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Khattab F, Essam R, Elhadidy RF, Anis N. Intralesional combined digoxin and furosemide versus intralesional 5-flurouracil for the treatment of recalcitrant plantar warts: a prospective, randomized study. Arch Dermatol Res 2024; 316:411. [PMID: 38878078 PMCID: PMC11180028 DOI: 10.1007/s00403-024-03014-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 04/22/2024] [Accepted: 04/26/2024] [Indexed: 06/19/2024]
Abstract
There are many therapeutic modalities for plantar warts, however treating it remains challenging. Intralesional injection of 5-fluorouarcil and combined digoxin and furosemide were observed to be effective and safe, however no comparison study between them was done. Our study was conducted to evaluate the efficacy of both therapies in the treatment of plantar warts. 90 adult patients with multiple recalcitrant plantar warts were included in our study. They were randomly allocated to one of three groups; combined digoxin and furosemide, 5-fluorouarcil, or normal saline group. Fortnightly injections were done into all studied warts till complete clearance or up to 5 sessions. Warts were evaluated clinically and dermoscopically. Clinical response was reported in 24 patients (80%) of the combined digoxin and furosemide group with 40% complete response and in 24 patients (80%) of the 5-fluorouarcil group with 33.3% complete response. No statistically significant difference was observed between the two groups concerning efficacy and safety. Intralesional injection of 5-fluorouarcil and combined digoxin and furosemide are nearly equivalent in efficacy and safety for plantar wart treatment. Dermoscopy helps to take the truthful judgment about complete clearance of warts.
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Affiliation(s)
- Fathia Khattab
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Reham Essam
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Reham F Elhadidy
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Nourhan Anis
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
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2
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Jamshed F, Dashti F, Ouyang X, Mehal WZ, Banini BA. New uses for an old remedy: Digoxin as a potential treatment for steatohepatitis and other disorders. World J Gastroenterol 2023; 29:1824-1837. [PMID: 37032732 PMCID: PMC10080697 DOI: 10.3748/wjg.v29.i12.1824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/12/2023] [Accepted: 03/14/2023] [Indexed: 03/28/2023] Open
Abstract
Repurposing of the widely available and relatively cheap generic cardiac gly-coside digoxin for non-cardiac indications could have a wide-ranging impact on the global burden of several diseases. Over the past several years, there have been significant advances in the study of digoxin pharmacology and its potential non-cardiac clinical applications, including anti-inflammatory, antineoplastic, metabolic, and antimicrobial use. Digoxin holds promise in the treatment of gastrointestinal disease, including nonalcoholic steatohepatitis and alcohol-associated steatohepatitis as well as in obesity, cancer, and treatment of viral infections, among other conditions. In this review, we provide a summary of the clinical uses of digoxin to date and discuss recent research on its emerging applications.
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Affiliation(s)
- Fatima Jamshed
- Section of Digestive Diseases, Yale School of Medicine, New Haven, CT 06510, United States
- Griffin Hospital-Yale University, Derby, CT 06418, United States
| | - Farzaneh Dashti
- Section of Digestive Diseases, Yale School of Medicine, New Haven, CT 06510, United States
| | - Xinshou Ouyang
- Section of Digestive Diseases, Yale School of Medicine, New Haven, CT 06510, United States
| | - Wajahat Z Mehal
- Section of Digestive Diseases, Yale School of Medicine, New Haven, CT 06510, United States
- West Haven Veterans Medical Center, West Haven, CT 06516, United States
| | - Bubu A Banini
- Section of Digestive Diseases, Yale School of Medicine, New Haven, CT 06510, United States
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3
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Nasr M, Abdelaty S, Elkholy BM. A comparative clinico-dermoscopic study of intralesional injection of combined digoxin and furosemide, Candida antigen, and vitamin D3 for multiple warts. J Cosmet Dermatol 2023; 22:1344-1353. [PMID: 36606379 DOI: 10.1111/jocd.15581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/05/2022] [Accepted: 12/11/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Immunostimulatory and antiproliferative therapies have been widely used for the treatment of multiple warts. Recently, anti-HPV activity of ionic contra viral therapy (ICVT) which is comprised of combined digoxin and furosemide has been demonstrated. AIM To evaluate and compare the effectiveness and safety of intralesional injection of Candida antigen, vitamin D3, and combined digoxin and furosemide in the treatment of multiple warts. PATIENTS AND METHODS Seventy-five patients with numerous warts were randomly assigned to one of three equal groups: Candida antigen, vitamin D3, or a combination of digoxin and furosemide. In the Candida antigen group, injections into the biggest wart were done. In the vitamin D3 and combined digoxin/furosemide groups, the agent was injected into each wart with a maximum of five injected warts. Injections were repeated every 2 weeks until clearance or for a total of five sessions. RESULTS There was a statistically significant difference in the overall therapeutic response among the studied groups in favor of the intralesional Candida antigen group (60%), followed by the vitamin D3 group (48%) and the ionic contraviral therapy group (28%) (p = 0.02). However, the difference between both Candida antigen and vitamin D groups was not significant (p = 0.59). CONCLUSIONS Intralesional Candida antigen immunotherapy and vitamin D3 antiproliferative therapy are significantly more effective than ICVT. LIMITATIONS Short follow-up period and relatively small sample size.
