Despite the enormous disease burden associated with dengue virus infections, a licensed antiviral drug is lacking. Here, we show that the paracetamol (acetaminophen) metabolite AM404 inhibits dengue virus replication. Moreover, we find that mutations in NS4B that were previously found to confer resistance to the antiviral compounds NITD-618 and SDM25N also render dengue virus insensitive to AM404. Our work provides further support for NS4B as a direct or indirect target for antiviral drug development.
Dengue virus (DENV) is a major health concern. The virus was initially estimated to cause 50 million to 100 million infections each year (1, 2), but more recent estimates suggest even greater numbers (390 million infections, of which 96 million manifest clinically) (3). Dengue is a mosquito-transmitted infection that was once considered a tropical disease, but the virus is spreading rapidly across the globe and is now endemic in 128 countries, with up to 4 billion people at risk of infection (1, 4-7). No specific drug or licensed vaccine is available for DENV infection, leaving vector control the only option to prevent transmission, although this approach is threatened by the emergence of insecticide resistance (8-10). A specific antiviral therapeutic agent would be an important tool to inhibit virus replication and transmission and to reduce the global burden of DENV.To identify new inhibitors of DENV replication, we screened the NIH Clinical Collection, a library of small molecules with a history of use in humans, using a replicon-based assay in HeLa cells (11). In this DENV serotype 2 (DENV2) (strain New Guinea C [NGC])-based replicon (RepDVPacLuc), the structural genes are replaced by a puromycin resistance gene and a firefly luciferase (FLuc) reporter gene, which can be assessed as a readout for virus replication (11,12). AM404 (PubChem identification no. 6604822) was one of the compounds that, at a concentration of 10 M, reduced FLuc activity in HeLa DENV2 replicon cells by Ͼ50%, relative to the dimethyl sulfoxide (DMSO) control, without affecting cell viability by Ͼ20%. AM404, also known as Narachidonoylphenolamine, is an active metabolite of paracetamol (acetaminophen) (Fig. 1A) and is suggested to be responsible for all or part of its analgesic activity (13,14).To confirm the results from our screen, we analyzed an independent batch of AM404 (Tocris Bioscience; purity, 99.5% by HPLC) for antiviral activity on HeLa DENV2 replicon cells and found that AM404, but not paracetamol, reduced FLuc activity in a dose-dependent manner (50% effective concentration [EC 50 ], 3.6 M [95% confidence interval [CI], 3.0 to 4.2 M]) (Fig. 1B). As expected (15-17), the nucleoside analogue ribavirin (SigmaAldrich), which was used as a positive control, also inhibited virus replication in a dose-dependent manner (EC 50 , 2.2 M [95% CI, 1.8 to 2.6 M]) (Fig. 1B). Importantly, none of the compounds affected cell viability, as assessed by a colorimetric assay for cell metabolic activity (Fig. 1B). We next analyzed whether AM404 al...