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Ghosh R, Chakraborty A, Biswas A, Chowdhuri S. Potential therapeutic use of corticosteroids as SARS CoV-2 main protease inhibitors: a computational study. J Biomol Struct Dyn 2020; 40:2053-2066. [PMID: 33094701 PMCID: PMC7596904 DOI: 10.1080/07391102.2020.1835728] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The outbreak of COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS CoV-2), represents a pandemic threat to global public health. To date, ∼530,000 people died of this disease worldwide. Presently, researchers/clinicians are adopting the drug repurposing strategy to combat this disease. It has also been observed that some repurposed anti-viral drugs may serve as potent inhibitors of SARS CoV-2 Mpro, a key component of viral replication. Apart from these anti-viral drugs, recently dexamethasone (an important corticosteroid) is effectively used to treat COVID-19 patients. However, the mechanism behind the mode of its action is not so clear. Additionally, the effect of other well-known corticosteroids to control this disease by inhibiting the proteolytic activity of Mpro is ambiguous. In this study, we have adopted computational approaches to understand these aspects. Six well-known corticosteroids (cortisone, hydrocortisone, prednisolone, methylprednisolone, betamethasone and dexamethasone) and two repurposed drugs (darunavir and lopinavir) against COVID-19 were subjected for molecular docking studies. Two of them (betamethasone and dexamethasone) were selected by comparing their binding affinities with selected repurposed drugs toward Mpro. Betamethasone and dexamethasone interacted with both the catalytic residues of Mpro (His41 and Cys145). Molecular dynamics studies further revealed that these two Mpro-corticosteroid complexes are more stable, experience less conformational fluctuations and more compact than Mpro-darunavir/lopinavir complexes. These findings were additionally validated by MM-GBSA analysis. This study provides corroboration for execution of anti-COVID-19 activity of dexamethasone. Our study also emphasizes on the use of another important corticosteroid (betamethasone) as potential therapeutic agent for COVID-19 treatment.
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Affiliation(s)
- Rajesh Ghosh
- School of Basic Sciences, Indian Institute of Technology Bhubaneswar, Bhubaneswar, India
| | - Ayon Chakraborty
- School of Basic Sciences, Indian Institute of Technology Bhubaneswar, Bhubaneswar, India
| | - Ashis Biswas
- School of Basic Sciences, Indian Institute of Technology Bhubaneswar, Bhubaneswar, India
| | - Snehasis Chowdhuri
- School of Basic Sciences, Indian Institute of Technology Bhubaneswar, Bhubaneswar, India
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Gracia-Ahufinger I, Ferrando-Martínez S, Montejo M, Muñoz-Villanueva M, Cantisán S, Rivero A, Solana R, Leal M, Torre-Cisneros J. Pre-transplant thymic function is associated with the risk of cytomegalovirus disease after solid organ transplantation. Clin Microbiol Infect 2015; 21:511.e1-7. [DOI: 10.1016/j.cmi.2014.12.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 12/20/2014] [Accepted: 12/24/2014] [Indexed: 11/28/2022]
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Yamazaki R, Tanaka Y, Nakasone H, Sato M, Terasako-Saito K, Sakamoto K, Akahoshi Y, Nakano H, Ugai T, Yamasaki R, Wada H, Ishihara Y, Kawamura K, Ashizawa M, Kimura SI, Kikuchi M, Kako S, Kanda J, Tanihara A, Nishida J, Kanda Y. Allotype analysis to determine the origin of cytomegalovirus immunoglobulin-G after allogeneic stem cell transplantation. Transpl Infect Dis 2014; 16:904-13. [DOI: 10.1111/tid.12304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 07/17/2014] [Accepted: 08/07/2014] [Indexed: 11/26/2022]
Affiliation(s)
- R. Yamazaki
- Division of Hematology; Department of Internal Medicine; Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - Y. Tanaka
- Division of Hematology; Department of Internal Medicine; Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - H. Nakasone
- Division of Hematology; Department of Internal Medicine; Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - M. Sato
- Division of Hematology; Department of Internal Medicine; Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - K. Terasako-Saito
- Division of Hematology; Department of Internal Medicine; Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - K. Sakamoto
- Division of Hematology; Department of Internal Medicine; Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - Y. Akahoshi
- Division of Hematology; Department of Internal Medicine; Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - H. Nakano
- Division of Hematology; Department of Internal Medicine; Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - T. Ugai
- Division of Hematology; Department of Internal Medicine; Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - R. Yamasaki
- Division of Hematology; Department of Internal Medicine; Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - H. Wada
