Morphological cell profiling for drug repurposing against SARS-CoV-2 infection

Antiviral drug discovery has traditionally focused on targeting viral proteins, while host-directed strategies remain largely underexplored. Here, present a systematic drug repurposing strategy leveraging morphological profiling to identify host-targeting antivirals. Our image-based approach combines viral protein immunostaining with high-content Cell Painting analysis to simultaneously assess viral replication and provide in-depth analysis of host cell responses. By screening 5,275 repurposable drugs against SARS-CoV-2 infected cells, we identified compounds that reversed the infected cell phenotype, including ones not detected by conventional cytopathicity and antibody-based assays. A counter-screen excluded compounds whose antiviral activity was likely driven by drug-induced phospholipidosis (DIPL). Pathway enrichment analysis of compounds validated by both Cell Painting dose-response and DIPL assays, revealed host processes frequently hijacked by viruses, including innate immune responses and kinases. Among the top hits, both novel candidates, such as serdemetan, and previously reported broad-spectrum antivirals, such as sunitinib, were identified. Our approach constitutes an adaptable and scalable platform suited for diverse viral pathogens and cell systems. We provide a resource of open access screening data, images, and automated analysis pipelines to advance both antiviral discovery and pandemic preparedness.