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Affiliation(s)
- Mohamed Nasr
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Sara Abdelaty
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Basma M Elkholy
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Lofty AR, Elbakry AM, Omar GAB, Hamdino M. Intralesional combined furosemide and digoxin in cutaneous warts treatment: A randomized controlled clinical trial. Dermatol Ther 2022; 35:e15935. [PMID: 36226802 DOI: 10.1111/dth.15935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/09/2022] [Accepted: 10/12/2022] [Indexed: 11/30/2022]
Abstract
Although being a benign lesion, Warts can affect the quality of life by causing discomfort, disfigurement, and social embarrassment besides the tendency to spread. Cutaneous wart treatment faces many challenges as the development of an antiviral drug that can eradicate the human papilloma virus (HPV) is difficult. This clinical study aimed to assess the efficacy and safety of intralesional combined furosemide and digoxin in the treatment of multiple cutaneous warts. This double blinded randomized clinical trial included 80 adult patients with multiple cutaneous warts (≥2 warts) who were randomized into two groups, Group I (40 patients) treated with intralesional combined furosemide and digoxin and Group II (40 patients) who were treated with intralesional normal saline solution as a control group, weekly till improvement or for maximum five sessions. Clinical and dermoscopic evaluation at baseline, every session, and monthly for 6 months after the last session to detect any recurrence was performed. Complete wart clearance was observed in 92.5% of patients in the intralesional combined furosemide and digoxin group (Group I) compared with 10.0% in saline group (Group II), with highly statistically significant difference (P-value = 0.000). Pain during injection in 95.0% and 45.0% of patients in Group I and Group II respectively, treatment group was superior compared to control group. Intralesional injection of combined furosemide and digoxin can be a safe and effective treatment option in multiple cutaneous warts with minimal side effects in this study.
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Affiliation(s)
- Amira Reda Lofty
- Dermatology and Venereology Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Asmaa Mohamed Elbakry
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy for Girls, Al-Azhar University, Cairo, Egypt
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Heliopolis University, Cairo, Egypt
| | - Ghada Abdel Badea Omar
- Dermatology and Venereology Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Mervat Hamdino
- Dermatology and Venereology Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
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5
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Management of Difficult-to-Treat Warts: Traditional and New Approaches. Am J Clin Dermatol 2021; 22:379-394. [PMID: 33432476 DOI: 10.1007/s40257-020-00582-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 10/24/2022]
Abstract
Warts are regularly treated by dermatologists, and while many respond readily to first-line treatments, others may represent a therapeutic challenge. Large, deep, numerous, and extensive warts; treatment-resistant lesions with higher risk for side effects, such as hypopigmentation; or patients unable to tolerate or comply with our treatment regimen, may need alternative treatment options. In this work we review the characteristics of select modalities that should be considered for difficult-to-treat warts. We discuss efficacy and tolerability data as well as practical features that can guide us to select the best treatment for every scenario. Novel approaches, still in an investigational phase, are also discussed to illustrate potential future directions of wart treatment.