- Division of Hematology; Department of Internal Medicine; Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - Y. Ishihara
- Division of Hematology; Department of Internal Medicine; Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - K. Kawamura
- Division of Hematology; Department of Internal Medicine; Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - M. Ashizawa
- Division of Hematology; Department of Internal Medicine; Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - S.-I. Kimura
- Division of Hematology; Department of Internal Medicine; Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - M. Kikuchi
- Division of Hematology; Department of Internal Medicine; Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - S. Kako
- Division of Hematology; Department of Internal Medicine; Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - J. Kanda
- Division of Hematology; Department of Internal Medicine; Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - A. Tanihara
- Division of Hematology; Department of Internal Medicine; Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - J. Nishida
- Division of Hematology; Department of Internal Medicine; Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - Y. Kanda
- Division of Hematology; Department of Internal Medicine; Saitama Medical Center; Jichi Medical University; Saitama Japan
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Komura K, Hasegawa M, Hamaguchi Y, Yukami T, Nagai M, Yachie A, Sato S, Takehara K. Drug-Induced Hypersensitivity Syndrome Associated with Human Herpesvirus 6 and Cytomegalovirus Reactivation. J Dermatol 2014; 32:976-81. [PMID: 16471461 DOI: 10.1111/j.1346-8138.2005.tb00885.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2005] [Accepted: 06/28/2005] [Indexed: 10/25/2022]
Abstract
We describe a patient with drug-induced hypersensitivity syndrome (DIHS) associated with human herpesvirus 6 (HHV-6) and cytomegalovirus (CMV) infection induced by sulfasalazine. Two weeks after starting sulfasalazine to treat a rectal ulcer, the patient developed disseminated macular erythema accompanied by fever, liver injury, and lymphadenopathy. Seroconversion of antibodies to HHV-6 was observed. Systemic steroid treatment was not effective against the eruptions. Five months after the onset, he presented with an acute febrile disease. The detection of CMV antigen on peripheral blood leukocytes and positive staining for CMV on cutaneous endothelium indicated active CMV infection. Furthermore, he developed a bacteremia of methicillin resistant Staphylococcus aureus. An association the CMV reactivation with DIHS was suggested, although there remains the possibility that the systemic steroid treatment precipitated CMV reactivation. Recently, HHV-6 has been documented to have immunomodulating effects and to be associated with CMV reactivation. Therefore, we should pay attention to the possibility of CMV reactivation in patients with DIHS in whom the immunomodulating virus of HHV-6 has been reactivated.
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Affiliation(s)
- Kazuhiro Komura
- Department of Dermatology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
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Hu CF, Wang CC, Chen SJ, Perng CL, Yang HY, Fan HC. Prognostic values of a combination of intervals between respiratory illness and onset of neurological symptoms and elevated serum IgM titers in Mycoplasma pneumoniae encephalopathy. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2013; 47:497-502. [PMID: 23968755 DOI: 10.1016/j.jmii.2013.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Revised: 06/10/2013] [Accepted: 06/25/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND/PURPOSE To retrospectively analyze the clinical manifestations of Mycoplasma pneumoniae (M. pneumoniae)-associated encephalopathy in pediatric patients. METHODS Pediatric patients with positive serum anti-M. pneumoniae immunoglobulin M (IgM) were enrolled in this study. Clinical signs and symptoms, laboratory data, neuroimaging findings, and electrophysiological data were reviewed. RESULTS Of 1000 patients identified, 11 (1.1%; male:female ratio = 7:4) had encephalopathy and were admitted to the pediatric intensive care unit. Clinical presentation included fever, symptoms of respiratory illness, and gastrointestinal upset. Neurological symptoms included altered consciousness, seizures, coma, focal neurological signs, and personality change. Neuroimaging and electroencephalographic findings were non-specific. Specimens of cerebrospinal fluid (CSF) for M. pneumoniae polymerase chain reaction (PCR) were negative. Higher M. pneumoniae IgM titers and longer intervals between respiratory and CNS manifestations were associated with worse outcomes. CONCLUSION Clinical manifestations of M. pneumoniae-associated encephalopathy were variable. Diagnosis of M. pneumoniae encephalopathy should not rely on CSF detection of M. pneumoniae by PCR. M. pneumoniae IgM titers and intervals between respiratory and CNS manifestations might be possibly related to the prognosis of patients with M. pneumoniae-associated encephalopathy.
