<?xml version="1.0" encoding="UTF-8" standalone="no"?>
<!DOCTYPE article PUBLIC "-//NLM//DTD Journal Publishing DTD v2.3 20070202//EN" "journalpublishing.dtd">
<?covid-19-tdm?>
<article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" article-type="research-article" dtd-version="2.3" xml:lang="EN">
<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Immunol.</journal-id>
<journal-title>Frontiers in Immunology</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Immunol.</abbrev-journal-title>
<issn pub-type="epub">1664-3224</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3389/fimmu.2022.872047</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Immunology</subject>
<subj-group>
<subject>Original Research</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>Furin and TMPRSS2 Resistant Spike Induces Robust Humoral and Cellular Immunity Against SARS-CoV-2 Lethal Infection</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Lin</surname><given-names>Jhe-Jhih</given-names>
</name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Tien</surname><given-names>Chih-Feng</given-names>
</name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Kuo</surname><given-names>Yi-Ping</given-names>
</name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Lin</surname><given-names>En-Ju</given-names>
</name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Tsai</surname><given-names>Wei-Hsiang</given-names>
</name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Chen</surname><given-names>Ming-Yu</given-names>
</name>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Tsai</surname><given-names>Pei-Ju</given-names>
</name>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Su</surname><given-names>Yu-Wen</given-names>
</name>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Pathak</surname><given-names>Nikhil</given-names>
</name>
<xref ref-type="aff" rid="aff3"><sup>3</sup></xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Yang</surname><given-names>Jinn-Moon</given-names>
</name>
<xref ref-type="aff" rid="aff3"><sup>3</sup></xref>
<uri xlink:href="https://loop.frontiersin.org/people/35257"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Yu</surname><given-names>Chia-Yi</given-names>
</name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<uri xlink:href="https://loop.frontiersin.org/people/568927"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Chuang</surname><given-names>Zih-Shiuan</given-names>
</name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Wu</surname><given-names>Han-Chieh</given-names>
</name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<uri xlink:href="https://loop.frontiersin.org/people/732253"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Tsai</surname><given-names>Wan-Ting</given-names>
</name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Dai</surname><given-names>Shih-Syong</given-names>
</name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Liao</surname><given-names>Hung-Chun</given-names>
</name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Chai</surname><given-names>Kit Man</given-names>
</name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Su</surname><given-names>Yu-Siang</given-names>
</name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<uri xlink:href="https://loop.frontiersin.org/people/534899"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Chuang</surname><given-names>Tsung-Hsien</given-names>
</name>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Liu</surname><given-names>Shih-Jen</given-names>
</name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<xref ref-type="aff" rid="aff4"><sup>4</sup></xref>
<xref ref-type="aff" rid="aff5"><sup>5</sup></xref>
<uri xlink:href="https://loop.frontiersin.org/people/1704063"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Chen</surname><given-names>Hsin-Wei</given-names>
</name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<xref ref-type="aff" rid="aff4"><sup>4</sup></xref>
<xref ref-type="aff" rid="aff5"><sup>5</sup></xref>
<uri xlink:href="https://loop.frontiersin.org/people/482398"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Dou</surname><given-names>Horng-Yunn</given-names>
</name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<uri xlink:href="https://loop.frontiersin.org/people/667061"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Chen</surname><given-names>Feng-Jui</given-names>
</name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Chen</surname><given-names>Chiung-Tong</given-names>
</name>
<xref ref-type="aff" rid="aff6"><sup>6</sup></xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Liao</surname><given-names>Chin-Len</given-names>
</name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
</contrib>
<contrib contrib-type="author" corresp="yes">
<name>
<surname>Yu</surname><given-names>Guann-Yi</given-names>
</name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<xref ref-type="author-notes" rid="fn001"><sup>*</sup></xref>
<uri xlink:href="https://loop.frontiersin.org/people/1217325"/>
</contrib>
</contrib-group>
<aff id="aff1"><sup>1</sup><institution>National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes</institution>, <addr-line>Zhunan</addr-line>, <country>Taiwan</country></aff>
<aff id="aff2"><sup>2</sup><institution>Immunology Research Center, National Health Research Institutes</institution>, <addr-line>Zhunan</addr-line>, <country>Taiwan</country></aff>
<aff id="aff3"><sup>3</sup><institution>Department of Biological Science and Technology, National Yang Ming Chiao Tung University</institution>, <addr-line>Hsinchu</addr-line>, <country>Taiwan</country></aff>
<aff id="aff4"><sup>4</sup><institution>Graduate Institute of Biomedical Sciences, China Medical University</institution>, <addr-line>Taichung</addr-line>, <country>Taiwan</country></aff>
<aff id="aff5"><sup>5</sup><institution>Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University</institution>, <addr-line>Kaohsiung</addr-line>, <country>Taiwan</country></aff>
<aff id="aff6"><sup>6</sup><institution>Institute of Biotechnology and Pharmaceutical Research, National Health Research Institutes</institution>, <addr-line>Zhunan</addr-line>, <country>Taiwan</country></aff>
<author-notes>
<fn fn-type="edited-by">
<p>Edited by: Pedro A. Reche, Complutense University of Madrid, Spain</p>
</fn>
<fn fn-type="edited-by">
<p>Reviewed by: Nurit P. Azouz, Cincinnati Children&#x2019;s Hospital Medical Center, United States; Igor B. Rogozin, National Institutes of Health (NIH), United States</p>
</fn>
<fn fn-type="corresp" id="fn001">
<p>*Correspondence: Guann-Yi Yu, <email xlink:href="mailto:guannyiy@nhri.edu.tw">guannyiy@nhri.edu.tw</email>
</p>
</fn>
<fn fn-type="other" id="fn002">
<p>This article was submitted to Vaccines and Molecular Therapeutics, a section of the journal Frontiers in Immunology</p>
</fn>
</author-notes>
<pub-date pub-type="epub">
<day>02</day>
<month>05</month>
<year>2022</year>
</pub-date>
<pub-date pub-type="collection">
<year>2022</year>
</pub-date>
<volume>13</volume>
<elocation-id>872047</elocation-id>
<history>
<date date-type="received">
<day>09</day>
<month>02</month>
<year>2022</year>
</date>
<date date-type="accepted">
<day>24</day>
<month>03</month>
<year>2022</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#xa9; 2022 Lin, Tien, Kuo, Lin, Tsai, Chen, Tsai, Su, Pathak, Yang, Yu, Chuang, Wu, Tsai, Dai, Liao, Chai, Su, Chuang, Liu, Chen, Dou, Chen, Chen, Liao and Yu</copyright-statement>
<copyright-year>2022</copyright-year>
<copyright-holder>Lin, Tien, Kuo, Lin, Tsai, Chen, Tsai, Su, Pathak, Yang, Yu, Chuang, Wu, Tsai, Dai, Liao, Chai, Su, Chuang, Liu, Chen, Dou, Chen, Chen, Liao and Yu</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/">
<p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</p>
</license>
</permissions>
<abstract>
<p>An effective COVID-19 vaccine against broad SARS-CoV-2 variants is still an unmet need. In the study, the vesicular stomatitis virus (VSV)-based vector was used to express the SARS-CoV-2 Spike protein to identify better vaccine designs. The replication-competent of the recombinant VSV-spike virus with C-terminal 19 amino acid truncation (S&#x394;19 Rep) was generated. A single dose of S&#x394;19 Rep intranasal vaccination is sufficient to induce protective immunity against SARS-CoV-2 infection in hamsters. All the clones isolated from the S&#x394;19 Rep virus contained R682G mutation located at the Furin cleavage site. An additional S813Y mutation close to the TMPRSS2 cleavage site was identified in some clones. The enzymatic processing of S protein was blocked by these mutations. The vaccination of the R682G-S813Y virus produced a high antibody response against S protein and a robust S protein-specific CD8<sup>+</sup> T cell response. The vaccinated animals were protected from the lethal SARS-CoV-2 (delta variant) challenge. The S antigen with resistance to enzymatic processes by Furin and TMPRSS2 will provide better immunogenicity for vaccine design.</p>
</abstract>
<kwd-group>
<kwd>SARS-CoV-2 Spike</kwd>
<kwd>VSV</kwd>
<kwd>pseudotype</kwd>
<kwd>replication-competent</kwd>
<kwd>S1/S2 cleavage site</kwd>
<kwd>furin</kwd>
<kwd>TMPRSS2</kwd>
<kwd>ACE2 transgenic mice</kwd>
</kwd-group>
<contract-sponsor id="cn001">Ministry of Health and Welfare<named-content content-type="fundref-id">10.13039/100008903</named-content>
</contract-sponsor>
<contract-sponsor id="cn002">Ministry of Science and Technology, Taiwan<named-content content-type="fundref-id">10.13039/501100004663</named-content>
</contract-sponsor>
<contract-sponsor id="cn003">National Health Research Institutes<named-content content-type="fundref-id">10.13039/501100004737</named-content>
</contract-sponsor>
<counts>
<fig-count count="8"/>
<table-count count="0"/>
<equation-count count="0"/>
<ref-count count="45"/>
<page-count count="15"/>
<word-count count="7717"/>
</counts>
</article-meta>
</front>
<body>
<sec id="s1" sec-type="intro">
<title>Introduction</title>
<p>A novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged in Wuhan, China in December 2019 and caused a coronavirus disease (COVID-19) pandemic. SARS-CoV-2 belongs to genus <italic>Coronavirus</italic> and family <italic>Coronaviridae</italic>. Typical symptoms of COVID-19 patients are fever or chills, dry cough, body aches, diarrhea, and loss of smell and taste (<xref ref-type="bibr" rid="B1">1</xref>). In severe cases, pneumonia and death can also occur. With the continuous circulation globally, SARS-CoV-2 variants have emerged from various countries and become dominant strain from time to time. Variants of concern (VOC) are variants that have high transmissibility, cause severe diseases, and reduce the effectiveness of vaccines or the accuracy of diagnostic detection. B.1.1.7 (Alpha), B.1.351 (Beta), P.1 (Gamma), B.1.617.2 (Delta), and B.1.1.529 (Omicron) are examples of VOC in the past two years. New generations of vaccines and therapeutics are still in urgent need.</p>
<p>The spike (S) protein is located on the viral envelope and interacts with the cellular receptor, Angiotensin-converting enzyme 2 (ACE2), during virus infection (<xref ref-type="bibr" rid="B2">2</xref>). S glycoproteins form homotrimers and are processed into S1 and S2 subunits by Furin protease (<xref ref-type="bibr" rid="B3">3</xref>, <xref ref-type="bibr" rid="B4">4</xref>). The receptor-binding domain (RBD) of the S1 subunit interacts with ACE2 during infection, and the S2 subunit is subsequently cleaved by TMPRSS2 protease to trigger virus-host membrane fusion (<xref ref-type="bibr" rid="B5">5</xref>). The enzymatic processes are critical to enhancing SARS-CoV-2 propagation in lung (<xref ref-type="bibr" rid="B6">6</xref>, <xref ref-type="bibr" rid="B7">7</xref>). The conformation of S protein changes from closed to open state to expose the RBD region in the prefusion states for ACE2 binding. Potent neutralizing antibodies isolated from the recovered COVID-19 patients have been mapped to the N-terminal domain and RBD region on open or closed conformation (<xref ref-type="bibr" rid="B8">8</xref>). Current COVID-19 vaccine designs use S protein as the target antigen for the induction of neutralizing antibodies to block SARS-CoV-2 entry (<xref ref-type="bibr" rid="B9">9</xref>, <xref ref-type="bibr" rid="B10">10</xref>). Two proline substitution (2P), furin site mutation, and intermolecular disulfide bonds have been applied in the expression of the thermostable, closed S trimer as immunogen (<xref ref-type="bibr" rid="B3">3</xref>, <xref ref-type="bibr" rid="B11">11</xref>&#x2013;<xref ref-type="bibr" rid="B13">13</xref>).</p>
