Article(id=1195000462970700492, tenantId=1146029695717560320, journalId=1190317699101192196, issueId=1195000462479966923, articleNumber=1001-2494(2025)07-0665-08, orderNo=null, doi=10.11669/cpj.2025.07.001, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1728921600000, receivedDateStr=2024-10-15, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1762839912406, onlineDateStr=2025-11-11, pubDate=1744041600000, pubDateStr=2025-04-08, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1762839912406, onlineIssueDateStr=2025-11-11, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1762839912406, creator=13701087609, updateTime=1762839912406, updator=13701087609, issue=Issue{id=1195000462479966923, tenantId=1146029695717560320, journalId=1190317699101192196, year='2025', volume='60', issue='7', pageStart='665', pageEnd='776', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1762839912289, creator=13701087609, updateTime=1762840003355, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1195000844501365697, tenantId=1146029695717560320, journalId=1190317699101192196, issueId=1195000462479966923, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1195000844501365698, tenantId=1146029695717560320, journalId=1190317699101192196, issueId=1195000462479966923, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=665, endPage=672, ext={EN=ArticleExt(id=1195000463146861262, articleId=1195000462970700492, tenantId=1146029695717560320, journalId=1190317699101192196, language=EN, title=Effect of SARS-CoV-2 RNA Polymerase Mutations on Remdesivir Resistance, columnId=null, journalTitle=Chinese Pharmaceutical Journal, columnName=null, runingTitle=null, highlight=null, articleAbstract=

The RNA-dependent RNA polymerase (RdRp) of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) plays a pivotal role in the virus's replication process and is a primary target for nucleoside analogue antiviral drugs. However, the ongoing mutations of the virus have led to the emergence of multiple variants of concern, such as Alpha, Beta, Gamma, Delta, and Omicron, resulting in recurrent waves of the pandemic that are yet to be fully controlled. Although the RdRp of the novel coronavirus is relatively conserved, ongoing research has identified several mutations at this protein, such as V166A, V166L, and P323L. The impact of these mutations on the antiviral efficacy of currently available small molecule drugs is noteworthy. This article reviews the influence of SARS-CoV-2 RdRp mutations on resistance to remdesivir, incorporating protein structure prediction of the mutation sites, with the aim of providing insights for optimizing antiviral treatment strategies against COVID-19.

, correspAuthors=Jianyuan ZHAO, Shan CEN, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, authorCompany=null, fund=null, authors=null, authorsList=Tianfu LIU, Boyuan YANG, Jianyuan ZHAO, Shan CEN), CN=ArticleExt(id=1195001326984741298, articleId=1195000462970700492, tenantId=1146029695717560320, journalId=1190317699101192196, language=CN, title=新型冠状病毒RNA聚合酶突变对瑞德西韦耐药性的影响, columnId=1190352408384471863, journalTitle=中国药学杂志, columnName=综述, runingTitle=null, highlight=null, articleAbstract=

新型冠状病毒RNA依赖性RNA聚合酶(RNA dependent-RNA polymerase, RdRp)是病毒复制过程中的关键酶,也是当前抗病毒治疗中核苷(酸)类似物药物的主要靶点。然而,新冠病毒持续变异,产生了Alpha、Beta、Gamma、Delta和Omicron等多种被关注的突变毒株,使得感染仍有发生。尽管新冠病毒RNA依赖性RNA聚合酶相对保守,但是随着研究的深入,在该蛋白上已报道存在多个位点的突变,如V166A,V166L和P323L等。这些突变对目前上市的小分子药物抗病毒活性的影响值得关注。笔者主要综述了新冠病毒RNA聚合酶突变对瑞德西韦耐药性的影响,同时结合突变位点的蛋白质结构模拟分析,以期为新冠病毒耐药研究和临床治疗提供参考。

, correspAuthors=赵建元, 岑山, authorNote=null, correspAuthorsNote=
*赵建元,女,博士,副研究员 研究方向:病毒学基础研究和抗病毒药物应用;
岑山,男,博士,研究员 研究方向:病毒宿主互作、抗病毒天然免疫和抗病毒药物 Tel:(010)63039279
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刘天福,男,博士研究生 研究方向:抗病毒药物

