T-705(Favipiravir) inhibition of arenavirus replication in cell culture

A number of New World arenaviruses (Junín [JUNV], Machupo [MACV], and Guanarito [GTOV] viruses) can cause human disease ranging from mild febrile illness to a severe and often fatal hemorrhagic fever syndrome. These highly pathogenic viruses and the Old World Lassa fever virus pose a significant threat to public health and national security. The only licensed antiviral agent with activity against these viruses, ribavirin, has had mixed success in treating severe arenaviral disease and is associated with significant toxicities. A novel pyrazine derivative currently in clinical trials for the treatment of influenza virus infections, T-705 (favipiravir), has demonstrated broad-spectrum activity against a number of RNA viruses, including arenaviruses. T-705 has also been shown to be effective against Pichinde arenavirus infection in a hamster model. Here, we demonstrate the robust antiviral activity of T-705 against authentic highly pathogenic arenaviruses in cell culture. We show that T-705 disrupts an early or intermediate stage in viral replication, distinct from absorption or release, and that its antiviral activity in cell culture is reversed by the addition of purine bases and nucleosides, but not with pyrimidines. Specific inhibition of viral replication/transcription by T-705 was demonstrated using a lymphocytic choriomeningitis arenavirus replicon system. Our findings indicate that T-705 acts to inhibit arenavirus replication/transcription and may directly target the viral RNA-dependent RNA polymerase. Several New World arenaviruses, including Junín (JUNV), Machupo (MACV), and Guanarito (GTOV) viruses, as well as the related Old World Lassa virus, are among a phylogenetically diverse group of negative-sense RNA viruses that cause severe viral hemorrhagic fevers (VHFs) in regions of the world where they are endemic (9). The National Institutes of Health has classified these viruses as category A agents because of the threat they pose to the U.S. population (20). Despite the biodefense and public health risks associated with these highly pathogenic viruses, there are no FDA-licensed arenavirus vaccines and current antiarenaviral therapy is limited to an off-label use of ribavirin (1-β-d-ribofuranosyl-1,2,4-triazole-3-carboxamide), which has had only mixed success in the treatment of severe infections and is associated with significant toxicity in humans (4, 15, 27). Therefore, it is important to develop novel and effective antiviral drugs to combat arenaviral hemorrhagic fevers. T-705 (favipiravir; 6-fluoro-3-hydroxy-2-pyrazinecarboxamide) is a pyrazine derivative with broad antiviral activity against RNA viruses, including influenza viruses (6, 16, 24, 25), flaviviruses (13, 19), bunyaviruses, and several nonpathogenic arenaviruses (10-12). Moreover, studies employing the hamster Pichinde virus (PICV) infection model of acute arenaviral disease have demonstrated that T-705 can be used effectively to treat advanced infections in animals (10). However, T-705 has not yet been tested against highly pathogenic human arenaviruses. Evidence indicates that T-705 is ribosylated and phosphorylated to the active T-705-4-ribofuranosyl-5′-triphosphate form (T-705RTP) that inhibits influenza virus infection by interfering with viral RNA replication and transcription through inhibition of the virus RNA-dependent RNA polymerase (RdRp) (7). The broad activity of T-705 against a number of RNA viruses suggests that this inhibitor may target a conserved functional element in the viral polymerase. The ability of T-705 to specifically target the viral replication machinery may minimize the possibility of in vivotoxicity. In contrast, ribavirin also inhibits cellular IMP dehydrogenase (IMPDH), a key enzyme in guanosine biosynthesis, and thereby perturbs cellular nucleotide pools. In the present study, we explored the mechanism of action of T-705 in cell culture and assessed the in vitro activity of T-705 against three highly pathogenic arenaviruses