<p>The vesicular stomatitis virus (VSV) is a member of the <italic>Rhabdoviridae</italic> family and its genome only encodes five proteins: nucleoprotein (N), phosphoprotein (P), matrix protein (M), glycoprotein (G), and large polymerase protein (L). VSV G protein is responsible for viral binding, cell fusion, endocytosis, and entry. The VSV&#x394;G vector has been applied to create recombinant viruses carrying the viral envelope protein (glycoprotein) from high pathogenic viruses for neutralization activity, antiviral evaluation, or vaccine design (<xref ref-type="bibr" rid="B14">14</xref>&#x2013;<xref ref-type="bibr" rid="B16">16</xref>). The VSV&#x394;G vector also has been used to express SARS-CoV-2 S protein for vaccine development (<xref ref-type="bibr" rid="B17">17</xref>, <xref ref-type="bibr" rid="B18">18</xref>).</p>
<p>In this study, the replication-competent VSV-based SARS-CoV-2 S vaccine was generated, and the recombinant virus clones with different mutations were further characterized. The mutant containing mutations on the Furin and TMPRSS2 cleavage sites had higher potency to induce both humoral and cellular immunity against lethal SARS-CoV-2 infection. The information will advance our knowledge in vaccine design against emerging infectious diseases.</p>
</sec>
<sec id="s2" sec-type="results">
<title>Results</title>
<sec id="s2_1">
<title>Generation of Replication-Competent Recombinant VSV Expressing SARS-CoV-2 S Protein</title>
<p>VSV&#x394;G vector to express glycoprotein from high pathogenic virus has been applied in vaccine development. Hence, the human codon-optimized Spike cDNA lacking C-terminal ER retention signal (S&#x394;19) was inserted into the VSV&#x394;G-GFP DNA vector for <italic>in vivo</italic> gene expression as depicted in <xref ref-type="fig" rid="f1"><bold>Figure&#xa0;1A</bold></xref>. The VSV&#x394;G-S&#x394;19 RNA genome was then rescued with helper plasmids (VSV N, P, L, and G) in the presence of T7 polymerase expression (<xref ref-type="bibr" rid="B19">19</xref>). The rescued virus particles enveloped with VSV G protein (VSV&#x394;G-S&#x394;19/G) were infectious to drive GFP and S protein expression in Vero E6, HEK293T-hACE2, and BHK21-hACE2 cells (<xref ref-type="fig" rid="f1"><bold>Figures&#xa0;1B, C</bold></xref>). It has been shown that ACE2 is the main receptor for SARS-CoV-2 infection, and human ACE2 expression in BHK-21 and A549 cells enhances the VSV-based S pseudotyped virus and rVSV-S infection (<xref ref-type="bibr" rid="B20">20</xref>, <xref ref-type="bibr" rid="B21">21</xref>). Therefore, the hACE2-overexpressing HEK293T and BHK-21 were used for rVSV-S infection and related experiments. A substantial amount of VSV&#x394;G-S&#x394;19 virus secretion in the culture supernatant was detected from HEK293T-hACE2 and BHK21-hACE2 cells (<xref ref-type="fig" rid="f1"><bold>Figure&#xa0;1C</bold></xref>), but the virus titer decreased during passages (<xref ref-type="fig" rid="f1"><bold>Figure&#xa0;1D</bold></xref>).</p>
<fig id="f1" position="float">
<label>Figure&#xa0;1</label>
<caption>
<p>Generation of recombinant vesicular stomatitis virus (VSV) expressing the C-terminal 19 amino acid deletion SARS-CoV-2 spike mutant (VSV&#x394;G-S&#x394;19) with replication capability. <bold>(A)</bold> Schematic representation of the genomic organization of the G protein-deficient VSV vector (VSV&#x394;G) inserted with the C-terminal 19 amino acid truncated SARS-CoV-2 spike protein (S&#x394;19). N, nucleoprotein; P, phosphoprotein; M, matrix; GFP, green fluorescent protein; L, large polymerase. <bold>(B, C)</bold> Vero E6, HEK293T-hACE2, and BHK21-hACE2 cells were infected with the VSV&#x394;G-S&#x394;19 virus (early passage, moi=0.5). Virus-driven GFP expression was monitored by fluorescence microscopy at 24 hrs post-infection <bold>(B)</bold>. The S&#x394;19 protein expression in cells (left panel) and supernatant (right panel) was examined by immunoblotting <bold>(C)</bold>. <bold>(D)</bold> The VSV&#x394;G-S&#x394;19 virus was propagated in HEK293T-hACE2 cells, and the virus titer was determined in BHK21-hACE2 cells. <bold>(E)</bold> After a few passages in HEK293T-hACE2 cells, the viruses were inoculated in BHK21-hACE2 cells with limiting dilution. The replication-competent VSV&#x394;G-S&#x394;19 viruses (S&#x394;19 Rep) emerging from BHK21-hACE2 cells were observed with GFP monitoring. <bold>(F)</bold> The S protein expression on recombinant virus particles of VSV&#x394;G/G, the early passage of VSV&#x394;G-S&#x394;19 enveloped with the VSV glycoprotein (S&#x394;19/G; replication incompetent) and S&#x394;19 Rep virus was examined by immunoblotting. <bold>(G, H)</bold> Vero E6 cells were infected with the S&#x394;19 Rep virus (moi=1, n=3). Virus titer <bold>(G)</bold> and S protein expression on virus particles <bold>(H)</bold> in culture supernatant were examined. moi, multiplicity of infection; dpi, days post-infection. Scale bar: 100 &#xb5;m.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fimmu-13-872047-g001.tif"/>
</fig>
<p>Recent studies showed that VSV&#x394;G-SARS-CoV-2 S has the capability to generate replication-competent viruses with few mutations in the S gene (<xref ref-type="bibr" rid="B20">20</xref>, <xref ref-type="bibr" rid="B22">22</xref>). After several repeated passages in BHK21-hACE2 cells, the virus-infected cell clusters (GFP<sup>+</sup>) emerged during the limiting dilution condition (<xref ref-type="fig" rid="f1"><bold>Figure&#xa0;1E</bold></xref>), and the emerged replication-competent virus (S&#x394;19 Rep) could be further expanded in HEK293T-hACE2 cells at high titer. To further confirm the incorporation of S protein into S&#x394;19 Rep viral particles, immunoblotting was performed (<xref ref-type="fig" rid="f1"><bold>Figure&#xa0;1F</bold></xref>). The S&#x394;19 Rep virus contained more uncleaved S protein compared to the non-replicating virus, VSV&#x394;G-S&#x394;19/G, in which the viral particles were enveloped with VSV G protein to maintain virus production. Moreover, the S&#x394;19 Rep virus was able to propagate efficiently in Vero E6 cells with high yield (<xref ref-type="fig" rid="f1"><bold>Figure&#xa0;1G</bold></xref>), and the S&#x394;19 protein on virus particles was predominantly as the uncleaved form (<xref ref-type="supplementary-material" rid="SM1"><bold>Figure&#xa0;1H</bold></xref>). In summary, replication-competent S&#x394;19 Rep could be generated and propagated efficiently in cells.</p>
</sec>
<sec id="s2_2">
<title>Intranasal Vaccination of S&#x394;19 Rep Virus Effectively Induces Anti-spike Antibodies With Neutralizing Activity in Hamsters</title>
<p>Recent studies have demonstrated that VSV expressing the S protein can be a vaccine candidate against SARS-CoV-2 (<xref ref-type="bibr" rid="B17">17</xref>, <xref ref-type="bibr" rid="B18">18</xref>, <xref ref-type="bibr" rid="B23">23</xref>). To examine whether VSV&#x394;G-S&#x394;19 virus with replication activity could stimulate better protective immunity against SARS-CoV-2 infection, Golden Syrian hamsters (<xref ref-type="bibr" rid="B24">24</xref>, <xref ref-type="bibr" rid="B25">25</xref>) were immunized twice with VSV&#x394;G/G (vector control), S&#x394;19/G, or S&#x394;19 Rep virus <italic>via</italic> intranasal administration (i.n.; 10<sup>6</sup> ffu or pfu/hamster) as depicted in <xref ref-type="fig" rid="f2"><bold>Figure&#xa0;2A</bold></xref>. The immunized-hamsters did not show significant weight loss after virus administration, suggesting that the immunization was well tolerated (<xref ref-type="fig" rid="f2"><bold>Figure&#xa0;2B</bold></xref>).</p>
<fig id="f2" position="float">
<label>Figure&#xa0;2</label>
<caption>
<p>The S&#x394;19 Rep virus effectively stimulates anti-spike antibodies with neutralizing activity in hamsters. <bold>(A)</bold> Experimental design of the prime-boost vaccination with VSV&#x394;G/G (control virus), VSV&#x394;G-S&#x394;19/G (replication-incompetent virus), and S&#x394;19 Rep in Gold Syrian hamster by intranasal (i.n.) administration (1&#xd7;10<sup>6</sup> pfu or ffu/hamster; n=5-6). Body weight of vaccinated hamsters was monitored periodically <bold>(B)</bold>. Serum samples collected from 3 and 7 weeks post-vaccination were subjected to ELISA for anti-spike specific IgG antibody <bold>(C)</bold>, the VSV&#x394;G-Spike pseudovirus-based neutralization assay <bold>(D)</bold>, the RBD-hACE2 interaction competition assay <bold>(E)</bold>, the SARS-CoV-2 neutralization assay <bold>(F)</bold>, and the the S<sup>variant</sup> EM-LvFluc viruses-based neutralization assay <bold>(G)</bold>. <bold>(H)</bold> Lung sections obtained from hamsters infected with VSV&#x394;G/G or S&#x394;19 Rep (1&#xd7;10<sup>6</sup> pfu or ffu/hamster; i.n.) at 20 hrs post-infection were stained with anti-S antibodies and counterstained with DAPI. <italic>**P &lt;</italic> 0.01. Scale bar: 20 &#x3bc;m.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fimmu-13-872047-g002.tif"/>
</fig>
<p>To evaluate the immune response, anti-S antibody titers in serum collected from Week 3 and 7 were evaluated by ELISA (<xref ref-type="fig" rid="f2"><bold>Figure&#xa0;2C</bold></xref>). The S&#x394;19 Rep virus induced high anti-S antibodies in the hamsters on Week 3, and the antibody titer remained high at Week 7. In contrast, the anti-S antibody titer was low in the S&#x394;19/G-immunized hamsters on Week 3 and slightly elevated after the boost immunization on Week 7. The VSV&#x394;G/G-immunized hamster did not have anti-S antibodies in the blood. Interestingly, both the Week 3 and 7 antiserum from the S&#x394;19 Rep-immunized hamsters could block VSV&#x394;G-Spike pseudovirus infection (<xref ref-type="fig" rid="f2"><bold>Figure&#xa0;2D</bold></xref>), interfere with RBD-hACE2 interaction (<xref ref-type="fig" rid="f2"><bold>Figure&#xa0;2E</bold></xref>), and neutralize SARS-CoV-2 virus (hCoV-19/Taiwan/4/2020) infection in Vero E6 cells (<xref ref-type="fig" rid="f2"><bold>Figure&#xa0;2F</bold></xref>). On the contrary, anti-S antibodies in the S&#x394;19/G-immunized hamsters did not show much neutralizing activity in these assays. In addition, the lentiviral vector with firefly luciferase reporter packaged with E, M, and S variants (S<sup>variant</sup> EM-LvFluc), including S<sup>D614G</sup>, S<sup>D614G+N501Y</sup>, S<sup>B1.1.7</sup>, and S<sup>B1.351</sup>, were generated and used for neutralization tests (<xref ref-type="bibr" rid="B26">26</xref>) (<xref ref-type="fig" rid="f2"><bold>Figure&#xa0;2G</bold></xref>). The S&#x394;19 Rep antisera from Week 7 effectively blocked S<sup>WT</sup> and S<sup>variant</sup> pseudovirus infection. To examine whether S protein expression was stimulated by the S&#x394;19 Rep virus vaccination in hamsters, the lung tissues were collected at 20 hrs post-vaccination and subjected to immunofluorescent staining with anti-S antibody (<xref ref-type="fig" rid="f1"><bold>Figure&#xa0;2H</bold></xref>). The S protein expression was induced by the S&#x394;19 Rep virus in the epithelial cells in the trachea and scattered in a few surrounding pneumocytes, suggesting that the S&#x394;19 Rep undergoes transient replication in the lung to stimulate immune responses. Collectively, these data show that the intranasal administration of the replication-competent S&#x394;19 Rep virus efficiently induces anti-S antibodies with potent and broad neutralizing activity against SARS-CoV-2.</p>
</sec>
<sec id="s2_3">
<title>Prime-Boost or a Single Dose of the S&#x394;19 Rep Vaccination Protects Hamsters From SARS-CoV-2 Infection</title>
<p>To evaluate the efficacy of the S&#x394;19 Rep vaccination, the prime-boost immunized hamsters were challenged with SARS-CoV-2 (1x10<sup>5</sup> TCID<sub>50</sub>/hamster; i.n.; <xref ref-type="fig" rid="f3"><bold>Figure&#xa0;3A</bold></xref>). The VSV&#x394;G/G-immunized hamsters showed body weight loss and gradually recovered after day 7-post infection (dpi) (<xref ref-type="fig" rid="f3"><bold>Figure&#xa0;3B</bold></xref>). The S&#x394;19/G-immunized hamsters had slight body weight loss only in the first few days after infection. In contrast, the S&#x394;19 Rep-immunized animals did not have obvious weight loss throughout the experiment. The virus titer in lungs from the VSV&#x394;G-immunized hamsters was up to 1x10<sup>9</sup> TCID<sub>50</sub>/ml (1/2 lung was homogenized in 2ml) on 3 dpi, and it was decreased to one-tenth in the lungs from the S&#x394;19/G-immunized animals (<xref ref-type="fig" rid="f3"><bold>Figure&#xa0;3C</bold></xref>). Surprisingly, the SARS-CoV-2 virus was not detected in the lungs obtained from the S&#x394;19 Rep-immunized animals. The viral E and N RNA were also not detected in the 3 dpi lungs from the S&#x394;19 Rep-immunized animals evaluated by quantitative real-time PCR (<xref ref-type="fig" rid="f3"><bold>Figure&#xa0;3D</bold></xref>). Consistently, the SARS-CoV-2 N antigen was highly expressed in the VSV&#x394;G/G-immunized lungs by immunohistochemistry staining, decreased in the S&#x394;19/G-immunized lungs, and absent in the S&#x394;19 Rep-immunized lungs (3 dpi, <xref ref-type="fig" rid="f3"><bold>Figure&#xa0;3E</bold></xref>). The pulmonary inflammation caused by SARS-CoV-2 infection was evident in the VSV&#x394;G/G-immunized lungs at 6 dpi with hematoxylin &amp; eosin staining but not observed in the S&#x394;19 Rep-immunized lungs (<xref ref-type="fig" rid="f3"><bold>Figure&#xa0;3F</bold></xref>).</p>
