Inhibition of the replication of SARS-CoV-2 in human cells by the FDA-approved drug chlorpromazine

Abstract

Introduction: Urgent action is needed to fight the ongoing coronavirus disease 2019 (COVID-19) pandemic by reducing the number of infected cases, contagiousness and severity. Chlorpromazine (CPZ), an antipsychotic from the phenothiazine group, is known to inhibit clathrin-mediated endocytosis and has antiviral activity against severe acute respiratory syndrome coronavirus-1 (SARS-CoV-1) and Middle East respiratory syndrome coronavirus. The aim of this in-vitro study was to test CPZ against SARS-CoV-2 in monkey and human cells.

Materials and methods: Monkey VeroE6 cells and human alveolar basal epithelial A549-ACE2 cells were infected with SARS-CoV-2 in the presence of various concentrations of CPZ. Supernatants were harvested at day 2 and analysed by quantitative reverse transcription polymerase chain reaction (RT-qPCR) for the presence of SARS-CoV-2 RNA. Cell viability was assessed in non-infected cells.

Results: CPZ was found to have antiviral activity against SARS-CoV-2 in monkey VeroE6 cells, with a half maximal inhibitory concentration (IC₅₀) of 8.2 µM, half maximal cytotoxic concentration (CC₅₀) of 13.5 µM, and selectivity index (SI) of 1.65. In human A549-ACE2 cells, CPZ was also found to have anti-SARS-CoV-2 activity, with IC₅₀ of 11.3 µM, CC₅₀ of 23.1 µM and SI of 2.04.

Discussion: Although the measured SI values are low, the IC₅₀ values measured in vitro may translate to CPZ dosages used in routine clinical practice because of the high biodistribution of CPZ in lungs and saliva. Also, the distribution of CPZ in brain could be of interest for treating or preventing neurological and psychiatric forms of COVID-19.

Conclusions: These preclinical findings support clinical investigation of the repurposing of CPZ, a drug with mild side effects, in the treatment of patients with COVID-19.

Keywords: COVID-19; Chlorpromazine; Human cells; Repurposing of molecules; SARS-CoV-2.

Fig. 1

Antiviral activity of chlorpromazine (CPZ) against severe acute respiratory syndrome coronavirus-2 in vitro in monkey VeroE6 cells (A) and human A549-ACE2 cells (B). Viral load in supernatants was measured at 48 h (left Y axis), and viability under increasing concentrations of the antiviral compound is shown. Error bars denote standard error of the mean. IC₅₀, half maximal inhibitory concentration; CC₅₀, half maximal cytotoxic concentration.

Fig. 2

Review of temporal distribution of chlorpromazine (CPZ) in lungs, saliva and brain. Ratio of tissue to plasma CPZ concentrations (log scale) after administration of a single dose of CPZ are represented for lungs (red), saliva or salivary glands (yellow) and brain (blue) in rodents (solid symbols) and humans (open symbols). Derived from previous preclinical and clinical studies [[25], [26], [27], [28],31,32].