBDs</data-title><source>EMDataBank</source><pub-id pub-id-type="accession" xlink:href="https://emdataresource.org/EMD-71515">EMD-71515</pub-id></element-citation></p><p><element-citation publication-type="data" specific-use="isSupplementedBy" id="dataset5"><person-group person-group-type="author"><name><surname>Fan</surname><given-names>C</given-names></name><name><surname>Dam</surname><given-names>KA</given-names></name><name><surname>Bjorkman</surname><given-names>PJ</given-names></name></person-group><year iso-8601-date="2025">2025</year><data-title>SARS-CoV-2 Wuhan-Hu-1/BA.1/Delta spike heterotrimer (HT3) with 1-'up' RBD</data-title><source>EMDataBank</source><pub-id pub-id-type="accession" xlink:href="https://emdataresource.org/EMD-71516">EMD-71516</pub-id></element-citation></p></sec><ack id="ack"><title>Acknowledgements</title><p>We thank J Vielmetter, A Lam, and the Caltech Protein Expression Center for assistance with protein production, S Chen and the Caltech Cryo-EM facility for cryo-EM data collection, M Anaya (Caltech) for a BirA expression plasmid, JE Robinson (Tulane University) for the JR-52 antibody, J Bloom (Fred Hutchinson Cancer Research Center) and T Starr (University of Utah) for RBD libraries, and J Bloom (Fred Hutchinson) and P Bieniasz (Rockefeller University) for neutralization assay reagents. We thank J Keeffe for guidance on ELISA method development, A West for Swift DMS support, Y Tam (Acuitas Therapeutics) for careful reading of the manuscript, B Wold, G Tolomiczenko, and the Caltech Merkin Institute for Translational Research for helpful discussions. Cryo-EM was performed in the Beckman Institute Resource Center for Transmission Electron Microscopy at Caltech. We thank Labcorp Drug Development–Antibody Reagents and Vaccines (Denver, PA) (formerly Covance, Inc) for mouse immunization studies, and RNAcore (Houston Methodist Research Institute) for synthesis of mRNAs and helpful discussion. These studies were funded by Wellcome Leap (PJB), the National Institutes of Health P01-AI165075 (PJB) and DP5OD033362 (MAGH), Gates Foundation INV-034638 (PJB) and INV-056219 (MAGH), the Merkin Institute for Translational Research (Caltech) (PJB), and the George Mason University Fast Grants (PJB). This manuscript is the result of funding in whole or in part by the National Institutes of Health (NIH). It is subject to the NIH Public Access Policy. Through acceptance of this federal funding, NIH has been given a right to make this manuscript publicly available in PubMed Central upon the Official Date of Publication, as defined by NIH.</p></ack><ref-list><title>References</title><ref id="bib1"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Alsoussi</surname><given-names>WB</given-names></name><name><surname>Malladi</surname><given-names>SK</given-names></name><name><surname>Zhou</surname><given-names>JQ</given-names></name><name><surname>Liu</surname><given-names>Z</given-names></name><name><surname>Ying</surname><given-names>B</given-names></name><name><surname>Kim</surname><given-names>W</given-names></name><name><surname>Schmitz</surname><given-names>AJ</given-names></name><name><surname>Lei</surname><given-names>T</given-names></name><name><surname>Horvath</surname><given-names>SC</given-names></name><name><surname>Sturtz</surname><given-names>AJ</given-names></name><name><surname>McIntire</surname><given-names>KM</given-names></name><name><surname>Evavold</surname><given-names>B</given-names></name><name><surname>Han</surname><given-names>F</given-names></name><name><surname>Scheaffer</surname><given-names>SM</given-names></name><name><surname>Fox</surname><given-names>IF</given-names></name><name><surname>Mirza</surname><given-names>SF</given-names></name><name><surname>Parra-Rodriguez</surname><given-names>L</given-names></name><name><surname>Nachbagauer</surname><given-names>R</given-names></name><name><surname>Nestorova</surname><given-names>B</given-names></name><name><surname>Chalkias</surname><given-names>S</given-names></name><name><surname>Farnsworth</surname><given-names>CW</given-names></name><name><surname>Klebert</surname><given-names>MK</given-names></name><name><surname>Pusic</surname><given-names>I</given-names></name><name><surname>Strnad</surname><given-names>BS</given-names></name><name><surname>Middleton</surname><given-names>WD</given-names></name><name><surname>Teefey</surname><given-names>SA</given-names></name><name><surname>Whelan</surname><given-names>SPJ</given-names></name><name><surname>Diamond</surname><given-names>MS</given-names></name><name><surname>Paris</surname><given-names>R</given-names></name><name><surname>O’Halloran</surname><given-names>JA</given-names></name><name><surname>Presti</surname><given-names>RM</given-names></name><name><surname>Turner</surname><given-names>JS</given-names></name><name><surname>Ellebedy</surname><given-names>AH</given-names></name></person-group><year iso-8601-date="2023">2023</year><article-title>SARS-CoV-2 Omicron boosting induces de novo B cell response in humans</article-title><source>Nature</source><volume>617</volume><fpage>592</fpage><lpage>598</lpage><pub-id pub-id-type="doi">10.1038/s41586-023-06025-4</pub-id><pub-id pub-id-type="pmid">37011668</pub-id></element-citation></ref><ref id="bib2"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Andrews</surname><given-names>N</given-names></name><name><surname>Stowe</surname><given-names>J</given-names></name><name><surname>Kirsebom</surname><given-names>F</given-names></name><name><surname>Toffa</surname><given-names>S</given-names></name><name><surname>Rickeard</surname><given-names>T</given-names></name><name><surname>Gallagher</surname><given-names>E</given-names></name><name><surname>Gower</surname><given-names>C</given-names></name><name><surname>Kall</surname><given-names>M</given-names></name><name><surname>Groves</surname><given-names>N</given-names></name><name><surname>O’Connell</surname><given-names>A-M</given-names></name><name><surname>Simons</surname><given-names>D</given-names></name><name><surname>Blomquist</surname><given-names>PB</given-names></name><name><surname>Zaidi</surname><given-names>A</given-names></name><name><surname>Nash</surname><given-names>S</given-names></name><name><surname>Iwani Binti Abdul Aziz</surname><given-names>N</given-names></name><name><surname>Thelwall</surname><given-names>S</given-names></name><name><surname>Dabrera</surname><given-names>G</given-names></name><name><surname>Myers</surname><given-names>R</given-names></name><name><surname>Amirthalingam</surname><given-names>G</given-names></name><name><surname>Gharbia</surname><given-names>S</given-names></name><name><surname>Barrett</surname><given-names>JC</given-names></name><name><surname>Elson</surname><given-names>R</given-names></name><name><surname>Ladhani</surname><given-names>SN</given-names></name><name><surname>Ferguson</surname><given-names>N</given-names></name><name><surname>Zambon</surname><given-names>M</given-names></name><name><surname>Campbell</surname><given-names>CNJ</given-names></name><name><surname>Brown</surname><given-names>K</given-names></name><name><surname>Hopkins</surname><given-names>S</given-names></name><name><surname>Chand</surname><given-names>M</given-names></name><name><surname>Ramsay</surname><given-names>M</given-names></name><name><surname>Lopez Bernal</surname><given-names>J</given-names></name></person-group><year iso-8601-date="2022">2022a</year><article-title>Covid-19 vaccine effectiveness against the Omicron (B.1.1.529) variant</article-title><source>The New England Journal of Medicine</source><volume>386</volume><fpage>1532</fpage><lpage>1546</lpage><pub-id pub-id-type="doi">10.1056/NEJMoa2119451</pub-id><pub-id pub-id-type="pmid">35249272</pub-id></element-citation></ref><ref id="bib3"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Andrews</surname><given-names>N</given-names></name><name><surname>Stowe</surname><given-names>J</given-names></name><name><surname>Kirsebom</surname><given-names>F</given-names></name><name><surname>Toffa</surname><given-names>S</given-names></name><name><surname>Sachdeva</surname><given-names>R</given-names></name><name><surname>Gower</surname><given-names>C</given-names></name><name><surname>Ramsay</surname><given-names>M</given-names></name><name><surname>Lopez Bernal</surname><given-names>J</given-names></name></person-group><year iso-8601-date="2022">2022b</year><article-title>Effectiveness of COVID-19 booster vaccines against COVID-19-related symptoms, hospitalization and death in England</article-title><source>Nature Medicine</source><volume>28</volume><fpage>831</fpage><lpage>837</lpage><pub-id pub-id-type="doi">10.1038/s41591-022-01699-1</pub-id><pub-id pub-id-type="pmid">35045566</pub-id></element-citation></ref><ref id="bib4"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Baden</surname><given-names>LR</given-names></name><name><surname>El Sahly</surname><given-names>HM</given-names></name><name><surname>Essink</surname><given-names>B</given-names></name><name><surname>Kotloff</surname><given-names>K</given-names></name><name><surname>Frey</surname><given-names>S</given-names></name><name><surname>Novak</surname><given-names>R</given-names></name><name><surname>Diemert</surname><given-names>D</given-names></name><name><surname>Spector</surname><given-names>SA</given-names></name><name><surname>Rouphael</surname><given-names>N</given-names></name><name><surname>Creech</surname><given-names>CB</given-names></name><name><surname>McGettigan</surname><given-names>J</given-names></name><name><surname>Khetan</surname><given-names>S</given-names></name><name><surname>Segall</surname><given-names>N</given-names></name><name><surname>Solis</surname><given-names>J</given-names></name><name><surname>Brosz</surname><given-names>A</given-names></name><name><surname>Fierro</surname><given-names>C</given-names></name><name><surname>Schwartz</surname><given-names>H</given-names></name><name><surname>Neuzil</surname><given-names>K</given-names></name><name><surname>Corey</surname><given-names>L</given-names></name><name><surname>Gilbert</surname><given-names>P</given-names></name><name><surname>Janes</surname><given-names>H</given-names></name><name><surname>Follmann</surname><given-names>D</given-names></name><name><surname>Marovich</surname><given-names>M</given-names></name><name><surname>Mascola</surname><given-names>J</given-names></name><name><surname>Polakowski</surname><given-names>L</given-names></name><name><surname>Ledgerwood</surname><given-names>J</given-names></name><name><surname>Graham</surname><given-names>BS</given-names></name><name><surname>Bennett</surname><given-names>H</given-names></name><name><surname>Pajon</surname><given-names>R</given-names></name><name><surname>Knightly</surname><given-names>C</given-names></name><name><surname>Leav</surname><given-names>B</given-names></name><name><surname>Deng</surname><given-names>W</given-names></name><name><surname>Zhou</surname><given-names>H</given-names></name><name><surname>Han</surname><given-names>S</given-names></name><name><surname>Ivarsson</surname><given-names>M</given-names></name><name><surname>Miller</surname><given-names>J</given-names></name><name><surname>Zaks</surname><given-names>T</given-names></name></person-group><year iso-8601-date="2021">2021</year><article-title>Efficacy and safety of the mRNA-1273 SARS-CoV-2 vaccine</article-title><source>New England Journal of Medicine</source><volume>384</volume><fpage>403</fpage><lpage>416</lpage><pub-id pub-id-type="doi">10.1056/NEJMoa2035389</pub-id></element-citation></ref><ref id="bib5"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Balinsky</surname><given-names>CA</given-names></name><name><surname>Jiang</surname><given-names>L</given-names></name><name><surname>Jani</surname><given-names>V</given-names></name><name><surname>Cheng</surname><given-names>Y</given-names></name><name><surname>Zhang</surname><given-names>Z</given-names></name><name><surname>Belinskaya</surname><given-names>T</given-names></name><name><surname>Qiu</surname><given-names>Q</given-names></name><name><surname>Long</surname><given-names>TK</given-names></name><name><surname>Schilling</surname><given-names>MA</given-names></name><name><surname>Jenkins</surname><given-names>SA</given-names></name><name><surname>Corson</surname><given-names>KS</given-names></name><name><surname>Martin</surname><given-names>NJ</given-names></name><name><surname>Letizia</surname><given-names>AG</given-names></name><name><surname>Hontz</surname><given-names>RD</given-names></name><name><surname>Sun</surname><given-names>P</given-names></name></person-group><year iso-8601-date="2023">2023</year><article-title>Antibodies to S2 domain of SARS-CoV-2 spike protein in Moderna mRNA vaccinated subjects sustain antibody-dependent NK cell-mediated cell cytotoxicity against Omicron BA.1</article-title><source>Frontiers in Immunology</source><volume>14</volume><elocation-id>1266829</elocation-id><pub-id pub-id-type="doi">10.3389/fimmu.2023.1266829</pub-id><pub-id pub-id-type="pmid">38077368</pub-id></element-citation></ref><ref id="bib6"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Barnes</surname><given-names>CO</given-names></name><name><surname>Jette</surname><given-names>CA</given-names></name><name><surname>Abernathy</surname><given-names>ME</given-names></name><name><surname>Dam</surname><given-names>KMA</given-names></name><name><surname>Esswein</surname><given-names>SR</given-names></name><name><surname>Gristick</surname><given-names>HB</given-names></name><name><surname>Malyutin</surname><given-names>AG</given-names></name><name><surname>Sharaf</surname><given-names>NG</given-names></name><name><surname>Huey-Tubman</surname><given-names>KE</given-names></name><name><surname>Lee</surname><given-names>YE</given-names></name><name><surname>Robbiani</surname><given-names>DF</given-names></name><name><surname>Nussenzweig</surname><given-names>MC</given-names></name><name><surname>West</surname><given-names>AP</given-names><suffix>Jr</suffix></name><name><surname>Bjorkman</surname><given-names>PJ</given-names></name></person-group><year iso-8601-date="2020">2020</year><article-title>SARS-CoV-2 neutralizing antibody structures inform therapeutic strategies</article-title><source>Nature</source><volume>588</volume><fpage>682</fpage><lpage>687</lpage><pub-id pub-id-type="doi">10.1038/s41586-020-2852-1</pub-id><pub-id pub-id-type="pmid">33045718</pub-id></element-citation></ref><ref id="bib7"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Bowen</surname><given-names>JE</given-names></name><name><surname>Park</surname><given-names>YJ</given-names></name><name><surname>Stewart</surname><given-names>C</given-names></name><name><surname>Brown</surname><given-names>JT</given-names></name><name><surname>Sharkey</surname><given-names>WK</given-names></name><name><surname>Walls</surname><given-names>AC</given-names></name><name><surname>Joshi</surname><given-names>A</given-names></name><name><surname>Sprouse</surname><given-names>KR</given-names></name><name><surname>McCallum</surname><given-names>M</given-names></name><name><surname>Tortorici</surname><given-names>MA</given-names></name><name><surname>Franko</surname><given-names>NM</given-names></name><name><surname>Logue</surname><given-names>JK</given-names></name><name><surname>Mazzitelli</surname><given-names>IG</given-names></name><name><surname>Nguyen</surname><given-names>AW</given-names></name><name><surname>Silva</surname><given-names>RP</given-names></name><name><surname>Huang</surname><given-names>Y</given-names></name><name><surname>Low</surname><given-names>JS</given-names></name><name><surname>Jerak</surname><given-names>J</given-names></name><name><surname>Tiles</surname><given-names>SW</given-names></name><name><surname>Ahmed</surname><given-names>K</given-names></name><name><surname>Shariq</surname><given-names>A</given-names></name><name><surname>Dan</surname><given-names>JM</given-names></name><name><surname>Zhang</surname><given-names>Z</given-names></name><name><surname>Weiskopf</surname><given-names>D</given-names></name><name><surname>Sette</surname><given-names>A</given-names></name><name><surname>Snell</surname><given-names>G</given-names></name><name><surname>Posavad</surname><given-names>CM</given-names></name><name><surname>Iqbal</surname><given-names>NT</given-names></name><name><surname>Geffner</surname><given-names>J</given-names></name><name><surname>Bandera</surname><given-names>A</given-names></name><name><surname>Gori</surname><given-names>A</given-names></name><name><surname>Sallusto</surname><given-names>F</given-names></name><name><surname>Maynard</surname><given-names>JA</given-names></name><name><surname>Crotty</surname><given-names>S</given-names></name><name><surname>Van Voorhis</surname><given-names>WC</given-names></name><name><surname>Simmerling</surname><given-names>C</given-names></name><name><surname>Grifantini</surname><given-names>R</given-names></name><name><surname>Chu</surname><given-names>HY</given-names></name><name><surname>Corti</surname><given-names>D</given-names></name><name><surname>Veesler</surname><given-names>D</given-names></name></person-group><year iso-8601-date="2022">2022</year><article-title>SARS-CoV-2 spike conformation determines plasma neutralizing activity elicited by a wide panel of human vaccines</article-title><source>Science Immunology</source><volume>7</volume><elocation-id>eadf1421</elocation-id><pub-id pub-id-type="doi">10.1126/sciimmunol.adf1421</pub-id><pub-id pub-id-type="pmid">36356052</pub-id></element-citation></ref><ref id="bib8"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Callaway</surname><given-names>HM</given-names></name><name><surname>Hastie</surname><given-names>KM</given-names></name><name><surname>Schendel</surname><given-names>SL</given-names></name><name><surname>Li</surname><given-names>H</given-names></name><name><surname>Yu</surname><given-names>X</given-names></name><name><surname>Shek</surname><given-names>J</given-names></name><name><surname>Buck</surname><given-names>T</given-names></name><name><surname>Hui</surname><given-names>S</given-names></name><name><surname>Bedinger</surname><given-names>D</given-names></name><name><surname>Troup</surname><given-names>C</given-names></name><name><surname>Dennison</surname><given-names>SM</given-names></name><name><surname>Li</surname><given-names>K</given-names></name><name><surname>Alpert</surname><given-names>MD</given-names></name><name><surname>Bailey</surname><given-names>CC</given-names></name><name><surname>Benzeno</surname><given-names>S</given-names></name><name><surname>Bonnevier</surname><given-names>JL</given-names></name><name><surname>Chen</surname><given-names>JQ</given-names></name><name><surname>Chen</surname><given-names>C</given-names></name><name><surname>Cho</surname><given-names>H</given-names></name><name><surname>Crompton</surname><given-names>PD</given-names></name><name><surname>Dussupt</surname><given-names>V</given-names></name><name><surname>Entzminger</surname><given-names>KC</given-names></name><name><surname>Ezzyat</surname><given-names>Y</given-names></name><name><surname>Fleming</surname><given-names>JK</given-names></name><name><surname>Geukens</surname><given-names>N</given-names></name><name><surname>Gilbert</surname><given-names>AE</given-names></name><name><surname>Guan</surname><given-names>Y</given-names></name><name><surname>Han</surname><given-names>X</given-names></name><name><surname>Harvey</surname><given-names>CJ</given-names></name><name><surname>Hatler</surname><given-names>JM</given-names></name><name><surname>Howie</surname><given-names>B</given-names></name><name><surname>Hu</surname><given-names>C</given-names></name><name><surname>Huang</surname><given-names>A</given-names></name><name><surname>Imbrechts</surname><given-names>M</given-names></name><name><surname>Jin</surname><given-names>A</given-names></name><name><surname>Kamachi</surname><given-names>N</given-names></name><name><surname>Keitany</surname><given-names>G</given-names></name><name><surname>Klinger</surname><given-names>M</given-names></name><name><surname>Kolls</surname><given-names>JK</given-names></name><name><surname>Krebs</surname><given-names>SJ</given-names></name><name><surname>Li</surname><given-names>T</given-names></name><name><surname>Luo</surname><given-names>F</given-names></name><name><surname>Maruyama</surname><given-names>T</given-names></name><name><surname>Meehl</surname><given-names>MA</given-names></name><name><surname>Mendez-Rivera</surname><given-names>L</given-names></name><name><surname>Musa</surname><given-names>A</given-names></name><name><surname>Okumura</surname><given-names>CJ</given-names></name><name><surname>Rubin</surname><given-names>BER</given-names></name><name><surname>Sato</surname><given-names>AK</given-names></name><name><surname>Shen</surname><given-names>M</given-names></name><name><surname>Singh</surname><given-names>A</given-names></name><name><surname>Song</surname><given-names>S</given-names></name><name><surname>Tan</surname><given-names>J</given-names></name><name><surname>Trimarchi</surname><given-names>JM</given-names></name><name><surname>Upadhyay</surname><given-names>DP</given-names></name><name><surname>Wang</surname><given-names>Y</given-names></name><name><surname>Yu</surname><given-names>L</given-names></name><name><surname>Yuan</surname><given-names>TZ</given-names></name><name><surname>Yusko</surname><given-names>E</given-names></name><name><surname>Peters</surname><given-names>B</given-names></name><name><surname>Tomaras</surname><given-names>G</given-names></name><name><surname>Saphire</surname><given-names>EO</given-names></name></person-group><year