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6
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Fathy G, Abo-Elmagd WM, Afify AA. Intralesional combined digoxin and furosemide in plantar warts: Does it work? J Cosmet Dermatol 2021; 20:2606-2611. [PMID: 33389796 DOI: 10.1111/jocd.13913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/28/2020] [Accepted: 12/10/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Warts are small, benign growths caused by human papilloma virus. No treatment has yet proven 100% effective for a cure. DNA viruses rely on K + influx for replication. Both digoxin and furosemide inhibit the K + influx by interacting with cell membrane ion co-transporters. Therefore, it is hypothesized that these two compounds may be valuable in the treatment of warts. AIMS Our aim was to evaluate the efficacy and safety of intralesional injection of a combination of digoxin and furosemide in treatment of plantar warts. PATIENTS/METHODS This two-armed single blinded randomized clinical trial included 40 cases with multiple plantar warts (≥3warts) divided into 2 groups (20 cases each). The first group received intralesional normal saline and the second group received intralesional combined digoxin and furosemide, one session every week for maximum 5 injection sessions. RESULTS On comparing between the 2 groups regarding response to treatment (reduction in number of warts), the first group showed no change in number of warts (82 warts before and after treatment), whereas, in the second group, the number of warts before treatment was 80 while after treatment it was 40 (50% reduction in number). There was a statistically significant difference between the two groups as regard the change in the total number of warts (P < .001). CONCLUSIONS Intralesional injection of combined digoxin and furosemide is safe and effective treatment option in multiple plantar warts.
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Affiliation(s)
- Ghada Fathy
- Dermatology Department-Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Boff L, Schreiber A, da Rocha Matos A, Del Sarto J, Brunotte L, Munkert J, Melo Ottoni F, Silva Ramos G, Kreis W, Castro Braga F, José Alves R, Maia de Pádua R, Maria Oliveira Simões C, Ludwig S. Semisynthetic Cardenolides Acting as Antiviral Inhibitors of Influenza A Virus Replication by Preventing Polymerase Complex Formation. Molecules 2020; 25:molecules25204853. [PMID: 33096707 PMCID: PMC7587960 DOI: 10.3390/molecules25204853] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 02/05/2023] Open
Abstract
Influenza virus infections represent a major public health issue by causing annual epidemics and occasional pandemics that affect thousands of people worldwide. Vaccination is the main prophylaxis to prevent these epidemics/pandemics, although the effectiveness of licensed vaccines is rather limited due to the constant mutations of influenza virus antigenic characteristics. The available anti-influenza drugs are still restricted and there is an increasing viral resistance to these compounds, thus highlighting the need for research and development of new antiviral drugs. In this work, two semisynthetic derivatives of digitoxigenin, namely C10 (3β-((N-(2-hydroxyethyl)aminoacetyl)amino-3-deoxydigitoxigenin) and C11 (3β-(hydroxyacetyl)amino-3-deoxydigitoxigenin), showed anti-influenza A virus activity by affecting the expression of viral proteins at the early and late stages of replication cycle, and altering the transcription and synthesis of new viral proteins, thereby inhibiting the formation of new virions. Such antiviral action occurred due to the interference in the assembly of viral polymerase, resulting in an impaired polymerase activity and, therefore, reducing viral replication. Confirming the in vitro results, a clinically relevant ex vivo model of influenza virus infection of human tumor-free lung tissues corroborated the potential of these compounds, especially C10, to completely abrogate influenza A virus replication at the highest concentration tested (2.0 µM). Taken together, these promising results demonstrated that C10 and C11 can be considered as potential new anti-influenza drug candidates.
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Affiliation(s)
- Laurita Boff
- Institute of Virology (IVM), Centre for Molecular Biology of Inflammation (ZMBE), Westfaelische Wilhelms University (WWU), 48149 Münster, Germany; (L.B.); (A.S.); (A.d.R.M.); (J.D.S.); (L.B.); (S.L.)
- Laboratory of Applied Virology, Department of Pharmaceutical Sciences, Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina 88040-900, Brazil
| | - André Schreiber
- Institute of Virology (IVM), Centre for Molecular Biology of Inflammation (ZMBE), Westfaelische Wilhelms University (WWU), 48149 Münster, Germany; (L.B.); (A.S.); (A.d.R.M.); (J.D.S.); (L.B.); (S.L.)
| | - Aline da Rocha Matos
- Institute of Virology (IVM), Centre for Molecular Biology of Inflammation (ZMBE), Westfaelische Wilhelms University (WWU), 48149 Münster, Germany; (L.B.); (A.S.); (A.d.R.M.); (J.D.S.); (L.B.); (S.L.)
- Respiratory Viruses and Measles Laboratory, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro 22775-051, Brazil
| | - Juliana Del Sarto
- Institute of Virology (IVM), Centre for Molecular Biology of Inflammation (ZMBE), Westfaelische Wilhelms University (WWU), 48149 Münster, Germany; (L.B.); (A.S.); (A.d.R.M.); (J.D.S.); (L.B.); (S.L.)
