The chimpanzee monoclonal antibody (MAb) 5H2 is specific for dengue virus type 4 (DENV-4) and neutralizes the virus at a high titer in vitro. The epitope detected by the antibody was mapped by sequencing neutralization escape variants of the virus. One variant contained a Lys 174 -Glu substitution and another contained a Pro 176 -Leu substitution in domain I of the DENV-4 envelope protein (E). These mutations reduced binding affinity for the antibody 18-to >100-fold. Humanized immunoglobulin G (IgG) 5H2, originally produced from an expression vector, has been shown to be a variant containing a nine-amino-acid deletion in the Fc region which completely ablates antibody-dependent enhancement of DENV replication in vitro. The variant MAb, termed IgG 5H2 ⌬D, is particularly attractive for exploring its protective capacity in vivo. Passive transfer of IgG 5H2 ⌬D at 20 g/mouse afforded 50% protection of suckling mice against challenge with 25 50% lethal doses of mouse neurovirulent DENV-4 strain H241. Passive transfer of antibody to monkeys was conducted to demonstrate proof of concept for protection against DENV challenge. Monkeys that received 2 mg/kg of body weight of IgG 5H2 ⌬D were completely protected against 100 50% monkey infectious doses (MID 50 ) of DENV-4, as indicated by the absence of viremia and seroconversion. A DENV-4 escape mutant that contained a Lys 174 -Glu substitution identical to that found in vitro was isolated from monkeys challenged with 10 6 MID 50 of DENV-4. This substitution was also present in all naturally occurring isolates belonging to DENV-4 genotype III. These studies have important implications for possible antibody-mediated prevention of DENV infection.The four dengue virus serotypes (dengue virus types 1 to 4 [DENV-1 to DENV-4]) cause more morbidity in humans than any other arthropod-borne flaviviruses (40). Up to 100 million DENV infections occur every year, mostly in tropical and subtropical areas where the vector mosquitoes, principally Aedes aegypti and Aedes albopictus, are present. Dengue illnesses range from mild fever to severe dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS), which has fatality rates ranging from Ͻ1% to 5% in children. The most severe dengue (Ͼ90% fatality rate) occurs in patients reinfected with DENV of a serotype different from that in the primary infection (15, 50). Antibody-dependent enhancement (ADE) of DENV replication has been proposed as an underlying pathogenic mechanism of severe DHF/DSS (17). A safe and effective vaccine against dengue is still not available.Early studies of DENV infections in human volunteers showed that homotypic immunity against the same serotype is life-long but that heterotypic immunity against other serotypes lasts only months (49). Since antibodies provide the important component of acquired immunity against infection, type-specific immunity afforded by antibody may contribute significantly to long-term protection. Antigenic differences exist among strains of the same serotype (21). DENV variants that form ...