iso-8601-date="2023">2023</year><article-title>Bivalent intra-spike binding provides durability against emergent Omicron lineages: Results from a global consortium</article-title><source>Cell Reports</source><volume>42</volume><elocation-id>112014</elocation-id><pub-id pub-id-type="doi">10.1016/j.celrep.2023.112014</pub-id><pub-id pub-id-type="pmid">36681898</pub-id></element-citation></ref><ref id="bib9"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Carreño</surname><given-names>JM</given-names></name><name><surname>Singh</surname><given-names>G</given-names></name><name><surname>Simon</surname><given-names>V</given-names></name><name><surname>Krammer</surname><given-names>F</given-names></name><collab>PVI study group</collab></person-group><year iso-8601-date="2023">2023</year><article-title>Bivalent COVID-19 booster vaccines and the absence of BA.5-specific antibodies</article-title><source>The Lancet. Microbe</source><volume>4</volume><elocation-id>e569</elocation-id><pub-id pub-id-type="doi">10.1016/S2666-5247(23)00118-0</pub-id><pub-id pub-id-type="pmid">37141905</pub-id></element-citation></ref><ref id="bib10"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Cele</surname><given-names>S</given-names></name><name><surname>Jackson</surname><given-names>L</given-names></name><name><surname>Khoury</surname><given-names>DS</given-names></name><name><surname>Khan</surname><given-names>K</given-names></name><name><surname>Moyo-Gwete</surname><given-names>T</given-names></name><name><surname>Tegally</surname><given-names>H</given-names></name><name><surname>San</surname><given-names>JE</given-names></name><name><surname>Cromer</surname><given-names>D</given-names></name><name><surname>Scheepers</surname><given-names>C</given-names></name><name><surname>Amoako</surname><given-names>DG</given-names></name><name><surname>Karim</surname><given-names>F</given-names></name><name><surname>Bernstein</surname><given-names>M</given-names></name><name><surname>Lustig</surname><given-names>G</given-names></name><name><surname>Archary</surname><given-names>D</given-names></name><name><surname>Smith</surname><given-names>M</given-names></name><name><surname>Ganga</surname><given-names>Y</given-names></name><name><surname>Jule</surname><given-names>Z</given-names></name><name><surname>Reedoy</surname><given-names>K</given-names></name><name><surname>Hwa</surname><given-names>SH</given-names></name><name><surname>Giandhari</surname><given-names>J</given-names></name><name><surname>Blackburn</surname><given-names>JM</given-names></name><name><surname>Gosnell</surname><given-names>BI</given-names></name><name><surname>Abdool Karim</surname><given-names>SS</given-names></name><name><surname>Hanekom</surname><given-names>W</given-names></name><name><surname>Davies</surname><given-names>MA</given-names></name><name><surname>Hsiao</surname><given-names>M</given-names></name><name><surname>Martin</surname><given-names>D</given-names></name><name><surname>Mlisana</surname><given-names>K</given-names></name><name><surname>Wibmer</surname><given-names>CK</given-names></name><name><surname>Williamson</surname><given-names>C</given-names></name><name><surname>York</surname><given-names>D</given-names></name><name><surname>Harrichandparsad</surname><given-names>R</given-names></name><name><surname>Herbst</surname><given-names>K</given-names></name><name><surname>Jeena</surname><given-names>P</given-names></name><name><surname>Khoza</surname><given-names>T</given-names></name><name><surname>Kløverpris</surname><given-names>H</given-names></name><name><surname>Leslie</surname><given-names>A</given-names></name><name><surname>Madansein</surname><given-names>R</given-names></name><name><surname>Magula</surname><given-names>N</given-names></name><name><surname>Manickchund</surname><given-names>N</given-names></name><name><surname>Marakalala</surname><given-names>M</given-names></name><name><surname>Mazibuko</surname><given-names>M</given-names></name><name><surname>Moshabela</surname><given-names>M</given-names></name><name><surname>Mthabela</surname><given-names>N</given-names></name><name><surname>Naidoo</surname><given-names>K</given-names></name><name><surname>Ndhlovu</surname><given-names>Z</given-names></name><name><surname>Ndung’u</surname><given-names>T</given-names></name><name><surname>Ngcobo</surname><given-names>N</given-names></name><name><surname>Nyamande</surname><given-names>K</given-names></name><name><surname>Patel</surname><given-names>V</given-names></name><name><surname>Smit</surname><given-names>T</given-names></name><name><surname>Steyn</surname><given-names>A</given-names></name><name><surname>Wong</surname><given-names>E</given-names></name><name><surname>von Gottberg</surname><given-names>A</given-names></name><name><surname>Bhiman</surname><given-names>JN</given-names></name><name><surname>Lessells</surname><given-names>RJ</given-names></name><name><surname>Moosa</surname><given-names>MYS</given-names></name><name><surname>Davenport</surname><given-names>MP</given-names></name><name><surname>de Oliveira</surname><given-names>T</given-names></name><name><surname>Moore</surname><given-names>PL</given-names></name><name><surname>Sigal</surname><given-names>A</given-names></name><collab>NGS-SA</collab><collab>COMMIT-KZN Team</collab></person-group><year iso-8601-date="2022">2022</year><article-title>Omicron extensively but incompletely escapes Pfizer BNT162b2 neutralization</article-title><source>Nature</source><volume>602</volume><fpage>654</fpage><lpage>656</lpage><pub-id pub-id-type="doi">10.1038/s41586-021-04387-1</pub-id></element-citation></ref><ref id="bib11"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Chalkias</surname><given-names>S</given-names></name><name><surname>Harper</surname><given-names>C</given-names></name><name><surname>Vrbicky</surname><given-names>K</given-names></name><name><surname>Walsh</surname><given-names>SR</given-names></name><name><surname>Essink</surname><given-names>B</given-names></name><name><surname>Brosz</surname><given-names>A</given-names></name><name><surname>McGhee</surname><given-names>N</given-names></name><name><surname>Tomassini</surname><given-names>JE</given-names></name><name><surname>Chen</surname><given-names>X</given-names></name><name><surname>Chang</surname><given-names>Y</given-names></name><name><surname>Sutherland</surname><given-names>A</given-names></name><name><surname>Montefiori</surname><given-names>DC</given-names></name><name><surname>Girard</surname><given-names>B</given-names></name><name><surname>Edwards</surname><given-names>DK</given-names></name><name><surname>Feng</surname><given-names>J</given-names></name><name><surname>Zhou</surname><given-names>H</given-names></name><name><surname>Baden</surname><given-names>LR</given-names></name><name><surname>Miller</surname><given-names>JM</given-names></name><name><surname>Das</surname><given-names>R</given-names></name></person-group><year iso-8601-date="2022">2022</year><article-title>A bivalent Omicron-containing booster vaccine against Covid-19</article-title><source>The New England Journal of Medicine</source><volume>387</volume><fpage>1279</fpage><lpage>1291</lpage><pub-id pub-id-type="doi">10.1056/NEJMoa2208343</pub-id><pub-id pub-id-type="pmid">36112399</pub-id></element-citation></ref><ref id="bib12"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Chen</surname><given-names>Y</given-names></name><name><surname>Zhao</surname><given-names>X</given-names></name><name><surname>Zhou</surname><given-names>H</given-names></name><name><surname>Zhu</surname><given-names>H</given-names></name><name><surname>Jiang</surname><given-names>S</given-names></name><name><surname>Wang</surname><given-names>P</given-names></name></person-group><year iso-8601-date="2023">2023</year><article-title>Broadly neutralizing antibodies to SARS-CoV-2 and other human coronaviruses</article-title><source>Nature Reviews. Immunology</source><volume>23</volume><fpage>189</fpage><lpage>199</lpage><pub-id pub-id-type="doi">10.1038/s41577-022-00784-3</pub-id><pub-id pub-id-type="pmid">36168054</pub-id></element-citation></ref><ref id="bib13"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Cobey</surname><given-names>S</given-names></name><name><surname>Hensley</surname><given-names>SE</given-names></name></person-group><year iso-8601-date="2017">2017</year><article-title>Immune history and influenza virus susceptibility</article-title><source>Current Opinion in Virology</source><volume>22</volume><fpage>105</fpage><lpage>111</lpage><pub-id pub-id-type="doi">10.1016/j.coviro.2016.12.004</pub-id><pub-id pub-id-type="pmid">28088686</pub-id></element-citation></ref><ref id="bib14"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Cohen</surname><given-names>AA</given-names></name><name><surname>Gnanapragasam</surname><given-names>PNP</given-names></name><name><surname>Lee</surname><given-names>YE</given-names></name><name><surname>Hoffman</surname><given-names>PR</given-names></name><name><surname>Ou</surname><given-names>S</given-names></name><name><surname>Kakutani</surname><given-names>LM</given-names></name><name><surname>Keeffe</surname><given-names>JR</given-names></name><name><surname>Wu</surname><given-names>HJ</given-names></name><name><surname>Howarth</surname><given-names>M</given-names></name><name><surname>West</surname><given-names>AP</given-names></name><name><surname>Barnes</surname><given-names>CO</given-names></name><name><surname>Nussenzweig</surname><given-names>MC</given-names></name><name><surname>Bjorkman</surname><given-names>PJ</given-names></name></person-group><year iso-8601-date="2021">2021</year><article-title>Mosaic nanoparticles elicit cross-reactive immune responses to zoonotic coronaviruses in mice</article-title><source>Science</source><volume>371</volume><fpage>735</fpage><lpage>741</lpage><pub-id pub-id-type="doi">10.1126/science.abf6840</pub-id></element-citation></ref><ref id="bib15"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Cohen</surname><given-names>AA</given-names></name><name><surname>van Doremalen</surname><given-names>N</given-names></name><name><surname>Greaney</surname><given-names>AJ</given-names></name><name><surname>Andersen</surname><given-names>H</given-names></name><name><surname>Sharma</surname><given-names>A</given-names></name><name><surname>Starr</surname><given-names>TN</given-names></name><name><surname>Keeffe</surname><given-names>JR</given-names></name><name><surname>Fan</surname><given-names>C</given-names></name><name><surname>Schulz</surname><given-names>JE</given-names></name><name><surname>Gnanapragasam</surname><given-names>PNP</given-names></name><name><surname>Kakutani</surname><given-names>LM</given-names></name><name><surname>West</surname><given-names>AP</given-names></name><name><surname>Saturday</surname><given-names>G</given-names></name><name><surname>Lee</surname><given-names>YE</given-names></name><name><surname>Gao</surname><given-names>H</given-names></name><name><surname>Jette</surname><given-names>CA</given-names></name><name><surname>Lewis</surname><given-names>MG</given-names></name><name><surname>Tan</surname><given-names>TK</given-names></name><name><surname>Townsend</surname><given-names>AR</given-names></name><name><surname>Bloom</surname><given-names>JD</given-names></name><name><surname>Munster</surname><given-names>VJ</given-names></name><name><surname>Bjorkman</surname><given-names>PJ</given-names></name></person-group><year iso-8601-date="2022">2022</year><article-title>Mosaic RBD nanoparticles protect against challenge by diverse sarbecoviruses in animal models</article-title><source>Science</source><volume>377</volume><elocation-id>eabq0839</elocation-id><pub-id pub-id-type="doi">10.1126/science.abq0839</pub-id></element-citation></ref><ref id="bib16"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Cohen</surname><given-names>AA</given-names></name><name><surname>Keeffe</surname><given-names>JR</given-names></name><name><surname>Schiepers</surname><given-names>A</given-names></name><name><surname>Dross</surname><given-names>SE</given-names></name><name><surname>Greaney</surname><given-names>AJ</given-names></name><name><surname>Rorick</surname><given-names>AV</given-names></name><name><surname>Gao</surname><given-names>H</given-names></name><name><surname>Gnanapragasam</surname><given-names>PNP</given-names></name><name><surname>Fan</surname><given-names>C</given-names></name><name><surname>West</surname><given-names>AP</given-names><suffix>Jr</suffix></name><name><surname>Ramsingh</surname><given-names>AI</given-names></name><name><surname>Erasmus</surname><given-names>JH</given-names></name><name><surname>Pata</surname><given-names>JD</given-names></name><name><surname>Muramatsu</surname><given-names>H</given-names></name><name><surname>Pardi</surname><given-names>N</given-names></name><name><surname>Lin</surname><given-names>PJC</given-names></name><name><surname>Baxter</surname><given-names>S</given-names></name><name><surname>Cruz</surname><given-names>R</given-names></name><name><surname>Quintanar-Audelo</surname><given-names>M</given-names></name><name><surname>Robb</surname><given-names>E</given-names></name><name><surname>Serrano-Amatriain</surname><given-names>C</given-names></name><name><surname>Magneschi</surname><given-names>L</given-names></name><name><surname>Fotheringham</surname><given-names>IG</given-names></name><name><surname>Fuller</surname><given-names>DH</given-names></name><name><surname>Victora</surname><given-names>GD</given-names></name><name><surname>Bjorkman</surname><given-names>PJ</given-names></name></person-group><year iso-8601-date="2024">2024</year><article-title>Mosaic sarbecovirus nanoparticles elicit cross-reactive responses in pre-vaccinated animals</article-title><source>Cell</source><volume>187</volume><fpage>5554</fpage><lpage>5571</lpage><pub-id pub-id-type="doi">10.1016/j.cell.2024.07.052</pub-id><pub-id pub-id-type="pmid">39197450</pub-id></element-citation></ref><ref id="bib17"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Collier</surname><given-names>ARY</given-names></name><name><surname>Miller</surname><given-names>J</given-names></name><name><surname>Hachmann</surname><given-names>NP</given-names></name><name><surname>McMahan</surname><given-names>K</given-names></name><name><surname>Liu</surname><given-names>J</given-names></name><name><surname>Bondzie</surname><given-names>EA</given-names></name><name><surname>Gallup</surname><given-names>L</given-names></name><name><surname>Rowe</surname><given-names>M</given-names></name><name><surname>Schonberg</surname><given-names>E</given-names></name><name><surname>Thai</surname><given-names>S</given-names></name><name><surname>Barrett</surname><given-names>J</given-names></name><name><surname>Borducchi</surname><given-names>EN</given-names></name><name><surname>Bouffard</surname><given-names>E</given-names></name><name><surname>Jacob-Dolan</surname><given-names>C</given-names></name><name><surname>Mazurek</surname><given-names>CR</given-names></name><name><surname>Mutoni</surname><given-names>A</given-names></name><name><surname>Powers</surname><given-names>O</given-names></name><name><surname>Sciacca</surname><given-names>M</given-names></name><name><surname>Surve</surname><given-names>N</given-names></name><name><surname>VanWyk</surname><given-names>H</given-names></name><name><surname>Wu</surname><given-names>C</given-names></name><name><surname>Barouch</surname><given-names>DH</given-names></name></person-group><year iso-8601-date="2023">2023</year><article-title>Immunogenicity of BA.5 bivalent mRNA vaccine boosters</article-title><source>The New England Journal of Medicine</source><volume>388</volume><fpage>565</fpage><lpage>567</lpage><pub-id pub-id-type="doi">10.1056/NEJMc2213948</pub-id><pub-id pub-id-type="pmid">36630611</pub-id></element-citation></ref><ref