<fig id="f3" position="float">
<label>Figure&#xa0;3</label>
<caption>
<p>Prime-boost S&#x394;19 Rep vaccination protects hamsters from SARS-CoV-2 infection. <bold>(A)</bold> Experimental design of the prime-boost vaccination and SARS-CoV-2 challenge (1&#xd7;10<sup>5</sup> TCID<sub>50</sub>/hamster; i.n.) in hamsters. <bold>(B)</bold> Body weight loss post-SARS-CoV-2 challenge. <bold>(C)</bold> The virus titers of SARS-CoV-2 in the lung at 3 dpi were detected by TCID<sub>50</sub> assay. <bold>(D)</bold> Viral RNA transcripts of E and N genes in the lung (3 dpi) were measured by quantitative real-time PCR. <bold>(E)</bold> Viral N protein expression in the lung (3 dpi) was detected by immunohistochemistry and quantified using ImageJ software. Scale bar: 100 &#x3bc;m. <bold>(F)</bold> H&amp;E staining of lung tissue at 6 dpi. Scale bar: 500 &#x3bc;m (40X) and 100 &#x3bc;m (200X). <italic>*P &lt;</italic> 0.05; <italic>**P &lt;</italic> 0.01.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fimmu-13-872047-g003.tif"/>
</fig>
<p>As a single dose of the S&#x394;19 Rep vaccination could induce high titer anti-S antibodies with neutralization activity in hamsters (Week 3 in <xref ref-type="fig" rid="f2"><bold>Figures&#xa0;2C</bold></xref>&#x2013;<xref ref-type="fig" rid="f2"><bold>F</bold></xref>), a single dose of the S&#x394;19 Rep vaccination might be protective to SARS-CoV-2 infection. Therefore, hamsters with one dose of S&#x394;19 Rep immunization were challenged with SARS-CoV-2 infection (1x10<sup>5</sup> TCID<sub>50</sub>/hamster; i.n.; <xref ref-type="fig" rid="f4"><bold>Figure&#xa0;4A</bold></xref>). The hamsters with one dose of VSV&#x394;G/G immunization were used as a control group. Similarly, the S&#x394;19 Rep-immunized hamsters were resistant to SARS-CoV-2 infection and therefore did not show body weight loss after infection (<xref ref-type="fig" rid="f4"><bold>Figure&#xa0;4B</bold></xref>). No virus titer, viral RNA, and N protein expression were observed in the lung with the S&#x394;19 Rep vaccination at 3 dpi (<xref ref-type="fig" rid="f4"><bold>Figures&#xa0;4C</bold></xref>&#x2013;<xref ref-type="fig" rid="f4"><bold>E</bold></xref>). The inflammation induced by the SARS-CoV-2 infection was also absent in the S&#x394;19 Rep-immunized lung tissue at 6 dpi (<xref ref-type="fig" rid="f4"><bold>Figure&#xa0;4F</bold></xref>). Taken together, a single dose of S&#x394;19 Rep intranasal vaccination is sufficient to induce robust immunity against SARS-CoV-2 infection.</p>
<fig id="f4" position="float">
<label>Figure&#xa0;4</label>
<caption>
<p>A single dose S&#x394;19 Rep vaccination induces effective immunity against SARS-CoV-2 infection. <bold>(A)</bold> Experimental design of a single dose vaccination (1&#xd7;10<sup>6</sup> pfu or ffu/hamster; i.n.; n=10) and SARS-CoV-2 challenge (1&#xd7;10<sup>5</sup> TCID<sub>50</sub>/hamster; i.n.). <bold>(B)</bold> Body weight loss post-SARS-CoV-2 challenge. SARS-CoV-2 virus titer <bold>(C)</bold>, viral RNA <bold>(D)</bold>, and N protein expression <bold>(E)</bold> in the lung at 3 dpi were assessed. Scale bar: 20 &#x3bc;m. <bold>(F)</bold> H&amp;E staining of lung tissue (3, 6, and 9 dpi). Scale bar: 500 &#x3bc;m (40X) and 100 &#x3bc;m (200X). <italic>*P &lt;</italic> 0.05; <italic>**P &lt;</italic> 0.01.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fimmu-13-872047-g004.tif"/>
</fig>
</sec>
<sec id="s2_4">
<title>R682G and S813Y Mutations Reduce the Substrate-Protease Binding Affinity</title>
<p>Recent studies showed that the replication-competent VSV&#x394;G-SARS-CoV-2 S harbors unique adoptive mutations (<xref ref-type="bibr" rid="B18">18</xref>, <xref ref-type="bibr" rid="B20">20</xref>, <xref ref-type="bibr" rid="B22">22</xref>, <xref ref-type="bibr" rid="B27">27</xref>). To examine whether any mutations had accumulated in the S&#x394;19 Rep virus, the viral RNAs extracted from cell culture supernatant were subjected to amplicon sequencing assay utilizing the ONT MinION device (<xref ref-type="bibr" rid="B28">28</xref>). The mutations of the dominant strain that occurred in the viral protein-coding sequence were listed in <xref ref-type="supplementary-material" rid="SM1"><bold>Table S1</bold></xref>. Two nonsynonymous substitutions, R682G (74.10%) and S813Y (46.22%) were identified in the S&#x394;19 gene, which are close to the Furin- and TMPRSS2-cleavage sites, respectively (<xref ref-type="fig" rid="f5"><bold>Figure&#xa0;5A</bold></xref>). To further characterize the R682G and S813Y mutations on S&#x394;19 Rep virus, viral clones were isolated <italic>via</italic> limiting dilution in BHK21-hACE2 cells and then amplified in HEK293T-hACE2 cells (<xref ref-type="supplementary-material" rid="SM1"><bold>Figure S1A</bold></xref>). Some viral clones lost GFP expression but caused obvious CPE. 9 viral clones with the stable S protein expression were subjected sequencing (<xref ref-type="supplementary-material" rid="SM1"><bold>Figures S1B, C</bold></xref>). All the clones sequenced had R682G mutation, and all the GFP<sup>-</sup> clones sequenced had S813Y mutation. Two additional mutations, P793H and R1107H, were also identified in some clones.</p>
<fig id="f5" position="float">
<label>Figure&#xa0;5</label>
<caption>
<p>The R682G and S813Y mutations in Spike protein lead to altered enzyme binding and proteolysis. <bold>(A)</bold> The Furin and TMPRSS2 cleavage motifs are shown in the spike protein sequences of SARS-CoV, SARS-CoV-2 WT, and mutants. Furin cleavage occurs between the S1 and S2 subunits, while the TMPRSS2 cleavage occurs within the S2 subunit. <bold>(B)</bold> The S protein structure and interactions of the WT (wild-type; green), R682G (orange), and R682G-S813Y (magenta) mutants were modeled using the Phyre2 web portal. The full spike proteins are aligned, and the specific mutation sites are shown in insights of the Furin and TMPRSS2 cleavage sites. <bold>(C, D)</bold> Molecular docking of spike protein peptide substrates (of WT and mutants) with Furin and TMPRSS2 using iGEMDOCK. The protease active site (surface) and the binding poses (2D diagrams) of the WT (green stick) and mutants (mutated residue in red sticks) were shown. The active site subpockets (dotted curves) with residues (catalytic residues labels underlined) were also displayed. The interactions (solid black lines, E-dark red, H-green, V-grey) and total interaction energies (I.E in kcal/mol) were examined. The interaction table details the substrate-subpocket residue interactions.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fimmu-13-872047-g005.tif"/>
</fig>
<p>The R682G mutation in the S protein slightly changed the conformation of the loop (<xref ref-type="fig" rid="f5"><bold>Figure&#xa0;5B</bold></xref>) but did not cause any change in the interactions with the neighboring residues, thus the spike structural flexibility and stability are unaffected by this mutation. The mutation of S813 to Y813 in the loop (near the TMPRSS2 cleavage site) does not affect the local loop structure. However, the H-bonding interaction of S813 with E868 residue of the adjacent helix is lost in the mutant that contains Y813 (red circle in <xref ref-type="fig" rid="f5"><bold>Figure&#xa0;5B</bold></xref>) and may alter the S protein structural stability.</p>
<p>Furin and TMPRSS2 are important human proteases essential for SARS-CoV-2 S protein cleavage and maturation, leading to RBD opening and binding to host ACE2 receptor to mediate virus entry (<xref ref-type="bibr" rid="B29">29</xref>). To further examine the effect of mutations in the protease substrate motifs on proteolysis, their binding mechanisms with proteases were evaluated by iGEMDOCK (<xref ref-type="bibr" rid="B30">30</xref>) (<xref ref-type="fig" rid="f5"><bold>Figures&#xa0;5C, D</bold></xref>). In Furin protease (<xref ref-type="fig" rid="f5"><bold>Figure&#xa0;5B</bold></xref>), the peptide substrates <sup>681</sup>P<bold>R</bold>RAR<sup>685</sup> (WT) and <sup>681</sup>P<bold>G</bold>RAR<sup>685</sup> (R682G mutant) were docked into the active site and interacted with the catalytic residues S368 and H194. At the S4 subpocket, R682 residue interacts with subpocket residues D264, Y308, and E236, contributing to strong substrate binding with an I.E of -129.8 kcal/mol. However, the R682G mutation disrupted these interactions leading to an unoccupied S4 subpocket (Table in <xref ref-type="fig" rid="f5"><bold>Figure&#xa0;5C</bold></xref>) and thus an overall weakened binding of the peptide with I.E of -78.7 kcal/mol.</p>
<p>The binding poses of <sup>812</sup>P<bold>S</bold>KR<sup>815</sup> (WT) and <sup>812</sup>P<bold>Y</bold>KR<sup>815</sup> (S813Y mutant) in the TMPRSS2 active site subpockets were also analyzed (<xref ref-type="fig" rid="f5"><bold>Figure&#xa0;5D</bold></xref>). The PSKR engaged S1&#x2019; and S1-S4 subpockets by interaction with residues including catalytic S441 and H296, where Ser (S) strongly forms H-bonding with the S3 subpocket residues G462 and S463 (red outline in <xref ref-type="fig" rid="f5"><bold>Figure&#xa0;5D</bold></xref>), with an overall I.E of -299 kcal/mol. These H-bonding interactions at S3 are missing in the PYKR substrate-binding pose due to mutation to Tyr (Y), also observed in the interaction table in <xref ref-type="fig" rid="f5"><bold>Figure&#xa0;5D</bold></xref>. This mutation decreases the overall interaction energy I.E to -177.3 kcal/mol, and it reduces binding affinity for mutant substrate peptides and the rate of proteolysis by TMPRSS2 compared to WT. These docking results indicated that the R682G and S813Y mutations reduced the substrate-protease binding affinity to Furin and TMPRSS2, respectively, and thus may hinder the proteolysis process.</p>
</sec>
<sec id="s2_5">
<title>The R682G and S813Y Mutations of S Protein Facilitate Recombinant Virus Production</title>
<p>When the S&#x394;19 Rep clones with R682G and R682G-S813Y mutations were amplified in HEK293T-hACE2 cells, the virus production was higher in the R682G-S813Y mutant (<xref ref-type="fig" rid="f6"><bold>Figure&#xa0;6A</bold></xref>). The S protein expression in the R682G and R682G-S813Y mutant virus-infected cells was shown as a full-length form which was due to the inhibition of the S1/S2 cleavage by R682G mutation (<xref ref-type="fig" rid="f6"><bold>Figure&#xa0;6B</bold></xref>). To test whether S813Y mutation changes S protein structure and protease sensitivity, the S&#x394;19 Rep viruses were treated with TPCK-trypsin. As shown in <xref ref-type="fig" rid="f6"><bold>Figure&#xa0;6C</bold></xref>, the S2 protein and a smaller fragment (S2&#x2019;) appeared in the R682G mutant after trypsin digestion. In contrast, the S2&#x2019; fragment was not generated from the R682G-S813Y mutant virus with trypsin digestion, suggesting that the S813Y mutation changes the S protein to become resistant to enzymatic processing.</p>
<fig id="f6" position="float">
<label>Figure&#xa0;6</label>
<caption>
<p>R682G and S813Y mutations facilitate rVSV-S replication. <bold>(A)</bold> HEK293T-hACE2 cells were infected with the S&#x394;19 Rep virus with R682G or R682G-S813Y mutation. Virus titer in the culture supernatant was measured (moi=0.1, 3 dpi, n=4). <bold>(B)</bold> Virus-infected cell lysate (moi=1, 1 dpi) was subjected to immunoblotting with anti-S2 antibodies. <bold>(C)</bold> The viral particles in the culture supernatant were digested with TPCK-trypsin (2 &#x3bc;g/ml at 37&#xb0;C for 30 min) and analyzed by immunoblotting. <bold>(D)</bold> S&#x394;19 beta variant (B.1.351) gene with and without R682G mutation was inserted into the VSV&#x394;G-GFP DNA vector and co-transfected with all the required helper plasmids in HEK293T-hACE2 cells to rescue recombinant VSV&#x394;G-S&#x394;19 (B.1.351)/G virus. Virus replication was monitored by GFP expression. The rescued viruses were collected to infect BHK21-hACE2 cells with limiting dilution, and further amplified in HEK293T-hACE2 cells. <bold>(E)</bold> The Spike protein expression pattern of the replication-competent S&#x394;19 (B.1.351-R682G) virus was examined by immunoblotting alone with S&#x394;18 and S&#x394;18 (B.1.351) pseudoviruses for comparison. Scale bar: 100 &#x3bc;m. *<italic>P</italic> &lt; 0.05.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fimmu-13-872047-g006.tif"/>
</fig>
<p>As all the S&#x394;19 Rep clones harbored R682G mutation, we suspect that the mutation might stabilize S protein as full-length form and accelerate recombinant VSV&#x394;G-S&#x394;19 virus to become replication-competent. To test the hypothesis, recombinant VSV&#x394;G-S&#x394;19 (B.1.351) -WT or -R682G mutant constructs were made, and virus production was monitored by GFP expression (<xref ref-type="fig" rid="f6"><bold>Figure&#xa0;6D</bold></xref>). The replication-competent virus of R682G mutant was emerged after being expended in the BHK21-hACE2 cells, which did not occur in the WT group. The S protein in the S&#x394;19 (B1351-R682G) Rep virus was also present as an uncleaved form (<xref ref-type="fig" rid="f6"><bold>Figure&#xa0;6E</bold></xref>), and no additional adaptive mutation was identified in the S gene of the viral RNA. Taken together, the R682G mutation blocks the S1/S2 cleavage and facilitates Rep virus packaging. The S813Y mutation attenuates further processing of S2 protein.</p>
