2026-06-14T03:38:16Zhttps://repisalud.isciii.es/rest/oai/request

oai:repisalud.isciii.es:20.500.12105/159732025-04-24T18:12:29Zcom_20.500.12105_2052com_20.500.12105_2051com_20.500.12105_15322col_20.500.12105_19609col_20.500.12105_16961

00925njm 22002777a 4500 dc Santos Bravo, Marta author Alonso, Rodrigo author Soria, Dafne author Sánchez Palomino, Sonsoles author Sanzo Machuca, Ángela author Rodríguez, Cristina author Alcamí, José author Díez-Fuertes, Francisco author Simarro Redon, Àlvar author Hurtado, Juan Carlos author Fernández Avilés, Francesc author Bodro, Marta author Rubio, Elisa author Villanueva, Jose Luis author Vergara, Andrea author Castro, Pedro author Tuset, Montserrat author Cuesta, Genoveva author Puerta, Pedro author García, Carolina author Mosquera Gutierrez, Maria del Mar author Martínez, Miguel J author Vila, Jordi author Soriano, Alex author Marcos, María Ángeles author 2022-12-21 Remdesivir (RDV) was the first antiviral drug approved by the FDA to treat severe coronavirus disease-2019 (COVID-19) patients. RDV inhibits SARS-CoV-2 replication by stalling the non structural protein 12 (nsp12) subunit of the RNA-dependent RNA polymerase (RdRp). No evidence of global widespread RDV-resistance mutations has been reported, however, defining genetic pathways to RDV resistance and determining emergent mutations prior and subsequent antiviral therapy in clinical settings is necessary. This study identified 57/149 (38.3%) patients who did not respond to one course (5-days) (n = 36/111, 32.4%) or prolonged (5 to 20 days) (n = 21/38, 55.3%) RDV therapy by subgenomic RNA detection. Genetic variants in the nsp12 gene were detected in 29/49 (59.2%) non responder patients by Illumina sequencing, including the de novo E83D mutation that emerged in an immunosuppressed patient after receiving 10 + 8 days of RDV, and the L838I detected at baseline and/or after prolonged RDV treatment in 9/49 (18.4%) non responder subjects. Although 3D protein modeling predicted no interference with RDV, the amino acid substitutions detected in the nsp12 involved changes on the electrostatic outer surface and in secondary structures that may alter antiviral response. It is important for health surveillance to study potential mutations associated with drug resistance as well as the benefit of RDV retreatment, especially in immunosuppressed patients and in those with persistent replication. IMPORTANCE This study provides clinical and microbiologic data of an extended population of hospitalized patients for COVID-19 pneumonia who experienced treatment failure, detected by the presence of subgenomic RNA (sgRNA). The genetic variants found in the nsp12 pharmacological target of RDV bring into focus the importance of monitoring emergent mutations, one of the objectives of the World Health Organization (WHO) for health surveillance. These mutations become even more crucial as RDV keeps being prescribed and new molecules are being repurposed for the treatment of COVID-19. The present article offers new perspectives for the clinical management of non responder patients treated and retreated with RDV and emphasizes the need of further research of the benefit of combinatorial therapies and RDV retreatment, especially in immunosuppressed patients with persistent replication after therapy. Microbiol Spectr. 2022 Dec 21;10(6):e0244822. 10.1128/spectrum.02448-22 2165-0497 Microbiology spectrum 36354320 http://hdl.handle.net/20.500.12105/15973 COVID-19 Remdesivir Resistance mutations Subgenomic RNA Retreatment SARS-CoV-2 Genetic variants Genetic Study of SARS-CoV-2 Non Structural Protein 12 in COVID-19 Patients Non Responders to Remdesivir