Remdesivir Potently Inhibits SARS-CoV-2 in Human Lung Cells and Chimeric SARS-CoV Expressing the SARS-CoV-2 RNA Polymerase in Mice

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in 2019 as the causative agent of the novel pandemic viral disease COVID-19. With no approved therapies, this pandemic illustrates the urgent need for safe, broad-spectrum antiviral countermeasures against SARS-CoV-2 and future emerging CoVs. We report that remdesivir (RDV), a monophosphoramidate prodrug of an adenosine analog, potently inhibits SARS-CoV-2 replication in human lung cells and primary human airway epithelial cultures (EC50 = 0.01 µM). Weaker activity was observed in Vero E6 cells (EC50 = 1.65 µM) due to their low capacity to metabolize RDV. To rapidly evaluate in vivo efficacy, we engineered a chimeric SARS-CoV encoding the viral target of RDV, the RNA-dependent RNA polymerase, of SARS-CoV-2. In mice infected with chimeric virus, therapeutic RDV administration diminished lung viral load and improved pulmonary function as compared to vehicle treated animals. These data provide evidence that RDV is potently active against SARS-CoV-2 in vitro and in vivo, supporting its further clinical testing for treatment of COVID-19.Funding: This project was funded in part by the National Institute of Allergy and Infectious Diseases, National 284 Institutes of Health, Department of Health and Human Service awards: 1U19AI142759 (Antiviral Drug 285 Discovery and Development Center awarded to M.R.D. and R.S.B); 5R01AI132178 awarded to T.P.S. 286 and R.S.B.; and 5R01AI108197 awarded to M.R.D. and R.S.B. D.R.M was funded by T32 AI007151 and 287 a Burroughs Wellcome Fund Postdoctoral Enrichment Program Award. The Marsico Lung Institute 288 Tissue Procurement and Cell Culture Core is supported by NIH grant DK065988 and Cystic Fibrosis 289 Foundation grant BOUCHE15RO. We also are grateful for support from the Dolly Parton COVID-19 290 Research Fund, the VUMC Office of Research, and the Elizabeth B. Lamb Center for Pediatric Research 291 at Vanderbilt University. Conflict of Interest: The authors affiliated with Gilead Sciences, Inc. are employees of the company and own company stock. The other authors have no conflict of interest to report.Ethical Approval: Human tracheobronchial epithelial cells provided by Dr. Scott Randell were obtained from airway specimens resected from patients undergoing surgery under University of North Carolina Institutional Review Board-approved protocols (#03-1396) by the Cystic Fibrosis Center Tissue Culture Core.