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刘天福,男,博士研究生 研究方向:抗病毒药物

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刘天福,男,博士研究生 研究方向:抗病毒药物

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a-Nsp12蛋白基因结构示意图;β-β发夹结构功能域;NiRAN-核苷酸转移酶功能域;Interface-界面功能域;RdRp domain-RdRp功能域;Finger-手指域;Palm-掌心域;Thumb-拇指域;A~G-基序A,基序B,基序C,基序D,基序E,基序F和基序G;b-RdRp蛋白三维结构图;Finger-手指域;Palm-掌心域;Thumb-拇指域。

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结构域 突变
位点
临床
病例
体外
传代
RDV EC50比值
(突变株/野生株)
突变概率
/%
功能特点 参考文献
核苷酸转移酶(NiRAN) V166A 1 1 - 0.002 - [38-39]
结构域 V166L 2 1 1.5 0.004 可能与瑞德西韦(RDV)的增强有关 [40-41,43]
界面结构域 P323L - - 1.25 99.706 对药物敏感性的影响较小 [47]
RNA依赖性RNA聚合 A449V 2 - - 0.016 - [38,43]
酶手指域 F480L - - 1.5 0.001 对新冠病毒复制能力和耐药性影响较小 [44-46]
D484Y 1 - 3 - 可能与RDV的耐药性增强有关 [44-45]
I536V 1 - - 0.012 - [41]
V557L - - - - 使RdRp蛋白不稳定,相应毒株无法被拯救 [45]
S759A - 1 - - RdRp对瑞德西韦三磷酸(RDV-TP)的亲和力降低 [39]
RdRp手掌域 V792I 3 1 2.6 0.014 更容易克服RDV引起的延迟链终止 [39,47-48]
E796G - 1 2.6 0.001 显著减弱RDV的抗病毒作用 [45]
C799F - 2 1.9 0.002 显著减弱RDV的抗病毒作用 [45,49]
E802A - 1 2.14;6 - 增强了病毒对RDV的耐药性,同时降低病毒适应性 [50-51]
E802D 1 1 2.54;3.86;7.29 - 增强了病毒对RDV的耐药性,同时降低病毒复制能力 [45,50-51]
NiRAN结构域与界面结构域 V166L+P323L - - 1.5 - 增强了病毒对RDV的耐药性,同时降低病毒复制能力 [47]
RdRp手指域 F480L+V557L - - 3.76 - 增强了病毒对RDV的耐药性 [45]
RdRp手指域和手掌域 S759A+V792I - 1 7.3 - 显著增强病毒对RDV的耐药性 [39]
RdRp手掌域 E796G+C799F - 1 2.9 - 减弱RDV的抗病毒作用,同时降低病毒复制能力 [45]
), ArticleFig(id=1195055361947341606, tenantId=1146029695717560320, journalId=1190317699101192196, articleId=1195000462970700492, language=CN, label=表1, caption=