</sec>
<sec id="s2_6">
<title>The S&#x394;19 Rep R682G-S813Y Mutant Stimulates Robust Antibody Response and Th1 Response</title>
<p>It is known that SARS-CoV-2 S with Furin cleavage site mutation and S-2P substitutions is stabilized in the prefusion state to stimulate better immune responses (<xref ref-type="bibr" rid="B11">11</xref>, <xref ref-type="bibr" rid="B31">31</xref>). The R682G and R682G-S813Y mutants have lower sensitivity to enzymatic processes (<xref ref-type="bibr" rid="B14">14</xref>, <xref ref-type="bibr" rid="B32">32</xref>), which might enhance their potency during vaccination. To test the hypothesis, hamsters were immunized with R682G or R682G-S813Y mutants, and their immune responses were analyzed at two weeks post-immunization (<xref ref-type="fig" rid="f7"><bold>Figure&#xa0;7A</bold></xref>). All the immunized-hamsters did not show significant weight loss after immunization (<xref ref-type="supplementary-material" rid="SM1"><bold>Figure S2A</bold></xref>). Both&#xa0;R682G and R682G-S813Y mutants induced a high titer of antibodies against full-length S protein in the serum (<xref ref-type="fig" rid="f7"><bold>Figure&#xa0;7B</bold></xref>). Interestingly, the R682G-S813Y mutant stimulated a significantly higher titer of antibodies against the S2 region compared to the R682G mutant and the VSV&#x394;G/G virus (<xref ref-type="fig" rid="f7"><bold>Figure&#xa0;7C</bold></xref>). In addition, the serum collected from the R682G-S813Y mutant-immunized animals blocked the RBD-hACE2 interaction more effectively (<xref ref-type="fig" rid="f7"><bold>Figure 7D</bold></xref>). The serum collected from the R682G and R682G-S813Y groups could neutralize the VSV-based S pseudoviruses (<xref ref-type="fig" rid="f7"><bold>Figure&#xa0;7E</bold></xref> and <xref ref-type="supplementary-material" rid="SM1"><bold>Figure S2B</bold></xref>) and SARS-CoV-2 virus (<xref ref-type="fig" rid="f7"><bold>Figure&#xa0;7F</bold></xref>), but not much difference was observed between these two groups. IgA antibodies against the S protein were also elevated in lung homogenates from the R682G and R682G-S813Y groups (<xref ref-type="fig" rid="f7"><bold>Figure&#xa0;7G</bold></xref>). Taken together, intranasal vaccination of these two S&#x394;19 Rep strains stimulate a robust humoral immune response in hamster.</p>
<fig id="f7" position="float">
<label>Figure&#xa0;7</label>
<caption>
<p>The S&#x394;19 Rep (R682G-S813Y) mutant stimulates robust neutralizing antibodies and Th1 immune response in hamsters. <bold>(A)</bold> Experimental design of a single dose vaccination with VSV&#x394;G/G (control virus), S&#x394;19 Rep-R682G and S&#x394;19 Rep-R682G-S813Y in hamster (i.n.; 1&#xd7;10<sup>6</sup> pfu or ffu/hamster; n=4). The serum, spleen, and lung of the vaccinated hamsters were collected 2 weeks post-vaccination. Serum samples were subjected to anti-S<sub>FL</sub> <bold>(B)</bold> and anti-S2<sub>ECD</sub> <bold>(C)</bold> IgG ELISA, the RBD-hACE2 interaction competition assay <bold>(D)</bold>, and the neutralization assay with the VSV&#x394;G-based S pseudotyped virus <bold>(E)</bold> and SARS-CoV-2 virus <bold>(F)</bold>. The anti-S<sub>FL</sub> IgA expression in the lung homogenates was measured by ELISA <bold>(G)</bold>. The isolated hamster splenocytes were stimulated with or without trimeric-S protein (5 &#x3bc;g/ml) for 72 hrs, and subjected to detect the TNF-&#x3b1;, IL-2, IL-6, IFN-&#x3b3; and IL-12 mRNA expression by qRT-PCR <bold>(H)</bold>. <italic>*P &lt;</italic> 0.05; <italic>**P &lt;</italic> 0.01.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fimmu-13-872047-g007.tif"/>
</fig>
<p>Type 1 T helper (Th1) cells are important in the activation of the cellular immune responses, which are critical for virus infection control. Whether the S&#x394;19 Rep vaccination could stimulate cellular immunity was further evaluated. The spleen tissue was collected from the vaccinated-hamsters and subjected to splenocyte culture with or without trimeric-S protein stimulation for three days. When the cytokine expression was analyzed by qRT-PCR, the Th1-related cytokines, including TNF-&#x3b1;, IL-2, IL-6, IFN-&#x3b3;, and IL-12, were highly elevated in the splenocytes isolated from the S&#x394;19 Rep R682G-S813Y-vaccinated hamsters (<xref ref-type="fig" rid="f7"><bold>Figure&#xa0;7H</bold></xref>). The Th2 related cytokine expression (IL-4, IL-5, and IL-13) in the isolated splenocytes was not detected. The expression of TNF-&#x3b1;, IL-2, IL-6, IFN-&#x3b3;, and IL-12 mRNA were also elevated in the spleen tissue but no significant difference between the R682G and R682G-S813Y groups (<xref ref-type="supplementary-material" rid="SM1"><bold>Figure S2C</bold></xref>). These results suggest that the S&#x394;19 Rep R682G-S813Y virus could simultaneously induce humoral and cellular immunity against SRAS-CoV-2 S protein.</p>
</sec>
<sec id="s2_7">
<title>Vaccination With the R682G-S813Y Mutant Protects Mice From the SARS-CoV-2 Lethal Infection</title>
<p>To examine the S&#x394;19 Rep infectivity and the duration of S protein expression in mice, the K18-hACE2 transgenic mice were infected with the S&#x394;19 Rep R682G-S813Y virus (1x10<sup>8</sup> pfu/mouse; i.n.), and the expression of S protein in lung collected from Day 1 to 4 post-infection was monitored by immunostaining (<xref ref-type="supplementary-material" rid="SM1"><bold>Figure S3</bold></xref>). The transient S protein expression was detected only in the lung sections on Day1 post-infection. To evaluate whether the S&#x394;19 Rep vaccination could induce protective immunity against SARS-CoV-2 lethal infection, K18-hACE2 transgenic mice were immunized with the R682G and R682G-S813Y viruses. As mice seemed to have a strong innate immune response against the VSV vector, a high dose of S&#x394;19 Rep virus (1x10<sup>8</sup> pfu/mouse) and the prime-boost protocol were used to vaccinate the hACE2 mice. The S protein-specific antibodies and CD8<sup>+</sup> T cell responses were evaluated and compared between those immunizations. On day 14 post the prime-boost, the vaccination with R682G viruses as well as R682G-S813Y viruses led to a 10 to 20-fold induction of S protein-specific IgG in the serum compared to VSV&#x394;G/G control (<xref ref-type="fig" rid="f8"><bold>Figure&#xa0;8A</bold></xref>). The level of S protein-specific IgG induced by R682G-S813Y mutant increased persistently at day 28 after the prime-boost, suggesting a better S protein-specific antibody response of R682G-S813Y vaccine than R682G. Consistently, a significant induction of S protein-specific IgA was detected in the nasal lavage fluid of R682G-S813Y vaccinated-mice, which was less apparent in mice immunized with R682G virus (<xref ref-type="fig" rid="f8"><bold>Figure&#xa0;8B</bold></xref>). We subsequently explored the induction of S protein-specific CD8<sup>+</sup> T cells by the R682G-S813Y vaccine, which was required for a complete vaccine-mediated immune protection. To achieve this, splenocytes in the vaccinated-mice were harvested at day 35 post the prime-boost, left untreated (resting) or stimulated with PMA plus ionomycin (P+I) for 5 h in the 10% FBS/RPMI full medium, followed by the SARS-CoV-2 S protein-specific tetramer staining in CD8<sup>+</sup> T cells. As expected, R682G-S813Y vaccine greatly induced S protein-specific tetramer<sup>+</sup> CD8<sup>+</sup> T cells, while VSV&#x394;G/G control did not (<xref ref-type="fig" rid="f8"><bold>Figures&#xa0;8C, D</bold></xref>). However, the stimulation with P+I did not induce more tetramer<sup>+</sup> CD8<sup>+</sup> T cells. Meanwhile, the R682G-S813Y vaccine induced the production of IFN-&#x3b3; by CD8<sup>+</sup> T cells significantly upon stimulation with P+I, which was similar to those by VSV&#x394;G/G control (<xref ref-type="fig" rid="f8"><bold>Figures&#xa0;8E, F</bold></xref>). The results suggested that most of the IFN-&#x3b3; response in CD8<sup>+</sup> T cells mediated by the R682G-S813Y vaccine was driven from the VSV vector. Taken together, the R682G-S813Y vaccine boosted a superior prime-induced immunity with higher levels of S protein-specific IgG and IgA, and a higher frequency of S protein-specific CD8<sup>+</sup> T cells in mice.</p>
<fig id="f8" position="float">
<label>Figure&#xa0;8</label>
<caption>
<p>The S&#x394;19 Rep (R682G-S813Y)-vaccinated hACE2 transgenic mice were protected from the SARS-CoV-2 lethal infection. <bold>(A)</bold> K18-hACE2 transgenic mice were vaccinated with VSV&#x394;G/G (control virus), S&#x394;19 Rep-R682G, and S&#x394;19 Rep-R682G-S813Y twice on Day 0 and Day 21 (i.n.; 1&#xd7;10<sup>8</sup> pfu or ffu/mouse; n=5). Anti-S<sub>FL</sub> IgG titer in the serum samples collected on Day 14 and Day 28 was measured by ELISA. <bold>(B)</bold> Anti-S<sub>FL</sub> IgA titer in Nasal lavage fluid (Day 35) was detected by ELISA. <bold>(C&#x2013;F)</bold> Splenocytes were isolated on Day 35-post vaccination and stained with T cell markers and the H-2K(b) SARS-CoV-2 S Tetramer for flow cytometry. Some splenocytes were treated with PMA (50 ng/ml) and ionomycin (500 ng/ml) for 5 h to activate T cell (P+I). <bold>(G&#x2013;J)</bold> The vaccinated-mice were challenged with the SARS-CoV-2 Delta strain (1000 TCID<sub>50</sub>/mouse; i.n.; n=6-8). Mouse body weight loss <bold>(G)</bold> and survival rate <bold>(H)</bold> were monitored. Half of the infected-mice were sacrificed, and the virus titer <bold>(I)</bold> and viral RNA level <bold>(J)</bold> in the mouse lung were measured. *<italic>P</italic> &lt; 0.05; **<italic>P</italic> &lt; 0.01.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fimmu-13-872047-g008.tif"/>
</fig>
<p>When the K18-hACE2 mice were challenged with SARS-CoV-2 (Delta strain; 1000 TCID<sub>50</sub>/mouse), na&#xef;ve or the VSV&#x394;G/G vaccinated mice had obvious body weight loss and died on 8-10 dpi (<xref ref-type="fig" rid="f8"><bold>Figures&#xa0;8G, H</bold></xref>). In contrast, the R682G-S813Y virus vaccinated mice did not show body weight loss and all mice survived on 10 dpi. Consistently, virus titer and viral RNA were not detected in the R682G-S813Y mouse group (<xref ref-type="fig" rid="f8"><bold>Figures&#xa0;8I, J</bold></xref>), suggesting that these mice were fully protected from the virus challenge. In conclusion, antibody and T cell responses induced by the R682G-S813Y vaccine could protect the hACE2 transgenic mice from the lethal SARS-CoV-2 virus infection.</p>
</sec>
</sec>
<sec id="s3" sec-type="discussion">
<title>Discussion</title>
<p>The recombinant VSV (rVSV)-vectored vaccine platform has been used for protection against several viral pathogens. For instance, the VSV-Ebola (rVSV-ZEBOV) was approved by the FDA in 2019. The VSV is not a human pathogen, so preexisting immunity against the VSV vector is not a concern. The replication-competent rVSV can induce effective humoral and cellular immunity. Safety-wise, rVSV replication only lasts for a short duration <italic>in vivo</italic> as VSV is very sensitive to <italic>IFN</italic>-mediated antiviral responses. In addition, the replication-competent rVSV is easy to propagate with a high titer in cell culture. These phenotypes prove the great advantage of the rVSV vaccines in future applications. Indeed, the S&#x394;19 Rep (R682G-S813Y) virus has high immunogenicity to induce high titer of IgG and IgA and robust T cell response. The vaccine strain will provide a new choice for COVID-19 vaccine development.</p>
<p>The Replication-competent VSV-vectored S vaccines have also been established previously (<xref ref-type="bibr" rid="B14">14</xref>, <xref ref-type="bibr" rid="B18">18</xref>, <xref ref-type="bibr" rid="B20">20</xref>, <xref ref-type="bibr" rid="B23">23</xref>, <xref ref-type="bibr" rid="B27">27</xref>). Mutations identified from the previous study were located in the Furin cleavage site or C-terminal tail-truncation. The C-terminal cytoplasmic tail of S protein contains an ER retention signal (KxHxx), which facilitates S protein processing at the ER-Golgi intermediate compartment (ERGIC) and virus particle assembly (<xref ref-type="bibr" rid="B4">4</xref>). As VSV assembly mainly occurs at the plasma membrane, removal of the ER retention signal could facilitate the rVSV-S assembly, infectivity, and enhance the expression of S protein (<xref ref-type="bibr" rid="B20">20</xref>, <xref ref-type="bibr" rid="B27">27</xref>, <xref ref-type="bibr" rid="B33">33</xref>). Mutation or deletion of the furin cleavage site of S protein reduces SARS-CoV-2 entry and cell-cell spread, which leads to reduced virulence and pathogenesis in hamsters (<xref ref-type="bibr" rid="B34">34</xref>). Cheng et&#xa0;al. showed that the R682A mutation blocks Furin cleavage and reduces virus infectivity (<xref ref-type="bibr" rid="B35">35</xref>). In contrast, mutations in the multi-basic motif of the Furin cleavage site in the S protein seem to provide a growth advantage for the replication-competent VSV&#x394;G-S viruses (<xref ref-type="bibr" rid="B18">18</xref>, <xref ref-type="bibr" rid="B20">20</xref>, <xref ref-type="bibr" rid="B22">22</xref>). All the clones isolated in our study contain R682G mutation and the additional S813Y mutation located near the TMPRSS2 provide a growth advantage of the rVSV virus. Making the S protein resistant to the enzymatic processing is critical for the rVSV assembly and enhances virus production. The novel ribosomal pausing site, CGGCGG (RR) (<xref ref-type="bibr" rid="B36">36</xref>) was not present in our codon-optimized sequence (AGGAGA) or the R682G mutant (GGGAGA).</p>
