This review examines the protective roles and mechanisms of neutralizing antibodies (NAbs) against SARS-CoV-2 infection and their clinical implications. It explores NAbs' function in preventing primary infection and reinfection, detailing their persistence and the various immunoglobulin types involved (IgG, IgM, IgA). The review also covers the protective mechanisms of NAbs, including neutralization of viral entry and effector functions like ADCC, ADCP, and CDC. Clinical applications, including diagnostic value, assessment of protective immunity, and roles as severity/prognostic markers are discussed. Furthermore, the therapeutic and prophylactic potential of NAbs through convalescent plasma and monoclonal antibodies (mAbs), along with their challenges (ADE and variant emergence), are analyzed. Finally, the paper discusses the role of NAbs in COVID-19 vaccine development and the challenges associated with vaccine efficacy and safety.

Endeshaw Chekol Abebe, Tadesse Asmamaw Dejenie