新型冠状病毒RNA依赖性RNA聚合酶(RdRp)耐药相关突变位点及药物敏感性

, figureFileSmall=null, figureFileBig=null, tableContent=
结构域 突变
位点
临床
病例
体外
传代
RDV EC50比值
(突变株/野生株)
突变概率
/%
功能特点 参考文献
核苷酸转移酶(NiRAN) V166A 1 1 - 0.002 - [38-39]
结构域 V166L 2 1 1.5 0.004 可能与瑞德西韦(RDV)的增强有关 [40-41,43]
界面结构域 P323L - - 1.25 99.706 对药物敏感性的影响较小 [47]
RNA依赖性RNA聚合 A449V 2 - - 0.016 - [38,43]
酶手指域 F480L - - 1.5 0.001 对新冠病毒复制能力和耐药性影响较小 [44-46]
D484Y 1 - 3 - 可能与RDV的耐药性增强有关 [44-45]
I536V 1 - - 0.012 - [41]
V557L - - - - 使RdRp蛋白不稳定,相应毒株无法被拯救 [45]
S759A - 1 - - RdRp对瑞德西韦三磷酸(RDV-TP)的亲和力降低 [39]
RdRp手掌域 V792I 3 1 2.6 0.014 更容易克服RDV引起的延迟链终止 [39,47-48]
E796G - 1 2.6 0.001 显著减弱RDV的抗病毒作用 [45]
C799F - 2 1.9 0.002 显著减弱RDV的抗病毒作用 [45,49]
E802A - 1 2.14;6 - 增强了病毒对RDV的耐药性,同时降低病毒适应性 [50-51]
E802D 1 1 2.54;3.86;7.29 - 增强了病毒对RDV的耐药性,同时降低病毒复制能力 [45,50-51]
NiRAN结构域与界面结构域 V166L+P323L - - 1.5 - 增强了病毒对RDV的耐药性,同时降低病毒复制能力 [47]
RdRp手指域 F480L+V557L - - 3.76 - 增强了病毒对RDV的耐药性 [45]
RdRp手指域和手掌域 S759A+V792I - 1 7.3 - 显著增强病毒对RDV的耐药性 [39]
RdRp手掌域 E796G+C799F - 1 2.9 - 减弱RDV的抗病毒作用,同时降低病毒复制能力 [45]
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新型冠状病毒RNA聚合酶突变对瑞德西韦耐药性的影响
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刘天福 1 , 杨博元 2 , 赵建元 1, * , 岑山 1, *
中国药学杂志 | 综述 2025,60(7): 665-672
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中国药学杂志 | 综述 2025, 60(7): 665-672
新型冠状病毒RNA聚合酶突变对瑞德西韦耐药性的影响
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刘天福1, 杨博元2, 赵建元1, *, 岑山1, *
作者信息
  • 1 中国医学科学院, 北京协和医学院医药生物技术研究所, 北京 100050
  • 2 复旦大学医学院, 上海 200120
  • 刘天福,男,博士研究生 研究方向:抗病毒药物

通讯作者:

*赵建元,女,博士,副研究员 研究方向:病毒学基础研究和抗病毒药物应用;
岑山,男,博士,研究员 研究方向:病毒宿主互作、抗病毒天然免疫和抗病毒药物 Tel:(010)63039279
Effect of SARS-CoV-2 RNA Polymerase Mutations on Remdesivir Resistance
Tianfu LIU1, Boyuan YANG2, Jianyuan ZHAO1, *, Shan CEN1, *
Affiliations
  • 1 Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100050, China
  • 2 School of Medicine, Fudan University, Shanghai 200120, China
出版时间: 2025-04-08 doi: 10.11669/cpj.2025.07.001
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新型冠状病毒RNA依赖性RNA聚合酶(RNA dependent-RNA polymerase, RdRp)是病毒复制过程中的关键酶,也是当前抗病毒治疗中核苷(酸)类似物药物的主要靶点。然而,新冠病毒持续变异,产生了Alpha、Beta、Gamma、Delta和Omicron等多种被关注的突变毒株,使得感染仍有发生。尽管新冠病毒RNA依赖性RNA聚合酶相对保守,但是随着研究的深入,在该蛋白上已报道存在多个位点的突变,如V166A,V166L和P323L等。这些突变对目前上市的小分子药物抗病毒活性的影响值得关注。笔者主要综述了新冠病毒RNA聚合酶突变对瑞德西韦耐药性的影响,同时结合突变位点的蛋白质结构模拟分析,以期为新冠病毒耐药研究和临床治疗提供参考。

新型冠状病毒  /  RNA依赖性RNA聚合酶  /  瑞德西韦  /  药物敏感性

The RNA-dependent RNA polymerase (RdRp) of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) plays a pivotal role in the virus's replication process and is a primary target for nucleoside analogue antiviral drugs. However, the ongoing mutations of the virus have led to the emergence of multiple variants of concern, such as Alpha, Beta, Gamma, Delta, and Omicron, resulting in recurrent waves of the pandemic that are yet to be fully controlled. Although the RdRp of the novel coronavirus is relatively conserved, ongoing research has identified several mutations at this protein, such as V166A, V166L, and P323L. The impact of these mutations on the antiviral efficacy of currently available small molecule drugs is noteworthy. This article reviews the influence of SARS-CoV-2 RdRp mutations on resistance to remdesivir, incorporating protein structure prediction of the mutation sites, with the aim of providing insights for optimizing antiviral treatment strategies against COVID-19.

