24West Nile virus (WNV) is a medically important emerging arbovirus causing serious 25 neuroinfections in humans against which no approved antiviral therapy is currently available. 26In this study, we demonstrate that 2´-C-methyl-or 4´-azido-modified nucleosides are highly 27 effective inhibitors of WNV replication, showing nanomolar or low micromolar anti-WNV 28 activity and negligible cytotoxicity in cell culture. One representative of C2´-methylated 29 nucleosides, 7-deaza-2´-C-methyladenosine, significantly protected WNV-infected mice from 30 disease progression and mortality. Twice daily treatment at 25 mg/kg starting at the time of 31 infection resulted in 100% survival of the mice. This compound was highly effective, even if 32 the treatment was initiated 3 days post-infection, at the time of a peak of viremia, which 33 resulted in a 90% survival rate. However, the antiviral effect of 7-deaza-2´-C-34 methyladenosine was absent or negligible when the treatment was started 8 days post-35 infection (i.e., at the time of extensive brain infection). The 4´-azido moiety appears to be 36 another important determinant for highly efficient inhibition of WNV replication in vitro. 37However, the strong anti-WNV effect of 4´-azidocytidine and 4´-azido-aracytidine was cell 38 type-dependent and observed predominantly in PS cells. The effect was much less 39 pronounced in Vero cells. Our results indicate that 2´-C-methylated or 4´-azidated 40 nucleosides merit further investigation as potential therapeutic agents for treating WNV 41 infections, as well as infections caused by other medically important flaviviruses. 42 43 44