A SARS-CoV-2 Mpro mutation conferring ensitrelvir resistance paradoxically increases nirmatrelvir susceptibility
Abstract
SARS-CoV-2
variants
resistant
to
current
antivirals
remain
a
significant
threat,
particularly
in
high-risk
patients.
Although
nirmatrelvir
and
ensitrelvir
both
target
the
viral
3CL
protease
(Mpro),
their
distinct
susceptibility
profiles
may
allow
alternative
therapeutic
approaches.
Here,
we
identified
novel
deletion
mutation
at
glycine
23
(Δ23G)
Mpro
that
conferred
substantial
resistance
(~
35-fold)
while
paradoxically
increasing
8-fold).
This
opposite
pattern
was
confirmed
vitro
hamster
infection
model.
Recombinant
viruses
carrying
Mpro-Δ23G
exhibited
impaired
replication,
pathogenicity,
transmissibility
compared
wild-type,
though
co-occurring
T45I
partially
restored
fitness.
Structural
analyses
revealed
critical
conformational
changes
catalytic
loop
(Ile136–Val148)
β-hairpin
(Cys22–Thr26),
directly
influencing
inhibitor
binding
selectivity.
These
results
highlight
differential
of
inhibitors,
supporting
potential
sequential
or
use
patients
requiring
prolonged
antiviral
treatment.
Research Square (Research Square), Год журнала: 2025, Номер unknown
Опубликована: Апрель 21, 2025
Язык: Английский