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キーワード:
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要旨:
N4-hydroxycytidine (NHC), the active compound of the drug Molnupiravir, is
incorporated into SARS-CoV-2 RNA, causing false basepairing. The desired
result is an ‘error catastrophe’, but this bears the risk of mutated virus progeny.
To address this experimentally, we propagated the initial SARS-CoV-2 strain in
the presence of NHC. Deep sequencing revealed numerous NHC-induced
mutations and host cell-adapted virus variants. The presence of the neutralizing
nanobody Re5D06 selected for immune escape mutations, in particular p.E484K
and p.F490S, which are key mutations of the Beta/Gamma and Omicron-XBB
strains, respectively. With NHC treatment, nanobody resistance occurred two
passages earlier than without. Thus, within the limitations of this purely in vitro
study, we conclude that the combined action of Molnupiravir and a spike-
neutralizing antagonist leads to the rapid emergence of escape mutants. We
propose caution use and supervision when using Molnupiravir, especially when
patients are still at risk of spreading virus.