<p>The conformation of S protein changes from closed to open state to expose the RBD region in the prefusion states for ACE2 binding. Furin cleavage at the S1/S2 junction promotes the conformation transition from closed to open state and facilitates virus infection. The R682G mutation reduces the furin cleavage efficiency of S protein, which may keep the S protein in a closed conformation. As a residual level of S1 and S2 are detected by immunoblotting, the proteolysis of the S1/S2 junction is not completely blocked by the R682G mutation. On the other hand, the slow processivity of the R682G and S813Y mutants might have a longer half-life for immune stimulation. Neutralizing antibodies mapped to the RBD domain on closed conformation have high potency to block SARS-CoV-2 infection (<xref ref-type="bibr" rid="B8">8</xref>). The conformation changes of the R682G and S813Y mutations may not affect the generation of neutralizing antibodies significantly. Johnson et&#xa0;al. showed that the SARS-CoV-2 virus with &#x394;PRRA mutation on S protein conferred protection against re-challenge with the parental SARS-CoV-2 (<xref ref-type="bibr" rid="B34">34</xref>). Probably due to the conformation changes or more intact S molecules on the &#x394;PRRA virions, the neutralization values of the sera from the COVID-19 patients were reduced against the &#x394;PRRA mutant versus parental virus. These phenotypes of &#x394;PRRA might also apply to the R682G and S813Y mutants.</p>
<p>Several studies showed that the furin cleavage site of S protein is required for SARS-CoV-2 virus entry and cell-cell fusion (<xref ref-type="bibr" rid="B7">7</xref>, <xref ref-type="bibr" rid="B29">29</xref>, <xref ref-type="bibr" rid="B37">37</xref>). Papa et&#xa0;al. showed that furin cleavage is not essential for processing S protein, and other proteases could cleave the S1/S2 junction (<xref ref-type="bibr" rid="B7">7</xref>). Current evidence suggests that SARS-CoV-2 enters cells through TMPRSS2- or cathepsin-meditated pathways (<xref ref-type="bibr" rid="B38">38</xref>, <xref ref-type="bibr" rid="B39">39</xref>). The SARS-CoV-2 carrying with WT spike enters the cell preferentially <italic>via</italic> TMPRSS2-dependent pathway, whereas SARS-CoV-2 without the S1/S2 cleavage site infects cell <italic>via</italic> cathepsin-dependent pathway (<xref ref-type="bibr" rid="B40">40</xref>). With the reduced sensitivity to furin and TMPRSS2 cleavage, the rVSV-S R682G and R682G-S813Y viruses might enter cells through both TMPRSS2- or cathepsin-meditated pathways for infection and immune stimulation.</p>
<p>We suspect that the proteases-resistant S protein might be more stable and therefore serve as a better antigen for vaccination. Riley et&#xa0;al. resolved the structure of spike trimer by negative stain EM and cryo-EM (<xref ref-type="bibr" rid="B41">41</xref>) and showed that a higher percentage of the S protein without furin cleavage site remains as trimeric form compared to the wild-type S protein. Trimeric-S, which has the S1/S2 cleavage site replaced by GSAS, is a potent antigen for the induction of neutralization antibodies (<xref ref-type="bibr" rid="B3">3</xref>). In line with this, immunization of the recombinant S proteins carrying two proline substitution (2P) and furin site mutation completely protects mice from SARS-CoV-2 challenge and produces a higher serum neutralization titer compared to the wild type S antigen immunization in mice (<xref ref-type="bibr" rid="B42">42</xref>). The protease-resistant and 2P mutations to stabilized S antigens have been applied in several vaccine designs (<xref ref-type="bibr" rid="B31">31</xref>, <xref ref-type="bibr" rid="B43">43</xref>). The S&#x394;19 Rep R682G virus induces a high neutralizing antibody response. The S&#x394;19 Rep R682G-S813Y virus stimulates better antibody response against S2 region and triggers a much stronger CD8<sup>+</sup> T cell response. The S2 subunit is more conserved within coronaviruses and SRAS-CoV-2 variants. A neutralizing antibody specific to the S2 subunit with cross-reactivity to carious coronaviruses is recently identified (<xref ref-type="bibr" rid="B44">44</xref>). The R682G-S813Y mutation might sustain more extended rVSV replication in animals, and the mutant S antigen might also have a longer half-life for the immune cells to recognize. The mutations could be included in the new generation of vaccine design.</p>
</sec>
<sec id="s4">
<title>Material and Methods</title>
<sec id="s4_1">
<title>Cells and Virus</title>
<p>BHK-21 cells were maintained in RPMI medium (Hyclone, Marlborough, MA) containing 5% FBS (Hyclone, Marlborough, MA), 1x Penicillin Streptomycin (PS) solution (Corning, New York). HEK293T/17 cells and Vero E6 cells were maintained in 10% FBS in DMEM/High glucose medium (Hyclone, Marlborough, MA) with 1X PS solution. Human ACE2 overexpression in BHK-21 and HEK293T cells was achieved following a previously published method (<xref ref-type="bibr" rid="B26">26</xref>). SARS-CoV-2 virus (hCoV-19/Taiwan/4/2020) and Delta virus (hCoV-19/Taiwan/1144/2021) were kindly provided by the Taiwan Centers for Disease Control and amplified in Vero76 cells in M199 medium with 2&#x2009;&#x3bc;g/mL TPCK-trypsin. All SARS-CoV-2 experiments were performed in a biosafety level 3 (BSL-3) laboratory.</p>
</sec>
<sec id="s4_2">
<title>VSV&#x394;G/S Pseudovirus and the Replication-Competent VSV&#x394;G-S&#x394;19 Virus</title>
<p>The VSV&#x394;G-GFP/G virus was recovered from the VSV&#x394;G-GFP-2.6 plasmid and helper plasmids (G, L, N, and P; Kerafast, Boston, MA) by following previously described methods (<xref ref-type="bibr" rid="B19">19</xref>). Human codon-optimized S cDNA encoding the WT (wild-type, MN908947.3) or variants were inserted in the pVax1 expression vector. Codon optimization is based on OptimumGene from GenScript. The BHK-21 cells were transfected with pVax1-SARS-CoV-2 S plasmid using lipofectamine 2000 (ThermoFisher, Waltham, MA) and infected with the VSV&#x394;G-GFP/G virus (moi=5) the next day. After incubation for 24 hrs, the cultured supernatants were clarified by centrifugation at 1,320 &#xd7; g for 10 min and stored at -80&#xb0;C. For titration, BHK21-hACE2 cells were infected with serially-diluted S<sub>pp</sub> stock, and the virus titer (ffu/ml) was calculated by counting GFP positive cells. The S cDNA lacking C-terminal ER retention signal (S&#x394;19) was PCR amplified and inserted into the VSV-&#x394;G-GFP-2.6 vector. The replication-competent S&#x394;19 virus was recovered by the following method described previously (<xref ref-type="bibr" rid="B22">22</xref>) and briefly described in the Supplementary Methods.</p>
</sec>
<sec id="s4_3">
<title>Immunoblotting Analysis</title>
<p>Cells were lysed by lysis buffer (50 mM Tris, 250 mM NaCl, 3 mM EDTA, 1% Triton X-100, 0.5% NP-40, 10% Glycerol, 1x PI cocktail). Cell lysate (10-50 &#x3bc;g) or viral supernatant were subjected to SDS-PAGE and transferred onto PVDF membrane. The primary antibodies were used in the study: anti-SARS-CoV-2 S2 (Genetex, Hsinchu, Taiwan; Cat#632604), anti-VSV-M (Absolute, Boston, MA), and anti-beta-actin (Sigma, St. Louis, MO). The rabbit anti-RBD (RBD antigen purified from <italic>E.coli</italic>) was generated in-house. The secondary antibodies were purchased from Jackson immunoresearch (West Grove, PA). The detection signals were developed with SuperSignal West Pico PLUS Chemiluminescent Substrate (Thermo Scientific, Rockford, IL) and imaged by Amersham Imager 600 (Dealer GE Healthcare).</p>
</sec>
<sec id="s4_4">
<title>Immunization and SARS-CoV-2 Challenging in Hamster and Mice</title>
<p>The 7-9 weeks old female Golden Syrian hamsters were purchased from the National Laboratory Animal Breeding and Research Center (Taipei, Taiwan). Hamsters were intranasally immunized with 1&#xd7;10<sup>6</sup> ffu or pfu of recombinant VSV viruses with a single dose or two doses at a 4 weeks interval. For SARS-CoV-2 challenge tests, immunized hamsters were intranasally inoculated with 1&#xd7;10<sup>5</sup> TCID<sub>50</sub> of SARS-CoV-2 (hCoV-19/Taiwan/4/2020). K18-human ACE2 transgenic mice (<xref ref-type="bibr" rid="B32">32</xref>) were imported from the Jackson Laboratory and bred at BioLASCO Taiwan and NHRI. The transgenic mice were immunized with 1&#xd7;10<sup>8</sup> ffu or pfu of recombinant VSV viruses with boost doses at a 3 weeks interval.</p>
</sec>
<sec id="s4_5">
<title>Enzyme-Linked Immunosorbent Assay</title>
<p>Serum, lung homogenate, and nasal lavage fluid (NLF) were subjected to ELISA to detect anti-S-specific IgG or IgA titer. 96-well ELISA plates were coated with either 4 &#x3bc;g/ml recombinant trimeric-S protein (S<sub>FL</sub>; homemade from 293T cells) or SARS-CoV-2 S2 extra-cellular domain (S2<sub>ECD</sub>, SinoBiologicals, Beijing, China) in PBS overnight at 4&#xb0;C, and blocked with 1% BSA in PBST (PBS with 0.05% Tween-20) at room temperature for 1 hr. Lung homogenate, NLF, or diluted serum serially were added to the coated plates and incubated for 1 hr at room temperature. Following washes, bound IgG and IgA were detected using HRP-conjugated goat anti-hamster IgG or IgA (Arigo Biolaboratories; Hsinchu, Taiwan) or anti-mouse IgG or IgA (Invitrogen) and developed with 1-Step Ultra TMB-ELISA Substrate Solution (ThermoFisher).</p>
</sec>
<sec id="s4_6">
<title>RBD-hACE2 Inhibition Assay</title>
<p>The inhibition of the RBD-hACE2 interaction of the hamster serum was performed using the anti-SARS-CoV-2 neutralizing antibody titer serologic assay kit (ACROBiosystems, Newark, DE; cat#TAS-K003) by following the manufacturer&#x2019;s instructions.</p>
</sec>
<sec id="s4_7">
<title>Neutralization Assay</title>
<p>The neutralizing antibody titers in hamster and mouse serum were evaluated with the VSV- and lentivirus-based pseudoviruses or with SARS-CoV-2 virus Wuhan strain. Detailed information can be found in the Supplementary Methods.</p>
</sec>
<sec id="s4_8">
<title>Bioinformatics Modeling and Docking</title>
<p>The structures of the WT and mutated-S (R682G and S813Y) were predicted and modeled using the Phyre2 web portal (<xref ref-type="bibr" rid="B45">45</xref>). Molecular Docking was used to understand the binding mechanisms of S peptide substrates with Furin (PDB ID: 7HZD) and TMPRSS2 (PDB ID: 7MEQ) proteases, both in ligand-bound complex forms. To further investigate the binding mechanisms of the WT and mutant substrates with targets, we performed docking using iGEMDOCK (<xref ref-type="bibr" rid="B30">30</xref>). Detailed information can be found in the <xref ref-type="supplementary-material" rid="SM1"><bold>Supplementary Methods</bold></xref>.</p>
</sec>
<sec id="s4_9">
<title>Quantitative Real-Time PCR</title>
<p>RNA was extracted from lung homogenate using TRIzol LS (ThermoFisher) and subjected to qRT-PCR using the KAPA PROBE FAST One-Step kit (Roche, Basel, Switzerland) with primers and probes specific for the SARS-CoV-2 N and E genes, and &#x3b3;-actin (housekeeping gene). To examine the cytokine responses, RNA was isolated from lung homogenates or splenocytes as described above. cDNA was synthesized using the FIREScript<sup>&#xae;</sup> RT cDNA synthesis KIT (Solis BioDyne, Tartu, Estonia) and subjected to the qPCR with gene-specific primers and SYBR green dye to determine the quantification cycle (Cq). All reactions were detected using the Applied Biosystems QuantStudio 6 and 7 Flex Real-Time PCR Systems. Relative RNA expression level was calculated using the &#x394;&#x394;Cq method with &#x3b3;-actin as an internal control. The primer sequences used in the study are listed in the Supplementary Methods.</p>
</sec>
<sec id="s4_10">
<title>Immunohistochemistry</title>
<p>Paraffin-embedded tissue sections were rehydrated using a standard procedure and subjected to antigen retrieval with S1700 Target Retrieval Solution (Agilent, Santa Clara, CA). Anti-N antibody (GeneTex#135357) was used to stain virus-infected cells at 4&#xb0;C overnight, followed by incubation with a secondary antibody (EnVision<sup>+</sup> system-HRP labeled polymer, Agilent) at RT for 1 hr. The sections were then incubated with DAB substrate for color development and counterstained with hematoxylin. The integrated density of the N staining signal was further quantified by ImageJ software.</p>