id="bib18"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Corbett</surname><given-names>KS</given-names></name><name><surname>Edwards</surname><given-names>DK</given-names></name><name><surname>Leist</surname><given-names>SR</given-names></name><name><surname>Abiona</surname><given-names>OM</given-names></name><name><surname>Boyoglu-Barnum</surname><given-names>S</given-names></name><name><surname>Gillespie</surname><given-names>RA</given-names></name><name><surname>Himansu</surname><given-names>S</given-names></name><name><surname>Schäfer</surname><given-names>A</given-names></name><name><surname>Ziwawo</surname><given-names>CT</given-names></name><name><surname>DiPiazza</surname><given-names>AT</given-names></name><name><surname>Dinnon</surname><given-names>KH</given-names></name><name><surname>Elbashir</surname><given-names>SM</given-names></name><name><surname>Shaw</surname><given-names>CA</given-names></name><name><surname>Woods</surname><given-names>A</given-names></name><name><surname>Fritch</surname><given-names>EJ</given-names></name><name><surname>Martinez</surname><given-names>DR</given-names></name><name><surname>Bock</surname><given-names>KW</given-names></name><name><surname>Minai</surname><given-names>M</given-names></name><name><surname>Nagata</surname><given-names>BM</given-names></name><name><surname>Hutchinson</surname><given-names>GB</given-names></name><name><surname>Wu</surname><given-names>K</given-names></name><name><surname>Henry</surname><given-names>C</given-names></name><name><surname>Bahl</surname><given-names>K</given-names></name><name><surname>Garcia-Dominguez</surname><given-names>D</given-names></name><name><surname>Ma</surname><given-names>L</given-names></name><name><surname>Renzi</surname><given-names>I</given-names></name><name><surname>Kong</surname><given-names>WP</given-names></name><name><surname>Schmidt</surname><given-names>SD</given-names></name><name><surname>Wang</surname><given-names>L</given-names></name><name><surname>Zhang</surname><given-names>Y</given-names></name><name><surname>Phung</surname><given-names>E</given-names></name><name><surname>Chang</surname><given-names>LA</given-names></name><name><surname>Loomis</surname><given-names>RJ</given-names></name><name><surname>Altaras</surname><given-names>NE</given-names></name><name><surname>Narayanan</surname><given-names>E</given-names></name><name><surname>Metkar</surname><given-names>M</given-names></name><name><surname>Presnyak</surname><given-names>V</given-names></name><name><surname>Liu</surname><given-names>C</given-names></name><name><surname>Louder</surname><given-names>MK</given-names></name><name><surname>Shi</surname><given-names>W</given-names></name><name><surname>Leung</surname><given-names>K</given-names></name><name><surname>Yang</surname><given-names>ES</given-names></name><name><surname>West</surname><given-names>A</given-names></name><name><surname>Gully</surname><given-names>KL</given-names></name><name><surname>Stevens</surname><given-names>LJ</given-names></name><name><surname>Wang</surname><given-names>N</given-names></name><name><surname>Wrapp</surname><given-names>D</given-names></name><name><surname>Doria-Rose</surname><given-names>NA</given-names></name><name><surname>Stewart-Jones</surname><given-names>G</given-names></name><name><surname>Bennett</surname><given-names>H</given-names></name><name><surname>Alvarado</surname><given-names>GS</given-names></name><name><surname>Nason</surname><given-names>MC</given-names></name><name><surname>Ruckwardt</surname><given-names>TJ</given-names></name><name><surname>McLellan</surname><given-names>JS</given-names></name><name><surname>Denison</surname><given-names>MR</given-names></name><name><surname>Chappell</surname><given-names>JD</given-names></name><name><surname>Moore</surname><given-names>IN</given-names></name><name><surname>Morabito</surname><given-names>KM</given-names></name><name><surname>Mascola</surname><given-names>JR</given-names></name><name><surname>Baric</surname><given-names>RS</given-names></name><name><surname>Carfi</surname><given-names>A</given-names></name><name><surname>Graham</surname><given-names>BS</given-names></name></person-group><year iso-8601-date="2020">2020</year><article-title>SARS-CoV-2 mRNA vaccine design enabled by prototype pathogen preparedness</article-title><source>Nature</source><volume>586</volume><fpage>567</fpage><lpage>571</lpage><pub-id pub-id-type="doi">10.1038/s41586-020-2622-0</pub-id><pub-id pub-id-type="pmid">32756549</pub-id></element-citation></ref><ref id="bib19"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Crawford</surname><given-names>KHD</given-names></name><name><surname>Eguia</surname><given-names>R</given-names></name><name><surname>Dingens</surname><given-names>AS</given-names></name><name><surname>Loes</surname><given-names>AN</given-names></name><name><surname>Malone</surname><given-names>KD</given-names></name><name><surname>Wolf</surname><given-names>CR</given-names></name><name><surname>Chu</surname><given-names>HY</given-names></name><name><surname>Tortorici</surname><given-names>MA</given-names></name><name><surname>Veesler</surname><given-names>D</given-names></name><name><surname>Murphy</surname><given-names>M</given-names></name><name><surname>Pettie</surname><given-names>D</given-names></name><name><surname>King</surname><given-names>NP</given-names></name><name><surname>Balazs</surname><given-names>AB</given-names></name><name><surname>Bloom</surname><given-names>JD</given-names></name></person-group><year iso-8601-date="2020">2020</year><article-title>Protocol and reagents for Pseudotyping lentiviral particles with SARS-CoV-2 spike protein for neutralization assays</article-title><source>Viruses</source><volume>12</volume><elocation-id>513</elocation-id><pub-id pub-id-type="doi">10.3390/v12050513</pub-id></element-citation></ref><ref id="bib20"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Davis-Gardner</surname><given-names>ME</given-names></name><name><surname>Lai</surname><given-names>L</given-names></name><name><surname>Wali</surname><given-names>B</given-names></name><name><surname>Samaha</surname><given-names>H</given-names></name><name><surname>Solis</surname><given-names>D</given-names></name><name><surname>Lee</surname><given-names>M</given-names></name><name><surname>Porter-Morrison</surname><given-names>A</given-names></name><name><surname>Hentenaar</surname><given-names>IT</given-names></name><name><surname>Yamamoto</surname><given-names>F</given-names></name><name><surname>Godbole</surname><given-names>S</given-names></name><name><surname>Liu</surname><given-names>Y</given-names></name><name><surname>Douek</surname><given-names>DC</given-names></name><name><surname>Lee</surname><given-names>FEH</given-names></name><name><surname>Rouphael</surname><given-names>N</given-names></name><name><surname>Moreno</surname><given-names>A</given-names></name><name><surname>Pinsky</surname><given-names>BA</given-names></name><name><surname>Suthar</surname><given-names>MS</given-names></name></person-group><year iso-8601-date="2023">2023</year><article-title>Neutralization against BA.2.75.2, BQ.1.1, and XBB from mRNA bivalent booster</article-title><source>The New England Journal of Medicine</source><volume>388</volume><fpage>183</fpage><lpage>185</lpage><pub-id pub-id-type="doi">10.1056/NEJMc2214293</pub-id><pub-id pub-id-type="pmid">36546661</pub-id></element-citation></ref><ref id="bib21"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Fan</surname><given-names>C</given-names></name><name><surname>Cohen</surname><given-names>AA</given-names></name><name><surname>Park</surname><given-names>M</given-names></name><name><surname>Hung</surname><given-names>AFH</given-names></name><name><surname>Keeffe</surname><given-names>JR</given-names></name><name><surname>Gnanapragasam</surname><given-names>PNP</given-names></name><name><surname>Lee</surname><given-names>YE</given-names></name><name><surname>Gao</surname><given-names>H</given-names></name><name><surname>Kakutani</surname><given-names>LM</given-names></name><name><surname>Wu</surname><given-names>Z</given-names></name><name><surname>Kleanthous</surname><given-names>H</given-names></name><name><surname>Malecek</surname><given-names>KE</given-names></name><name><surname>Williams</surname><given-names>JC</given-names></name><name><surname>Bjorkman</surname><given-names>PJ</given-names></name></person-group><year iso-8601-date="2022">2022</year><article-title>Neutralizing monoclonal antibodies elicited by mosaic RBD nanoparticles bind conserved sarbecovirus epitopes</article-title><source>Immunity</source><volume>55</volume><fpage>2419</fpage><lpage>2435</lpage><pub-id pub-id-type="doi">10.1016/j.immuni.2022.10.019</pub-id><pub-id pub-id-type="pmid">36370711</pub-id></element-citation></ref><ref id="bib22"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Fan</surname><given-names>C</given-names></name><name><surname>Keeffe</surname><given-names>JR</given-names></name><name><surname>Malecek</surname><given-names>KE</given-names></name><name><surname>Cohen</surname><given-names>AA</given-names></name><name><surname>West</surname><given-names>AP</given-names><suffix>Jr</suffix></name><name><surname>Baharani</surname><given-names>VA</given-names></name><name><surname>Rorick</surname><given-names>AV</given-names></name><name><surname>Gao</surname><given-names>H</given-names></name><name><surname>Gnanapragasam</surname><given-names>PNP</given-names></name><name><surname>Rho</surname><given-names>S</given-names></name><name><surname>Alvarez</surname><given-names>J</given-names></name><name><surname>Segovia</surname><given-names>LN</given-names></name><name><surname>Hatziioannou</surname><given-names>T</given-names></name><name><surname>Bieniasz</surname><given-names>PD</given-names></name><name><surname>Bjorkman</surname><given-names>PJ</given-names></name></person-group><year iso-8601-date="2025">2025</year><article-title>Cross-reactive sarbecovirus antibodies induced by mosaic RBD nanoparticles</article-title><source>PNAS</source><volume>122</volume><elocation-id>e2501637122</elocation-id><pub-id pub-id-type="doi">10.1073/pnas.2501637122</pub-id><pub-id pub-id-type="pmid">40402246</pub-id></element-citation></ref><ref id="bib23"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Feng</surname><given-names>S</given-names></name><name><surname>Phillips</surname><given-names>DJ</given-names></name><name><surname>White</surname><given-names>T</given-names></name><name><surname>Sayal</surname><given-names>H</given-names></name><name><surname>Aley</surname><given-names>PK</given-names></name><name><surname>Bibi</surname><given-names>S</given-names></name><name><surname>Dold</surname><given-names>C</given-names></name><name><surname>Fuskova</surname><given-names>M</given-names></name><name><surname>Gilbert</surname><given-names>SC</given-names></name><name><surname>Hirsch</surname><given-names>I</given-names></name><name><surname>Humphries</surname><given-names>HE</given-names></name><name><surname>Jepson</surname><given-names>B</given-names></name><name><surname>Kelly</surname><given-names>EJ</given-names></name><name><surname>Plested</surname><given-names>E</given-names></name><name><surname>Shoemaker</surname><given-names>K</given-names></name><name><surname>Thomas</surname><given-names>KM</given-names></name><name><surname>Vekemans</surname><given-names>J</given-names></name><name><surname>Villafana</surname><given-names>TL</given-names></name><name><surname>Lambe</surname><given-names>T</given-names></name><name><surname>Pollard</surname><given-names>AJ</given-names></name><name><surname>Voysey</surname><given-names>M</given-names></name><collab>Oxford COVID Vaccine Trial Group</collab></person-group><year iso-8601-date="2021">2021</year><article-title>Correlates of protection against symptomatic and asymptomatic SARS-CoV-2 infection</article-title><source>Nature Medicine</source><volume>27</volume><fpage>2032</fpage><lpage>2040</lpage><pub-id pub-id-type="doi">10.1038/s41591-021-01540-1</pub-id><pub-id pub-id-type="pmid">34588689</pub-id></element-citation></ref><ref id="bib24"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Greaney</surname><given-names>AJ</given-names></name><name><surname>Loes</surname><given-names>AN</given-names></name><name><surname>Crawford</surname><given-names>KHD</given-names></name><name><surname>Starr</surname><given-names>TN</given-names></name><name><surname>Malone</surname><given-names>KD</given-names></name><name><surname>Chu</surname><given-names>HY</given-names></name><name><surname>Bloom</surname><given-names>JD</given-names></name></person-group><year iso-8601-date="2021">2021a</year><article-title>Comprehensive mapping of mutations in the SARS-CoV-2 receptor-binding domain that affect recognition by polyclonal human plasma antibodies</article-title><source>Cell Host &amp; Microbe</source><volume>29</volume><fpage>463</fpage><lpage>476</lpage><pub-id pub-id-type="doi">10.1016/j.chom.2021.02.003</pub-id></element-citation></ref><ref id="bib25"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Greaney</surname><given-names>AJ</given-names></name><name><surname>Starr</surname><given-names>TN</given-names></name><name><surname>Barnes</surname><given-names>CO</given-names></name><name><surname>Weisblum</surname><given-names>Y</given-names></name><name><surname>Schmidt</surname><given-names>F</given-names></name><name><surname>Caskey</surname><given-names>M</given-names></name><name><surname>Gaebler</surname><given-names>C</given-names></name></person-group><year iso-8601-date="2021">2021b</year><article-title>Mapping mutations to the SARS-CoV-2 RBD that escape binding by different classes of antibodies</article-title><source>Nature Communications</source><volume>12</volume><elocation-id>4196</elocation-id><pub-id pub-id-type="doi">10.1038/s41467-021-24435-8</pub-id></element-citation></ref><ref id="bib26"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Gruell</surname><given-names>H</given-names></name><name><surname>Vanshylla</surname><given-names>K</given-names></name><name><surname>Tober-Lau</surname><given-names>P</given-names></name><name><surname>Hillus</surname><given-names>D</given-names></name><name><surname>Schommers</surname><given-names>P</given-names></name><name><surname>Lehmann</surname><given-names>C</given-names></name><name><surname>Kurth</surname><given-names>F</given-names></name><name><surname>Sander</surname><given-names>LE</given-names></name><name><surname>Klein</surname><given-names>F</given-names></name></person-group><year iso-8601-date="2022">2022</year><article-title>mRNA booster immunization elicits potent neutralizing serum activity against the SARS-CoV-2 Omicron variant</article-title><source>Nature Medicine</source><volume>28</volume><fpage>477</fpage><lpage>480</lpage><pub-id pub-id-type="doi">10.1038/s41591-021-01676-0</pub-id><pub-id pub-id-type="pmid">35046572</pub-id></element-citation></ref><ref id="bib27"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hills</surname><given-names>RA</given-names></name><name><surname>Tan</surname><given-names>TK</given-names></name><name><surname>Cohen</surname><given-names>AA</given-names></name><name><surname>Keeffe</surname><given-names>JR</given-names></name><name><surname>Keeble</surname><given-names>AH</given-names></name><name><surname>Gnanapragasam</surname><given-names>PNP</given-names></name><name><surname>Storm</surname><given-names>KN</given-names></name><name><surname>Rorick</surname><given-names>AV</given-names></name><name><surname>West</surname><given-names>AP</given-names><suffix>Jr</suffix></name><name><surname>Hill</surname><given-names>ML</given-names></name><name><surname>Liu</surname><given-names>S</given-names></name><name><surname>Gilbert-Jaramillo</surname><given-names>J</given-names></name><name><surname>Afzal</surname><given-names>M</given-names></name><name><surname>Napier</surname><given-names>A</given-names></name><name><surname>Admans</surname><given-names>G</given-names></name><name><surname>James</surname><given-names>WS</given-names></name><name><surname>Bjorkman</surname><given-names>PJ</given-names></name><name><surname>Townsend</surname><given-names>AR</given-names></name><name><surname>Howarth</surname><given-names>MR</given-names></name></person-group><year iso-8601-date="2024">2024</year><article-title>Proactive vaccination using multiviral Quartet Nanocages to elicit broad anti-coronavirus responses</article-title><source>Nature Nanotechnology</source><volume>19</volume><fpage>1216</fpage><lpage>1223</lpage><pub-id pub-id-type="doi">10.1038/s41565-024-01655-9</pub-id><pub-id pub-id-type="pmid">38710880</pub-id></element-citation></ref><ref id="bib28"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hoffmann</surname><given-names>MAG</given-names></name><name><surname>Yang</surname><given-names>Z</given-names></name><name><surname>Huey-Tubman</surname><given-names>KE</given-names></name><name><surname>Cohen</surname><given-names>AA</given-names></name><name><surname>Gnanapragasam</surname><given-names>PNP</given-names></name><name><surname>Nakatomi</surname><given-names>LM</given-names></name><name><surname>Storm</surname><given-names>KN</given-names></name><name><surname>Moon</surname><given-names>WJ</given-names></name><name><surname>Lin</surname><given-names>PJC</given-names></name><name><surname>West</surname><given-names>AP</given-names></name><name><surname>Bjorkman</surname><given-names>PJ</given-names></name></person-group><year iso-8601-date="2023">2023</year><article-title>ESCRT recruitment to SARS-CoV-2 spike induces virus-like particles that improve mRNA vaccines</article-title><source>Cell</source><volume>186</volume><fpage>2380</fpage><lpage>2391</lpage><pub-id pub-id-type="doi">10.1016/j.cell.2023.04.024</pub-id></element-citation></ref><ref id="bib29"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hogan</surname><given-names>MJ</given-names></name><name><surname>Pardi</surname><given-names>N</given-names></name></person-group><year iso-8601-date="2022">2022</year><article-title>mRNA Vaccines in the COVID-19 Pandemic and Beyond</article-title><source>Annual Review of Medicine</source><volume>73</volume><fpage>17</fpage><lpage>39</lpage><pub-id pub-id-type="doi">10.1146/annurev-med-042420-112725</pub-id><pub-id pub-id-type="pmid">34669432</pub-id></element-citation></ref><ref id="bib30"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hsieh</surname><given-names>CL</given-names></name><name><surname>Goldsmith</surname><given-names>JA</given-names></name><name><surname>Schaub</surname><given-names>JM</given-names></name><name><surname>DiVenere</surname><given-names>AM</given-names></name><name><surname>Kuo</surname><given-names>HC</given-names></name><name><surname>Javanmardi</surname><given-names>K</given-names></name><name><surname>Le</surname><given-names>KC</given-names></name><name><surname>Wrapp</surname><given-names>D</given-names></name><name><surname>Lee</surname><given-names>AG</given-names></name><name><surname>Liu</surname><given-names>Y</given-names></name><name><surname>Chou</surname><given-names>CW</given-names></name><name><surname>Byrne</surname><given-names>PO</given-names></name><name><surname>Hjorth</surname><given-names>CK</given-names></name><name><surname>Johnson</surname><given-names>NV</given-names></name><name><surname>Ludes-Meyers</surname><given-names>J</given-names></name><name><surname>Nguyen</surname><given-names>AW</given-names></name><name><surname>Park</surname><given-names>J</given-names></name><name><surname>Wang</surname><given-names>N</given-names></name><name><surname>Amengor</surname><given-names>D</given-names></name><name><surname>Lavinder</surname><given-names>JJ</given-names></name><name><surname>Ippolito</surname><given-names>GC</given-names></name><name><surname>Maynard</surname><given-names>JA</given-names></name><name><surname>Finkelstein</surname><given-names>IJ</given-names></name><name><surname>McLellan</surname><given-names>JS</given-names></name></person-group><year iso-8601-date="2020">2020</year><article-title>Structure-based design of prefusion-stabilized SARS-CoV-2 spikes</article-title><source>Science</source><volume>369</volume><fpage>1501</fpage><lpage>1505</lpage><pub-id pub-id-type="doi">10.1126/science.abd0826</pub-id></element-citation></ref><ref id="bib31"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hsieh</surname><given-names>CL</given-names></name><name><surname>Leist</surname><given-names>SR</given-names></name><name><surname>Miller</surname><given-names>EH</given-names></name><name><surname>Zhou</surname><given-names>L</given-names></name><name><surname>Powers</surname><given-names>JM</given-names></name><name><surname>Tse</surname><given-names>AL</given-names></name><name><surname>Wang</surname><given-names>A</given-names></name><name><surname>West</surname><given-names>A</given-names></name><name><surname>Zweigart</surname><given-names>MR</given-names></name><name><surname>Schisler</surname><given-names>JC</given-names></name><name><surname>Jangra</surname><given-names>RK</given-names></name><name><surname>Chandran</surname><given-names>K</given-names></name><name><surname>Baric</surname><given-names>RS</given-names></name><name><surname>McLellan</surname><given-names>JS</given-names></name></person-group><year iso-8601-date="2024">2024</year><article-title>Prefusion-stabilized SARS-CoV-2 S2-only antigen provides protection against SARS-CoV-2 challenge</article-title><source>Nature Communications</source><volume>15</volume><elocation-id>1553</elocation-id><pub-id