Prevention of herpes simplex virus infection and latency by prophylactic treatment with acyclovir in a weanling mouse model

Technological Innovations in Photochemistry for Organic Synthesis: Flow Chemistry, High-Throughput Experimentation, Scale-up, and Photoelectrochemistry

Photoinduced chemical transformations have received in recent years a tremendous amount of attention, providing a plethora of opportunities to synthetic organic chemists. However, performing a photochemical transformation can be quite a challenge because of various issues related to the delivery of photons. These challenges have barred the widespread adoption of photochemical steps in the chemical industry. However, in the past decade, several technological innovations have led to more reproducible, selective, and scalable photoinduced reactions. Herein, we provide a comprehensive overview of these exciting technological advances, including flow chemistry, high-throughput experimentation, reactor design and scale-up, and the combination of photo- and electro-chemistry.

Late-Stage 18 F-Difluoromethyl Labeling of N-Heteroaromatics with High Molar Activity for PET Imaging

Despite a growing interest in CHF2 in medicinal chemistry, there is a lack of efficient methods for the insertion of CHF18 F into druglike compounds. Herein described is a photoredox flow reaction for 18 F-difluoromethylation of N-heteroaromatics that are widely used in medicinal chemistry. Following the two-step synthesis for a new 18 F-difluoromethylation reagent, the photoredox reaction is completed within two minutes and proceeds by C-H activation, circumventing the need for pre-functionalization of the substrate. The method is operationally simple and affords straightforward access to radiolabeled N-heteroaromatics with high molar activity suitable for biological in vivo studies and clinical application.

Valacyclovir in the Treatment of Herpes Simplex, Herpes Zoster, and other Viral Infections

Background:

Genital herpes and herpes labialis are prevalent, physically and pychologically painful, and often disabling. Herpes zoster is often very painful and may result in months or years of postherpetic neuralgia (PHN). Over the past two decades, the treatment of these conditions has been transformed by guanosine nucleoside antivirals such as valacyclovir (Valtrex®), a highly bioavailable prodrug of acyclovir (Zovirax®), and famciclovir (Famvir®), a highly bioavailable prodrug of penciclovir (Denavir®).

Objective:

We describe the pharmacology, pharmacokinetics, and clinical efficacy of valacyclovir for the treatment of herpes simplex, herpes zoster, and other viral infections. Valacyclovir is also compared with acyclovir and famciclovir.

Methods:

All published literature containing the word “valacyclovir” was reviewed and summarized.

Results:

Valacyclovir is the only oral antiviral agent approved for therapy of herpes labialis, the only antiviral drug approved for a 3-day course in the episodic treatment of recurrent genital herpes, as well as the only antiviral drug approved for once daily dosing for suppressive therapy. In herpes zoster, valacyclovir is more effective than acyclovir and equally effective as famciclovir at hastening the healing of zoster-associated pain and PHN.

Conclusion:

Valacyclovir is safe and effective in the therapy of patients with herpes simplex and herpes zoster and may be useful in other viral infections.

Prophylactic Valacyclovir to Prevent Outbreaks of Primary Herpes Gladiatorum at a 28-Day Wrestling Camp: A 10-Year Review

OBJECTIVE

To determine efficacy of using oral antiviral medication to reduce herpes gladiatorum (HG) at summer high-school wrestling camps.

DESIGN

Usage of antiviral medication hypothetically reduces the likelihood of HG outbreaks. This is an observational study examining the effectiveness of oral antiviral medications in reducing outbreaks of HG because of Herpes Simplex type-1 virus (HSV).

SETTING

A 28-day high-school summer wrestling camp at the University of Minnesota from 2003 to 2012.

PARTICIPANTS

Each summer approximately 300 high-school wrestlers, age 13 to 18 years of age, participated in this camp.

INTERVENTIONS

All athletes were recommended to take valacyclovir 1 g once a day for the duration of the camp. Athletes who did not use any antiviral medication comprised the comparison group for this study. Individuals were screened daily and those with outbreaks of HG were withheld from practice for 120 hours in accordance with National Collegiate Athletic Association/National Federation of State High School Associations guidelines.

MAIN OUTCOME MEASURES

To measure viral outbreaks of HG due to HSV-1, determine level of compliance, and determine efficacy of antiviral medication in reducing the occurrence of HG at this 28-day wrestling camp.

RESULTS

Of the 2793 athletes who completed camp, 1995 (71%) used antiviral medication, and 36 outbreaks occurred. Eighty-four athletes had a known history of HG/recurrent herpes labialis. Overall, prophylactic antiviral medication resulted in an 84.7% decrease in the probability of an outbreak. Prophylactic valacyclovir (1 g daily) lowered the incidence of individual outbreaks by 89.5%.