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Affiliation(s)
- Chih-Fen Hu
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Chih-Chien Wang
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Shyi-Jou Chen
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Cherng-Lih Perng
- Division of Clinical Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Hsin-Yi Yang
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Hueng-Chuen Fan
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.
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Torre-Cisneros J, Fariñas MC, Castón JJ, Aguado JM, Cantisán S, Carratalá J, Cervera C, Cisneros JM, Cordero E, Crespo-Leiro MG, Fortún J, Frauca E, Gavaldá J, Gil-Vernet S, Gurguí M, Len O, Lumbreras C, Marcos MÁ, Martín-Dávila P, Monforte V, Montejo M, Moreno A, Muñoz P, Navarro D, Pahissa A, Pérez JL, Rodriguez-Bernot A, Rumbao J, San Juan R, Santos F, Varo E, Zurbano F. GESITRA-SEIMC/REIPI recommendations for the management of cytomegalovirus infection in solid-organ transplant patients. Enferm Infecc Microbiol Clin 2011; 29:735-58. [DOI: 10.1016/j.eimc.2011.05.022] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Accepted: 05/30/2011] [Indexed: 12/31/2022]
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Scott GM, Naing Z, Pavlovic J, Iwasenko JM, Angus P, Jones R, Rawlinson WD. Viral factors influencing the outcome of human cytomegalovirus infection in liver transplant recipients. J Clin Virol 2011; 51:229-33. [PMID: 21641274 DOI: 10.1016/j.jcv.2011.05.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 04/14/2011] [Accepted: 05/09/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Cytomegalovirus (CMV) remains the leading viral cause of disease following orthotopic liver transplantation (OLT) despite the availability of antiviral agents for prophylaxis and therapy. OBJECTIVE Examine the viral factors that influence the outcome of CMV infection following valganciclovir prophylaxis or laboratory-guided preemptive therapy in OLT recipients. STUDY DESIGN The value of valganciclovir prophylaxis and laboratory-guided preemptive therapy for the prevention of CMV infection and disease was observed in 64 OLT recipients. Prophylaxis was given to all CMV seronegative recipients receiving a liver from a seropositive donor (D+R-; n=15), and all other recipients were randomised to receive either prophylaxis (n=24) or laboratory-guided preemptive therapy (n=25). Recipients were monitored for CMV DNAemia, viral load, emergence of antiviral resistant strains and co-infections. RESULTS CMV end-organ disease and antiviral resistant strains only occurred in D+R- recipients despite the use of prophylaxis in these patients. The D+R- recipients commencing prophylaxis immediately following transplantation had better outcomes compared to those for whom prophylaxis was delayed due to renal impairment. Prophylaxis reduced the incidence of CMV DNAemia, persistent infection, and high viral loads for CMV seropositive (D-R+and D+R+) recipients, but laboratory-guided preemptive therapy effectively controlled CMV infection and prevented disease in these OLT recipients. CONCLUSION Delaying the commencement of valganciclovir prophylaxis may be associated with worse outcomes for high-risk OLT recipients. Laboratory-guided pre-emptive therapy remains an alternative approach for seropositive recipients at lower risk of CMV disease.
