Cytomegalovirus (CMV) is a ubiquitous human pathogen that increases the morbidity and mortality of immunocompromised individuals. The current FDA-approved treatments for CMV infection are intended to be virus specific, yet they have significant adverse side effects, including nephrotoxicity and hematological toxicity. Thus, there is a medical need for safer and more effective CMV therapeutics. Using a high-content screen, we identified the cardiac glycoside convallatoxin as an effective compound that inhibits CMV infection. Using a panel of cardiac glycoside variants, we assessed the structural elements critical for anti-CMV activity by both experimental and in silico methods. Analysis of the antiviral effects, toxicities, and pharmacodynamics of different variants of cardiac glycosides identified the mechanism of inhibition as reduction of methionine import, leading to decreased immediate-early gene translation without significant toxicity. Also, convallatoxin was found to dramatically reduce the proliferation of clinical CMV strains, implying that its mechanism of action is an effective strategy to block CMV dissemination. Our study has uncovered the mechanism and structural elements of convallatoxin, which are important for effectively inhibiting CMV infection by targeting the expression of immediate-early genes.
IMPORTANCECytomegalovirus is a highly prevalent virus capable of causing severe disease in certain populations. The current FDA-approved therapeutics all target the same stage of the viral life cycle and induce toxicity and viral resistance. We identified convallatoxin, a novel cell-targeting antiviral that inhibits CMV infection by decreasing the synthesis of viral proteins. At doses low enough for cells to tolerate, convallatoxin was able to inhibit primary isolates of CMV, including those resistant to the anti-CMV drug ganciclovir. In addition to identifying convallatoxin as a novel antiviral, limiting mRNA translation has a dramatic impact on CMV infection and proliferation. C ytomegalovirus (CMV) is an extremely large betaherpesvirus with over 230,000 bp and over 200 open reading frames. While the majority of CMV infections in immunocompetent hosts are asymptomatic (1), the phenomenon of latency allows the virus to establish a permanent and persistent infection. CMV is highly seroprevalent in the human population (Ͼ60%), with broad cell tropism, and can be transmitted through bodily fluids and organ transplantation and transplacentally from mother to fetus (2). Reactivation of latent CMV can cause disease in any population but is a particular source of morbidity and mortality for immunocompromised patients (3). It is estimated that treatment of CMV costs the United States $4.4 billion every year (4), and congenital CMV infections are the leading cause of permanent congenital neurological disabilities in the United States (5). The current FDA-approved therapies all target the viral DNA polymerase, and none are approved for use in pregnant women or newborns. These compounds can cause sever...