pub-id-type="doi">10.1038/s41467-024-45404-x</pub-id><pub-id pub-id-type="pmid">38378768</pub-id></element-citation></ref><ref id="bib32"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Karikó</surname><given-names>K</given-names></name><name><surname>Muramatsu</surname><given-names>H</given-names></name><name><surname>Welsh</surname><given-names>FA</given-names></name><name><surname>Ludwig</surname><given-names>J</given-names></name><name><surname>Kato</surname><given-names>H</given-names></name><name><surname>Akira</surname><given-names>S</given-names></name><name><surname>Weissman</surname><given-names>D</given-names></name></person-group><year iso-8601-date="2008">2008</year><article-title>Incorporation of pseudouridine into mRNA yields superior nonimmunogenic vector with increased translational capacity and biological stability</article-title><source>Molecular Therapy</source><volume>16</volume><fpage>1833</fpage><lpage>1840</lpage><pub-id pub-id-type="doi">10.1038/mt.2008.200</pub-id><pub-id pub-id-type="pmid">18797453</pub-id></element-citation></ref><ref id="bib33"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Karikó</surname><given-names>K</given-names></name><name><surname>Muramatsu</surname><given-names>H</given-names></name><name><surname>Ludwig</surname><given-names>J</given-names></name><name><surname>Weissman</surname><given-names>D</given-names></name></person-group><year iso-8601-date="2011">2011</year><article-title>Generating the optimal mRNA for therapy: HPLC purification eliminates immune activation and improves translation of nucleoside-modified, protein-encoding mRNA</article-title><source>Nucleic Acids Research</source><volume>39</volume><elocation-id>e142</elocation-id><pub-id pub-id-type="doi">10.1093/nar/gkr695</pub-id><pub-id pub-id-type="pmid">21890902</pub-id></element-citation></ref><ref id="bib34"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Keeton</surname><given-names>R</given-names></name><name><surname>Tincho</surname><given-names>MB</given-names></name><name><surname>Ngomti</surname><given-names>A</given-names></name><name><surname>Baguma</surname><given-names>R</given-names></name><name><surname>Benede</surname><given-names>N</given-names></name><name><surname>Suzuki</surname><given-names>A</given-names></name><name><surname>Khan</surname><given-names>K</given-names></name><name><surname>Cele</surname><given-names>S</given-names></name><name><surname>Bernstein</surname><given-names>M</given-names></name><name><surname>Karim</surname><given-names>F</given-names></name><name><surname>Madzorera</surname><given-names>SV</given-names></name><name><surname>Moyo-Gwete</surname><given-names>T</given-names></name><name><surname>Mennen</surname><given-names>M</given-names></name><name><surname>Skelem</surname><given-names>S</given-names></name><name><surname>Adriaanse</surname><given-names>M</given-names></name><name><surname>Mutithu</surname><given-names>D</given-names></name><name><surname>Aremu</surname><given-names>O</given-names></name><name><surname>Stek</surname><given-names>C</given-names></name><name><surname>du Bruyn</surname><given-names>E</given-names></name><name><surname>Van Der Mescht</surname><given-names>MA</given-names></name><name><surname>de Beer</surname><given-names>Z</given-names></name><name><surname>de Villiers</surname><given-names>TR</given-names></name><name><surname>Bodenstein</surname><given-names>A</given-names></name><name><surname>van den Berg</surname><given-names>G</given-names></name><name><surname>Mendes</surname><given-names>A</given-names></name><name><surname>Strydom</surname><given-names>A</given-names></name><name><surname>Venter</surname><given-names>M</given-names></name><name><surname>Giandhari</surname><given-names>J</given-names></name><name><surname>Naidoo</surname><given-names>Y</given-names></name><name><surname>Pillay</surname><given-names>S</given-names></name><name><surname>Tegally</surname><given-names>H</given-names></name><name><surname>Grifoni</surname><given-names>A</given-names></name><name><surname>Weiskopf</surname><given-names>D</given-names></name><name><surname>Sette</surname><given-names>A</given-names></name><name><surname>Wilkinson</surname><given-names>RJ</given-names></name><name><surname>de Oliveira</surname><given-names>T</given-names></name><name><surname>Bekker</surname><given-names>LG</given-names></name><name><surname>Gray</surname><given-names>G</given-names></name><name><surname>Ueckermann</surname><given-names>V</given-names></name><name><surname>Rossouw</surname><given-names>T</given-names></name><name><surname>Boswell</surname><given-names>MT</given-names></name><name><surname>Bhiman</surname><given-names>JN</given-names></name><name><surname>Moore</surname><given-names>PL</given-names></name><name><surname>Sigal</surname><given-names>A</given-names></name><name><surname>Ntusi</surname><given-names>NAB</given-names></name><name><surname>Burgers</surname><given-names>WA</given-names></name><name><surname>Riou</surname><given-names>C</given-names></name></person-group><year iso-8601-date="2022">2022</year><article-title>T cell responses to SARS-CoV-2 spike cross-recognize Omicron</article-title><source>Nature</source><volume>603</volume><fpage>488</fpage><lpage>492</lpage><pub-id pub-id-type="doi">10.1038/s41586-022-04460-3</pub-id><pub-id pub-id-type="pmid">35102311</pub-id></element-citation></ref><ref id="bib35"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Khoury</surname><given-names>DS</given-names></name><name><surname>Docken</surname><given-names>SS</given-names></name><name><surname>Subbarao</surname><given-names>K</given-names></name><name><surname>Kent</surname><given-names>SJ</given-names></name><name><surname>Davenport</surname><given-names>MP</given-names></name><name><surname>Cromer</surname><given-names>D</given-names></name></person-group><year iso-8601-date="2023">2023</year><article-title>Predicting the efficacy of variant-modified COVID-19 vaccine boosters</article-title><source>Nature Medicine</source><volume>29</volume><fpage>574</fpage><lpage>578</lpage><pub-id pub-id-type="doi">10.1038/s41591-023-02228-4</pub-id><pub-id pub-id-type="pmid">36864253</pub-id></element-citation></ref><ref id="bib36"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Korber</surname><given-names>B</given-names></name><name><surname>Fischer</surname><given-names>WM</given-names></name><name><surname>Gnanakaran</surname><given-names>S</given-names></name><name><surname>Yoon</surname><given-names>H</given-names></name><name><surname>Theiler</surname><given-names>J</given-names></name><name><surname>Abfalterer</surname><given-names>W</given-names></name><name><surname>Hengartner</surname><given-names>N</given-names></name><name><surname>Giorgi</surname><given-names>EE</given-names></name><name><surname>Bhattacharya</surname><given-names>T</given-names></name><name><surname>Foley</surname><given-names>B</given-names></name><name><surname>Hastie</surname><given-names>KM</given-names></name><name><surname>Parker</surname><given-names>MD</given-names></name><name><surname>Partridge</surname><given-names>DG</given-names></name><name><surname>Evans</surname><given-names>CM</given-names></name><name><surname>Freeman</surname><given-names>TM</given-names></name><name><surname>de Silva</surname><given-names>TI</given-names></name><name><surname>Angyal</surname><given-names>A</given-names></name><name><surname>Brown</surname><given-names>RL</given-names></name><name><surname>Carrilero</surname><given-names>L</given-names></name><name><surname>Green</surname><given-names>LR</given-names></name><name><surname>Groves</surname><given-names>DC</given-names></name><name><surname>Johnson</surname><given-names>KJ</given-names></name><name><surname>Keeley</surname><given-names>AJ</given-names></name><name><surname>Lindsey</surname><given-names>BB</given-names></name><name><surname>Parsons</surname><given-names>PJ</given-names></name><name><surname>Raza</surname><given-names>M</given-names></name><name><surname>Rowland-Jones</surname><given-names>S</given-names></name><name><surname>Smith</surname><given-names>N</given-names></name><name><surname>Tucker</surname><given-names>RM</given-names></name><name><surname>Wang</surname><given-names>D</given-names></name><name><surname>Wyles</surname><given-names>MD</given-names></name><name><surname>McDanal</surname><given-names>C</given-names></name><name><surname>Perez</surname><given-names>LG</given-names></name><name><surname>Tang</surname><given-names>H</given-names></name><name><surname>Moon-Walker</surname><given-names>A</given-names></name><name><surname>Whelan</surname><given-names>SP</given-names></name><name><surname>LaBranche</surname><given-names>CC</given-names></name><name><surname>Saphire</surname><given-names>EO</given-names></name><name><surname>Montefiori</surname><given-names>DC</given-names></name></person-group><year iso-8601-date="2020">2020</year><article-title>Tracking changes in SARS-CoV-2 Spike: Evidence that D614G increases infectivity of the COVID-19 virus</article-title><source>Cell</source><volume>182</volume><fpage>812</fpage><lpage>827</lpage><pub-id pub-id-type="doi">10.1016/j.cell.2020.06.043</pub-id></element-citation></ref><ref id="bib37"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Landau</surname><given-names>M</given-names></name><name><surname>Mayrose</surname><given-names>I</given-names></name><name><surname>Rosenberg</surname><given-names>Y</given-names></name><name><surname>Glaser</surname><given-names>F</given-names></name><name><surname>Martz</surname><given-names>E</given-names></name><name><surname>Pupko</surname><given-names>T</given-names></name><name><surname>Ben-Tal</surname><given-names>N</given-names></name></person-group><year iso-8601-date="2005">2005</year><article-title>ConSurf 2005: The projection of evolutionary conservation scores of residues on protein structures</article-title><source>Nucleic Acids Research</source><volume>33</volume><fpage>W299</fpage><lpage>W302</lpage><pub-id pub-id-type="doi">10.1093/nar/gki370</pub-id><pub-id pub-id-type="pmid">15980475</pub-id></element-citation></ref><ref id="bib38"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Li</surname><given-names>CJ</given-names></name><name><surname>Chang</surname><given-names>SC</given-names></name></person-group><year iso-8601-date="2023">2023</year><article-title>SARS-CoV-2 spike S2-specific neutralizing antibodies</article-title><source>Emerging Microbes &amp; Infections</source><volume>12</volume><elocation-id>2220582</elocation-id><pub-id pub-id-type="doi">10.1080/22221751.2023.2220582</pub-id></element-citation></ref><ref id="bib39"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Liu</surname><given-names>L</given-names></name><name><surname>Iketani</surname><given-names>S</given-names></name><name><surname>Guo</surname><given-names>Y</given-names></name><name><surname>Chan</surname><given-names>JFW</given-names></name><name><surname>Wang</surname><given-names>M</given-names></name><name><surname>Liu</surname><given-names>L</given-names></name><name><surname>Luo</surname><given-names>Y</given-names></name><name><surname>Chu</surname><given-names>H</given-names></name><name><surname>Huang</surname><given-names>Y</given-names></name><name><surname>Nair</surname><given-names>MS</given-names></name><name><surname>Yu</surname><given-names>J</given-names></name><name><surname>Chik</surname><given-names>KKH</given-names></name><name><surname>Yuen</surname><given-names>TTT</given-names></name><name><surname>Yoon</surname><given-names>C</given-names></name><name><surname>To</surname><given-names>KKW</given-names></name><name><surname>Chen</surname><given-names>H</given-names></name><name><surname>Yin</surname><given-names>MT</given-names></name><name><surname>Sobieszczyk</surname><given-names>ME</given-names></name><name><surname>Huang</surname><given-names>Y</given-names></name><name><surname>Wang</surname><given-names>HH</given-names></name><name><surname>Sheng</surname><given-names>Z</given-names></name><name><surname>Yuen</surname><given-names>KY</given-names></name><name><surname>Ho</surname><given-names>DD</given-names></name></person-group><year iso-8601-date="2022">2022</year><article-title>Striking antibody evasion manifested by the Omicron variant of SARS-CoV-2</article-title><source>Nature</source><volume>602</volume><fpage>676</fpage><lpage>681</lpage><pub-id pub-id-type="doi">10.1038/s41586-021-04388-0</pub-id><pub-id pub-id-type="pmid">35016198</pub-id></element-citation></ref><ref id="bib40"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Mastronarde</surname><given-names>DN</given-names></name></person-group><year iso-8601-date="2005">2005</year><article-title>Automated electron microscope tomography using robust prediction of specimen movements</article-title><source>Journal of Structural Biology</source><volume>152</volume><fpage>36</fpage><lpage>51</lpage><pub-id pub-id-type="doi">10.1016/j.jsb.2005.07.007</pub-id></element-citation></ref><ref id="bib41"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>McBride</surname><given-names>CE</given-names></name><name><surname>Li</surname><given-names>J</given-names></name><name><surname>Machamer</surname><given-names>CE</given-names></name></person-group><year iso-8601-date="2007">2007</year><article-title>The Cytoplasmic tail of the severe acute respiratory syndrome coronavirus spike protein contains a novel endoplasmic reticulum retrieval signal that binds COPI and promotes interaction with membrane protein</article-title><source>Journal of Virology</source><volume>81</volume><fpage>2418</fpage><lpage>2428</lpage><pub-id pub-id-type="doi">10.1128/JVI.02146-06</pub-id></element-citation></ref><ref id="bib42"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Miettinen</surname><given-names>HM</given-names></name><name><surname>Rose</surname><given-names>JK</given-names></name><name><surname>Mellman</surname><given-names>I</given-names></name></person-group><year iso-8601-date="1989">1989</year><article-title>Fc receptor isoforms exhibit distinct abilities for coated pit localization as a result of cytoplasmic domain heterogeneity</article-title><source>Cell</source><volume>58</volume><fpage>317</fpage><lpage>327</lpage><pub-id pub-id-type="doi">10.1016/0092-8674(89)90846-5</pub-id></element-citation></ref><ref id="bib43"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Miller</surname><given-names>J</given-names></name><name><surname>Hachmann</surname><given-names>NP</given-names></name><name><surname>Collier</surname><given-names>AY</given-names></name><name><surname>Lasrado</surname><given-names>N</given-names></name><name><surname>Mazurek</surname><given-names>CR</given-names></name><name><surname>Patio</surname><given-names>RC</given-names></name><name><surname>Powers</surname><given-names>O</given-names></name><name><surname>Surve</surname><given-names>N</given-names></name><name><surname>Theiler</surname><given-names>J</given-names></name><name><surname>Korber</surname><given-names>B</given-names></name><name><surname>Barouch</surname><given-names>DH</given-names></name></person-group><year iso-8601-date="2023">2023</year><article-title>Substantial neutralization escape by SARS-CoV-2 Omicron variants BQ.1.1 and XBB.1</article-title><source>New England Journal of Medicine</source><volume>388</volume><fpage>662</fpage><lpage>664</lpage><pub-id pub-id-type="doi">10.1056/NEJMc2214314</pub-id></element-citation></ref><ref id="bib44"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Muik</surname><given-names>A</given-names></name><name><surname>Lui</surname><given-names>BG</given-names></name><name><surname>Bacher</surname><given-names>M</given-names></name><name><surname>Wallisch</surname><given-names>AK</given-names></name><name><surname>Toker</surname><given-names>A</given-names></name><name><surname>Couto</surname><given-names>CIC</given-names></name><name><surname>Güler</surname><given-names>A</given-names></name><name><surname>Mampilli</surname><given-names>V</given-names></name><name><surname>Schmitt</surname><given-names>GJ</given-names></name><name><surname>Mottl</surname><given-names>J</given-names></name><name><surname>Ziegenhals</surname><given-names>T</given-names></name><name><surname>Fesser</surname><given-names>S</given-names></name><name><surname>Reinholz</surname><given-names>J</given-names></name><name><surname>Wernig</surname><given-names>F</given-names></name><name><surname>Schraut</surname><given-names>KG</given-names></name><name><surname>Hefesha</surname><given-names>H</given-names></name><name><surname>Cai</surname><given-names>H</given-names></name><name><surname>Yang</surname><given-names>Q</given-names></name><name><surname>Walzer</surname><given-names>KC</given-names></name><name><surname>Grosser</surname><given-names>J</given-names></name><name><surname>Strauss</surname><given-names>S</given-names></name><name><surname>Finlayson</surname><given-names>A</given-names></name><name><surname>Krüger</surname><given-names>K</given-names></name><name><surname>Ozhelvaci</surname><given-names>O</given-names></name><name><surname>Grikscheit</surname><given-names>K</given-names></name><name><surname>Kohmer</surname><given-names>N</given-names></name><name><surname>Ciesek</surname><given-names>S</given-names></name><name><surname>Swanson</surname><given-names>KA</given-names></name><name><surname>Vogel</surname><given-names>AB</given-names></name><name><surname>Türeci</surname><given-names>Ö</given-names></name><name><surname>Sahin</surname><given-names>U</given-names></name></person-group><year iso-8601-date="2022">2022</year><article-title>Exposure to BA.4/5 S protein drives neutralization of Omicron BA.1, BA.2, BA.2.12.1, and BA.4/5 in vaccine-experienced humans and mice</article-title><source>Science Immunology</source><volume>7</volume><elocation-id>eade9888</elocation-id><pub-id pub-id-type="doi">10.1126/sciimmunol.ade9888</pub-id><pub-id pub-id-type="pmid">36378074</pub-id></element-citation></ref><ref id="bib45"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Oberhardt</surname><given-names>V</given-names></name><name><surname>Luxenburger</surname><given-names>H</given-names></name><name><surname>Kemming</surname><given-names>J</given-names></name><name><surname>Schulien</surname><given-names>I</given-names></name><name><surname>Ciminski</surname><given-names>K</given-names></name><name><surname>Giese</surname><given-names>S</given-names></name><name><surname>Csernalabics</surname><given-names>B</given-names></name><name><surname>Lang-Meli</surname><given-names>J</given-names></name><name><surname>Janowska</surname><given-names>I</given-names></name><name><surname>Staniek</surname><given-names>J</given-names></name><name><surname>Wild</surname><given-names>K</given-names></name><name><surname>Basho</surname><given-names>K</given-names></name><name><surname>Marinescu</surname><given-names>MS</given-names></name><name><surname>Fuchs</surname><given-names>J</given-names></name><name><surname>Topfstedt</surname><given-names>F</given-names></name><name><surname>Janda</surname><given-names>A</given-names></name><name><surname>Sogukpinar</surname><given-names>O</given-names></name><name><surname>Hilger</surname><given-names>H</given-names></name><name><surname>Stete</surname><given-names>K</given-names></name><name><surname>Emmerich</surname><given-names>F</given-names></name><name><surname>Bengsch</surname><given-names>B</given-names></name><name><surname>Waller</surname><given-names>CF</given-names></name><name><surname>Rieg</surname><given-names>S</given-names></name><name><surname>Boettler</surname><given-names>T</given-names></name><name><surname>Zoldan</surname><given-names>K</given-names></name><name><surname>Kochs</surname><given-names>G</given-names></name><name><surname>Schwemmle</surname><given-names>M</given-names></name><name><surname>Rizzi</surname><given-names>M</given-names></name><name><surname>Thimme</surname><given-names>R</given-names></name><name><surname>Neumann-Haefelin</surname><given-names>C</given-names></name><name><surname>Hofmann</surname><given-names>M</given-names></name></person-group><year