Cross-Reacting Antibodies Enhance Dengue Virus Infection in Humans

Dengue virus co-circulates as four serotypes and sequential infections with more than one serotype are common. One hypothesis for the increased severity seen in secondary infections is antibody dependent enhancement (ADE) leading to increased replication in Fc-receptor-bearing cells. In this study we have generated a panel of human monoclonal antibodies to dengue virus. Antibodies to the structural precursor-membrane protein (prM) dominate the response. These antibodies are highly cross-reactive among the dengue virus serotypes and, even at high concentrations, do not neutralise infection but potently promote ADE. We propose that the partial cleavage of prM from the viral surface reduces the density of antigen available for viral neutralisation, leaving dengue viruses susceptible to ADE by anti-prM, a finding which has implications for future vaccine design