</sec>
<sec id="s4_11">
<title>Flow Cytometry</title>
<p>The spleens were collected from the vaccinated mice and the single-cell suspensions of splenocytes were prepared, washed twice with FACS buffer, and maintained in the dark at 4&#xb0;C for the staining procedure. To stain intracellular cytokines, GolgiPlug&#x2122; Protein Transport Inhibitor containing Brefeldin A (BD 555029) was supplied to cell culture at 5 h before cell collection. Viable cells were gated after staining with Fixable Viability Stain 620 (564996, BD Horizon&#x2122;). For FACS staining, cells were first incubated with PE-Labeled Tetramer (H-2K(b) SARS-CoV-2 S 539-546 VNFNFNGL, NIH Tetramer Core Facility), APC-CD3e (145-2C1, BD), BV421-CD8 (53-6.7, BioLegend), BV510-CD4 (RM4-5, BD) for 60 min on ice, followed by two washes in FACS buffer. The cells were fixed and permeabilized using the Cytofix/Cytoperm&#x2122; Fixation/Permeabilization Solution Kit (554714, BD Pharmingen&#x2122;), and incubated with Alexa488-IFN-&#x3b3; (XMG1.2, BD) for 30 min on ice. A flow cytometer (CantoII; BD) and FACSDiva software (BD) were used to acquire flow cytometric data, with FlowJo software<sup>TM10</sup> used for analysis.</p>
</sec>
<sec id="s4_12">
<title>Statistical Analysis</title>
<p>All data are denoted as the mean &#xb1; SEM and were analyzed using one-way ANOVA with Bartlett&#x2019;s test <italic>via</italic> GraphPad Prism software. Statistical significance was assigned when <italic>p-values</italic> were &lt; 0.05.</p>
</sec>
</sec>
<sec id="s5" sec-type="data-availability">
<title>Data Availability Statement</title>
<p>The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.</p>
</sec>
<sec id="s6" sec-type="ethics-statement">
<title>Ethics Statement</title>
<p>All animal-related experiments were conducted in compliance with the guidelines of the Laboratory Animal Center of NHRI. The animal protocol (NHRI-IACUC-109102-A-S02 and NHRI-IACUC-109139-A) was approved by the Institutional Animal Care and Use Committee of NHRI, according to the Guide for the Care and Use of Laboratory Animals (NRC 2011).</p>
</sec>
<sec id="s7" sec-type="author-contributions">
<title>Author Contributions</title>
<p>Conduct the research work: J-JL, C-FT, Y-PK, E-JL, W-HT, M-YC, P-JT, NP, Z-SC, H-CW, W-TT, S-SD, H-CL, KMC, Y-SS. Manuscript preparation J-JL, C-FT, Y-WS, NP, G-YY. Experiment design and result discussion: Y-WS, J-MY, C-YY, T-HC, S-JL, H-WC, H-YD, F-JC, C-TC, C-LL, G-YY. All authors contributed to the article and approved the submitted version.</p>
</sec>
<sec id="s8" sec-type="funding-information">
<title>Funding</title>
<p>The funding is provided by the Ministry of Health and Welfare, Taiwan (MOHW 109-TDU-C-222-000010), by the Ministry of Science and Technology (MOST 109-2327-B-400-004), and by NHRI (IV-111-PP-03).</p>
</sec>
<sec id="s9" sec-type="COI-statement">
<title>Conflict of Interest</title>
<p>The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
</sec>
<sec id="s10" sec-type="disclaimer">
<title>Publisher&#x2019;s Note</title>
<p>All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.</p>
</sec>
</body>
<back>
<ack>
<title>Acknowledgments</title>
<p>We are thankful for the assistance of the P3 laboratory team from NHRI. We also thank the NIH Tetramer facility to provide the SRAS-CoV S tetramer.</p>
</ack>
<sec id="s11" sec-type="supplementary-material">
<title>Supplementary Material</title>
<p>The Supplementary Material for this article can be found online at: <ext-link ext-link-type="uri" xlink:href="https://www.frontiersin.org/articles/10.3389/fimmu.2022.872047/full#supplementary-material">https://www.frontiersin.org/articles/10.3389/fimmu.2022.872047/full#supplementary-material</ext-link>
</p>
<supplementary-material xlink:href="DataSheet_1.docx" id="SM1" mimetype="application/vnd.openxmlformats-officedocument.wordprocessingml.document"/>
<supplementary-material xlink:href="DataSheet_2.docx" id="SM2" mimetype="application/vnd.openxmlformats-officedocument.wordprocessingml.document"/>
<supplementary-material xlink:href="DataSheet_3.docx" id="SM3" mimetype="application/vnd.openxmlformats-officedocument.wordprocessingml.document"/>
</sec>
<ref-list>
<title>References</title>
<ref id="B1">
<label>1</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Zheng</surname> <given-names>J</given-names>
</name>
</person-group>. <article-title>SARS-CoV-2: An Emerging Coronavirus That Causes a Global Threat</article-title>. <source>Int J Biol Sci</source> (<year>2020</year>) <volume>16</volume>:<page-range>1678&#x2013;85</page-range>. doi: <pub-id pub-id-type="doi">10.7150/ijbs.45053</pub-id>
</citation>
</ref>
<ref id="B2">
<label>2</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Hoffmann</surname> <given-names>M</given-names>
</name>
<name>
<surname>Kleine-Weber</surname> <given-names>H</given-names>
</name>
<name>
<surname>Schroeder</surname> <given-names>S</given-names>
</name>
<name>
<surname>Kruger</surname> <given-names>N</given-names>
</name>
<name>
<surname>Herrler</surname> <given-names>T</given-names>
</name>
<name>
<surname>Erichsen</surname> <given-names>S</given-names>
</name>
<etal/>
</person-group>. <article-title>SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor</article-title>. <source>Cell</source> (<year>2020</year>) <volume>181</volume>:<page-range>271&#x2013;80</page-range>. doi: <pub-id pub-id-type="doi">10.1016/j.cell.2020.02.052</pub-id>
</citation>
</ref>
<ref id="B3">
<label>3</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Xiong</surname> <given-names>X</given-names>
</name>
<name>
<surname>Qu</surname> <given-names>K</given-names>
</name>
<name>
<surname>Ciazynska</surname> <given-names>KA</given-names>
</name>
<name>
<surname>Hosmillo</surname> <given-names>M</given-names>
</name>
<name>
<surname>Carter</surname> <given-names>AP</given-names>
</name>
<name>
<surname>Ebrahimi</surname> <given-names>S</given-names>
</name>
<etal/>
</person-group>. <article-title>A Thermostable, Closed SARS-CoV-2 Spike Protein Trimer</article-title>. <source>Nat Struct Mol Biol</source> (<year>2020</year>) <volume>27</volume>:<page-range>934&#x2013;41</page-range>. doi: <pub-id pub-id-type="doi">10.1038/s41594-020-0478-5</pub-id>
</citation>
</ref>
<ref id="B4">
<label>4</label>
<citation citation-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>. <article-title>Structure, Function, and Antigenicity of the SARS-CoV-2 Spike Glycoprotein</article-title>. <source>Cell</source> (<year>2020</year>) <volume>181</volume>:<fpage>281+</fpage>. doi: <pub-id pub-id-type="doi">10.1016/j.cell.2020.02.058</pub-id>
</citation>
</ref>
<ref id="B5">
<label>5</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Huang</surname> <given-names>Y</given-names>
</name>
<name>
<surname>Yang</surname> <given-names>C</given-names>
</name>
<name>
<surname>Xu</surname> <given-names>XF</given-names>
</name>
<name>
<surname>Xu</surname> <given-names>W</given-names>
</name>
<name>
<surname>Liu</surname> <given-names>SW</given-names>
</name>
</person-group>. <article-title>Structural and Functional Properties of SARS-CoV-2 Spike Protein: Potential Antivirus Drug Development for COVID-19</article-title>. <source>Acta Pharmacol Sin</source> (<year>2020</year>) <volume>41</volume>:<page-range>1141&#x2013;9</page-range>. doi: <pub-id pub-id-type="doi">10.1038/s41401-020-0485-4</pub-id>
</citation>
</ref>
<ref id="B6">
<label>6</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Hoffmann</surname> <given-names>M</given-names>
</name>
<name>
<surname>Kleine-Weber</surname> <given-names>H</given-names>
</name>
<name>
<surname>Pohlmann</surname> <given-names>S</given-names>
</name>
</person-group>. <article-title>A Multibasic Cleavage Site in the Spike Protein of SARS-CoV-2 Is Essential for Infection of Human Lung Cells</article-title>. <source>Mol Cell</source> (<year>2020</year>) <volume>78</volume>:<fpage>779+</fpage>. doi: <pub-id pub-id-type="doi">10.1016/j.molcel.2020.04.022</pub-id>
</citation>
</ref>
<ref id="B7">
<label>7</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Papa</surname> <given-names>G</given-names>
</name>
<name>
<surname>Mallery</surname> <given-names>DL</given-names>
</name>
<name>
<surname>Albecka</surname> <given-names>A</given-names>
</name>
<name>
<surname>Welch</surname> <given-names>LG</given-names>
</name>
<name>
<surname>Cattin-Ortola</surname> <given-names>J</given-names>
</name>
<name>
<surname>Luptak</surname> <given-names>J</given-names>
</name>
<etal/>
</person-group>. <article-title>Furin Cleavage of SARS-CoV-2 Spike Promotes But Is Not Essential for Infection and Cell-Cell Fusion</article-title>. <source>PloS Pathog</source> (<year>2021</year>) <volume>17</volume>:<elocation-id>e1009246</elocation-id>. doi: <pub-id pub-id-type="doi">10.1371/journal.ppat.1009246</pub-id>
</citation>
</ref>
<ref id="B8">
<label>8</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Liu</surname> <given-names>L</given-names>
</name>
<name>
<surname>Wang</surname> <given-names>P</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>Rapp</surname> <given-names>M</given-names>
</name>
<name>
<surname>Wang</surname> <given-names>Q</given-names>
</name>
<etal/>
</person-group>. <article-title>Potent Neutralizing Antibodies Against Multiple Epitopes on SARS-CoV-2 Spike</article-title>. <source>Nature</source> (<year>2020</year>) <volume>584</volume>:<page-range>450&#x2013;6</page-range>. doi: <pub-id pub-id-type="doi">10.1038/s41586-020-2571-7</pub-id>
</citation>
</ref>
<ref id="B9">
<label>9</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Tregoning</surname> <given-names>JS</given-names>
</name>
<name>
<surname>Brown</surname> <given-names>ES</given-names>
</name>
<name>
<surname>Cheeseman</surname> <given-names>HM</given-names>
</name>
<name>
<surname>Flight</surname> <given-names>KE</given-names>
</name>
<name>
<surname>Higham</surname> <given-names>SL</given-names>
</name>
<name>
<surname>Lemm</surname> <given-names>NM</given-names>
</name>
<etal/>
</person-group>. <article-title>Vaccines for COVID-19</article-title>. <source>Clin Exp Immunol</source> (<year>2020</year>) <volume>202</volume>:<page-range>162&#x2013;92</page-range>. doi: <pub-id pub-id-type="doi">10.1111/cei.13517</pub-id>
</citation>
</ref>
<ref id="B10">
<label>10</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Li</surname> <given-names>YD</given-names>
</name>
<name>
<surname>Chi</surname> <given-names>WY</given-names>
</name>
<name>
<surname>Su</surname> <given-names>JH</given-names>
</name>
<name>
<surname>Ferrall</surname> <given-names>L</given-names>
</name>
<name>
<surname>Hung</surname> <given-names>CF</given-names>
</name>
<name>
<surname>Wu</surname> <given-names>TC</given-names>
</name>
</person-group>. <article-title>Coronavirus Vaccine Development: From SARS and MERS to COVID-19</article-title>. <source>J BioMed Sci</source> (<year>2020</year>) <volume>27</volume>:<fpage>104</fpage>. doi: <pub-id pub-id-type="doi">10.1186/s12929-020-00695-2</pub-id>
</citation>
</ref>
<ref id="B11">
<label>11</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Juraszek</surname> <given-names>J</given-names>
</name>
<name>
<surname>Rutten</surname> <given-names>L</given-names>
</name>
<name>
<surname>Blokland</surname> <given-names>S</given-names>
</name>
<name>
<surname>Bouchier</surname> <given-names>P</given-names>
</name>
<name>
<surname>Voorzaat</surname> <given-names>R</given-names>
</name>
<name>
<surname>Ritschel</surname> <given-names>T</given-names>
</name>
<etal/>
</person-group>. <article-title>Stabilizing the Closed SARS-CoV-2 Spike Trimer</article-title>. <source>Nat Commun</source> (<year>2021</year>) <volume>12</volume>:<fpage>244</fpage>. doi: <pub-id pub-id-type="doi">10.1038/s41467-020-20321-x</pub-id>
</citation>
</ref>
<ref id="B12">
<label>12</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>McCallum</surname> <given-names>M</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>Corti</surname> <given-names>D</given-names>
</name>
<name>
<surname>Veesler</surname> <given-names>D</given-names>
</name>
</person-group>. <article-title>Structure-Guided Covalent Stabilization of Coronavirus Spike Glycoprotein Trimers in the Closed Conformation</article-title>. <source>Nat Struct Mol Biol</source> (<year>2020</year>) <volume>27</volume>:<page-range>942&#x2013;9</page-range>. doi: <pub-id pub-id-type="doi">10.1038/s41594-020-0483-8</pub-id>
</citation>
</ref>
<ref id="B13">
<label>13</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Sasaki</surname> <given-names>M</given-names>
</name>
<name>
<surname>Toba</surname> <given-names>S</given-names>
</name>
<name>
<surname>Itakura</surname> <given-names>Y</given-names>
</name>
<name>
<surname>Chambaro</surname> <given-names>HM</given-names>
</name>
<name>
<surname>Kishimoto</surname> <given-names>M</given-names>
</name>
<name>
<surname>Tabata</surname> <given-names>K</given-names>