iso-8601-date="2021">2021</year><article-title>Rapid and stable mobilization of CD8+ T cells by SARS-CoV-2 mRNA vaccine</article-title><source>Nature</source><volume>597</volume><fpage>268</fpage><lpage>273</lpage><pub-id pub-id-type="doi">10.1038/s41586-021-03841-4</pub-id></element-citation></ref><ref id="bib46"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Painter</surname><given-names>MM</given-names></name><name><surname>Mathew</surname><given-names>D</given-names></name><name><surname>Goel</surname><given-names>RR</given-names></name><name><surname>Apostolidis</surname><given-names>SA</given-names></name><name><surname>Pattekar</surname><given-names>A</given-names></name><name><surname>Kuthuru</surname><given-names>O</given-names></name><name><surname>Baxter</surname><given-names>AE</given-names></name><name><surname>Herati</surname><given-names>RS</given-names></name><name><surname>Oldridge</surname><given-names>DA</given-names></name><name><surname>Gouma</surname><given-names>S</given-names></name><name><surname>Hicks</surname><given-names>P</given-names></name><name><surname>Dysinger</surname><given-names>S</given-names></name><name><surname>Lundgreen</surname><given-names>KA</given-names></name><name><surname>Kuri-Cervantes</surname><given-names>L</given-names></name><name><surname>Adamski</surname><given-names>S</given-names></name><name><surname>Hicks</surname><given-names>A</given-names></name><name><surname>Korte</surname><given-names>S</given-names></name><name><surname>Giles</surname><given-names>JR</given-names></name><name><surname>Weirick</surname><given-names>ME</given-names></name><name><surname>McAllister</surname><given-names>CM</given-names></name><name><surname>Dougherty</surname><given-names>J</given-names></name><name><surname>Long</surname><given-names>S</given-names></name><name><surname>D’Andrea</surname><given-names>K</given-names></name><name><surname>Hamilton</surname><given-names>JT</given-names></name><name><surname>Betts</surname><given-names>MR</given-names></name><name><surname>Bates</surname><given-names>P</given-names></name><name><surname>Hensley</surname><given-names>SE</given-names></name><name><surname>Grifoni</surname><given-names>A</given-names></name><name><surname>Weiskopf</surname><given-names>D</given-names></name><name><surname>Sette</surname><given-names>A</given-names></name><name><surname>Greenplate</surname><given-names>AR</given-names></name><name><surname>Wherry</surname><given-names>EJ</given-names></name></person-group><year iso-8601-date="2021">2021</year><article-title>Rapid induction of antigen-specific CD4<sup>+</sup> T cells is associated with coordinated humoral and cellular immunity to SARS-CoV-2 mRNA vaccination</article-title><source>Immunity</source><volume>54</volume><fpage>2133</fpage><lpage>2142</lpage><pub-id pub-id-type="doi">10.1016/j.immuni.2021.08.001</pub-id><pub-id pub-id-type="pmid">34453880</pub-id></element-citation></ref><ref id="bib47"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Pallesen</surname><given-names>J</given-names></name><name><surname>Wang</surname><given-names>N</given-names></name><name><surname>Corbett</surname><given-names>KS</given-names></name><name><surname>Wrapp</surname><given-names>D</given-names></name><name><surname>Kirchdoerfer</surname><given-names>RN</given-names></name><name><surname>Turner</surname><given-names>HL</given-names></name><name><surname>Cottrell</surname><given-names>CA</given-names></name><name><surname>Becker</surname><given-names>MM</given-names></name><name><surname>Wang</surname><given-names>L</given-names></name><name><surname>Shi</surname><given-names>W</given-names></name><name><surname>Kong</surname><given-names>WP</given-names></name><name><surname>Andres</surname><given-names>EL</given-names></name><name><surname>Kettenbach</surname><given-names>AN</given-names></name><name><surname>Denison</surname><given-names>MR</given-names></name><name><surname>Chappell</surname><given-names>JD</given-names></name><name><surname>Graham</surname><given-names>BS</given-names></name><name><surname>Ward</surname><given-names>AB</given-names></name><name><surname>McLellan</surname><given-names>JS</given-names></name></person-group><year iso-8601-date="2017">2017</year><article-title>Immunogenicity and structures of a rationally designed prefusion MERS-CoV spike antigen</article-title><source>PNAS</source><volume>114</volume><fpage>E7348</fpage><lpage>E7357</lpage><pub-id pub-id-type="doi">10.1073/pnas.1707304114</pub-id></element-citation></ref><ref id="bib48"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Pardi</surname><given-names>N</given-names></name><name><surname>Tuyishime</surname><given-names>S</given-names></name><name><surname>Muramatsu</surname><given-names>H</given-names></name><name><surname>Kariko</surname><given-names>K</given-names></name><name><surname>Mui</surname><given-names>BL</given-names></name><name><surname>Tam</surname><given-names>YK</given-names></name><name><surname>Madden</surname><given-names>TD</given-names></name><name><surname>Hope</surname><given-names>MJ</given-names></name><name><surname>Weissman</surname><given-names>D</given-names></name></person-group><year iso-8601-date="2015">2015</year><article-title>Expression kinetics of nucleoside-modified mRNA delivered in lipid nanoparticles to mice by various routes</article-title><source>Journal of Controlled Release</source><volume>217</volume><fpage>345</fpage><lpage>351</lpage><pub-id pub-id-type="doi">10.1016/j.jconrel.2015.08.007</pub-id><pub-id pub-id-type="pmid">26264835</pub-id></element-citation></ref><ref id="bib49"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Park</surname><given-names>YJ</given-names></name><name><surname>Pinto</surname><given-names>D</given-names></name><name><surname>Walls</surname><given-names>AC</given-names></name><name><surname>Liu</surname><given-names>Z</given-names></name><name><surname>De Marco</surname><given-names>A</given-names></name><name><surname>Benigni</surname><given-names>F</given-names></name><name><surname>Zatta</surname><given-names>F</given-names></name><name><surname>Silacci-Fregni</surname><given-names>C</given-names></name><name><surname>Bassi</surname><given-names>J</given-names></name><name><surname>Sprouse</surname><given-names>KR</given-names></name><name><surname>Addetia</surname><given-names>A</given-names></name><name><surname>Bowen</surname><given-names>JE</given-names></name><name><surname>Stewart</surname><given-names>C</given-names></name><name><surname>Giurdanella</surname><given-names>M</given-names></name><name><surname>Saliba</surname><given-names>C</given-names></name><name><surname>Guarino</surname><given-names>B</given-names></name><name><surname>Schmid</surname><given-names>MA</given-names></name><name><surname>Franko</surname><given-names>NM</given-names></name><name><surname>Logue</surname><given-names>JK</given-names></name><name><surname>Dang</surname><given-names>HV</given-names></name><name><surname>Hauser</surname><given-names>K</given-names></name><name><surname>di Iulio</surname><given-names>J</given-names></name><name><surname>Rivera</surname><given-names>W</given-names></name><name><surname>Schnell</surname><given-names>G</given-names></name><name><surname>Rajesh</surname><given-names>A</given-names></name><name><surname>Zhou</surname><given-names>J</given-names></name><name><surname>Farhat</surname><given-names>N</given-names></name><name><surname>Kaiser</surname><given-names>H</given-names></name><name><surname>Montiel-Ruiz</surname><given-names>M</given-names></name><name><surname>Noack</surname><given-names>J</given-names></name><name><surname>Lempp</surname><given-names>FA</given-names></name><name><surname>Janer</surname><given-names>J</given-names></name><name><surname>Abdelnabi</surname><given-names>R</given-names></name><name><surname>Maes</surname><given-names>P</given-names></name><name><surname>Ferrari</surname><given-names>P</given-names></name><name><surname>Ceschi</surname><given-names>A</given-names></name><name><surname>Giannini</surname><given-names>O</given-names></name><name><surname>de Melo</surname><given-names>GD</given-names></name><name><surname>Kergoat</surname><given-names>L</given-names></name><name><surname>Bourhy</surname><given-names>H</given-names></name><name><surname>Neyts</surname><given-names>J</given-names></name><name><surname>Soriaga</surname><given-names>L</given-names></name><name><surname>Purcell</surname><given-names>LA</given-names></name><name><surname>Snell</surname><given-names>G</given-names></name><name><surname>Whelan</surname><given-names>SPJ</given-names></name><name><surname>Lanzavecchia</surname><given-names>A</given-names></name><name><surname>Virgin</surname><given-names>HW</given-names></name><name><surname>Piccoli</surname><given-names>L</given-names></name><name><surname>Chu</surname><given-names>HY</given-names></name><name><surname>Pizzuto</surname><given-names>MS</given-names></name><name><surname>Corti</surname><given-names>D</given-names></name><name><surname>Veesler</surname><given-names>D</given-names></name></person-group><year iso-8601-date="2022">2022</year><article-title>Imprinted antibody responses against SARS-CoV-2 Omicron sublineages</article-title><source>Science</source><volume>378</volume><fpage>619</fpage><lpage>627</lpage><pub-id pub-id-type="doi">10.1126/science.adc9127</pub-id><pub-id pub-id-type="pmid">36264829</pub-id></element-citation></ref><ref id="bib50"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Pinto</surname><given-names>D</given-names></name><name><surname>Sauer</surname><given-names>MM</given-names></name><name><surname>Czudnochowski</surname><given-names>N</given-names></name><name><surname>Low</surname><given-names>JS</given-names></name><name><surname>Tortorici</surname><given-names>MA</given-names></name><name><surname>Housley</surname><given-names>MP</given-names></name><name><surname>Noack</surname><given-names>J</given-names></name><name><surname>Walls</surname><given-names>AC</given-names></name><name><surname>Bowen</surname><given-names>JE</given-names></name><name><surname>Guarino</surname><given-names>B</given-names></name><name><surname>Rosen</surname><given-names>LE</given-names></name><name><surname>di Iulio</surname><given-names>J</given-names></name><name><surname>Jerak</surname><given-names>J</given-names></name><name><surname>Kaiser</surname><given-names>H</given-names></name><name><surname>Islam</surname><given-names>S</given-names></name><name><surname>Jaconi</surname><given-names>S</given-names></name><name><surname>Sprugasci</surname><given-names>N</given-names></name><name><surname>Culap</surname><given-names>K</given-names></name><name><surname>Abdelnabi</surname><given-names>R</given-names></name><name><surname>Foo</surname><given-names>C</given-names></name><name><surname>Coelmont</surname><given-names>L</given-names></name><name><surname>Bartha</surname><given-names>I</given-names></name><name><surname>Bianchi</surname><given-names>S</given-names></name><name><surname>Silacci-Fregni</surname><given-names>C</given-names></name><name><surname>Bassi</surname><given-names>J</given-names></name><name><surname>Marzi</surname><given-names>R</given-names></name><name><surname>Vetti</surname><given-names>E</given-names></name><name><surname>Cassotta</surname><given-names>A</given-names></name><name><surname>Ceschi</surname><given-names>A</given-names></name><name><surname>Ferrari</surname><given-names>P</given-names></name><name><surname>Cippà</surname><given-names>PE</given-names></name><name><surname>Giannini</surname><given-names>O</given-names></name><name><surname>Ceruti</surname><given-names>S</given-names></name><name><surname>Garzoni</surname><given-names>C</given-names></name><name><surname>Riva</surname><given-names>A</given-names></name><name><surname>Benigni</surname><given-names>F</given-names></name><name><surname>Cameroni</surname><given-names>E</given-names></name><name><surname>Piccoli</surname><given-names>L</given-names></name><name><surname>Pizzuto</surname><given-names>MS</given-names></name><name><surname>Smithey</surname><given-names>M</given-names></name><name><surname>Hong</surname><given-names>D</given-names></name><name><surname>Telenti</surname><given-names>A</given-names></name><name><surname>Lempp</surname><given-names>FA</given-names></name><name><surname>Neyts</surname><given-names>J</given-names></name><name><surname>Havenar-Daughton</surname><given-names>C</given-names></name><name><surname>Lanzavecchia</surname><given-names>A</given-names></name><name><surname>Sallusto</surname><given-names>F</given-names></name><name><surname>Snell</surname><given-names>G</given-names></name><name><surname>Virgin</surname><given-names>HW</given-names></name><name><surname>Beltramello</surname><given-names>M</given-names></name><name><surname>Corti</surname><given-names>D</given-names></name><name><surname>Veesler</surname><given-names>D</given-names></name></person-group><year iso-8601-date="2021">2021</year><article-title>Broad betacoronavirus neutralization by a stem helix-specific human antibody</article-title><source>Science</source><volume>373</volume><fpage>1109</fpage><lpage>1116</lpage><pub-id pub-id-type="doi">10.1126/science.abj3321</pub-id><pub-id pub-id-type="pmid">34344823</pub-id></element-citation></ref><ref id="bib51"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Planas</surname><given-names>D</given-names></name><name><surname>Veyer</surname><given-names>D</given-names></name><name><surname>Baidaliuk</surname><given-names>A</given-names></name><name><surname>Staropoli</surname><given-names>I</given-names></name><name><surname>Guivel-Benhassine</surname><given-names>F</given-names></name><name><surname>Rajah</surname><given-names>MM</given-names></name><name><surname>Planchais</surname><given-names>C</given-names></name><name><surname>Porrot</surname><given-names>F</given-names></name><name><surname>Robillard</surname><given-names>N</given-names></name><name><surname>Puech</surname><given-names>J</given-names></name><name><surname>Prot</surname><given-names>M</given-names></name><name><surname>Gallais</surname><given-names>F</given-names></name><name><surname>Gantner</surname><given-names>P</given-names></name><name><surname>Velay</surname><given-names>A</given-names></name><name><surname>Le Guen</surname><given-names>J</given-names></name><name><surname>Kassis-Chikhani</surname><given-names>N</given-names></name><name><surname>Edriss</surname><given-names>D</given-names></name><name><surname>Belec</surname><given-names>L</given-names></name><name><surname>Seve</surname><given-names>A</given-names></name><name><surname>Courtellemont</surname><given-names>L</given-names></name><name><surname>Péré</surname><given-names>H</given-names></name><name><surname>Hocqueloux</surname><given-names>L</given-names></name><name><surname>Fafi-Kremer</surname><given-names>S</given-names></name><name><surname>Prazuck</surname><given-names>T</given-names></name><name><surname>Mouquet</surname><given-names>H</given-names></name><name><surname>Bruel</surname><given-names>T</given-names></name><name><surname>Simon-Lorière</surname><given-names>E</given-names></name><name><surname>Rey</surname><given-names>FA</given-names></name><name><surname>Schwartz</surname><given-names>O</given-names></name></person-group><year iso-8601-date="2021">2021</year><article-title>Reduced sensitivity of SARS-CoV-2 variant Delta to antibody neutralization</article-title><source>Nature</source><volume>596</volume><fpage>276</fpage><lpage>280</lpage><pub-id pub-id-type="doi">10.1038/s41586-021-03777-9</pub-id><pub-id pub-id-type="pmid">34237773</pub-id></element-citation></ref><ref id="bib52"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Polack</surname><given-names>FP</given-names></name><name><surname>Thomas</surname><given-names>SJ</given-names></name><name><surname>Kitchin</surname><given-names>N</given-names></name><name><surname>Absalon</surname><given-names>J</given-names></name><name><surname>Gurtman</surname><given-names>A</given-names></name><name><surname>Lockhart</surname><given-names>S</given-names></name><name><surname>Perez</surname><given-names>JL</given-names></name><name><surname>Pérez Marc</surname><given-names>G</given-names></name><name><surname>Moreira</surname><given-names>ED</given-names></name><name><surname>Zerbini</surname><given-names>C</given-names></name><name><surname>Bailey</surname><given-names>R</given-names></name><name><surname>Swanson</surname><given-names>KA</given-names></name><name><surname>Roychoudhury</surname><given-names>S</given-names></name><name><surname>Koury</surname><given-names>K</given-names></name><name><surname>Li</surname><given-names>P</given-names></name><name><surname>Kalina</surname><given-names>WV</given-names></name><name><surname>Cooper</surname><given-names>D</given-names></name><name><surname>Frenck</surname><given-names>RW</given-names><suffix>Jr</suffix></name><name><surname>Hammitt</surname><given-names>LL</given-names></name><name><surname>Türeci</surname><given-names>Ö</given-names></name><name><surname>Nell</surname><given-names>H</given-names></name><name><surname>Schaefer</surname><given-names>A</given-names></name><name><surname>Ünal</surname><given-names>S</given-names></name><name><surname>Tresnan</surname><given-names>DB</given-names></name><name><surname>Mather</surname><given-names>S</given-names></name><name><surname>Dormitzer</surname><given-names>PR</given-names></name><name><surname>Şahin</surname><given-names>U</given-names></name><name><surname>Jansen</surname><given-names>KU</given-names></name><name><surname>Gruber</surname><given-names>WC</given-names></name><collab>C4591001 Clinical Trial Group</collab></person-group><year iso-8601-date="2020">2020</year><article-title>Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine</article-title><source>The New England Journal of Medicine</source><volume>383</volume><fpage>2603</fpage><lpage>2615</lpage><pub-id pub-id-type="doi">10.1056/NEJMoa2034577</pub-id><pub-id pub-id-type="pmid">33301246</pub-id></element-citation></ref><ref id="bib53"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Punjani</surname><given-names>A</given-names></name><name><surname>Rubinstein</surname><given-names>JL</given-names></name><name><surname>Fleet</surname><given-names>DJ</given-names></name><name><surname>Brubaker</surname><given-names>MA</given-names></name></person-group><year iso-8601-date="2017">2017</year><article-title>cryoSPARC: Algorithms for rapid unsupervised cryo-EM structure determination</article-title><source>Nature Methods</source><volume>14</volume><fpage>290</fpage><lpage>296</lpage><pub-id pub-id-type="doi">10.1038/nmeth.4169</pub-id><pub-id pub-id-type="pmid">28165473</pub-id></element-citation></ref><ref