SARS-CoV-2  /  RNA-dependent RNA polymerase  /  remdesivir  /  drug sensitivity
刘天福, 杨博元, 赵建元, 岑山. 新型冠状病毒RNA聚合酶突变对瑞德西韦耐药性的影响. 中国药学杂志, 2025 , 60 (7) : 665 -672 . DOI: 10.11669/cpj.2025.07.001
Tianfu LIU, Boyuan YANG, Jianyuan ZHAO, Shan CEN. Effect of SARS-CoV-2 RNA Polymerase Mutations on Remdesivir Resistance[J]. Chinese Pharmaceutical Journal, 2025 , 60 (7) : 665 -672 . DOI: 10.11669/cpj.2025.07.001
病毒性疾病可对公共卫生和全球经济造成深远的影响[1]。引发新型冠状病毒感染的严重急性呼吸综合征冠状病毒2(severe acute respiratory syndrome coronavirus 2, SARS-Cov-2)是一种单股正链RNA病毒。其与严重急性呼吸综合征(severe acute respiratory syndrome,SARS)冠状病毒以及中东呼吸综合征(Middle East respiratory syndrome,MERS)病毒在基因组序列上具有较高的相似性[2]。鉴于冠状病毒固有的高变异性,研发靶向相对保守的RNA复制关键酶——RNA依赖性RNA聚合酶(RNA-dependent RNA polymerase, RdRp)的药物,具有广谱抗病毒的潜力[3]
目前,以SARS-CoV-2 RdRp为靶点的上市药物主要为核苷(酸)类似物,如瑞德西韦(remdesivir, RDV)、莫诺匹拉韦(molnupiravir, NHC)、法匹拉韦(favipiravir, FPV)氢溴酸氘瑞米德(deuremidevir,VV116)及阿兹夫定(azvudine, FNC)[4-11]。此类药物在宿主细胞内转化为活性的三磷酸形式,与RdRp的催化中心结合从而抑制病毒RNA的合成[12]。RDV是首个获得美国食品药品监督管理局(Food and Drug Administration,FDA)批准用于治疗COVID-19的小分子药物,也是在临床上应用最广的抗病毒药物之一[13]。RDV通过延迟链终止效应抑制病毒RNA合成[14]。NHC可替代胞苷三磷酸(cytidine triphosphate,CTP)和尿苷三磷酸(uridine triphosphate,UTP)插入RNA模板中通过增加突变频率发挥抗病毒效果[15-16]。FPV通过模拟鸟苷三磷酸(guanosine triphosphate,GTP)的结构作为底物参与RNA合成诱发突变发生[17]。VV116通过与核苷三磷酸竞争性结合,干扰病毒RNA合成[18]。FNC通过与RNA聚合酶相互作用,有效抑制病毒RNA的合成[19]。这些药物具有良好的体内外抗病毒活性,并在临床研究中均表现出良好的安全性和有效性[20-25]
然而,随着病毒的持续进化,新的病毒测序数据表明RdRp正发生突变[26]。这些突变直接关系到抗病毒药物的效果,因为RdRp的结构变化直接影响药物的结合能力和抑制效果。本文对RDV耐药性相关的新冠病毒RdRp突变进行了全面综述,包括临床研究和体外实验结果,以期为未来的药物开发、耐药机制研究和临床用药指导提供科学依据。
在SARS-CoV-2的生命周期中,RdRp复合物负责病毒RNA的合成。该复合物主要由3种非结构蛋白(non-structural proteins,Nsp)组成,包括Nsp12、Nsp7和Nsp8[27]。在该复合物中,Nsp12执行病毒RNA合成功能,而Nsp7和Nsp8则作为辅助因子,增强催化效率。Nsp12的结构由4个主要功能域构成,见图1[28-29]
N端β发夹结构功能域(D29~K50),对维持蛋白质的整体稳定性至关重要;套式病毒RdRp相关核苷酸转移酶功能域(nidovirus RdRp-associated nucleotidyltransferase,NiRAN)(D60~R249),参与病毒RNA的修饰和调控过程[30];界面功能域(interface domain,A250~R365),在复合物的组装和功能中起到桥梁作用;RdRp功能域(S366~F920),作为催化RNA合成的主要活性区域,直接参与病毒RNA的复制过程。这些功能域的相互协作是SARS-CoV-2病毒RNA复制的基础。
