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Science Advances
Article . 2025 . Peer-reviewed
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Science Advances
Article . 2025
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Strategy to overcome a nirmatrelvir resistance mechanism in the SARS-CoV-2 nsp5 protease

Authors: Grace Neilsen; Shuiyun Lan; Ryan L. Slack; Zachary C. Lorson; Andres Emanuelli Castaner; Rachel Lee; Kristin G. Edwards; +11 Authors

Strategy to overcome a nirmatrelvir resistance mechanism in the SARS-CoV-2 nsp5 protease

Abstract

E166V in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nsp5 protease confers strong resistance to the antiviral component of Paxlovid, nirmatrelvir (NIR), in passaging and clinical samples. In SARS-CoV-2 replicons, E166V drastically decreased Washington (WA1) but not Omicron (BA.1) fitness (20- versus 2-fold), suggesting a lower barrier to resistance in the BA.1 strain and consistent with observed differences in respective nsp5 dimerization affinities. Crystal structures reveal a steric clash between the rigid, bulky NIR tert -butyl group and the β-branched Val 166 , disrupting the covalent binding of NIR to the catalytic Cys 145 and leading to high resistance in BA.1 and WA1 replicons. NIR-resistant replicons remained susceptible to GC376, which can still covalently bind Cys 145 by avoiding a steric clash with Val 166 through “wiggling and jiggling.” Hence, strategic flexibility is a strategy that will help design second-generation antivirals against NIR-resistant viruses.

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Keywords

Lactams, Proline, SARS-CoV-2, COVID-19, Viral Nonstructural Proteins, Crystallography, X-Ray, Antiviral Agents, COVID-19 Drug Treatment, Leucine, Drug Resistance, Viral, Nitriles, Humans, Biomedicine and Life Sciences, Sulfonic Acids, Coronavirus 3C Proteases

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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
9
Top 10%
Average
Top 10%
Green
gold