id="bib54"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Robbiani</surname><given-names>DF</given-names></name><name><surname>Gaebler</surname><given-names>C</given-names></name><name><surname>Muecksch</surname><given-names>F</given-names></name><name><surname>Lorenzi</surname><given-names>JCC</given-names></name><name><surname>Wang</surname><given-names>Z</given-names></name><name><surname>Cho</surname><given-names>A</given-names></name><name><surname>Agudelo</surname><given-names>M</given-names></name><name><surname>Barnes</surname><given-names>CO</given-names></name><name><surname>Gazumyan</surname><given-names>A</given-names></name><name><surname>Finkin</surname><given-names>S</given-names></name><name><surname>Hägglöf</surname><given-names>T</given-names></name><name><surname>Oliveira</surname><given-names>TY</given-names></name><name><surname>Viant</surname><given-names>C</given-names></name><name><surname>Hurley</surname><given-names>A</given-names></name><name><surname>Hoffmann</surname><given-names>HH</given-names></name><name><surname>Millard</surname><given-names>KG</given-names></name><name><surname>Kost</surname><given-names>RG</given-names></name><name><surname>Cipolla</surname><given-names>M</given-names></name><name><surname>Gordon</surname><given-names>K</given-names></name><name><surname>Bianchini</surname><given-names>F</given-names></name><name><surname>Chen</surname><given-names>ST</given-names></name><name><surname>Ramos</surname><given-names>V</given-names></name><name><surname>Patel</surname><given-names>R</given-names></name><name><surname>Dizon</surname><given-names>J</given-names></name><name><surname>Shimeliovich</surname><given-names>I</given-names></name><name><surname>Mendoza</surname><given-names>P</given-names></name><name><surname>Hartweger</surname><given-names>H</given-names></name><name><surname>Nogueira</surname><given-names>L</given-names></name><name><surname>Pack</surname><given-names>M</given-names></name><name><surname>Horowitz</surname><given-names>J</given-names></name><name><surname>Schmidt</surname><given-names>F</given-names></name><name><surname>Weisblum</surname><given-names>Y</given-names></name><name><surname>Michailidis</surname><given-names>E</given-names></name><name><surname>Ashbrook</surname><given-names>AW</given-names></name><name><surname>Waltari</surname><given-names>E</given-names></name><name><surname>Pak</surname><given-names>JE</given-names></name><name><surname>Huey-Tubman</surname><given-names>KE</given-names></name><name><surname>Koranda</surname><given-names>N</given-names></name><name><surname>Hoffman</surname><given-names>PR</given-names></name><name><surname>West</surname><given-names>AP</given-names><suffix>Jr</suffix></name><name><surname>Rice</surname><given-names>CM</given-names></name><name><surname>Hatziioannou</surname><given-names>T</given-names></name><name><surname>Bjorkman</surname><given-names>PJ</given-names></name><name><surname>Bieniasz</surname><given-names>PD</given-names></name><name><surname>Caskey</surname><given-names>M</given-names></name><name><surname>Nussenzweig</surname><given-names>MC</given-names></name></person-group><year iso-8601-date="2020">2020</year><article-title>Convergent antibody responses to SARS-CoV-2 in convalescent individuals</article-title><source>Nature</source><volume>584</volume><fpage>437</fpage><lpage>442</lpage><pub-id pub-id-type="doi">10.1038/s41586-020-2456-9</pub-id><pub-id pub-id-type="pmid">32555388</pub-id></element-citation></ref><ref id="bib55"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Rydyznski Moderbacher</surname><given-names>C</given-names></name><name><surname>Ramirez</surname><given-names>SI</given-names></name><name><surname>Dan</surname><given-names>JM</given-names></name><name><surname>Grifoni</surname><given-names>A</given-names></name><name><surname>Hastie</surname><given-names>KM</given-names></name><name><surname>Weiskopf</surname><given-names>D</given-names></name><name><surname>Belanger</surname><given-names>S</given-names></name><name><surname>Abbott</surname><given-names>RK</given-names></name><name><surname>Kim</surname><given-names>C</given-names></name><name><surname>Choi</surname><given-names>J</given-names></name><name><surname>Kato</surname><given-names>Y</given-names></name><name><surname>Crotty</surname><given-names>EG</given-names></name><name><surname>Kim</surname><given-names>C</given-names></name><name><surname>Rawlings</surname><given-names>SA</given-names></name><name><surname>Mateus</surname><given-names>J</given-names></name><name><surname>Tse</surname><given-names>LPV</given-names></name><name><surname>Frazier</surname><given-names>A</given-names></name><name><surname>Baric</surname><given-names>R</given-names></name><name><surname>Peters</surname><given-names>B</given-names></name><name><surname>Greenbaum</surname><given-names>J</given-names></name><name><surname>Saphire</surname><given-names>EO</given-names></name><name><surname>Smith</surname><given-names>DM</given-names></name><name><surname>Sette</surname><given-names>A</given-names></name><name><surname>Crotty</surname><given-names>S</given-names></name></person-group><year iso-8601-date="2020">2020</year><article-title>Antigen-specific adaptive immunity to SARS-CoV-2 in acute COVID-19 and associations with age and disease severity</article-title><source>Cell</source><volume>183</volume><fpage>996</fpage><lpage>1012</lpage><pub-id pub-id-type="doi">10.1016/j.cell.2020.09.038</pub-id><pub-id pub-id-type="pmid">33010815</pub-id></element-citation></ref><ref id="bib56"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Sanders</surname><given-names>RW</given-names></name><name><surname>Derking</surname><given-names>R</given-names></name><name><surname>Cupo</surname><given-names>A</given-names></name><name><surname>Julien</surname><given-names>JP</given-names></name><name><surname>Yasmeen</surname><given-names>A</given-names></name><name><surname>de Val</surname><given-names>N</given-names></name><name><surname>Kim</surname><given-names>HJ</given-names></name><name><surname>Blattner</surname><given-names>C</given-names></name><name><surname>de la Peña</surname><given-names>AT</given-names></name><name><surname>Korzun</surname><given-names>J</given-names></name><name><surname>Golabek</surname><given-names>M</given-names></name><name><surname>de los Reyes</surname><given-names>K</given-names></name><name><surname>Ketas</surname><given-names>TJ</given-names></name><name><surname>van Gils</surname><given-names>MJ</given-names></name><name><surname>King</surname><given-names>CR</given-names></name><name><surname>Wilson</surname><given-names>IA</given-names></name><name><surname>Ward</surname><given-names>AB</given-names></name><name><surname>Klasse</surname><given-names>PJ</given-names></name><name><surname>Moore</surname><given-names>JP</given-names></name></person-group><year iso-8601-date="2013">2013</year><article-title>A next-generation cleaved, soluble HIV-1 Env Trimer, BG505 SOSIP.664 gp140, expresses multiple epitopes for broadly neutralizing but not non-neutralizing antibodies</article-title><source>PLOS Pathogens</source><volume>9</volume><elocation-id>e1003618</elocation-id><pub-id pub-id-type="doi">10.1371/journal.ppat.1003618</pub-id></element-citation></ref><ref id="bib57"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Saphire</surname><given-names>EO</given-names></name><name><surname>Parren</surname><given-names>PW</given-names></name><name><surname>Pantophlet</surname><given-names>R</given-names></name><name><surname>Zwick</surname><given-names>MB</given-names></name><name><surname>Morris</surname><given-names>GM</given-names></name><name><surname>Rudd</surname><given-names>PM</given-names></name><name><surname>Dwek</surname><given-names>RA</given-names></name><name><surname>Stanfield</surname><given-names>RL</given-names></name><name><surname>Burton</surname><given-names>DR</given-names></name><name><surname>Wilson</surname><given-names>IA</given-names></name></person-group><year iso-8601-date="2001">2001</year><article-title>Crystal structure of a neutralizing human IGG against HIV-1: A template for vaccine design</article-title><source>Science</source><volume>293</volume><fpage>1155</fpage><lpage>1159</lpage><pub-id pub-id-type="doi">10.1126/science.1061692</pub-id><pub-id pub-id-type="pmid">11498595</pub-id></element-citation></ref><ref id="bib58"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Scheaffer</surname><given-names>SM</given-names></name><name><surname>Lee</surname><given-names>D</given-names></name><name><surname>Whitener</surname><given-names>B</given-names></name><name><surname>Ying</surname><given-names>B</given-names></name><name><surname>Wu</surname><given-names>K</given-names></name><name><surname>Liang</surname><given-names>CY</given-names></name><name><surname>Jani</surname><given-names>H</given-names></name><name><surname>Martin</surname><given-names>P</given-names></name><name><surname>Amato</surname><given-names>NJ</given-names></name><name><surname>Avena</surname><given-names>LE</given-names></name><name><surname>Berrueta</surname><given-names>DM</given-names></name><name><surname>Schmidt</surname><given-names>SD</given-names></name><name><surname>O’Dell</surname><given-names>S</given-names></name><name><surname>Nasir</surname><given-names>A</given-names></name><name><surname>Chuang</surname><given-names>GY</given-names></name><name><surname>Stewart-Jones</surname><given-names>G</given-names></name><name><surname>Koup</surname><given-names>RA</given-names></name><name><surname>Doria-Rose</surname><given-names>NA</given-names></name><name><surname>Carfi</surname><given-names>A</given-names></name><name><surname>Elbashir</surname><given-names>SM</given-names></name><name><surname>Thackray</surname><given-names>LB</given-names></name><name><surname>Edwards</surname><given-names>DK</given-names></name><name><surname>Diamond</surname><given-names>MS</given-names></name></person-group><year iso-8601-date="2023">2023</year><article-title>Bivalent SARS-CoV-2 mRNA vaccines increase breadth of neutralization and protect against the BA.5 Omicron variant in mice</article-title><source>Nature Medicine</source><volume>29</volume><fpage>247</fpage><lpage>257</lpage><pub-id pub-id-type="doi">10.1038/s41591-022-02092-8</pub-id><pub-id pub-id-type="pmid">36265510</pub-id></element-citation></ref><ref id="bib59"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Song</surname><given-names>S</given-names></name><name><surname>Madewell</surname><given-names>ZJ</given-names></name><name><surname>Liu</surname><given-names>M</given-names></name><name><surname>Miao</surname><given-names>Y</given-names></name><name><surname>Xiang</surname><given-names>S</given-names></name><name><surname>Huo</surname><given-names>Y</given-names></name><name><surname>Sarkar</surname><given-names>S</given-names></name><name><surname>Chowdhury</surname><given-names>A</given-names></name><name><surname>Longini</surname><given-names>IM</given-names><suffix>Jr</suffix></name><name><surname>Yang</surname><given-names>Y</given-names></name></person-group><year iso-8601-date="2024">2024</year><article-title>A systematic review and meta-analysis on the effectiveness of bivalent mRNA booster vaccines against Omicron variants</article-title><source>Vaccine</source><volume>42</volume><fpage>3389</fpage><lpage>3396</lpage><pub-id pub-id-type="doi">10.1016/j.vaccine.2024.04.049</pub-id><pub-id pub-id-type="pmid">38653679</pub-id></element-citation></ref><ref id="bib60"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Starr</surname><given-names>TN</given-names></name><name><surname>Greaney</surname><given-names>AJ</given-names></name><name><surname>Hilton</surname><given-names>SK</given-names></name><name><surname>Ellis</surname><given-names>D</given-names></name><name><surname>Crawford</surname><given-names>KHD</given-names></name><name><surname>Dingens</surname><given-names>AS</given-names></name><name><surname>Navarro</surname><given-names>MJ</given-names></name><name><surname>Bowen</surname><given-names>JE</given-names></name><name><surname>Tortorici</surname><given-names>MA</given-names></name><name><surname>Walls</surname><given-names>AC</given-names></name><name><surname>King</surname><given-names>NP</given-names></name><name><surname>Veesler</surname><given-names>D</given-names></name><name><surname>Bloom</surname><given-names>JD</given-names></name></person-group><year iso-8601-date="2020">2020</year><article-title>Deep mutational scanning of SARS-CoV-2 receptor binding domain reveals constraints on folding and ACE2 binding</article-title><source>Cell</source><volume>182</volume><fpage>1295</fpage><lpage>1310</lpage><pub-id pub-id-type="doi">10.1016/j.cell.2020.08.012</pub-id><pub-id pub-id-type="pmid">32841599</pub-id></element-citation></ref><ref id="bib61"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Starr</surname><given-names>TN</given-names></name><name><surname>Greaney</surname><given-names>AJ</given-names></name><name><surname>Hannon</surname><given-names>WW</given-names></name><name><surname>Loes</surname><given-names>AN</given-names></name><name><surname>Hauser</surname><given-names>K</given-names></name><name><surname>Dillen</surname><given-names>JR</given-names></name><name><surname>Ferri</surname><given-names>E</given-names></name><name><surname>Farrell</surname><given-names>AG</given-names></name><name><surname>Dadonaite</surname><given-names>B</given-names></name><name><surname>McCallum</surname><given-names>M</given-names></name><name><surname>Matreyek</surname><given-names>KA</given-names></name><name><surname>Corti</surname><given-names>D</given-names></name><name><surname>Veesler</surname><given-names>D</given-names></name><name><surname>Snell</surname><given-names>G</given-names></name><name><surname>Bloom</surname><given-names>JD</given-names></name></person-group><year iso-8601-date="2022">2022</year><article-title>Shifting mutational constraints in the SARS-CoV-2 receptor-binding domain during viral evolution</article-title><source>Science</source><volume>377</volume><fpage>420</fpage><lpage>424</lpage><pub-id pub-id-type="doi">10.1126/science.abo7896</pub-id></element-citation></ref><ref id="bib62"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Tan</surname><given-names>CY</given-names></name><name><surname>Chiew</surname><given-names>CJ</given-names></name><name><surname>Pang</surname><given-names>D</given-names></name><name><surname>Lee</surname><given-names>VJ</given-names></name><name><surname>Ong</surname><given-names>B</given-names></name><name><surname>Wang</surname><given-names>LF</given-names></name><name><surname>Ren</surname><given-names>EC</given-names></name><name><surname>Lye</surname><given-names>DC</given-names></name><name><surname>Tan</surname><given-names>KB</given-names></name></person-group><year iso-8601-date="2023">2023</year><article-title>Effectiveness of bivalent mRNA vaccines against medically attended symptomatic SARS-CoV-2 infection and COVID-19-related hospital admission among SARS-CoV-2-naive and previously infected individuals: a retrospective cohort study</article-title><source>The Lancet Infectious Diseases</source><volume>23</volume><fpage>1343</fpage><lpage>1348</lpage><pub-id pub-id-type="doi">10.1016/S1473-3099(23)00373-0</pub-id></element-citation></ref><ref id="bib63"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Taylor</surname><given-names>AL</given-names></name><name><surname>Starr</surname><given-names>TN</given-names></name></person-group><year iso-8601-date="2023">2023</year><article-title>Deep mutational scans of XBB.1.5 and BQ.1.1 reveal ongoing epistatic drift during SARS-CoV-2 evolution</article-title><source>PLOS Pathogens</source><volume>19</volume><elocation-id>e1011901</elocation-id><pub-id pub-id-type="doi">10.1371/journal.ppat.1011901</pub-id><pub-id pub-id-type="pmid">38157379</pub-id></element-citation></ref><ref id="bib64"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Tseng</surname><given-names>HF</given-names></name><name><surname>Ackerson</surname><given-names>BK</given-names></name><name><surname>Luo</surname><given-names>Y</given-names></name><name><surname>Sy</surname><given-names>LS</given-names></name><name><surname>Talarico</surname><given-names>CA</given-names></name><name><surname>Tian</surname><given-names>Y</given-names></name><name><surname>Bruxvoort</surname><given-names>KJ</given-names></name><name><surname>Tubert</surname><given-names>JE</given-names></name><name><surname>Florea</surname><given-names>A</given-names></name><name><surname>Ku</surname><given-names>JH</given-names></name><name><surname>Lee</surname><given-names>GS</given-names></name><name><surname>Choi</surname><given-names>SK</given-names></name><name><surname>Takhar</surname><given-names>HS</given-names></name><name><surname>Aragones</surname><given-names>M</given-names></name><name><surname>Qian</surname><given-names>L</given-names></name></person-group><year iso-8601-date="2022">2022</year><article-title>Effectiveness of mRNA-1273 against SARS-CoV-2 Omicron and delta variants</article-title><source>Nature Medicine</source><volume>28</volume><fpage>1063</fpage><lpage>1071</lpage><pub-id pub-id-type="doi">10.1038/s41591-022-01753-y</pub-id><pub-id pub-id-type="pmid">35189624</pub-id></element-citation></ref><ref id="bib65"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Walls</surname><given-names>AC</given-names></name><name><surname>Park</surname><given-names>YJ</given-names></name><name><surname>Tortorici</surname><given-names>MA</given-names></name><name><surname>Wall</surname><given-names>A</given-names></name><name><surname>McGuire</surname><given-names>AT</given-names></name><name><surname>Veesler</surname><given-names>D</given-names></name></person-group><year iso-8601-date="2020">2020</year><article-title>Structure, function, and antigenicity of the SARS-CoV-2 spike glycoprotein</article-title><source>Cell</source><volume>181</volume><fpage>281</fpage><lpage>292</lpage><pub-id pub-id-type="doi">10.1016/j.cell.2020.02.058</pub-id><pub-id pub-id-type="pmid">32155444</pub-id></element-citation></ref><ref id="bib66"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Wang</surname><given-names>Z</given-names></name><name><surname>Muecksch</surname><given-names>F</given-names></name><name><surname>Cho</surname><given-names>A</given-names></name><name><surname>Gaebler</surname><given-names>C</given-names></name><name><surname>Hoffmann</surname><given-names>HH</given-names></name><name><surname>Ramos</surname><given-names>V</given-names></name><name><surname>Zong</surname><given-names>S</given-names></name><name><surname>Cipolla</surname><given-names>M</given-names></name><name><surname>Johnson</surname><given-names>B</given-names></name><name><surname>Schmidt</surname><given-names>F</given-names></name><name><surname>DaSilva</surname><given-names>J</given-names></name><name><surname>Bednarski</surname><given-names>E</given-names></name><name><surname>Ben Tanfous</surname><given-names>T</given-names></name><name><surname>Raspe</surname><given-names>R</given-names></name><name><surname>Yao</surname><given-names>K</given-names></name><name><surname>Lee</surname><given-names>YE</given-names></name><name><surname>Chen</surname><given-names>T</given-names></name><name><surname>Turroja</surname><given-names>M</given-names></name><name><surname>Milard</surname><given-names>KG</given-names></name><name><surname>Dizon</surname><given-names>J</given-names></name><name><surname>Kaczynska</surname><given-names>A</given-names></name><name><surname>Gazumyan</surname><given-names>A</given-names></name><name><surname>Oliveira</surname><given-names>TY</given-names></name><name><surname>Rice</surname><given-names>CM</given-names></name><name><surname>Caskey</surname><given-names>M</given-names></name><name><surname>Bieniasz</surname><given-names>PD</given-names></name><name><surname>Hatziioannou</surname><given-names>T</given-names></name><name><surname>Barnes</surname><given-names>CO</given-names></name><name><surname>Nussenzweig</surname><given-names>MC</given-names></name></person-group><year iso-8601-date="2022">2022</year><article-title>Analysis of memory B cells identifies conserved neutralizing