Furin Cleavage Site Is Key to SARS-CoV-2 Pathogenesis

Johnson, Bryan A.; Xie, Xuping; Kalveram, Birte; Lokugamage, Kumari G.; Muruato, Antonio; Zou, Jing; Zhang, Xianwen; Juelich, Terry; Smith, Jennifer K.; Zhang, Lihong; Bopp, Nathen; Schindewolf, Craig; Vu, Michelle; Vanderheiden, Abigail; Swetnam, Daniele; Plante, Jessica A.; Aguilar, Patricia; Plante, Kenneth S.; Lee, Benhur; Weaver, Scott C.; Suthar, Mehul S.; Routh, Andrew L.; Ren, Ping; Ku, Zhiqiang; An, Zhiqiang; Debbink, Kari; Shi, Pei Yong; Freiberg, Alexander N.; Menachery, Vineet D.

SARS-CoV-2 has resulted in a global pandemic and shutdown economies around the world. Sequence analysis indicates that the novel coronavirus (CoV) has an insertion of a furin cleavage site (PRRAR) in its spike protein. Absent in other group 2B CoVs, the insertion may be a key factor in the replication and virulence of SARS-CoV-2. To explore this question, we generated a SARS-CoV-2 mutant lacking the furin cleavage site (ΔPRRA) in the spike protein. This mutant virus replicated with faster kinetics and improved fitness in Vero E6 cells. The mutant virus also had reduced spike protein processing as compared to wild-type SARS-CoV-2. In contrast, the ΔPRRA had reduced replication in Calu3 cells, a human respiratory cell line, and had attenuated disease in a hamster pathogenesis model. Despite the reduced disease, the ΔPRRA mutant offered robust protection from SARS-CoV-2 rechallenge. Importantly, plaque reduction neutralization tests (PRNT(50)) with COVID-19 patient sera and monoclonal antibodies against the receptor-binding domain found a shift, with the mutant virus resulting in consistently reduced PRNT(50) titers. Together, these results demonstrate a critical role for the furin cleavage site insertion in SARS-CoV-2 replication and pathogenesis. In addition, these findings illustrate the importance of this insertion in evaluating neutralization and other downstream SARS-CoV-2 assays.