The mosquito-borne Japanese encephalitis virus (JEV) causes serious illness worldwide that is associated with high morbidity and mortality. Currently, there are no effective drugs approved for the treatment of JEV infection. Drug-repurposing screening is an alternative approach to discover potential antiviral agents. In this study, high-content screening (HCS) of a natural extracts library was performed, and two hit FDA-approved Na ϩ /K ϩ -ATPase inhibitors, ouabain and digoxin, were identified as having robust efficiency against JEV infection with the selectivity indexes over 1,000. The results indicated that ouabain and digoxin blocked the JEV infection at the replication stage by targeting the Na ϩ /K ϩ -ATPase. Furthermore, it was proven that ouabain significantly reduced the morbidity and mortality caused by JEV in a BALB/c mouse model. This work demonstrated that Na ϩ /K ϩ -ATPase could serve as the target of treatment of JEV infection, and ouabain has the potential to be developed as an effective anti-JEV drug.Ethics statements and mice. All animal experimental procedures were carried out according to ethical guidelines and were approved by the Animal Care Committee of the Wuhan Institute of Virology (permit number, WIVA25201705).Cells and viruses. BHK-21, Vero, and Huh-7 cells were maintained in Dulbecco modified Eagle medium (DMEM) (HyClone, Logan, UT, USA) supplement with 10% fetal bovine serum (FBS) (Gibco, Grand Island, NY, USA). U251 cells were maintained in minimum essential medium (MEM) (HyClone) supplement with 10% FBS. JEV AT31 and SA14 strains were generated by using the infectious clones of pMWJEAT-AT31 (kindly provided by T. Wakita, Tokyo Metropolitan Institute for Neuroscience) and pACYC-JEV-SA14 (GenBank accession no. U14163) as previously described (32), respectively. The infectious clone plasmids were linearized, subjected to in vitro transcription, and electroporated into BHK-21 cells. Three days later, the supernatant was collected and stored at Ϫ80°C in aliquots (33, 34). The virus stocks were propagated and titrated by a plaque assay in BHK-21 cells.Optimization of HCS assay conditions. The cell density, infective dose, and assay endpoint were optimized for the HCS assay. Different densities (2,000 to 10,000 cells per well) of Vero cells were infected at MOI values ranging from 0.2 to 1. Cell viability was detected at different times (24 to 72 h) after JEV inoculation. The appropriate cell density, infective dose, and assay endpoint for the HCS assay were selected by comparing the signal-to-basal ratio (S/B), the coefficient of variation (CV), and z values under different conditions as previously described (11); 10 M manidipine and 0.5% DMSO were used as positive and negative controls, respectively.HCS assay of drug library screening. A library of 1,034 compounds from natural extracts was purchased from Weikeqi Biotech (Sichuan, China). Compounds were stored as 10 mM stock solutions in DMSO at -80°C until use. As shown in Fig. 1A, Vero cells were dissociated and seeded at a density of ...