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais 31270-901, Brazil; (F.M.O.); (G.S.R.); (F.C.B.); (R.J.A.); (R.M.d.P.)
| | - Linda Brunotte
- Institute of Virology (IVM), Centre for Molecular Biology of Inflammation (ZMBE), Westfaelische Wilhelms University (WWU), 48149 Münster, Germany; (L.B.); (A.S.); (A.d.R.M.); (J.D.S.); (L.B.); (S.L.)
| | - Jennifer Munkert
- Pharmaceutical Biology, Department of Biology, Friedrich-Alexander-University, 91054 Erlangen-Nuremberg, Germany; (J.M.); (W.K.)
| | - Flaviano Melo Ottoni
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais 31270-901, Brazil; (F.M.O.); (G.S.R.); (F.C.B.); (R.J.A.); (R.M.d.P.)
| | - Gabriela Silva Ramos
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais 31270-901, Brazil; (F.M.O.); (G.S.R.); (F.C.B.); (R.J.A.); (R.M.d.P.)
| | - Wolfgang Kreis
- Pharmaceutical Biology, Department of Biology, Friedrich-Alexander-University, 91054 Erlangen-Nuremberg, Germany; (J.M.); (W.K.)
| | - Fernão Castro Braga
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais 31270-901, Brazil; (F.M.O.); (G.S.R.); (F.C.B.); (R.J.A.); (R.M.d.P.)
| | - Ricardo José Alves
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais 31270-901, Brazil; (F.M.O.); (G.S.R.); (F.C.B.); (R.J.A.); (R.M.d.P.)
| | - Rodrigo Maia de Pádua
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais 31270-901, Brazil; (F.M.O.); (G.S.R.); (F.C.B.); (R.J.A.); (R.M.d.P.)
| | - Cláudia Maria Oliveira Simões
- Laboratory of Applied Virology, Department of Pharmaceutical Sciences, Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina 88040-900, Brazil
- Correspondence:
| | - Stephan Ludwig
- Institute of Virology (IVM), Centre for Molecular Biology of Inflammation (ZMBE), Westfaelische Wilhelms University (WWU), 48149 Münster, Germany; (L.B.); (A.S.); (A.d.R.M.); (J.D.S.); (L.B.); (S.L.)
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Rijsbergen M, Rijneveld R, Todd M, Feiss GL, Kouwenhoven STP, Quint KD, van Alewijk DCJG, de Koning MNC, Klaassen ES, Burggraaf J, Rissmann R, van Poelgeest MIE. Results of phase 2 trials exploring the safety and efficacy of omiganan in patients with human papillomavirus-induced genital lesions. Br J Clin Pharmacol 2020; 86:2133-2143. [PMID: 31755993 DOI: 10.1111/bcp.14181] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 10/14/2019] [Accepted: 10/21/2019] [Indexed: 12/22/2022] Open
Abstract
AIMS To assess safety and tolerability and explore pharmacodynamics and efficacy of omiganan in external anogenital warts (AGW) and vulvar high-grade squamous intraepithelial lesions (HSIL). METHODS Two randomized controlled trials in patients with external AGW and vulvar HSIL were conducted. Patients received topical omiganan 2.5% or placebo gel once daily for 12 weeks with a follow-up of 12 weeks. Safety and tolerability were monitored and pharmacodynamics and clinical efficacy of omiganan were assessed by analysing lesion count, size and viral load. Self-reported pain, itch and quality of life were assessed by an electronic diary and questionnaire. RESULTS Twenty-four AGW and 12 vulvar HSIL patients were enrolled. All patients had a high treatment adherence (99%). No serious adverse events occurred and all adverse events (n = 27) were mild, transient and self-limiting. The treatment groups were not different in terms of safety and tolerability, lesion count and size, and patient-reported outcomes pain, itch and quality of life. Human papillomavirus load significantly reduced after 12 weeks of treatment with omiganan compared to placebo (-96.6%; 95% confidence interval -99.9 to -7.4%; P = .045) in AGW patients only. CONCLUSION Topical omiganan appears to be safe in patients with AGW and vulvar HSIL and reduced human papillomavirus load after 12 weeks of treatment in AGW patients.