根据晶体结构(PDB ID:7BV2)[29],新冠病毒Nsp12蛋白的RdRp结构域在空间构型上呈现出与人类手部相似的形态(图1b),主要由3个亚结构域组成:手指域(残基397~581和621~679)、掌心域(残基582~619和680~814)以及拇指域(残基819~920)[31]。在RNA合成过程中,病毒的RNA模板首先与手指域进行识别和结合,这一步骤是聚合酶活动的初始阶段。随后,RNA模板链被精确定位至掌心域,这是核苷酸三磷酸(nucleoside triphosphates,NTPs)的主要捕获区域。在掌心域内,NTPs在镁离子或锰离子的辅助下,通过与RNA模板链的碱基互补配对,被掺入新生的RNA链中。在RNA链的延伸过程中,拇指域的作用是调节新合成RNA链的移动,确保RNA聚合反应高效进行。
由掌心域和手指域共同形成的中心腔是RNA合成生化过程发生的核心场所。中心腔由模板/引物入口通道、NTPs进入通道以及新生RNA链的出口通道组成。结构上,中心腔由7个基序构成,基序A~E位于掌心域,基序F和G位于手指域[27]。其中,基序A(N611~M626)和基序C(F753~N767)在RNA合成过程中最为关键[32]。基序A中包含催化基序D618,D623,与NTPs形成氢键[33]。基序C含有S759~D760~D761催化基序,其中D760和D761残基参与镁离子配位,催化NTP焦磷酸基团的释放[29]。NTP穿过由K545、R553和R555组成的亲水性通道后进入催化中心[28]。基序D(A771~E796)决定核苷酸添加的效率和保真度[34]。基序B(G678~T710),基序E(H810~V820)、基序F(L544~V557)、基序G(K500~L514)共同稳定RNA模板链[28-29,35]
当前,靶向新冠病毒RdRp的上市药物主要为核苷(酸)类似物。这些药物通过模仿NTPs的结构,充当病毒RNA合成过程中的底物以干扰和破坏病毒RNA合成。然而靶点蛋白突变可能对药物的抑制作用造成影响。
由吉利德公司研发的核苷酸类抗病毒药物RDV(商品名Veklury),于2020年5月1日获得FDA紧急使用授权,用于治疗COVID-19住院患者(成人患者和12岁及以上儿童患者,且患者体质量至少为40 kg)。RDV作为前体药物,在体内经过组织蛋白酶A、羧酸酯酶1、组氨酸三核苷酸结合蛋白1、单磷酸和双磷酸激酶的作用,转化为其活性形式瑞德西韦三磷酸(remdesivir triphosphate,RDV-TP)。RDV-TP与SARS-CoV-2 RdRp结合,并与ATP竞争性地嵌入新合成的RNA链中,引起延迟链终止[14,36-38]
在Beigel等[4]开展的随机双盲对照临床试验中,共纳入1 062名新冠患者(RDV组541人,安慰剂组521人)。结果显示,与安慰剂组相比,接受RDV治疗的患者中位恢复时间从15 d缩短至10 d。此外,RDV组在改善临床症状、患者死亡率方面均表现出较好的效果,死亡率从15.2%降至11.4%。然而,Wang等[20,39]的临床试验显示,在患者病程后期使用RDV未能显著缩短患者的恢复时间,仅在症状持续时间不超过10 d的早期患者中观察到显著的症状改善。世界卫生组织“团结”试验(solidarity trial)的最终报告表明RDV对部分患者(未接受机械通气但需要氧气支持)有效,可显著其降低死亡率和疾病进展的风险[40]。此外,RDV对Alpha、Beta、Delta和Omicron毒株的活性保持稳定,对Omicron BA.1、BA.2、BA.4、BA.5、BQ.1.1和XBB亦表现出较高的抗病毒活性[41]
尽管RDV在体内外均表现出良好的抗病毒效果,但靶点蛋白RdRp(Nsp12)的突变可能导致其抗病毒效果减弱。因此,本文综述了目前文献报道的RDV耐药相关的RdRp突变,并结合美国国家生物技术信息中心(National Center of Biotechnology Information, NCBI)的病毒数据库(https://www.ncbi.nlm.nih.gov/labs/virus/vssi/#/)中2024年1月1日至11月17日的91 946条测序结果与对照序列(YP_009724389.1)进行比对,并对各个突变的发生率进行了统计,见表1。另外,将RdRp晶体结构(PDB ID:7BV2)经DynaMut2平台分析,模拟了Nsp12突变前后相邻氨基酸残基相互作用模式[29,42]