</name>
<etal/>
</person-group>. <article-title>SARS-CoV-2 Bearing a Mutation at the S1/S2 Cleavage Site Exhibits Attenuated Virulence and Confers Protective Immunity</article-title>. <source>Mbio</source> (<year>2021</year>) <volume>12</volume>:<fpage>e0141521</fpage>. doi: <pub-id pub-id-type="doi">10.1128/mBio.01415-21</pub-id>
</citation>
</ref>
<ref id="B14">
<label>14</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Liu</surname> <given-names>RQ</given-names>
</name>
<name>
<surname>Wang</surname> <given-names>JL</given-names>
</name>
<name>
<surname>Shao</surname> <given-names>Y</given-names>
</name>
<name>
<surname>Wang</surname> <given-names>XJ</given-names>
</name>
<name>
<surname>Zhang</surname> <given-names>HL</given-names>
</name>
<name>
<surname>Shuai</surname> <given-names>L</given-names>
</name>
<etal/>
</person-group>. <article-title>A Recombinant VSV-Vectored MERS-CoV Vaccine Induces Neutralizing Antibody and T Cell Responses in Rhesus Monkeys After Single Dose Immunization</article-title>. <source>Antivir Res</source> (<year>2018</year>) <volume>150</volume>:<page-range>30&#x2013;8</page-range>. doi: <pub-id pub-id-type="doi">10.1016/j.antiviral.2017.12.007</pub-id>
</citation>
</ref>
<ref id="B15">
<label>15</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Suder</surname> <given-names>E</given-names>
</name>
<name>
<surname>Furuyama</surname> <given-names>W</given-names>
</name>
<name>
<surname>Feldmann</surname> <given-names>H</given-names>
</name>
<name>
<surname>Marzi</surname> <given-names>A</given-names>
</name>
<name>
<surname>de Wit</surname> <given-names>E</given-names>
</name>
</person-group>. <article-title>The Vesicular Stomatitis Virus-Based Ebola Virus Vaccine: From Concept to Clinical Trials</article-title>. <source>Hum Vacc Immunother</source> (<year>2018</year>) <volume>14</volume>:<page-range>2107&#x2013;13</page-range>. doi: <pub-id pub-id-type="doi">10.1080/21645515.2018.1473698</pub-id>
</citation>
</ref>
<ref id="B16">
<label>16</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Fathi</surname> <given-names>A</given-names>
</name>
<name>
<surname>Dahlke</surname> <given-names>C</given-names>
</name>
<name>
<surname>Addo</surname> <given-names>MM</given-names>
</name>
</person-group>. <article-title>Recombinant Vesicular Stomatitis Virus Vector Vaccines for WHO Blueprint Priority Pathogens</article-title>. <source>Hum Vaccin Immunother</source> (<year>2019</year>) <volume>15</volume>:<page-range>2269&#x2013;85</page-range>. doi: <pub-id pub-id-type="doi">10.1080/21645515.2019.1649532</pub-id>
</citation>
</ref>
<ref id="B17">
<label>17</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Case</surname> <given-names>JB</given-names>
</name>
<name>
<surname>Rothlauf</surname> <given-names>PW</given-names>
</name>
<name>
<surname>Chen</surname> <given-names>RE</given-names>
</name>
<name>
<surname>Kafai</surname> <given-names>NM</given-names>
</name>
<name>
<surname>Fox</surname> <given-names>JM</given-names>
</name>
<name>
<surname>Smith</surname> <given-names>BK</given-names>
</name>
<etal/>
</person-group>. <article-title>Replication-Competent Vesicular Stomatitis Virus Vaccine Vector Protects Against SARS-CoV-2-Mediated Pathogenesis in Mice</article-title>. <source>Cell Host Microbe</source> (<year>2020</year>) <volume>28</volume>:<fpage>465+</fpage>. doi: <pub-id pub-id-type="doi">10.1016/j.chom.2020.07.018</pub-id>
</citation>
</ref>
<ref id="B18">
<label>18</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Yahalom-Ronen</surname> <given-names>Y</given-names>
</name>
<name>
<surname>Tamir</surname> <given-names>H</given-names>
</name>
<name>
<surname>Melamed</surname> <given-names>S</given-names>
</name>
<name>
<surname>Politi</surname> <given-names>B</given-names>
</name>
<name>
<surname>Shifman</surname> <given-names>O</given-names>
</name>
<name>
<surname>Achdout</surname> <given-names>H</given-names>
</name>
<etal/>
</person-group>. <article-title>A Single Dose of Recombinant VSV-G-Spike Vaccine Provides Protection Against SARS-CoV-2 Challenge</article-title>. <source>Nat Commun</source> (<year>2020</year>) <volume>11</volume>:<fpage>6402</fpage>. doi: <pub-id pub-id-type="doi">10.1038/s41467-020-20228-7</pub-id>
</citation>
</ref>
<ref id="B19">
<label>19</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Whitt</surname> <given-names>MA</given-names>
</name>
</person-group>. <article-title>Generation of VSV Pseudotypes Using Recombinant Delta G-VSV for Studies on Virus Entry, Identification of Entry Inhibitors, and Immune Responses to Vaccines</article-title>. <source>J Virol Methods</source> (<year>2010</year>) <volume>169</volume>:<page-range>365&#x2013;74</page-range>. doi: <pub-id pub-id-type="doi">10.1016/j.jviromet.2010.08.006</pub-id>
</citation>
</ref>
<ref id="B20">
<label>20</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Dieterle</surname> <given-names>ME</given-names>
</name>
<name>
<surname>Haslwanter</surname> <given-names>D</given-names>
</name>
<name>
<surname>Bortz</surname> <given-names>RH</given-names> <suffix>3rd</suffix>
</name>
<name>
<surname>Wirchnianski</surname> <given-names>AS</given-names>
</name>
<name>
<surname>Lasso</surname> <given-names>G</given-names>
</name>
<name>
<surname>Vergnolle</surname> <given-names>O</given-names>
</name>
<etal/>
</person-group>. <article-title>A Replication-Competent Vesicular Stomatitis Virus for Studies of SARS-CoV-2 Spike-Mediated Cell Entry and its Inhibition</article-title>. <source>bioRxiv</source> (<year>2020</year>) <volume>28</volume>:<page-range>486&#x2013;96.e6</page-range>. doi: <pub-id pub-id-type="doi">10.1101/2020.05.20.105247</pub-id>
</citation>
</ref>
<ref id="B21">
<label>21</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Xiong</surname> <given-names>HL</given-names>
</name>
<name>
<surname>Wu</surname> <given-names>YT</given-names>
</name>
<name>
<surname>Cao</surname> <given-names>JL</given-names>
</name>
<name>
<surname>Yang</surname> <given-names>R</given-names>
</name>
<name>
<surname>Liu</surname> <given-names>YX</given-names>
</name>
<name>
<surname>Ma</surname> <given-names>J</given-names>
</name>
<etal/>
</person-group>. <article-title>Robust Neutralization Assay Based on SARS-CoV-2 S-Protein-Bearing Vesicular Stomatitis Virus (VSV) Pseudovirus and ACE2-Overexpressing BHK21 Cells</article-title>. <source>Emerg Microbes Infect</source> (<year>2020</year>) <volume>9</volume>:<page-range>2105&#x2013;13</page-range>. doi: <pub-id pub-id-type="doi">10.1080/22221751.2020.1815589</pub-id>
</citation>
</ref>
<ref id="B22">
<label>22</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Schmidt</surname> <given-names>F</given-names>
</name>
<name>
<surname>Weisblum</surname> <given-names>Y</given-names>
</name>
<name>
<surname>Muecksch</surname> <given-names>F</given-names>
</name>
<name>
<surname>Hoffmann</surname> <given-names>HH</given-names>
</name>
<name>
<surname>Michailidis</surname> <given-names>E</given-names>
</name>
<name>
<surname>Lorenzi</surname> <given-names>JCC</given-names>
</name>
<etal/>
</person-group>. <article-title>Measuring SARS-CoV-2 Neutralizing Antibody Activity Using Pseudotyped and Chimeric Viruses</article-title>. <source>J Exp Med</source> (<year>2020</year>) <volume>217</volume>:<fpage>e20201181</fpage>. doi: <pub-id pub-id-type="doi">10.1084/jem.20201181</pub-id>
</citation>
</ref>
<ref id="B23">
<label>23</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Malherbe</surname> <given-names>DC</given-names>
</name>
<name>
<surname>Kurup</surname> <given-names>D</given-names>
</name>
<name>
<surname>Wirblich</surname> <given-names>C</given-names>
</name>
<name>
<surname>Ronk</surname> <given-names>AJ</given-names>
</name>
<name>
<surname>Mire</surname> <given-names>C</given-names>
</name>
<name>
<surname>Kuzmina</surname> <given-names>N</given-names>
</name>
<etal/>
</person-group>. <article-title>A Single Dose of Replication-Competent VSV-Vectored Vaccine Expressing SARS-CoV-2 S1 Protects Against Virus Replication in a Hamster Model of Severe COVID-19</article-title>. <source>NPJ Vaccines</source> (<year>2021</year>) <volume>6</volume>:<fpage>91</fpage>. doi: <pub-id pub-id-type="doi">10.1038/s41541-021-00352-1</pub-id>
</citation>
</ref>
<ref id="B24">
<label>24</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Sia</surname> <given-names>SF</given-names>
</name>
<name>
<surname>Yan</surname> <given-names>LM</given-names>
</name>
<name>
<surname>Chin</surname> <given-names>AWH</given-names>
</name>
<name>
<surname>Fung</surname> <given-names>K</given-names>
</name>
<name>
<surname>Choy</surname> <given-names>KT</given-names>
</name>
<name>
<surname>Wong</surname> <given-names>AYL</given-names>
</name>
<etal/>
</person-group>. <article-title>Pathogenesis and Transmission of SARS-CoV-2 in Golden Hamsters</article-title>. <source>Nature</source> (<year>2020</year>) <volume>583</volume>:<fpage>834+</fpage>. doi: <pub-id pub-id-type="doi">10.1038/s41586-020-2342-5</pub-id>
</citation>
</ref>
<ref id="B25">
<label>25</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Yang</surname> <given-names>SJ</given-names>
</name>
<name>
<surname>Wei</surname> <given-names>TC</given-names>
</name>
<name>
<surname>Hsu</surname> <given-names>CH</given-names>
</name>
<name>
<surname>Ho</surname> <given-names>SN</given-names>
</name>
<name>
<surname>Lai</surname> <given-names>CY</given-names>
</name>
<name>
<surname>Huang</surname> <given-names>SF</given-names>
</name>
<etal/>
</person-group>. <article-title>Characterization of Virus Replication, Pathogenesis, and Cytokine Responses in Syrian Hamsters Inoculated With SARS-CoV-2</article-title>. <source>J Inflammation Res</source> (<year>2021</year>) <volume>14</volume>:<page-range>3781&#x2013;95</page-range>. doi: <pub-id pub-id-type="doi">10.2147/JIR.S323026</pub-id>
</citation>
</ref>
<ref id="B26">
<label>26</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Wang</surname> <given-names>HI</given-names>
</name>
<name>
<surname>Chuang</surname> <given-names>ZS</given-names>
</name>
<name>
<surname>Kao</surname> <given-names>YT</given-names>
</name>
<name>
<surname>Lin</surname> <given-names>YL</given-names>
</name>
<name>
<surname>Liang</surname> <given-names>JJ</given-names>
</name>
<name>
<surname>Liao</surname> <given-names>CC</given-names>
</name>
<etal/>
</person-group>. <article-title>Small Structural Proteins E and M Render the SARS-CoV-2 Pseudovirus More Infectious and Reveal the Phenotype of Natural Viral Variants</article-title>. <source>Int J Mol Sci 22</source> (<year>2021</year>) <volume>22</volume>:<fpage>9087</fpage>. doi: <pub-id pub-id-type="doi">10.3390/ijms22169087</pub-id>
</citation>
</ref>
<ref id="B27">
<label>27</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Case</surname> <given-names>JB</given-names>
</name>
<name>
<surname>Rothlauf</surname> <given-names>PW</given-names>
</name>
<name>
<surname>Chen</surname> <given-names>RE</given-names>
</name>
<name>
<surname>Liu</surname> <given-names>ZM</given-names>
</name>
<name>
<surname>Zhao</surname> <given-names>HY</given-names>
</name>
<name>
<surname>Kim</surname> <given-names>AS</given-names>
</name>
<etal/>
</person-group>. <article-title>Neutralizing Antibody and Soluble ACE2 Inhibition of a Replication-Competent VSV-SARS-CoV-2 and a Clinical Isolate of SARS-CoV-2</article-title>. <source>Cell Host Microbe</source> (<year>2020</year>) <volume>28</volume>:<fpage>475+</fpage>. doi: <pub-id pub-id-type="doi">10.1016/j.chom.2020.06.021</pub-id>
</citation>
</ref>
<ref id="B28">
<label>28</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Liou</surname> <given-names>CH</given-names>
</name>
<name>
<surname>Wu</surname> <given-names>HC</given-names>
</name>
<name>
<surname>Liao</surname> <given-names>YC</given-names>
</name>
<name>
<surname>Lauderdale</surname> <given-names>TLY</given-names>
</name>
<name>
<surname>Huang</surname> <given-names>IW</given-names>
</name>
<name>
<surname>Chen</surname> <given-names>FJ</given-names>
</name>
</person-group>. <article-title>nanoMLST: Accurate Multilocus Sequence Typing Using Oxford Nanopore Technologies MinION With a Dual-Barcode Approach to Multiplex Large Numbers of Samples</article-title>. <source>Microb Genomics</source> (<year>2020</year>) <volume>6</volume>:<fpage>e000336</fpage>. doi: <pub-id pub-id-type="doi">10.1099/mgen.0.000336</pub-id>
</citation>
</ref>
<ref id="B29">
<label>29</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Xia</surname> <given-names>S</given-names>
</name>
<name>
<surname>Lan</surname> <given-names>Q</given-names>
</name>
<name>
<surname>Su</surname> <given-names>S</given-names>
</name>
<name>
<surname>Wang</surname> <given-names>X</given-names>
</name>
<name>
<surname>Xu</surname> <given-names>W</given-names>
</name>
<name>
<surname>Liu</surname> <given-names>Z</given-names>
</name>
<etal/>
