Clofazimine broadly inhibits coronaviruses including SARS-CoV-2

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  • Shuofeng Yuan
  • Xin Yin
  • Xiangzhi Meng
  • Jasper Fuk Woo Chan
  • Zi Wei Ye
  • Laura Riva
  • Lars Pache
  • Chris Chun Yiu Chan
  • Pok Man Lai
  • Chris Chung Sing Chan
  • Vincent Kwok Man Poon
  • Andrew Chak Yiu Lee
  • Naoko Matsunaga
  • Yuan Pu
  • Chun Kit Yuen
  • Jianli Cao
  • Ronghui Liang
  • Kaiming Tang
  • Li Sheng
  • Yushen Du
  • Wan Xu
  • Chit Ying Lau
  • Ko Yung Sit
  • Wing Kuk Au
  • Runming Wang
  • Yu Yuan Zhang
  • Yan Dong Tang
  • Jessica Pihl
  • Juntaek Oh
  • Kong Hung Sze
  • Anna Jinxia Zhang
  • Hin Chu
  • Kin Hang Kok
  • Dong Wang
  • Xue Hui Cai
  • Jeffrey D. Esko
  • Ivan Fan Ngai Hung
  • Ronald Adolphus Li
  • Honglin Chen
  • Hongzhe Sun
  • Dong Yan Jin
  • Ren Sun
  • Sumit K. Chanda
  • Kwok Yung Yuen

COVID-19 pandemic is the third zoonotic coronavirus (CoV) outbreak of the century after severe acute respiratory syndrome (SARS) in 20031 and Middle East respiratory syndrome (MERS) since 20122. Treatment options for CoVs are largely lacking. Here we show that clofazimine, an anti-leprosy drug with a favourable safety profile3, possesses pan-coronaviral inhibitory activity, and can antagonize SARS-CoV-2 and MERS-CoV replication in multiple in vitro systems. The FDA-approved molecule was found to inhibit viral spike-mediated cell fusion and viral helicase activity. In a hamster model of SARS-CoV-2 pathogenesis, prophylactic or therapeutic administration of clofazimine significantly reduced viral load in the lung and faecal viral shedding, and also mitigated inflammation associated with viral infection. Combinatorial application of clofazimine and remdesivir exhibited antiviral synergy in vitro and in vivo, and restricted upper respiratory tract viral shedding. Since clofazimine is orally bioavailable and has a comparatively low manufacturing cost, it is an attractive clinical candidate for outpatient treatment and remdesivir-based combinatorial therapy for hospitalized COVID-19 patients, particularly in developing countries. Taken together, our data provide evidence that clofazimine may have a role in the control of the current pandemic SARS-CoV-2, and, possibly most importantly, emerging CoVs of the future.

Original languageEnglish
JournalNature
Volume593
Pages (from-to)418–423
ISSN0028-0836
DOIs
Publication statusPublished - 2021

ID: 258895385