Screening of an FDA-approved compound library identifies four small-molecule inhibitors of Middle East respiratory syndrome coronavirus replication in cell culture.
Coronaviruses can cause respiratory and enteric disease in a wide variety of human and animal hosts. The 2003 outbreak of severe acute respiratory syndrome (SARS) first demonstrated the potentially lethal consequences of zoonotic coronavirus infections in humans. In 2012, a similar previously unknown coronavirus emerged, Middle East respiratory syndrome coronavirus (MERS-CoV), thus far causing over 650 laboratory-confirmed infections, with an unexplained steep rise in the number of cases being recorded over recent months. The human MERS fatality rate of ∼ 30% is alarmingly high, even though many deaths were associated with underlying medical conditions. Registered therapeutics for the treatment of coronavirus infections are not available. Moreover, the pace of drug development and registration for human use is generally incompatible with strategies to combat emerging infectious diseases. Therefore, we have screened a library of 348 FDA-approved drugs for anti-MERS-CoV activity in cell culture. If such compounds proved sufficiently potent, their efficacy might be directly assessed in MERS patients. We identified four compounds (chloroquine, chlorpromazine, loperamide, and lopinavir) inhibiting MERS-CoV replication in the low-micromolar range (50% effective concentrations [EC(50)s], 3 to 8 μM). Moreover, these compounds also inhibit the replication of SARS coronavirus and human coronavirus 229E. Although their protective activity (alone or in combination) remains to be assessed in animal models, our findings may offer a starting point for treatment of patients infected with zoonotic coronaviruses like MERS-CoV. Although they may not necessarily reduce viral replication to very low levels, a moderate viral load reduction may create a window during which to mount a protective immune response.
Molecular Virology Laboratory, Department of Medical Microbiology, Leiden University Medical Center, Leiden, Netherlands.
Adriaan H
AH
de Wilde
Rega Institute for Medical Research, KU, Leuven, Belgium.
Dirk
D
Jochmans
Molecular Virology Laboratory, Department of Medical Microbiology, Leiden University Medical Center, Leiden, Netherlands.
Clara C
CC
Posthuma
Molecular Virology Laboratory, Department of Medical Microbiology, Leiden University Medical Center, Leiden, Netherlands.
Jessika C
JC
Zevenhoven-Dobbe
Department of Viroscience, Erasmus Medical Center, Rotterdam, Netherlands.
Stefan
S
van Nieuwkoop
Department of Viroscience, Erasmus Medical Center, Rotterdam, Netherlands.
Theo M
TM
Bestebroer
Department of Viroscience, Erasmus Medical Center, Rotterdam, Netherlands.
Bernadette G
BG
van den Hoogen
Rega Institute for Medical Research, KU, Leuven, Belgium Johan.Neyts@rega.kuleuven.be E.J.Snijder@LUMC.nl.
Johan
J
Neyts
Molecular Virology Laboratory, Department of Medical Microbiology, Leiden University Medical Center, Leiden, Netherlands Johan.Neyts@rega.kuleuven.be E.J.Snijder@LUMC.nl.
Eric J
EJ
Snijder
D000818:Animals; D000998:Antiviral Agents / Q000494:pharmacology*; D002460:Cell Line; D002522:Chlorocebus aethiops; D002738:Chloroquine / Q000494:pharmacology; D002746:Chlorpromazine / Q000494:pharmacology; D028941:Coronavirus 229E, Human / Q000187:drug effects* / Q000502:physiology; D017277:Drug Approval; D022781:Hepatocytes / Q000187:drug effects / Q000473:pathology / Q000821:virology; D057166:High-Throughput Screening Assays; D006801:Humans; D020128:Inhibitory Concentration 50; D008139:Loperamide / Q000494:pharmacology; D061466:Lopinavir / Q000494:pharmacology; D065207:Middle East Respiratory Syndrome Coronavirus / Q000187:drug effects* / Q000502:physiology; D045473:Severe acute respiratory syndrome-related coronavirus / Q000187:drug effects* / Q000502:physiology; D054852:Small Molecule Libraries / Q000494:pharmacology*; D014709:Vero Cells; D014779:Virus Replication / Q000187:drug effects
D000998:Antiviral Agents; D054852:Small Molecule Libraries; D061466:Lopinavir; D008139:Loperamide; D002738:Chloroquine; D002746:Chlorpromazine