(1) Background: There is a strong need for prevention and treatment strategies for
COVID-19 that are not impacted by SARS-CoV-2 mutations emerging in variants of concern. After
virus infection, host ER resident
sigma receptors form direct interactions with non-structural SARS-CoV-2
proteins present in the replication complex. (2) Methods: In this work, highly specific
sigma receptor ligands were investigated for their ability to inhibit both SARS-CoV-2 genome replication and virus induced cellular toxicity. This study found
antiviral activity associated with agonism of the
sigma-1 receptor (e.g.,
SA4503),
ligation of the
sigma-2 receptor (e.g., CM398), and a combination of the two pathways (e.g., AZ66). (3) Results: Intermolecular contacts between these
ligands and
sigma receptors were identified by structural modeling. (4) Conclusions:
Sigma receptor ligands and drugs with off-target
sigma receptor binding characteristics were effective at inhibiting
SARS-CoV-2 infection in primate and human cells, representing a potential therapeutic avenue for
COVID-19 prevention and treatment.