Drug-induced phospholipidosis as an artifact in antiviral drug repurposing

Drug repurposing in principle can speed antiviral drug discovery. Among the molecules most frequently advanced in such repurposing efforts are a group of structurally diverse cationic amphiphilic drugs (CADs). While CADs have shown micromolar to mid-nanomolar antiviral activity in cell-based assays, they can induce phospholipidosis, confounding in COVID-19 repurposing. A barrier to the identification of phospholipidosis inducers has been the involved nature of the microscopy assays used to characterize them. To ease the identification of these artifacts, we describe a rapid microplate-based assay to detect phospholipidosis. Leveraging this assay, we quantified the prevalence of phospholipidosis-inducers across several cell-based antiviral repurposing screens. We selected 40 drugs reported to have micromolar antiviral activities and found that 26 of them (65%) induced phospholipidosis within the same concentration range as their reported antiviral activities. Intriguingly, we identified four non-CADs that also induce phospholipidosis, revealing a new group of drugs that can lead to this toxic event and highlighting the importance of facile experimental assays to detect it. Understanding how phospholipidosis can confound antiviral drug discovery, and its rapid detection, will help prevent what is an apparently general artifact, active across viruses, from distracting investigators from potentially more useful candidates.