epitopes on the N-terminal domain of variant SARS-Cov-2 spike proteins</article-title><source>Immunity</source><volume>55</volume><fpage>998</fpage><lpage>1012</lpage><pub-id pub-id-type="doi">10.1016/j.immuni.2022.04.003</pub-id><pub-id pub-id-type="pmid">35447092</pub-id></element-citation></ref><ref id="bib67"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Wang</surname><given-names>Q</given-names></name><name><surname>Bowen</surname><given-names>A</given-names></name><name><surname>Tam</surname><given-names>AR</given-names></name><name><surname>Valdez</surname><given-names>R</given-names></name><name><surname>Stoneman</surname><given-names>E</given-names></name><name><surname>Mellis</surname><given-names>IA</given-names></name><name><surname>Gordon</surname><given-names>A</given-names></name><name><surname>Liu</surname><given-names>L</given-names></name><name><surname>Ho</surname><given-names>DD</given-names></name></person-group><year iso-8601-date="2023">2023a</year><article-title>SARS-CoV-2 neutralising antibodies after bivalent versus monovalent booster</article-title><source>The Lancet. Infectious Diseases</source><volume>23</volume><fpage>527</fpage><lpage>528</lpage><pub-id pub-id-type="doi">10.1016/S1473-3099(23)00181-0</pub-id><pub-id pub-id-type="pmid">37003292</pub-id></element-citation></ref><ref id="bib68"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Wang</surname><given-names>Q</given-names></name><name><surname>Guo</surname><given-names>Y</given-names></name><name><surname>Tam</surname><given-names>AR</given-names></name><name><surname>Valdez</surname><given-names>R</given-names></name><name><surname>Gordon</surname><given-names>A</given-names></name><name><surname>Liu</surname><given-names>L</given-names></name><name><surname>Ho</surname><given-names>DD</given-names></name></person-group><year iso-8601-date="2023">2023b</year><article-title>Deep immunological imprinting due to the ancestral spike in the current bivalent COVID-19 vaccine</article-title><source>Cell Reports Medicine</source><volume>4</volume><elocation-id>101258</elocation-id><pub-id pub-id-type="doi">10.1016/j.xcrm.2023.101258</pub-id></element-citation></ref><ref id="bib69"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Wang</surname><given-names>Q</given-names></name><name><surname>Iketani</surname><given-names>S</given-names></name><name><surname>Li</surname><given-names>Z</given-names></name><name><surname>Liu</surname><given-names>L</given-names></name><name><surname>Guo</surname><given-names>Y</given-names></name><name><surname>Huang</surname><given-names>Y</given-names></name><name><surname>Bowen</surname><given-names>AD</given-names></name><name><surname>Liu</surname><given-names>M</given-names></name><name><surname>Wang</surname><given-names>M</given-names></name><name><surname>Yu</surname><given-names>J</given-names></name><name><surname>Valdez</surname><given-names>R</given-names></name><name><surname>Lauring</surname><given-names>AS</given-names></name><name><surname>Sheng</surname><given-names>Z</given-names></name><name><surname>Wang</surname><given-names>HH</given-names></name><name><surname>Gordon</surname><given-names>A</given-names></name><name><surname>Liu</surname><given-names>L</given-names></name><name><surname>Ho</surname><given-names>DD</given-names></name></person-group><year iso-8601-date="2023">2023c</year><article-title>Alarming antibody evasion properties of rising SARS-CoV-2 BQ and XBB subvariants</article-title><source>Cell</source><volume>186</volume><fpage>279</fpage><lpage>286</lpage><pub-id pub-id-type="doi">10.1016/j.cell.2022.12.018</pub-id><pub-id pub-id-type="pmid">36580913</pub-id></element-citation></ref><ref id="bib70"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>West</surname><given-names>AP</given-names></name><name><surname>Scharf</surname><given-names>L</given-names></name><name><surname>Horwitz</surname><given-names>J</given-names></name><name><surname>Klein</surname><given-names>F</given-names></name><name><surname>Nussenzweig</surname><given-names>MC</given-names></name><name><surname>Bjorkman</surname><given-names>PJ</given-names></name></person-group><year iso-8601-date="2013">2013</year><article-title>Computational analysis of anti–HIV-1 antibody neutralization panel data to identify potential functional epitope residues</article-title><source>PNAS</source><volume>110</volume><fpage>10598</fpage><lpage>10603</lpage><pub-id pub-id-type="doi">10.1073/pnas.1309215110</pub-id></element-citation></ref><ref id="bib71"><element-citation publication-type="web"><person-group person-group-type="author"><collab>WHO</collab></person-group><year iso-8601-date="2021">2021</year><article-title>Classification of Omicron (B.1.1.529): SARS‐CoV‐2 variant of concern</article-title><ext-link ext-link-type="uri" xlink:href="https://www.who.int/news/item/26-11-2021-classification-of-omicron-(b.1.1.529)-sars-cov-2-variant-of-concern">https://www.who.int/news/item/26-11-2021-classification-of-omicron-(b.1.1.529)-sars-cov-2-variant-of-concern</ext-link><date-in-citation iso-8601-date="2021-11-26">November 26, 2021</date-in-citation></element-citation></ref><ref id="bib72"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Wrapp</surname><given-names>D</given-names></name><name><surname>Wang</surname><given-names>N</given-names></name><name><surname>Corbett</surname><given-names>KS</given-names></name><name><surname>Goldsmith</surname><given-names>JA</given-names></name><name><surname>Hsieh</surname><given-names>CL</given-names></name><name><surname>Abiona</surname><given-names>O</given-names></name><name><surname>Graham</surname><given-names>BS</given-names></name><name><surname>McLellan</surname><given-names>JS</given-names></name></person-group><year iso-8601-date="2020">2020</year><article-title>Cryo-EM structure of the 2019-nCoV spike in the prefusion conformation</article-title><source>Science</source><volume>367</volume><fpage>1260</fpage><lpage>1263</lpage><pub-id pub-id-type="doi">10.1126/science.abb2507</pub-id></element-citation></ref><ref id="bib73"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ying</surname><given-names>B</given-names></name><name><surname>Scheaffer</surname><given-names>SM</given-names></name><name><surname>Whitener</surname><given-names>B</given-names></name><name><surname>Liang</surname><given-names>CY</given-names></name><name><surname>Dmytrenko</surname><given-names>O</given-names></name><name><surname>Mackin</surname><given-names>S</given-names></name><name><surname>Wu</surname><given-names>K</given-names></name><name><surname>Lee</surname><given-names>D</given-names></name><name><surname>Avena</surname><given-names>LE</given-names></name><name><surname>Chong</surname><given-names>Z</given-names></name><name><surname>Case</surname><given-names>JB</given-names></name><name><surname>Ma</surname><given-names>L</given-names></name><name><surname>Kim</surname><given-names>TTM</given-names></name><name><surname>Sein</surname><given-names>CE</given-names></name><name><surname>Woods</surname><given-names>A</given-names></name><name><surname>Berrueta</surname><given-names>DM</given-names></name><name><surname>Chang</surname><given-names>GY</given-names></name><name><surname>Stewart-Jones</surname><given-names>G</given-names></name><name><surname>Renzi</surname><given-names>I</given-names></name><name><surname>Lai</surname><given-names>YT</given-names></name><name><surname>Malinowski</surname><given-names>A</given-names></name><name><surname>Carfi</surname><given-names>A</given-names></name><name><surname>Elbashir</surname><given-names>SM</given-names></name><name><surname>Edwards</surname><given-names>DK</given-names></name><name><surname>Thackray</surname><given-names>LB</given-names></name><name><surname>Diamond</surname><given-names>MS</given-names></name></person-group><year iso-8601-date="2022">2022</year><article-title>Boosting with variant-matched or historical mRNA vaccines protects against Omicron infection in mice</article-title><source>Cell</source><volume>185</volume><fpage>1572</fpage><lpage>1587</lpage><pub-id pub-id-type="doi">10.1016/j.cell.2022.03.037</pub-id></element-citation></ref><ref id="bib74"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Zhang</surname><given-names>Z</given-names></name><name><surname>Mateus</surname><given-names>J</given-names></name><name><surname>Coelho</surname><given-names>CH</given-names></name><name><surname>Dan</surname><given-names>JM</given-names></name><name><surname>Moderbacher</surname><given-names>CR</given-names></name><name><surname>Gálvez</surname><given-names>RI</given-names></name><name><surname>Cortes</surname><given-names>FH</given-names></name><name><surname>Grifoni</surname><given-names>A</given-names></name><name><surname>Tarke</surname><given-names>A</given-names></name><name><surname>Chang</surname><given-names>J</given-names></name><name><surname>Escarrega</surname><given-names>EA</given-names></name><name><surname>Kim</surname><given-names>C</given-names></name><name><surname>Goodwin</surname><given-names>B</given-names></name><name><surname>Bloom</surname><given-names>NI</given-names></name><name><surname>Frazier</surname><given-names>A</given-names></name><name><surname>Weiskopf</surname><given-names>D</given-names></name><name><surname>Sette</surname><given-names>A</given-names></name><name><surname>Crotty</surname><given-names>S</given-names></name></person-group><year iso-8601-date="2022">2022</year><article-title>Humoral and cellular immune memory to four COVID-19 vaccines</article-title><source>Cell</source><volume>185</volume><fpage>2434</fpage><lpage>2451</lpage><pub-id pub-id-type="doi">10.1016/j.cell.2022.05.022</pub-id><pub-id pub-id-type="pmid">35764089</pub-id></element-citation></ref><ref id="bib75"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Zheng</surname><given-names>C</given-names></name><name><surname>Shao</surname><given-names>W</given-names></name><name><surname>Chen</surname><given-names>X</given-names></name><name><surname>Zhang</surname><given-names>B</given-names></name><name><surname>Wang</surname><given-names>G</given-names></name><name><surname>Zhang</surname><given-names>W</given-names></name></person-group><year iso-8601-date="2022">2022</year><article-title>Real-world effectiveness of COVID-19 vaccines: a literature review and meta-analysis</article-title><source>International Journal of Infectious Diseases</source><volume>114</volume><fpage>252</fpage><lpage>260</lpage><pub-id pub-id-type="doi">10.1016/j.ijid.2021.11.009</pub-id><pub-id pub-id-type="pmid">34800687</pub-id></element-citation></ref></ref-list></back><sub-article article-type="editor-report" id="sa0"><front-stub><article-id pub-id-type="doi">10.7554/eLife.108959.3.sa0</article-id><title-group><article-title>eLife Assessment</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Krzych</surname><given-names>Urszula</given-names></name><role specific-use="editor">Reviewing Editor</role><aff><institution>Walter Reed Army Institute of Research</institution><country>United States</country></aff></contrib></contrib-group><kwd-group kwd-group-type="evidence-strength"><kwd>Convincing</kwd></kwd-group><kwd-group kwd-group-type="claim-importance"><kwd>Useful</kwd></kwd-group></front-stub><body><p>This <bold>useful</bold> and interesting study provides evidence that EABR mRNA is at least as effective as standard S mRNA vaccines for SARS-CoV-2. The authors provide <bold>convincing</bold> justification for the conclusion that the inconsistent statistical significance for Omicron is likely due to immune imprinting or original antigenic sin. In this regard, the significance of the findings is stronger as it points to possible challenges for updated vaccine strategies in overcoming immune imprinting.</p></body></sub-article><sub-article article-type="referee-report" id="sa1"><front-stub><article-id pub-id-type="doi">10.7554/eLife.108959.3.sa1</article-id><title-group><article-title>Reviewer #1 (Public review):</article-title></title-group><contrib-group><contrib contrib-type="author"><anonymous/><role specific-use="referee">Reviewer</role></contrib></contrib-group></front-stub><body><p>Summary:</p><p>This study investigated the immunogenicity of a novel bivalent EABR mRNA vaccine for SARS-CoV-2 that expresses enveloped virus-like particles in pre-immune mice as a model for boosting the population that is already pre-immune to SARS-CoV-2. The study builds on promising data showing a monovalent EABR mRNA vaccine induced substantially higher antibody responses than a standard S mRNA vaccine in naïve mice. In pre-immune mice, the EABR booster increased the breadth and magnitude of the antibody response, but for Omicron, the effects were modest and often not statistically significant. The authors provide compelling evidence to support this may be due to immune imprinting.</p><p>This study also builds on prior work with additional experiments to elucidate the mechanisms that contributed to the EABR increased immunogenicity in naive mice including evidence that the vaccine is inducing responses to more RBD epitopes and a potential role for heterodimer formation as a mechanism whereby bivalent vaccines induce cross-reactive B cell responses.</p><p>Strengths:</p><p>Evaluating a novel SARS-CoV-2 vaccine that was substantially superior in naive mice in pre-immune mice as a model for its potential in the pre-immune population.</p><p>Providing insight into a possible role of immune imprinting in shaping immune responses to updated booster immunizations.</p><p>Minor weaknesses:</p><p>(1) Overall, immune responses against Omicron variants were substantially lower than against the ancestral Wu-1 strain that the mice were primed with. The authors speculate this is evidence of immune imprinting. While parallel controls (mice immunized 3 times with just the bivalent EABR vaccine) were not tested, the authors point to prior published work showing Omicron S antigen is a strong immunogen. This indicates the lower immune responses to Omicron are likely due to immune imprinting (or original antigenic sin) and not due to S immunogen being inherently less immunogenic than the S protein from the ancestral Wu-1 strain.</p><p>(2) The authors reported statistically significant increase in antibody responses with the bivalent EABR vaccine booster when compared to the monovalent S mRNA vaccine but consistently failed to show significantly higher responses when compared to the bi-valent S mRNA vaccine suggesting that in pre-immune mice, the EABR vaccine has no apparent advantage over the bivalent S mRNA vaccine which is the current standard. There were, however, some trends indicating the group sizes were insufficiently powered to see a difference. The discussion acknowledges these limitations of their studies and potential limited benefits of the EABR strategy in pre-immune mice vs standard bivalent mRNA vaccine.</p><p>(3) The EABR S mRNA vaccine was superior to the conventional mRNA S vaccine in naïve mice but not in pre-immune mice. The authors expanded the discussion to propose a possible role for immune imprinting in this result which is supported by the data.</p></body></sub-article><sub-article article-type="referee-report" id="sa2"><front-stub><article-id pub-id-type="doi">10.7554/eLife.108959.3.sa2</article-id><title-group><article-title>Reviewer #3 (Public review):</article-title></title-group><contrib-group><contrib contrib-type="author"><anonymous/><role specific-use="referee">Reviewer</role></contrib></contrib-group></front-stub><body><p>Summary:</p><p>The authors evaluated a novel bivalent (Wu1/BA.5 based) mRNA platform that uses the EABR strategy to produce enveloped virus-like particles for vaccination. These were tested as boosters in the context of pre-existing immunity in mice that received two prior immunizations with conventional Wu1 mRNA vaccines. The animal experimental timeline aimed at mimicking the vaccinations/booster schedule implemented during the COVID-19 pandemia. The authors tested and compared different booster strategies: (1) conventional Wu1 S protein encoding mRNA vaccine, (2) EABR Wu1 S protein encoding mRNA vaccine that produces enveloped virus-like particles, (3) conventional Wu1/BA.5 S protein encoding mRNA vaccine, and (4) EABR Wu1/BA.5 S protein encoding mRNA vaccine that produces enveloped virus-like particles. The EABR approach (monovalent or bivalent) enhanced the antibody response against Wu1 and Omicron subvariants. Interestingly, the bivalent EABR Wu1/BA.5 mRNA (strategy 4) generated polyclonal sera targeting multiple receptor-binding domain epitopes: these sera were more diverse than those generated with the other tested booster strategies (1 to 3).</p><p>Strengths:</p><p>The monovalent Wu1 S-EABR mRNA booster led to increase in antibody binding to tested Omicron variants (BA.5, BQ.1.1, XBB.1), while the bivalent Wu1/BA.5 S-EABR mRNA booster led to the highest Ab response against Omicron variants (BA.5, BQ.1.1, XBB.1) in pre-vaccinated mice.</p><p>Neutralization assays showed that the monovalent Wu1 S-EABR mRNA booster had the highest Wu1 neutralization activity and to a lesser extent the early BA.1 early Omicron variant. The monovalent Wu1 S-EABR mRNA booster and bivalent Wu1/BA.5 S-EABR mRNA booster had similar BA.5 neutralizing activity. Neutralizing activity of the different boosters was less pronounced with later Omicron variants BQ.1.1 and XBB.1. However, of the different boosters tested, the bivalent Wu1/BA.5 S-EABR mRNA booster induced the highest neutralizing titers. These results support that the EABR mRNA vaccine strategy helps improve neutralizing activity against different tested Omicron subvariants: a few (1 or 2) mRNA constructs expressing major antigens in enveloped virus-like particles likely provide a novel strategy to elicit an immune response that has the potential to neutralize subsequent variants.</p><p>The EABR enveloped virus-like particle strategy induces a more diverse antibody response, including epitopes not recognized by the other booster strategies: these new epitopes could play a role in neutralizing activity against new future variants.</p><p>Moreover, the bivalent Wu1/BA.5 S-EABR mRNA booster could potentially produce heterotrimeric S proteins to help activation of cross-reactive B cells and increase polyclass antibody responses.</p><p>Weaknesses:</p><p>When it comes to later Omicron variants (BQ.1.1 and XBB.1), there is a discrepancy between epitope binding response and neutralization titers: only a few binding antibodies have neutralizing activity with these later variants, showing a limitation of the EABR strategy.</p><p>The authors showed that the EABR mRNA strategy represents a novel antigen exposing strategy where antigens are produced at the cell surface and also at the surface of enveloped virus-like particles. This allows the production of novel antigens in addition to those that would be typically generated against cell surface exposed antigens. These novel antigens targeting new epitopes could potentially have neutralizing activity.</p><p>Using a bivalent EABR mRNA booster led to higher antibody titers and higher neutralizing activity. The challenge is to select the best antigen target/variant to support neutralizing activity against later virus variants.