Remdesivir prompts urotensin II receptor and induces cardiomyocyte dysfunction

In a current research posted to the bioRxiv* preprint server, researchers assessed the cardiac results of remdesivir.

Study: Activation of the urotensin-II receptor by anti-COVID-19 drug remdesivir induces cardiomyocyte dysfunction. Image Credit: felipe caparros/Shutterstock
Research: Activation of the urotensin-II receptor by anti-COVID-19 drug remdesivir induces cardiomyocyte dysfunction. Picture Credit score: felipe caparros/Shutterstock


Nucleoside analogs have been lengthy used for designing antiviral medicine. Nucleoside analogs inhibit viral RNA-dependent RNA polymerase (RdRp). A number of analogs, resembling remdesivir, favipiravir, and molnupiravir, have been accepted to deal with coronavirus illness 2019 (COVID-19).

Remdesivir, a modified adenosine analog, is quickly transformed to a mono-nucleoside kind upon intravenous administration. Subsequently, it’s metabolized by host enzymes to the lively triphosphate state. The lively drug is a selective and potent inhibitor of RdRp of many viruses. Initially used for treating the Ebola virus, remdesivir was accepted for COVID-19 amid the pandemic.

Though nicely tolerated by most sufferers, generally reported adversarial occasions embrace a rash, nausea, headache, and elevated transaminases. Furthermore, cardiovascular occasions resembling bradycardia, hypertension, T-wave abnormality, and QT prolongation have been reported.

Remdesivir distributes to a number of tissues, together with the center; nevertheless, the mechanisms underlying the cardiovascular issues stay unknown.

Molnupiravir and favipiravir have been used for COVID-19 therapy. Though totally different adversarial occasions have been reported, no cardiovascular occasion has been reported with using favipiravir or molnupiravir. Nucleosides or nucleotides additionally act as ligands for G-protein-coupled receptors (GPCRs). As nucleoside analogs mimic buildings, it’s hypothesized that they may activate GPCRs and trigger uncomfortable side effects.

The research and findings

Within the current research, researchers carried out a large-scale GPCR screening utilizing the three anti-COVID-19 medicine. The nucleoside analogs had been screened towards 348 GPCRs in a remodeling progress issue (TGF)-α shedding assay. Initially, screening was carried out utilizing Gα subunits for environment friendly detection of receptor activation. The authors famous that remdesivir selectively activated the urotensin II receptor (UTS2R).

Focus-response evaluation confirmed a half-maximal efficient focus (pEC50) of 4.89 for remdesivir, albeit decrease than that of urotensin II, the endogenous ligand of UTS2R. Intriguingly, remdesivir didn’t induce a β-arrestin recruitment response, not like urotensin II, and thus was a G-protein-biased ligand. The foremost and minor metabolites of remdesivir, GS-441524, and GS-704277, didn’t have an effect on the activation of UTS2R.

Additional investigation revealed that receptor activation required each the nucleoside base and the McGuigan prodrug moiety of remdesivir. In silico structural docking of UTS2R and remdesivir recognized a number of residues within the orthosteric pocket, probably stabilizing binding to remdesivir. Three residues of UTS2R (T304, N297, and M134) had been discovered to work together with remdesivir. Substituting these residues with others abolished the activation efficiency of remdesivir.

Subsequent, HEK293 cells expressing UTS2R had been stimulated with remdesivir, and the phosphorylation of extracellular sign regulation kinase (ERK) 1/2 was examined. Remdesivir therapy induced long-lasting phosphorylation of ERK1/2 in a dose-dependent method. Remdesivir-mediated phosphorylation was abolished within the presence of a UTS2R antagonist.

The influence of remdesivir on cardiomyocytes was assessed given the excessive expression of UTS2R and urotensin II in cardiovascular programs. The drug’s impact was analyzed on the sphere potential (FP) utilizing human-induced pluripotent stem (iPS) cell-derived cardiomyocytes, during which UTS2R ranges are corresponding to that of the center.

A multielectrode assay confirmed that remdesivir-treated cells confirmed extended FP period that was considerably suppressed within the presence of a UTS2R antagonist. The consequences of the drug on cardiac contractility had been assessed on neonatal rat cardiomyocytes (NRCMs). Power remdesivir software on NRCMs resulted in decreased contractility attenuated by UTS2R antagonist.

The workforce constructed 110 missense mutants akin to human single nucleotide variants (SNVs) within the UTS2R gene. Of those, 44 SNVs exhibited decrease sensitivity to remdesivir relative to the wildtype receptor. In distinction, 47 SNVs had decreased sensitivity to urotensin II.

Notably, 4 missense SNVs elevated sensitivity to remdesivir relative to wildtype. Of those, two SNVs had decrease sensitivity to urotensin II, whereas the opposite two had a reasonable/insignificant enhance in sensitivity to urotensin II. People with these mutations is likely to be extra vulnerable to remdesivir/UTS2R-mediated cardiotoxicity.


The authors found that remdesivir selectively activated UTS2R. UTS2R activation by urotensin II has been implicated in cardiac dysfunction. As such, UTS2R activation by remdesivir in cultured cardiomyocytes induced electrical abnormalities and impaired contractility, resembling the reported cardiac occasions in people. Notably, the adversarial results had been negated by antagonizing UTS2R or blocking the downstream signaling.

The findings prompt that the medical dose of remdesivir was satisfactory to set off UTS2R activation. However the discovering that UTS2R is activated by remdesivir resulting in cardiotoxicity, a limitation of the research is the dearth of medical proof.

In abstract, the research supplied mechanistic insights into remdesivir-mediated cardiac results and found that it acts as a selective UTS2R agonist.

*Necessary discover

bioRxiv publishes preliminary scientific studies that aren’t peer-reviewed and, due to this fact, shouldn’t be thought to be conclusive, information medical observe/health-related habits, or handled as established data.

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