RDV治疗的新冠患者病例中报告了Nsp12 V166A突变[43],且细胞实验获得的RDV耐药株中也发现了Nsp12 V166A突变[44],但是目前尚无单独治疗Nsp12 V166A突变的药物敏感性数据。另外,有两例新冠患者的临床报告显示使用RDV治疗后检测到Nsp12 V166L突变[45-46],经RDV处理的连续传代也检测到该突变,且该突变使RDV抗病毒的EC50值升高了50%[47]。模型预测显示,Nsp12 V166A导致其与K621的疏水作用力消失,使结合腔空间减小;Nsp12 V166L 突变后,增加了范德华力,使结合腔空间增大(图2)。因此,这两种突变可能都间接地影响了RdRp与NTP/RDV-TP的结合。
有两例新冠患者使用RDV治疗后检测到Nsp12 A449V突变[43,48]。但由于缺乏体外研究,该突变对药物敏感性的影响仍未明确。A449V突变显著增强了与L544之间的疏水相互作用,见图3,这种增强的疏水作用力可能影响RNA模板链的正确定位,可能对RDV引起的延迟链终止效应产生影响。
在RDV治疗失败的新冠患者体内检测到Nsp12 D484Y突变新冠毒株[49]。体外研究揭示Nsp12 D484Y突变株对RDV的EC50值是野生型的3倍[50],表明D484Y突变可能与耐药性增强有关。Torii等[50]通过数学建模对Nsp12的多种突变进行了功能研究,结果显示相比野生型,D484Y突变株的病毒产量有所提升。DynaMut2模拟分析显示,D484Y突变并未显著改变该残基与周围氨基酸的相互作用(图4)。
在SARS-CoV-2中,Nsp12 F480L单一突变株的EC50值为野生型的1.5倍,而F480L/V557L双突变株为野生型的3.76倍[50]。因此,共同突变使病毒对RDV的耐药性增强。结构预测显示,Nsp12 F480L突变降低了氨基酸侧链的疏水性并减小了侧链的体积。该突变导致原本存在于苯丙氨酸侧链与基序B中缬氨酸(V693)和异亮氨酸(I696)之间的疏水相互作用力丧失,可间接引起催化中心SDD空间结构的变化(图5)。
Nsp12 V557L突变与相邻残基的相互作用变化不大(图6)。但Pruijssers等[51]的分子建模研究表明,突变引起RNA模板链位置变化,对 NTPs结合产生影响。此外,Tchesnokov等[52]的研究揭示V557L突变可提高UTP的使用效率并产生耐药性。
Malsy等[46]报告的新冠患者病例中,在RDV治疗期间,SARS-CoV-2的Nsp12蛋白出现了I536V突变(突变频率为100。I536V突变显著增强了该位点与蛋白质中其他残基(如Y530和V373位点)的相互作用力(图7)。然而,由于该位点与各基序距离较远,其影响仍需进一步研究。
在3例新冠患者的报告显示,RDV治疗后均出现了Nsp12 V792I突变[53-54]。Stevens等[44]在病毒耐药突变实验中也检测到了S759A和V792I突变。V792I突变使RDV抗病毒的EC50值提高了2.6倍,而S759A和V792I双突变的病毒使RDV抗病毒的EC50值提高了7.3倍。RdRp S759A突变使RDV-TP的亲和力降低近90%。引入V792I突变,提高了UTP的利用效率。共同突变显著增强RDV的耐药性[44]。结构预测显示,Nsp12 V792I突变增强了其与基序A的相互作用,间接改变D623的空间位置,对NTP的选择和催化产生影响。另外,该突变还增加了其与P620之间的氢键和疏水作用力,增加了其与K621和V166之间的疏水作用力(图8)。
Nsp12 S759A发生在基序C的催化活性中心SDD基序中,由丝氨酸(serine,S)突变为丙氨酸(alanine,A)。突变后,A688和N691之间的相互作用消失(图9)。Stevens的研究发现,S759A突变导致1个氢键的缺失,从而降低了其与RDV-TP的亲和力[44]
Torii等[50]病毒耐药突变实验,筛选出RDV耐药株Nsp12 E796G和 C799F突变。该双突变毒株对RDV的EC50值是野生型毒株的2.9倍。而单突变实验显示,Nsp12 E796G和Nsp12 C799F使RDV抗病毒的EC50值分别提高了2.6倍和1.9倍。此外,Szemiel等[55]的研究也发现了Nsp12 C799F突变。通过结构预测,我们发现该突变使其与I779 之间的疏水作用力会丧失(图10)。
Nsp12 C799F突变中,侧链中亲水的巯基被苯环替代,疏水性和空间大小都有所提高。突变后形成与G616极性作用力,以及与W617的疏水作用力,并与基序D的I779,M794形成较强疏水作用力(图11)。经计算机模拟研究发现E796G和C799F提高了RNA结合位点的活动性,表明其与RDV的结合力减弱[50]
