Illingworth Christopher J R, Guerra-Assuncao Jose A, Gregg Samuel, Charles Oscar, Pang Juanita, Roy Sunando, Abdelnabi Rana, Neyts Johan, Breuer Judith
MRC-University of Glasgow Centre for Virus Research, 464 Bearsden Road, Glasgow G61 1QH, UK.
Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, UK.
Virus Evol. 2024 Jan 4;10(1):veae001. doi: 10.1093/ve/veae001. eCollection 2024.
Mutagenic antiviral drugs have shown promise against multiple viruses, but concerns have been raised about whether their use might promote the emergence of new and harmful viral variants. Recently, genetic signatures associated with molnupiravir use have been identified in the global SARS-COV-2 population. Here, we examine the consequences of using favipiravir and molnupiravir to treat SARS-CoV-2 infection in a hamster model, comparing viral genome sequence data collected from (1) untreated hamsters, and (2) from hamsters receiving effective and suboptimal doses of treatment. We identify a broadly linear relationship between drug dose and the extent of variation in treated viral populations, with a high proportion of this variation being composed of variants at frequencies of less than 1 per cent, below typical thresholds for variant calling. Treatment with an effective dose of antiviral drug was associated with a gain of between 7 and 10 variants per viral genome relative to drug-free controls: even after a short period of treatment a population founded by a transmitted virus could contain multiple sequence differences to that of the original host. Treatment with a suboptimal dose of drug showed intermediate gains of variants. No dose-dependent signal was identified in the numbers of single-nucleotide variants reaching frequencies in excess of 5 per cent. We did not find evidence to support the emergence of drug resistance or of novel immune phenotypes. Our study suggests that where onward transmission occurs, a short period of treatment with mutagenic drugs may be sufficient to generate a significant increase in the number of viral variants transmitted.
诱变抗病毒药物已显示出对多种病毒有效的前景,但人们担心其使用是否会促使新的有害病毒变体出现。最近,在全球严重急性呼吸综合征冠状病毒2(SARS-CoV-2)群体中已鉴定出与莫努匹韦使用相关的基因特征。在此,我们在仓鼠模型中研究使用法匹拉韦和莫努匹韦治疗SARS-CoV-2感染的后果,比较从(1)未治疗的仓鼠以及(2)接受有效和次优剂量治疗的仓鼠收集的病毒基因组序列数据。我们确定了药物剂量与治疗的病毒群体变异程度之间大致呈线性关系,这种变异的很大一部分由频率低于1%的变体组成,低于变异检测的典型阈值。与未使用药物的对照组相比,使用有效剂量的抗病毒药物治疗使每个病毒基因组的变体增加了7至10个:即使经过短时间治疗,由传播的病毒形成的群体与原始宿主的群体相比也可能包含多个序列差异。使用次优剂量药物治疗显示变体增加处于中间水平。在频率超过5%的单核苷酸变体数量中未发现剂量依赖性信号。我们没有找到支持耐药性或新免疫表型出现的证据。我们的研究表明,在发生病毒传播的情况下,用诱变药物进行短时间治疗可能足以使传播的病毒变体数量显著增加。