Intensive Care Res . The Potential Protective Role of GS-441524, a Metabolite of the Prodrug Remdesivir, in Vaccine Breakthrough SARS-CoV-2 Infections

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Intensive Care Res


. 2022 Nov 9;1-12.
doi: 10.1007/s44231-022-00021-4. Online ahead of print.
The Potential Protective Role of GS-441524, a Metabolite of the Prodrug Remdesivir, in Vaccine Breakthrough SARS-CoV-2 Infections


JiaYi Zhu ^{# 1 2 3} , Yuchong Li ^{# 1 4} , Jady Liang ^{1 2} , Samira Mubareka ^{3 5} , Arthur S Slutsky ^{1 4 6} , Haibo Zhang ^{1 2 4 6 7}



Affiliations

• PMID: 36407474
• PMCID: PMC9645326
• DOI: 10.1007/s44231-022-00021-4

Abstract

Cases of vaccine breakthrough, especially in variants of concern (VOCs) infections, are emerging in coronavirus disease (COVID-19). Due to mutations of structural proteins (SPs) (e.g., Spike proteins), increased transmissibility and risk of escaping from vaccine-induced immunity have been reported amongst the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Remdesivir was the first to be granted emergency use authorization but showed little impact on survival in patients with severe COVID-19. Remdesivir is a prodrug of the nucleoside analogue GS-441524 which is converted into the active nucleotide triphosphate to disrupt viral genome of the conserved non-structural proteins (NSPs) and thus block viral replication. GS-441524 exerts a number of pharmacological advantages over Remdesivir: (1) it needs fewer conversions for bioactivation to nucleotide triphosphate; (2) it requires only nucleoside kinase, while Remdesivir requires several hepato-renal enzymes, for bioactivation; (3) it is a smaller molecule and has a potency for aerosol and oral administration; (4) it is less toxic allowing higher pulmonary concentrations; (5) it is easier to be synthesized. The current article will focus on the discussion of interactions between GS-441524 and NSPs of VOCs to suggest potential application of GS-441524 in breakthrough SARS-CoV-2 infections.
Supplementary information: The online version contains supplementary material available at 10.1007/s44231-022-00021-4.

Keywords: Delta variant; Non-structural proteins; Omicron variant; RNA-dependent RNA polymerase; Variants of concerns.