在RDV治疗后,高病毒载量新冠患者的测序结果中存在Nsp12 E802D突变[56]。体外研究中,两个相互独立的耐药突变实验也报道了E802D突变[55]。将NSP12 E802D和NSP12 E802A突变引入新冠病毒后,RDV的EC50值分别提高到2.54倍和2.14倍[55]。 Gandhi等[56]验证了NSP12 E802A和NSP12 E802D突变使RDV抗病毒的EC50值分别提高了6倍和3.86倍。结构预测显示,E802D突变后失去了与残基D804和K807的作用力;E802A突变后失去了与D804、K807和G808之间的作用力(图12)。
本文结合RDV耐药性相关的临床研究和体外实验,对耐药相关突变的药物敏感性数据进行了汇总,如表1所示,其中V166A、A449V、I536V和S759A尚无药物敏感性数据。这些突变主要分布在基序A和基序D附近。V166L和V792I突变发生位置接近,均增强了其与基序A中K621的相互作用,如提高 UTP 的利用效率以缓解模板依赖性抑制。E796G和C799F均与I779存在相互作用,E796G突变后失去了与I779之间的相互作用,而C799F显著提高与I779 之间的作用力,但是两者均提高了RNA结合位点的柔性和RDV耐药性。
目前,关于RDV耐药新冠病毒的传播力和致病性的研究尚显不足。针对RDV耐药毒株复制能力的研究揭示Nsp12 P323L和D484Y突变能够增强病毒的复制能力;而V166L、F480L、V557L、S759A、V792I、E802A和E802D等突变则导致病毒复制效率下降[44,47,50,56-58]。此外,Nsp12 D484Y、C799F和E796G突变病毒感染效率均降低[50]
笔者在对比RdRp突变体分子内相互作用时,采用了预测突变蛋白具有较高准确性的DynaMut2平台[42],但其结果仅为计算机模拟与真实结构会存在差异。当前抗新冠治疗药物在突变株中的药物敏感性研究仍有待完善,特别是RDV耐药机制相关研究。建议采用计算机模拟与实验验证相结合的方法深入探讨突变背后的耐药机制;同时,利用深度学习技术对具有潜在耐药性的突变位点及新突变株的耐药特性进行预测分析。药物敏感性研究可为临床精准用药提供依据,针对耐药病毒使用多药联合治疗。
  • 国家自然科学基金面上项目资助(82373920)
  • 北京市自然科学基金资助(7232255)
  • 感染性疾病安徽省重点实验室资助课题(编号AHIDL-2404R)
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2025年第60卷第7期
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doi: 10.11669/cpj.2025.07.001
  • 接收时间:2024-10-15
  • 首发时间:2025-11-11
  • 出版时间:2025-04-08
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  • 收稿日期:2024-10-15
基金
国家自然科学基金面上项目资助(82373920)
北京市自然科学基金资助(7232255)
感染性疾病安徽省重点实验室资助课题(编号AHIDL-2404R)
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    1 中国医学科学院, 北京协和医学院医药生物技术研究所, 北京 100050
    2 复旦大学医学院, 上海 200120

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*赵建元,女,博士,副研究员 研究方向:病毒学基础研究和抗病毒药物应用;
岑山,男,博士,研究员 研究方向:病毒宿主互作、抗病毒天然免疫和抗病毒药物 Tel:(010)63039279
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2种不同金属材料的力学参数

Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)

Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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