Zika virus (ZIKV), a mosquito-borne flavivirus with homology to Dengue virus (DENV), has become a public health emergency. By characterizing memory lymphocytes from ZIKV-infected patients, we dissected ZIKV-specific and DENV-cross-reactive immune responses. Antibodies to nonstructural protein 1 (NS1) were largely ZIKV-specific and were used to develop a serological diagnostic tool. In contrast, antibodies against E protein domain I/II (EDI/II) were cross-reactive and, although poorly neutralizing, potently enhanced ZIKV and DENV infection in vitro and lethally enhanced DENVdisease in mice. Memory Tcells against NS1 or E proteins were poorly cross-reactive, even in donors preexposed to DENV. The most potent neutralizing antibodies were ZIKV-specific and targeted EDIII or quaternary epitopes on infectious virus. An EDIII-specific antibody protected mice from lethal ZIKV infection, illustrating the potential for antibody-based therapy.A fter its introduction into Brazil in 2015, Zika virus (ZIKV) has spread rapidly, and in February 2016, the World Health Organization (WHO) declared it a Public Health Emergency of International Concern (1-3). The main route of ZIKV infection is through bites by Aedes mosquitos, but the virus may also be sexually (4) and vertically transmitted (5). Although most of the ZIKV infections are asymptomatic or cause only mild symptoms, there is evidence that ZIKV infection can lead to neurological complications, such as Guillain-Barré syndrome in adults (6) and congenital birth defects, including microcephaly in the developing fetus (5,7,8), likely through its ability to infect human neural progenitor cells (9).Whereas flavivirus envelope (E) proteins mediate fusion and are the main target of neutralizing antibodies, the nonstructural protein 1 (NS1) is secreted by infected cells and is involved in immune evasion and pathogenesis (10). Two recent studies showed a high level of structural similarity between the E protein of ZIKV and that of other flaviviruses-such as dengue virus (DENV), yellow fever virus (YFV), and West Nile virus (WNV)-but also revealed distinct features that may be related to the ZIKV neurotropism (11,12). Similarly, the structural analysis of ZIKV NS1 revealed conserved features with NS1 of other flaviviruses, although with different electrostatic characteristics (13).A phenomenon that is characteristic of certain flaviviruses is the disease-enhancing activity of cross-reactive antibodies elicited by previous infections by heterologous viruses, termed antibodydependent enhancement (ADE). In the case of DENV, for which four serotypes are known, there is epidemiological evidence that a primary infection protects from reinfection with the same serotype but represents a risk factor for the development of severe disease upon reinfection with a different serotype (14). The exacerbated disease is triggered by E-and prM-specific antibodies that fail to neutralize the incoming virus but instead enhance its capture by Fc receptor-expressing (FcR + ) cells, leading to enhanced vi...

Zika virus (ZIKV) is a mosquito-borne flavivirus that emerged recently as a global health threat, causing a pandemic in the Americas. ZIKV infection mostly causes mild disease, but is linked to devastating congenital birth defects and Guillain-Barré syndrome in adults. The high level of cross-reactivity among flaviviruses and their cocirculation has complicated serological approaches to differentially detect ZIKV and dengue virus (DENV) infections, accentuating the urgent need for a specific and sensitive serological test. We previously generated a ZIKV nonstructural protein 1 (NS1)-specific human monoclonal antibody, which we used to develop an NS1-based competition ELISA. Well-characterized samples from RT-PCR-confirmed patients with Zika and individuals exposed to other flavivirus infections or vaccination were used in a comprehensive analysis to determine the sensitivity and specificity of the NS1 blockade-of-binding (BOB) assay, which was established in laboratories in five countries (Nicaragua, Brazil, Italy, United Kingdom, and Switzerland). Of 158 sera/ plasma from RT-PCR-confirmed ZIKV infections, 145 (91.8%) yielded greater than 50% inhibition. Of 171 patients with primary or secondary DENV infections, 152 (88.9%) scored negative. When the control group was extended to patients infected by other flaviviruses, other viruses, or healthy donors (n = 540), the specificity was 95.9%. We also analyzed longitudinal samples from DENV-immune and DENVnaive ZIKV infections and found inhibition was achieved within 10 d postonset of illness and maintained over time. Thus, the Zika NS1 BOB assay is sensitive, specific, robust, simple, low-cost, and accessible, and can detect recent and past ZIKV infections for surveillance, seroprevalence studies, and intervention trials.is a mosquito-borne flavivirus that is spread via the bite of infected Aedes mosquitoes or by sexual transmission and is responsible for the explosive 2015-2017 epidemic in the Americas. ZIKV infection during pregnancy is linked to devastating birth defects and associated anomalies, designated congenital Zika syndrome (1, 2), whereas in adults, ZIKV infection has been associated with Guillain Barré syndrome (3). Flaviviruses are enveloped RNA viruses containing an ∼11-kb positive-stranded RNA genome that encodes three structural and seven nonstructural proteins. Cells infected by flaviviruses secrete nonstructural protein 1 (NS1), which has multiple roles in immune evasion and pathogenesis (4, 5).Antibody responses generated in response to flavivirus infections are notoriously cross-reactive, representing a significant obstacle for the specific diagnosis of infection using serological assays. Multiple RT-PCR-based assays for the detection of ZIKV RNA are available, but their use is limited to the narrow window when viral RNA is detectable in body fluids. This is highly variable among patients and subject to reporting error, as symptoms are mild, and thus patients may take less notice of the day of onset, but in most cases, it is up to 7 d in serum, ...

SUMMARY Zika virus (ZIKV), a mosquito-borne flavivirus, causes devastating congenital birth defects. We isolated a human monoclonal antibody (mAb), ZKA190, that potently cross-neutralizes multi-lineage ZIKV strains. ZKA190 is highly effective in vivo in preventing morbidity and mortality of ZIKV-infected mice. NMR and cryo-electron microscopy show its binding to an exposed epitope on DIII of the E protein. ZKA190 Fab binds all 180 E protein copies, altering the virus quaternary arrangement and surface curvature. However, ZIKV escape mutants emerged in vitro and in vivo in the presence of ZKA190, as well as of other neutralizing mAbs. To counter this problem, we developed a bispecific antibody (FIT-1) comprising ZKA190 and a second mAb specific for DII of E protein. In addition to retaining high in vitro and in vivo potencies, FIT-1 robustly prevented viral escape, warranting its development as a ZIKV immunotherapy.

Zika virus (ZIKV) infection is endemic to several world regions, and many others are at high risk for seasonal outbreaks. Synthetic DNA-encoded monoclonal antibody (DMAb) is an approach that enables in vivo delivery of highly potent mAbs to control infections. We engineered DMAb-ZK190, encoding the mAb ZK190 neutralizing antibody, which targets the ZIKV E protein DIII domain. In vivo -delivered DMAb-ZK190 achieved expression levels persisting >10 weeks in mice and >3 weeks in non-human primate (NHPs), which is protective against ZIKV infectious challenge. This study is the first demonstration of infectious disease control in NHPs following in vivo delivery of a nucleic acid-encoded antibody, supporting the importance of this new platform.