A molnupiravir-associated mutational signature in global SARS-CoV-2 genomes

Abstract Molnupiravir, an antiviral medication widely used against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), acts by inducing mutations in the virus genome during replication. Most random mutations are likely to be deleterious to the virus and many will be lethal; thus, molnupiravir-induced elevated mutation rates reduce viral load 1,2 . However, if some patients treated with molnupiravir do not fully clear the SARS-CoV-2 infections, there could be the potential for onward transmission of molnupiravir-mutated viruses. Here we show that SARS-CoV-2 sequencing databases contain extensive evidence of molnupiravir mutagenesis. Using a systematic approach, we find that a specific class of long…

• WT
  Wellcome Trust

  Awards: 210918/Z/18/Z, FC001043, 210918
• FC
  Francis Crick Institute

  Award: FC001043
• NI
  National Institute for Health Research Health Protection Research Unit

  Award: 200907
• CR
  Cancer Research UK

  Award: FC001043
• NI
  National Institute for Health and Care Research

  Award: 200907
• DO
  Department of Health and Social Care
• CF
  Cystic Fibrosis Trust
• UO
  University of Oxford

  Award: 200907
• UO
  University of Liverpool
• PH
  Public Health England

  Award: 200907
• FB
  Fondation Botnar
• MR
  Medical Research Council

  Awards: 200907, MR/W005611/1, FC001043