</person-group>. <article-title>The Role of Furin Cleavage Site in SARS-CoV-2 Spike Protein-Mediated Membrane Fusion in the Presence or Absence of Trypsin</article-title>. <source>Signal Transduct Target Ther</source> (<year>2020</year>) <volume>5</volume>:<fpage>92</fpage>. doi: <pub-id pub-id-type="doi">10.1038/s41392-020-0184-0</pub-id>
</citation>
</ref>
<ref id="B30">
<label>30</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Hsu</surname> <given-names>KC</given-names>
</name>
<name>
<surname>Chen</surname> <given-names>YF</given-names>
</name>
<name>
<surname>Lin</surname> <given-names>SR</given-names>
</name>
<name>
<surname>Yang</surname> <given-names>JM</given-names>
</name>
</person-group>. <article-title>iGEMDOCK: A Graphical Environment of Enhancing GEMDOCK Using Pharmacological Interactions and Post-Screening Analysis</article-title>. <source>BMC Bioinf</source> (<year>2011</year>) <volume>12</volume>(<supplement>Suppl 1</supplement>):<fpage>S33</fpage>. doi: <pub-id pub-id-type="doi">10.1186/1471-2105-12-S1-S33</pub-id>
</citation>
</ref>
<ref id="B31">
<label>31</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Bos</surname> <given-names>R</given-names>
</name>
<name>
<surname>Rutten</surname> <given-names>L</given-names>
</name>
<name>
<surname>van der Lubbe</surname> <given-names>JEM</given-names>
</name>
<name>
<surname>Bakkers</surname> <given-names>MJG</given-names>
</name>
<name>
<surname>Hardenberg</surname> <given-names>G</given-names>
</name>
<name>
<surname>Wegmann</surname> <given-names>F</given-names>
</name>
<etal/>
</person-group>. <article-title>Ad26 Vector-Based COVID-19 Vaccine Encoding a Prefusion-Stabilized SARS-CoV-2 Spike Immunogen Induces Potent Humoral and Cellular Immune Responses</article-title>. <source>NPJ Vaccines</source> (<year>2020</year>) <volume>5</volume>:<fpage>91</fpage>. doi: <pub-id pub-id-type="doi">10.1038/s41541-020-00243-x</pub-id>
</citation>
</ref>
<ref id="B32">
<label>32</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Sun</surname> <given-names>CP</given-names>
</name>
<name>
<surname>Jan</surname> <given-names>JT</given-names>
</name>
<name>
<surname>Wang</surname> <given-names>IH</given-names>
</name>
<name>
<surname>Ma</surname> <given-names>HH</given-names>
</name>
<name>
<surname>Ko</surname> <given-names>HY</given-names>
</name>
<name>
<surname>Wu</surname> <given-names>PY</given-names>
</name>
<etal/>
</person-group>. <article-title>Rapid Generation of Mouse Model for Emerging Infectious Disease With the Case of Severe COVID-19</article-title>. <source>PloS Pathog</source> (<year>2021</year>) <volume>17</volume>:<fpage>e1009758</fpage>. doi: <pub-id pub-id-type="doi">10.1371/journal.ppat.1009758</pub-id>
</citation>
</ref>
<ref id="B33">
<label>33</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Ou</surname> <given-names>XY</given-names>
</name>
<name>
<surname>Liu</surname> <given-names>Y</given-names>
</name>
<name>
<surname>Lei</surname> <given-names>XB</given-names>
</name>
<name>
<surname>Li</surname> <given-names>P</given-names>
</name>
<name>
<surname>Mi</surname> <given-names>D</given-names>
</name>
<name>
<surname>Ren</surname> <given-names>LL</given-names>
</name>
<etal/>
</person-group>. <article-title>Characterization of Spike Glycoprotein of SARS-CoV-2 on Virus Entry and Its Immune Cross-Reactivity With SARS-CoV</article-title>. <source>Nat Commun</source> (<year>2020</year>) <volume>11</volume>:<fpage>1620</fpage>. doi: <pub-id pub-id-type="doi">10.1038/s41467-020-15562-9</pub-id>
</citation>
</ref>
<ref id="B34">
<label>34</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Johnson</surname> <given-names>BA</given-names>
</name>
<name>
<surname>Xie</surname> <given-names>X</given-names>
</name>
<name>
<surname>Bailey</surname> <given-names>AL</given-names>
</name>
<name>
<surname>Kalveram</surname> <given-names>B</given-names>
</name>
<name>
<surname>Lokugamage</surname> <given-names>KG</given-names>
</name>
<name>
<surname>Muruato</surname> <given-names>A</given-names>
</name>
<etal/>
</person-group>. <article-title>Loss of Furin Cleavage Site Attenuates SARS-CoV-2 Pathogenesis</article-title>. <source>Nature</source> (<year>2021</year>) <volume>591</volume>:<page-range>293&#x2013;9</page-range>. doi: <pub-id pub-id-type="doi">10.1038/s41586-021-03237-4</pub-id>
</citation>
</ref>
<ref id="B35">
<label>35</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Cheng</surname> <given-names>YW</given-names>
</name>
<name>
<surname>Chao</surname> <given-names>TL</given-names>
</name>
<name>
<surname>Li</surname> <given-names>CL</given-names>
</name>
<name>
<surname>Chiu</surname> <given-names>MF</given-names>
</name>
<name>
<surname>Kao</surname> <given-names>HC</given-names>
</name>
<name>
<surname>Wang</surname> <given-names>SH</given-names>
</name>
<etal/>
</person-group>. <article-title>Furin Inhibitors Block SARS-CoV-2 Spike Protein Cleavage to Suppress Virus Production and Cytopathic Effects</article-title>. <source>Cell Rep</source> (<year>2020</year>) <volume>33</volume>:<fpage>108254</fpage>. doi: <pub-id pub-id-type="doi">10.1016/j.celrep.2020.108254</pub-id>
</citation>
</ref>
<ref id="B36">
<label>36</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Postnikova</surname> <given-names>OA</given-names>
</name>
<name>
<surname>Uppal</surname> <given-names>S</given-names>
</name>
<name>
<surname>Huang</surname> <given-names>W</given-names>
</name>
<name>
<surname>Kane</surname> <given-names>MA</given-names>
</name>
<name>
<surname>Villasmil</surname> <given-names>R</given-names>
</name>
<name>
<surname>Rogozin</surname> <given-names>IB</given-names>
</name>
<etal/>
</person-group>. <article-title>The Functional Consequences of the Novel Ribosomal Pausing Site in SARS-CoV-2 Spike Glycoprotein RNA</article-title>. <source>Int J Mol Sci</source> (<year>2021</year>) <volume>22</volume>:<fpage>6490</fpage>. doi: <pub-id pub-id-type="doi">10.3390/ijms22126490</pub-id>
</citation>
</ref>
<ref id="B37">
<label>37</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Bestle</surname> <given-names>D</given-names>
</name>
<name>
<surname>Heindl</surname> <given-names>MR</given-names>
</name>
<name>
<surname>Limburg</surname> <given-names>H</given-names>
</name>
<name>
<surname>Van Lam van</surname> <given-names>T</given-names>
</name>
<name>
<surname>Pilgram</surname> <given-names>O</given-names>
</name>
<name>
<surname>Moulton</surname> <given-names>H</given-names>
</name>
<etal/>
</person-group>. <article-title>TMPRSS2 and Furin are Both Essential for Proteolytic Activation of SARS-CoV-2 in Human Airway Cells</article-title>. <source>Life Sci Alliance</source> (<year>2020</year>) <volume>3</volume>:<fpage>e202000786</fpage>. doi: <pub-id pub-id-type="doi">10.1101/2020.04.15.042085</pub-id>
</citation>
</ref>
<ref id="B38">
<label>38</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Padmanabhan</surname> <given-names>P</given-names>
</name>
<name>
<surname>Desikan</surname> <given-names>R</given-names>
</name>
<name>
<surname>Dixit</surname> <given-names>NM</given-names>
</name>
</person-group>. <article-title>Targeting TMPRSS2 and Cathepsin B/L Together May be Synergistic Against SARS-CoV-2 Infection</article-title>. <source>PloS Comput Biol</source> (<year>2020</year>) <volume>16</volume>:<elocation-id>e1008461</elocation-id>. doi: <pub-id pub-id-type="doi">10.1371/journal.pcbi.1008461</pub-id>
</citation>
</ref>
<ref id="B39">
<label>39</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Ou</surname> <given-names>T</given-names>
</name>
<name>
<surname>Mou</surname> <given-names>H</given-names>
</name>
<name>
<surname>Zhang</surname> <given-names>L</given-names>
</name>
<name>
<surname>Ojha</surname> <given-names>A</given-names>
</name>
<name>
<surname>Choe</surname> <given-names>H</given-names>
</name>
<name>
<surname>Farzan</surname> <given-names>M</given-names>
</name>
</person-group>. <article-title>Hydroxychloroquine-Mediated Inhibition of SARS-CoV-2 Entry Is Attenuated by TMPRSS2</article-title>. <source>PloS Pathog</source> (<year>2021</year>) <volume>17</volume>:<elocation-id>e1009212</elocation-id>. doi: <pub-id pub-id-type="doi">10.1371/journal.ppat.1009212</pub-id>
</citation>
</ref>
<ref id="B40">
<label>40</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Peacock</surname> <given-names>TP</given-names>
</name>
<name>
<surname>Goldhill</surname> <given-names>DH</given-names>
</name>
<name>
<surname>Zhou</surname> <given-names>J</given-names>
</name>
<name>
<surname>Baillon</surname> <given-names>L</given-names>
</name>
<name>
<surname>Frise</surname> <given-names>R</given-names>
</name>
<name>
<surname>Swann</surname> <given-names>OC</given-names>
</name>
<etal/>
</person-group>. <article-title>The Furin Cleavage Site in the SARS-CoV-2 Spike Protein Is Required for Transmission in Ferrets</article-title>. <source>Nat Microbiol</source> (<year>2021</year>) <volume>6</volume>:<fpage>899</fpage>&#x2013;<lpage>909</lpage>. doi: <pub-id pub-id-type="doi">10.1038/s41564-021-00908-w</pub-id>
</citation>
</ref>
<ref id="B41">
<label>41</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Riley</surname> <given-names>TP</given-names>
</name>
<name>
<surname>Chou</surname> <given-names>HT</given-names>
</name>
<name>
<surname>Hu</surname> <given-names>R</given-names>
</name>
<name>
<surname>Bzymek</surname> <given-names>KP</given-names>
</name>
<name>
<surname>Correia</surname> <given-names>AR</given-names>
</name>
<name>
<surname>Partin</surname> <given-names>AC</given-names>
</name>
<etal/>
</person-group>. <article-title>Enhancing the Prefusion Conformational Stability of SARS-CoV-2 Spike Protein Through Structure-Guided Design</article-title>. <source>Front Immunol</source> (<year>2021</year>) <volume>12</volume>:<elocation-id>660198</elocation-id>. doi: <pub-id pub-id-type="doi">10.3389/fimmu.2021.660198</pub-id>
</citation>
</ref>
<ref id="B42">
<label>42</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Amanat</surname> <given-names>F</given-names>
</name>
<name>
<surname>Strohmeier</surname> <given-names>S</given-names>
</name>
<name>
<surname>Rathnasinghe</surname> <given-names>R</given-names>
</name>
<name>
<surname>Schotsaert</surname> <given-names>M</given-names>
</name>
<name>
<surname>Coughlan</surname> <given-names>L</given-names>
</name>
<name>
<surname>Garcia-Sastre</surname> <given-names>A</given-names>
</name>
<etal/>
</person-group>. <article-title>Introduction of Two Prolines and Removal of the Polybasic Cleavage Site Lead to Higher Efficacy of a Recombinant Spike-Based SARS-CoV-2 Vaccine in the Mouse Model</article-title>. <source>mBio</source> (<year>2021</year>) <volume>12</volume>:<fpage>e02648-20</fpage>. doi: <pub-id pub-id-type="doi">10.1128/mBio.02648-20</pub-id>
</citation>
</ref>
<ref id="B43">
<label>43</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Tian</surname> <given-names>JH</given-names>
</name>
<name>
<surname>Patel</surname> <given-names>N</given-names>
</name>
<name>
<surname>Haupt</surname> <given-names>R</given-names>
</name>
<name>
<surname>Zhou</surname> <given-names>H</given-names>
</name>
<name>
<surname>Weston</surname> <given-names>S</given-names>
</name>
<name>
<surname>Hammond</surname> <given-names>H</given-names>
</name>
<etal/>
</person-group>. <article-title>SARS-CoV-2 Spike Glycoprotein Vaccine Candidate NVX-CoV2373 Immunogenicity in Baboons and Protection in Mice</article-title>. <source>Nat Commun</source> (<year>2021</year>) <volume>12</volume>:<fpage>372</fpage>. doi: <pub-id pub-id-type="doi">10.1038/s41467-020-20653-8</pub-id>
</citation>
</ref>
<ref id="B44">
<label>44</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Song</surname> <given-names>G</given-names>
</name>
<name>
<surname>He</surname> <given-names>WT</given-names>
</name>
<name>
<surname>Callaghan</surname> <given-names>S</given-names>
</name>
<name>
<surname>Anzanello</surname> <given-names>F</given-names>
</name>
<name>
<surname>Huang</surname> <given-names>DL</given-names>
</name>
<name>
<surname>Ricketts</surname> <given-names>J</given-names>
</name>
<etal/>
</person-group>. <article-title>Cross-Reactive Serum and Memory B-Cell Responses to Spike Protein in SARS-CoV-2 and Endemic Coronavirus Infection</article-title>. <source>Nat Commun</source> (<year>2021</year>) <volume>12</volume>:<fpage>2938</fpage>. doi: <pub-id pub-id-type="doi">10.1038/s41467-021-23074-3</pub-id>
</citation>
</ref>
<ref id="B45">
<label>45</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Kelley</surname> <given-names>LA</given-names>
</name>
<name>
<surname>Mezulis</surname> <given-names>S</given-names>
</name>
<name>
<surname>Yates</surname> <given-names>CM</given-names>
</name>
<name>
<surname>Wass</surname> <given-names>MN</given-names>
</name>
<name>
<surname>Sternberg</surname> <given-names>MJE</given-names>
</name>
</person-group>. <article-title>The Phyre2 Web Portal for Protein Modeling, Prediction and Analysis</article-title>. <source>Nat Protoc</source> (<year>2015</year>) <volume>10</volume>:<page-range>845&#x2013;58</page-range>. doi: <pub-id pub-id-type="doi">10.1038/nprot.2015.053</pub-id>
</citation>
</ref>
</ref-list>
</back>
</article>