</p></body></sub-article><sub-article article-type="author-comment" id="sa3"><front-stub><article-id pub-id-type="doi">10.7554/eLife.108959.3.sa3</article-id><title-group><article-title>Author response</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Fan</surname><given-names>Chengcheng</given-names></name><role specific-use="author">Author</role><aff><institution>Howard Hughes Medical Institute, California Institute of Technology</institution><addr-line><named-content content-type="city">Pasadena</named-content></addr-line><country>United States</country></aff></contrib><contrib contrib-type="author"><name><surname>Cohen</surname><given-names>Alexander A</given-names></name><role specific-use="author">Author</role><aff><institution>California Institute of Technology</institution><addr-line><named-content content-type="city">Pasadena</named-content></addr-line><country>United States</country></aff></contrib><contrib contrib-type="author"><name><surname>Dam</surname><given-names>Kim-Marie A</given-names></name><role specific-use="author">Author</role><aff><institution>Gladstone Institutes</institution><addr-line><named-content content-type="city">San Francisco</named-content></addr-line><country>United States</country></aff></contrib><contrib contrib-type="author"><name><surname>Rorick</surname><given-names>Annie V</given-names></name><role specific-use="author">Author</role><aff><institution>University of Washington</institution><addr-line><named-content content-type="city">Seattle</named-content></addr-line><country>United States</country></aff></contrib><contrib contrib-type="author"><name><surname>Priso Fils</surname><given-names>Ange-Célia I</given-names></name><role specific-use="author">Author</role><aff><institution>California Institute of Technology</institution><addr-line><named-content content-type="city">Pasadena</named-content></addr-line><country>United States</country></aff></contrib><contrib contrib-type="author"><name><surname>Yang</surname><given-names>Zhi</given-names></name><role specific-use="author">Author</role><aff><institution>University of California, Berkeley</institution><addr-line><named-content content-type="city">Berkeley</named-content></addr-line><country>United States</country></aff></contrib><contrib contrib-type="author"><name><surname>Gnanapragasam</surname><given-names>Priyanthi NP</given-names></name><role specific-use="author">Author</role><aff><institution>California Institute of Technology</institution><addr-line><named-content content-type="city">Pasadena</named-content></addr-line><country>United States</country></aff></contrib><contrib contrib-type="author"><name><surname>Segovia</surname><given-names>Luisa N</given-names></name><role specific-use="author">Author</role><aff><institution>California Institute of Technology</institution><addr-line><named-content content-type="city">Pasadena</named-content></addr-line><country>United States</country></aff></contrib><contrib contrib-type="author"><name><surname>Huey-Tubman</surname><given-names>Kathryn E</given-names></name><role specific-use="author">Author</role><aff><institution>California Institute of Technology</institution><addr-line><named-content content-type="city">Pasadena</named-content></addr-line><country>United States</country></aff></contrib><contrib contrib-type="author"><name><surname>Moon</surname><given-names>Woohyun J</given-names></name><role specific-use="author">Author</role><aff><institution>Acuitas Therapeutics</institution><addr-line><named-content content-type="city">Vancouver</named-content></addr-line><country>Canada</country></aff></contrib><contrib contrib-type="author"><name><surname>Lin</surname><given-names>Paulo JC</given-names></name><role specific-use="author">Author</role><aff><institution>Acuitas Therapeutics</institution><addr-line><named-content content-type="city">Vancouver</named-content></addr-line><country>Canada</country></aff></contrib><contrib contrib-type="author"><name><surname>Bjorkman</surname><given-names>Pamela J</given-names></name><role specific-use="author">Author</role><aff><institution>California Institute of Technology</institution><addr-line><named-content content-type="city">Pasadena</named-content></addr-line><country>United States</country></aff></contrib><contrib contrib-type="author"><name><surname>Hoffmann</surname><given-names>Magnus AG</given-names></name><role specific-use="author">Author</role><aff><institution>Gladstone Institutes</institution><addr-line><named-content content-type="city">San Francisco</named-content></addr-line><country>United States</country></aff></contrib></contrib-group></front-stub><body><p>The following is the authors’ response to the original reviews.</p><disp-quote content-type="editor-comment"><p><bold>eLife Assessment</bold></p><p>This report provides useful evidence that EABR mRNA is at least as effective as standard S mRNA vaccines for the SARS-CoV-2 booster vaccine. Although the methodology and the experimental approaches are solid, the inconsistent statistical significance throughout the study presents limitations in interpreting the results. Also, the absence of results showing possible mechanisms underlying the lack of benefit with EABR in the pre-immune makes the findings mostly observational.</p></disp-quote><p>Thank you for your assessment of our study. Respectfully, we do not agree that our study shows a lack of benefit of using the EABR approach. For the monovalent boosters, the S-EABR mRNA booster improved neutralizing antibody titers by 3.4-fold against BA.1 (p = 0.03; Fig. S5) and 4.8-fold against BA.5 (failed to reach statistical significance; Fig. 3B) compared to the regular S mRNA booster, which is consistent with the findings from our prior study in naïve mice. In addition, the bivalent S-EABR booster consistently elicited the highest neutralizing titers against all tested variants, including significantly higher titers against BA.5 and BQ.1.1 than the monovalent S booster. The bivalent S-EABR booster also induced detectable neutralization activity in a larger number of mice than all other boosters.</p><p>Consistent with this analysis, please note that reviewers 1 and 2 commented that “the EABR booster increased the breadth and magnitude of the antibody response, but the effects were modest and often not statistically significant” (reviewer 1) and “the authors found that across both monovalent and bivalent designs, the EABR antigens had improved antibody titers than conventional antigens, although they observed dampened titers against Omicron variants, likely due to immune imprinting” (reviewer 2).</p><p>We agree with the reviewers’ assessment that the EABR booster-mediated improvements were mostly modest, in particular against the BQ.1.1 and XBB.1 strains. We also acknowledge that the improvements in titers did not reach statistical significance in many cases, which we believe could have been addressed by adding more animals to our cohorts. Unfortunately, that would have been prohibitively expensive and time-consuming given that we already included 10 mice per group, which is standard practice in the vaccine field.</p><p>Finally, we also wish to point out that we did include experiments that addressed potential mechanistic differences between booster groups. For example, we conducted deep mutational scanning studies to determine polyclonal antibody epitope mapping profiles, showing that bivalent S-EABR boosters induced more balanced targeting of multiple RBD epitopes, which likely contributed to the observed improvements in neutralization. Our work also included cryo-EM studies demonstrating that bivalent S mRNA boosters promote heterotrimer formation, which could potentially drive preferential stimulation of cross-reactive B cells via intra-spike crosslinking. This represents a potential mechanism explaining how bivalent boosters outperformed monovalent boosters in our and many prior studies, which warrants further investigation. Finally, we also performed serum depletion assays, showing that the BA.5 neutralizing activity elicited by the bivalent Wu1/BA.5 S and S-EABR mRNA boosters was primarily driven by cross-neutralizing Abs induced by the primary vaccination series.</p><disp-quote content-type="editor-comment"><p><bold>Public Reviews:</bold></p><p><bold>Reviewer #1 (Public review):</bold></p><p>Summary:</p><p>This study investigated the immunogenicity of a novel bivalent EABR mRNA vaccine for SARS-CoV-2 that expresses enveloped virus-like particles in pre-immune mice as a model for boosting the population that is already pre-immune to SARS-CoV-2. The study builds on promising data showing a monovalent EABR mRNA vaccine induced substantially higher antibody responses than a standard S mRNA vaccine in naïve mice. In pre-immune mice, the EABR booster increased the breadth and magnitude of the antibody response, but the effects were modest and often not statistically significant.</p></disp-quote><p>We thank the reviewer for their accurate summary of our study. Please see our comments to the reviewer’s individual points below, as well as our responses to the editor’s assessment above.</p><disp-quote content-type="editor-comment"><p>Strengths:</p><p>Evaluating a novel SARS-CoV-2 vaccine that was substantially superior in naive mice in pre-immune mice as a model for its potential in the pre-immune population.</p><p>Weaknesses:</p><p>(1) Overall, immune responses against Omicron variants were substantially lower than against the ancestral Wu-1 strain that the mice were primed with. The authors speculate this is evidence of immune imprinting, but don't have the appropriate controls (mice immunized 3 times with just the bivalent EABR vaccine) to discern this. Without this control, it's not clear if the lower immune responses to Omicron are due to immune imprinting (or original antigenic sin) or because the Omicron S immunogen is just inherently more poorly immunogenic than the S protein from the ancestral Wu-1 strain.</p></disp-quote><p>The reviewer raises an important point, and we agree that including additional groups receiving three immunizations with the bivalent spike and/or spike-EABR mRNA vaccines would have improved the experimental design. However, we believe that several prior studies have already demonstrated that Omicron S immunogens are not inherently poorly immunogenic compared to the ancestral S; e.g., Scheaffer et al., Nat Med (2022); Ying et al., Cell (2022); Muik et al., Sci Immunol (2022). Based on these prior reports, we conclude that the lower neutralizing titers against Omicron variants in our study are most likely driven by immune imprinting as a result of the initial vaccination series with the ancestral S immunogen.</p><disp-quote content-type="editor-comment"><p>(2) The authors reported a statistically significant increase in antibody responses with the bivalent EABR vaccine booster when compared to the monovalent S mRNA vaccine, but consistently failed to show significantly higher responses when compared to the bivalent S mRNA vaccine, suggesting that in pre-immune mice, the EABR vaccine has no apparent advantage over the bivalent S mRNA vaccine which is the current standard. There were, however, some trends indicating the group sizes were insufficiently powered to see a difference. This is mostly glossed over throughout the manuscript. The discussion section needs to better acknowledge these limitations of their studies and the limited benefits of the EABR strategy in pre-immune mice vs the standard bivalent mRNA vaccine.</p></disp-quote><p>We acknowledge that the improvements in titers did not reach statistical significance in many cases, which we believe could have been addressed by adding more animals to our cohorts. Unfortunately, that would have been prohibitively expensive and timeconsuming given that we already included 10 mice per group, which is standard practice in the vaccine field. We added a “Limitations of the study” section at the end of the discussion to address all of these points in detail (lines 570-598 in the revised version).</p><disp-quote content-type="editor-comment"><p>(3) The discussion would benefit from additional explanation about why they think the EABR S mRNA vaccine was substantially superior in naïve mice vs the standard S mRNA vaccine in their previously published work, but here, there is not much difference in pre-immune mice.</p></disp-quote><p>As we pointed out in our response to the editor’s assessment above, the monovalent SEABR mRNA booster improved neutralizing antibody titers by 3.4-fold against BA.1 (p = 0.03; Fig. S5) and 4.8-fold against BA.5 (failed to reach statistical significance; Fig. 3B) compared to the conventional monovalent S mRNA booster, which is largely consistent with the findings from our prior study in naïve mice. Although the bivalent S-EABR mRNA booster consistently elicited higher neutralizing titers than the conventional bivalent S mRNA booster, we agree with the reviewer that these improvements were modest and not statistically significant. Overall, neutralizing activity against later Omicron variants, such as BQ.1.1 and XBB.1 was low. We attributed this finding to immune imprinting (see response to point (1) above) and acknowledged that the EABR approach was not able to effectively overcome this effect (see discussion section of the paper, lines 537-558; and “Limitations of the study” section, lines 570-598 in the revised version).</p><disp-quote content-type="editor-comment"><p><bold>Reviewer #2 (Public review):</bold></p><p>Summary:</p><p>In this manuscript, Fan, Cohen, and Dam et al. conducted a follow-up study to their prior work on the ESCRT- and ALIX-binding region (EABR) mRNA vaccine platform that they developed. They tested in mice whether vaccines made in this format will have improved binding/neutralization antibody capacity over conventional antigens when used as a booster. The authors tested this in both monovalent (Wu1 only) or bivalent (Wu1 + BA.5) designs. The authors found that across both monovalent and bivalent designs, the EABR antigens had improved antibody titers than conventional antigens, although they observed dampened titers against Omicron variants, likely due to immune imprinting. Deep mutational scanning experiments suggested that the improvement of the EABR format may be due to a more diversified antibody response. Finally, the authors demonstrate that co-expression of multiple spike proteins within a single cell can result in the formation of heterotrimers, which may have potential further usage as an antigen.</p></disp-quote><p>We thank the reviewer for their support and for the accurate summary and evaluation of our study.</p><disp-quote content-type="editor-comment"><p>Strengths:</p><p>(1) The experiments are conducted well and are appropriate to address the questions at hand. Given the significant time that is needed for testing of pre-existing immunity, due to the requirement of pre-vaccinated animals, it is a strength that the authors have conducted a thorough experiment with appropriate groups.</p><p>(2) The improvement in titers associated with EABR antigens bodes well for its potential use as a vaccine platform.</p><p>Weaknesses:</p><p>As noted above, this type of study requires quite a bit of initial time, so the authors cannot be blamed for this, but unfortunately, the vaccine designs that were tested are quite outdated. BA.5 has long been replaced by other variants, and importantly, bivalent vaccines are no longer used. Testing of contemporaneous strains as well as monovalent variant vaccines would be desirable to support the study.</p></disp-quote><p>We thank the reviewer for bringing up this important point. We agree that the variants used for this study are now outdated, and it would have been informative to evaluate conventional and EABR boosters against contemporaneous strains. However, as the reviewer correctly pointed out, this type of study requires a substantial amount of time to conduct and will therefore will likely always be outdated by the time the data are analyzed and prepared for publication. To accurately assess immune responses against recent or current strains in mice, multiple boosters would have been needed to mimic the pre-existing immune context in the human population in 2025. Assuming intervals of 6-7 months between boosters (as used in this study to mimic booster intervals in the human population as closely as possible), this type of study would have been challenging to conduct, especially given the limited lifespan of mice. Thus, we performed this proof-of-concept study using outdated variants to assess the potential of EABR-modified boosters. We greatly appreciate the reviewer’s understanding and acknowledge this limitation of our study, which is highlighted in the added “Limitations of the study” section in the revised version of the manuscript (lines 570-598).</p><disp-quote content-type="editor-comment"><p><bold>Recommendations for the authors:</bold></p><p><bold>Reviewer #1 (Recommendations for the authors):</bold></p><p>(1) The acronym RBD in the title should be spelled out.</p></disp-quote><p>We thank the reviewer for raising this point. We made this change in the revised version of the paper.</p><disp-quote content-type="editor-comment"><p>(2) Lines 167-168 describe no differences between the cohorts at day 244. It should also be stated that for all timepoints, there are no significant differences.</p></disp-quote><p>We modified the revised manuscript according to the reviewer’s suggestion (line 170).</p><disp-quote content-type="editor-comment"><p><bold>Reviewer #2 (Recommendations for the authors):</bold></p><p>(1) Given the focus on developing broad vaccines for future coronavirus outbreaks, it would be particularly informative to test whether the EABR antigens elicit broadened/heightened responses against other (beta)coronaviruses. If enough serum is left, it would seem straightforward to conduct neutralization assays against non-SARSCoV-2 coronaviruses.</p></disp-quote><p>We thank the reviewer for this valid suggestion. Unfortunately, the extensive analysis of the serum samples, including spike and RBD ELISAs and neutralization assays against multiple variants, deep mutational scanning, and depletion assays, used up the serum samples for most mice. We agree that it would be interesting to investigate whether bivalent EABR boosters elicit pan-sarbecovirus responses in future studies.</p><disp-quote content-type="editor-comment"><p>(2) In the bar plots for antibody titer changes, shown as log10 fold change, it is quite hard to interpret the difference between bars (e.g., what is the fold change difference between each bar in the same time point?). A table of mean {plus minus} SD values would be helpful.</p></disp-quote><p>That’s a great suggestion. We added a table (Table S1) presenting all the geometric mean neutralization titers for all timepoints and variants in the revised version of the manuscript.</p><disp-quote content-type="editor-comment"><p>(3) The development of heterotrimers as potential antigens is very interesting, but it seems out of place in the current manuscript. This should likely be in a separate, standalone manuscript.</p></disp-quote><p>We thank the reviewer for commenting on the heterotrimer part of our manuscript. The presented work was not intended to advance the development of heterotrimers as potential antigens. Instead, our findings demonstrate that bivalent spike mRNA vaccines readily generate heterotrimers, which could promote intra-spike crosslinking and potentially impact antibody epitope targeting profiles as suggested by the deep mutational scanning data for the bivalent S-EABR mRNA booster (Fig. 4; Fig. S7-8). We think this is an important consideration that warrants further investigation with regards to the development of future bivalent or multivalent vaccines.</p><disp-quote content-type="editor-comment"><p>(4) As a minor note, the sequences of the variants used or accession numbers should be provided in the Methods, since different groups have used different mutations for variants.</p></disp-quote><p>We added the accession numbers for the vaccine strains used in this study (lines 604605).</p></body></sub-article></article>