Metallodrug ranitidine bismuth citrate suppresses SARS-CoV-2 replication and relieves virus-associated pneumonia in Syrian hamsters

Nat Microbiol. 2020 Nov;5(11):1439-1448. doi: 10.1038/s41564-020-00802-x. Epub 2020 Oct 7.

Abstract

SARS-CoV-2 is causing a pandemic of COVID-19, with high infectivity and significant mortality1. Currently, therapeutic options for COVID-19 are limited. Historically, metal compounds have found use as antimicrobial agents, but their antiviral activities have rarely been explored. Here, we test a set of metallodrugs and related compounds, and identify ranitidine bismuth citrate, a commonly used drug for the treatment of Helicobacter pylori infection, as a potent anti-SARS-CoV-2 agent, both in vitro and in vivo. Ranitidine bismuth citrate exhibited low cytotoxicity and protected SARS-CoV-2-infected cells with a high selectivity index of 975. Importantly, ranitidine bismuth citrate suppressed SARS-CoV-2 replication, leading to decreased viral loads in both upper and lower respiratory tracts, and relieved virus-associated pneumonia in a golden Syrian hamster model. In vitro studies showed that ranitidine bismuth citrate and its related compounds exhibited inhibition towards both the ATPase (IC50 = 0.69 µM) and DNA-unwinding (IC50 = 0.70 µM) activities of the SARS-CoV-2 helicase via an irreversible displacement of zinc(II) ions from the enzyme by bismuth(III) ions. Our findings highlight viral helicase as a druggable target and the clinical potential of bismuth(III) drugs or other metallodrugs for the treatment of SARS-CoV-2 infection.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Antiviral Agents / pharmacology*
  • Betacoronavirus / drug effects*
  • Betacoronavirus / physiology
  • Bismuth / pharmacology*
  • COVID-19
  • COVID-19 Drug Treatment
  • Chemokines / metabolism
  • Chlorocebus aethiops
  • Coronavirus Infections / drug therapy
  • Coronavirus Infections / virology*
  • Cytokines / metabolism
  • Disease Models, Animal
  • HEK293 Cells
  • Humans
  • Lung / pathology
  • Lung / virology
  • Mesocricetus
  • Pandemics
  • Pneumonia, Viral / drug therapy
  • Pneumonia, Viral / virology*
  • RNA Helicases / metabolism
  • Ranitidine / analogs & derivatives*
  • Ranitidine / pharmacology
  • SARS-CoV-2
  • Vero Cells
  • Viral Load
  • Virus Replication / drug effects*

Substances

  • Antiviral Agents
  • Chemokines
  • Cytokines
  • ranitidine bismuth citrate
  • Ranitidine
  • RNA Helicases
  • Bismuth