CONCLUSIONS

Prophylactic use of valacyclovir 1 g once a day is efficacious in lowering the incidence of HSV outbreaks among adolescents at a 28-day wrestling camp.

Rapid polymerase chain reaction assay to detect herpes simplex virus in the genital tract of women in labor

OBJECTIVE

To develop a rapid quantitative real-time polymerase chain reaction (PCR) to detect herpes simplex virus (HSV) in the genital secretions of women that may be used in labor.

METHODS

Samples of genital secretions from women in labor, swabs of active genital lesions, and swabs of buffer solution were analyzed using a newly developed rapid HSV PCR assay to detect HSV glycoprotein B gene and quantitate virion copy number. A previously validated TaqMan PCR to detect HSV glycoprotein B gene was performed as the comparator gold standard. Positivity determination that optimized sensitivity and specificity was determined with receiver operating characteristic curves.

RESULTS

The median time to result for rapid HSV PCR was 2 hours (range 1.5-3.5 hours). A positivity determination rule that required both wells of the rapid test to detect 150 copies or greater of HSV per milliliter maximized specificity (96.7%) without appreciable loss of sensitivity (99.6%). Among positive samples, the correlation between the rapid test and TaqMan for the quantity of HSV isolated was excellent (R=0.96, P<.001). The rapid test had a positive predictive value of 96.7% and a negative predictive value of 99.6% in a population with HSV shedding prevalence of 10.8%, based on the prevalence of genital HSV previously found among HSV-2 seropositive women in labor.

CONCLUSION

Rapid HSV PCR provides results with excellent sensitivity and specificity within a timeframe that could inform clinical decision making for identifying neonates at risk of neonatal HSV infection.

LEVEL OF EVIDENCE

II.

Valacyclovir in the treatment of herpes simplex, herpes zoster, and other viral infections

BACKGROUND

Genital herpes and herpes labialis are prevalent, physically and psychologically painful, and often disabling. Herpes zoster is often very painful and may result in months or years of postherpetic neuralgia (PHN). Over the past two decades, the treatment of these conditions has been transformed by guanosine nucleoside antivirals such as valacyclovir (Valtrex, a highly bioavailable prodrug of acyclovir (Zovirax, and famciclovir (Famvir), a highly bioavailable prodrug of penciclovir (Denavir).

OBJECTIVE

We describe the pharmacology, pharmacokinetics, and clinical efficacy of valacyclovir for the treatment of herpes simplex, herpes zoster, and other viral infections. Valacyclovir is also compared with acyclovir and famciclovir.

METHODS

All published literature containing the word "valacyclovir" was reviewed and summarized.

RESULTS

Valacyclovir is the only oral antiviral agent approved for therapy of herpes labialis, the only antiviral drug approved for a 3-day course in the episodic treatment of recurrent genital herpes, as well as the only antiviral drug approved for once daily dosing for suppressive therapy. In herpes zoster, valacyclovir is more effective than acyclovir and equally effective as famciclovir at hastening the healing of zoster-associated pain and PHN.

CONCLUSION

Valacyclovir is safe and effective in the therapy of patients with herpes simplex and herpes zoster and may be useful in other viral infections.

Effect of famciclovir on herpes simplex virus type 1 corneal disease and establishment of latency in rabbits

Famciclovir (FCV) is efficacious in the treatment of acute herpes zoster and recurrent genital infections but has not been used to treat ocular herpes simplex virus (HSV) infections. We evaluated the efficacy of orally administered FCV in treating HSV-1 epithelial keratitis and determined its effects on the establishment of latency and subsequent reactivation. Rabbits were inoculated with HSV-1 strain 17 syn+ and treated twice daily with increasing concentrations of FCV (60 to 500 mg/kg of body weight). This resulted in a significant, dose-dependent improvement in keratitis scores, as well as prolonged survival. Regardless of the dose of drug used, all groups exhibited the high rates of spontaneous and induced reactivation characteristic of 17syn+. The efficacy of 250 mg of FCV per kg was also compared to topical treatment with 1% trifluorothymidine (TFT). Although TFT treatment was more effective at reducing eye disease, FCV-treated rabbits had a better survival rate. Real-time quantitative PCR analysis of rabbit trigeminal ganglia (TG) demonstrated that FCV significantly reduced the HSV-1 copy number compared to that after treatment with TFT or the placebo but not in a dose-dependent manner. In summary, oral FCV treatment significantly reduces the severity of corneal lesions, reduces the number of HSV-1 genomes in the TG, improves survival, and therefore may be beneficial in reducing the morbidity of HSV keratitis in the clinic.