Identification of Antibodies with Non-overlapping Neutralization Sites that Target Coxsackievirus A16

Hand, foot, and mouth disease is a common childhood illness primarily caused by coxsackievirus A16 (CVA16), for which there are no current vaccines or treatments. We identify three CVA16-specific neutralizing monoclonal antibodies (nAbs) with therapeutic potential: 18A7, 14B10, and NA9D7. We present atomic structures of these nAbs bound to all three viral particle forms—the mature virion, A-particle, and empty particle—and show that each Fab can simultaneously occupy the mature virion. Additionally, 14B10 or NA9D7 provide 100% protection against lethal CVA16 infection in a neonatal mouse model. 18A7 binds to a non-conserved epitope present in all three particles, whereas 14B10 and NA9D7 recognize broad protective epitopes but only bind the mature virion. NA9D7 targets an immunodominant site, which may overlap the receptor-binding site. These findings indicate that CVA16 vaccines should be based on mature virions and that these antibodies could be used to discriminate optimal virion-based immunogens. [Display omitted] •Atomic models show CVA16 can simultaneously bind three distinct potent nAbs•The neutralization sites vary across three forms of CVA16•CVA16 mature virion bearing conserved epitopes is the optimal vaccine immunogen•nAb-based assay allows quantification of mature virions for vaccine development He et al. describe a variety of atomic structures for three forms of coxsackievirus A16 complexed with three distinct neutralizing mAbs and map the neutralization sites. They suggest that the mature virion is the optimal immunogen for vaccine development and design an immune assay to specifically quantify such virion state.