Molnupiravir is an antiviral drug that has recently been approved by the FDA for the treatment of COVID-19. This drug is especially exciting because it is the first approved COVID-19 drug that can be taken as a pill, and also because it reduces the risk of hospitalization and death by 30%. Two recent research papers give us insight into the molecular biology of how molnupiravir works.
In order to reproduce, the virus SARS-CoV-2 needs to synthesize RNA. Usually, the enzyme it uses to do this, RNA-dependent RNA polymerase (RdRp), is an attractive target for makers of antiviral drugs. At present, many antiviral drugs block RdRp by mimicking RNA nucleotides. When such a drug gets incorporated into a new RNA strand, synthesis stops. Unfortunately, this drug strategy is not effective against SARS-CoV-2 because it has proofreading enzymes that allow synthesis to continue.
Two research teams in Germany and Canada recently showed that molnupiravir mimics cytidine and uridine, two RNA nucleotides. Molnupiravir incorporates into new RNA strands, like other antiviral drugs. But interestingly, RdRp continues to synthesize RNA. How, then, does molnupiravir prevent severe COVID-19?
Both teams addressed this question by combining RNA that contained molnupiravir with RdRp in vitro. They found that when RdRp uses this RNA to synthesize new RNA, molnupiravir causes mutations. After several generations, mutations build up to a lethal level and the virus can no longer reproduce.
Molnupiravir’s mechanism of action evades viral proofreading enzymes. Because of this, it may also find use in treating a broad variety of other viruses that also have these enzymes.
Kabinger F, Stiller C, Schmitzova J, et al. Mechanism of molnupiravir-induced SARS-CoV-2 mutagenesis. Nature Structural & Molecular Biology. 2021 Sep;28(9):740-746. PMID: 34381216
Gordon CJ, Tchesnokov EP, Schinazi RF, et al. Molnupiravir promotes SARS-CoV-2 mutagenesis via the RNA template. Journal of Biological Chemistry. 2021 Jul;297(1):100770. PMID: 33989635