“…Lithium has a narrow therapeutic window, however, and the concentration needed to inhibit N phosphorylation and to impair infectivity of SARS-CoV-2 and other coronaviruses in cell culture ( 6 , 8 , 18 – 20 ) is above the therapeutic range in humans [peak level ∼2 mM, trough levels ∼1 mM ( 16 )] and the level that induces behavioral changes in model organisms. For example, 1 mM lithium is sufficient to inhibit GSK-3 in humans ( 33 ), alter GSK-3–dependent behaviors in mice ( 32 , 44 ), and activate Wnt signaling in the mouse intestine ( 45 , 46 ), whereas the IC 50 for inhibition of N phosphorylation and inhibition of SARS-CoV-2 replication, as well as inhibition of phosphorylation of established GSK-3 substrates, in cultured cells is ∼10 mM. It is not clear why higher concentrations were needed to inhibit GSK-3 in cell culture compared to in vivo studies but, given the narrow therapeutic window for lithium in bipolar disorder, alternative GSK-3 inhibitors may be better tolerated in clinical settings involving coronavirus infection.…”