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Affiliation(s)
- G M Scott
- Virology Division, Department of Microbiology, SEALS, Prince of Wales Hospital, Sydney, Australia
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Razonable RR. Strategies for managing cytomegalovirus in transplant recipients. Expert Opin Pharmacother 2010; 11:1983-97. [PMID: 20642369 DOI: 10.1517/14656566.2010.492395] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
IMPORTANCE OF THE FIELD Cytomegalovirus (CMV) is the most important pathogen that affects transplant recipients, by directly causing clinical disease and by indirectly reducing patient and allograft survival. AREAS COVERED IN THIS REVIEW This review provides a brief overview of the direct and indirect effects of CMV disease and the traditional and newly described factors that increase the risk of disease after transplantation. Newly acquired data in the diagnostics, prevention and treatment of CMV infection are discussed, with emphasis on guidelines for management as recently endorsed by the American Society of Transplantation and the Transplantation Society. WHAT THE READER WILL GAIN The reader will gain up-to-date insights into the contemporary management of CMV after solid organ transplantation. Practical aspects of its diagnosis, prevention and treatment are discussed. Emerging concerns of late-onset CMV disease and antiviral resistance are also highlighted to emphasize the need to optimize CMV-prevention strategies. TAKE HOME MESSAGE Prevention of CMV disease is an important goal in the management of solid organ transplant recipients. The efficacy of CMV prevention should be measured not only by the significant reduction in CMV incidence but, as importantly, by the improvement in long-term allograft and patient survival.
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Affiliation(s)
- Raymund R Razonable
- William J von Liebig Transplant Center, College of Medicine, Mayo Clinic, Division of Infectious Diseases, Department of Internal Medicine, Rochester, MN 55905, USA.
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10
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Ticha O, Stouracova M, Kuman M, Studenik P, Freiberger T, Litzman J. Monitoring of CD38high expression in peripheral blood CD8+ lymphocytes in patients after kidney transplantation as a marker of cytomegalovirus infection. Transpl Immunol 2010; 24:50-6. [DOI: 10.1016/j.trim.2010.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 09/30/2010] [Accepted: 10/05/2010] [Indexed: 10/18/2022]
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11
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Buyck HC, Griffiths PD, Emery VC. Human cytomegalovirus (HCMV) replication kinetics in stem cell transplant recipients following anti-HCMV therapy. J Clin Virol 2010; 49:32-6. [DOI: 10.1016/j.jcv.2010.06.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Revised: 06/21/2010] [Accepted: 06/29/2010] [Indexed: 11/17/2022]
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Low-dose corticosteroid therapy increases the risk of cytomegalovirus reactivation. Pharmacotherapy 2009; 63:72-3. [DOI: 10.1016/j.biopha.2008.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2008] [Accepted: 03/12/2008] [Indexed: 11/19/2022]
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Egli A, Bergamin O, Müllhaupt B, Seebach J, Mueller N, Hirsch H. Cytomegalovirus-associated chorioretinitis after liver transplantation: case report and review of the literature. Transpl Infect Dis 2008; 10:27-43. [DOI: 10.1111/j.1399-3062.2007.00285.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Troselj-Vukic B, Milotic I, Milotic F, Crnic-Martinovic M, Grahovac B. Cytomegalovirus reactivation after low-dose steroid treatment for hemolytic anemia in a patient with primary Epstein-Barr virus infection. Wien Klin Wochenschr 2007; 119:435-7. [PMID: 17671826 DOI: 10.1007/s00508-007-0821-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2006] [Accepted: 03/19/2007] [Indexed: 10/23/2022]
Abstract
Cytomegalovirus reactivation is a well described event occurring after intensive therapeutic suppression of the immune function in patients with latent infection. Treatment protocols for suppression of the immune response often include high-dose steroids. However, it is not known whether even a low-dose steroid treatment can reactivate latent cytomegalovirus in otherwise healthy persons. We documented cytomegalovirus reactivation after low-dose steroid treatment for autoimmune hemolytic anemia as a complication of Epstein-Barr virus mononucleosis in an immunocompetent 21-year-old man.
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Abstract
Cytomegalovirus (CMV) has major consequences after allogeneic stem cell and solid organ transplantation. CMV may cause significant morbidity and mortality, and monitoring to detect reactivation to reduce disease or management of end organ disease is associated with increased resource utilization. Two other members of the beta-herpesvirus family, human herpesvirus (HHV) type 6 and HHV-7, are increasingly recognized as important pathogens in transplant recipients, either by direct infection (e.g., encephalitis, hepatitis, or pneumonitis) or via interaction with CMV. In addition to direct effects of CMV infection, such indirect effects as an increased risk for bacterial and fungal infections or impaired graft acceptance and function are important research topics. Diagnosis and treatment of CMV infection is currently more advanced than for HHV-6 and HHV-7.
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Affiliation(s)
- Per Ljungman
- Karolinska Institutet, SE-14186 Stockholm, Sweden.
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