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Affiliation(s)
| | | | - Marina Todd
- Centre for Human Drug Research, Leiden, the Netherlands
| | | | - Stijn T P Kouwenhoven
- Department of Dermatology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Koen D Quint
- Department of Dermatology, Leiden University Medical Centre, Leiden, the Netherlands
| | | | | | | | - Jacobus Burggraaf
- Centre for Human Drug Research, Leiden, the Netherlands.,Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
| | - Robert Rissmann
- Centre for Human Drug Research, Leiden, the Netherlands.,Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
| | - Mariëtte I E van Poelgeest
- Centre for Human Drug Research, Leiden, the Netherlands.,Department of Gynecology, Leiden University Medical Centre, Leiden, the Netherlands
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9
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Elucidation of the mechanism of anti-herpes action of two novel semisynthetic cardenolide derivatives. Arch Virol 2020; 165:1385-1396. [PMID: 32346764 PMCID: PMC7188521 DOI: 10.1007/s00705-020-04562-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/22/2020] [Indexed: 12/18/2022]
Abstract
Human herpesviruses are among the most prevalent pathogens worldwide and have become an important public health issue. Recurrent infections and the emergence of resistant viral strains reinforce the need of searching new drugs to treat herpes virus infections. Cardiac glycosides are used clinically to treat cardiovascular disturbances, such as congestive heart failure and atrial arrhythmias. In recent years, they have sparked new interest in their potential anti-herpes action. It has been previously reported by our research group that two new semisynthetic cardenolides, namely C10 (3β-[(N-(2-hydroxyethyl)aminoacetyl]amino-3-deoxydigitoxigenin) and C11 (3β-(hydroxyacetyl)amino-3-deoxydigitoxigenin), exhibited potential anti-HSV-1 and anti-HSV-2 with selectivity index values > 1,000, comparable with those of acyclovir. This work reports the mechanism investigation of anti-herpes action of these derivatives. The results demonstrated that C10 and C11 interfere with the intermediate and final steps of HSV replication, but not with the early stages, since they completely abolished the expression of the UL42 (β) and gD (γ) proteins and partially reduced that of ICP27 (α). Additionally, they were not virucidal and had no prophylactic effects. Both compounds inhibited HSV replication at nanomolar concentrations, but cardenolide C10 was more active than C11 and can be considered as an anti-herpes drug candidate including against acyclovir-resistant HSV-1 strains.
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10
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Zhang S, Xu X, Liu Y, Xue R, Li C, Chen P, Zhang X, Liang J. Successful clearance of extensive/recalcitrant cutaneous warts by acitretin monotherapy: A case series study. Dermatol Ther 2020; 33:e13390. [PMID: 32268448 DOI: 10.1111/dth.13390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 02/25/2020] [Accepted: 04/04/2020] [Indexed: 11/30/2022]
Abstract
Most available options for the treatment of warts are limited by the potential for scarring, pain, lack of response, or recurrences, and the patients are often unable to tolerate and accept those experiences. The aim of this study was to evaluate the clinical efficacy and safety of oral systemic acitretin monotherapy in patients with extensive/recalcitrant cutaneous warts. The patients were given a dose of acitretin of 0.8 mg kg-1 day-1 , and the clinical efficacy and safety of acitretin was assessed every 2 weeks for 2 months. A total of 14 patients (12 males and 2 females) were included, with an age of 14-60 years (mean 33 ± 14.7 years) and a course of 4-48 months (mean 21.6 ± 13.4 months). After 2 months of acitretin treatment, 42.9% (6/14) of patients (including warts of the feet, legs, and hands) exhibited complete response, 28.6% (4/14) excellent response, and 28.6% (4/14) good response. All patients demonstrated significant improvement, and the drug was well tolerated, with no patients discontinuing therapy due to side effects. Common mild side effects included dry skin and cheilitis. There were no recurrences during a follow-up period of 6 months. Acitretin monotherapy is an effective, safe, and well-tolerated treatment for patients with extensive/recalcitrant cutaneous warts who are unsuitable for or unwilling to accept traditional treatment methods.
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Affiliation(s)
- Sanquan Zhang
- Institute of Dermatology, Guangzhou Medical University, Guangzhou, People's Republic of China.,Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, People's Republic of China
| | - Xiao Xu
- Institute of Dermatology, Guangzhou Medical University, Guangzhou, People's Republic of China.,Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, People's Republic of China
| | - Yumei Liu
- Institute of Dermatology, Guangzhou Medical University, Guangzhou, People's Republic of China.,Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, People's Republic of China
| | - Rujun Xue
- Institute of Dermatology, Guangzhou Medical University, Guangzhou, People's Republic of China.,Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, People's Republic of China
| | - Changxing Li
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Pingjiao Chen
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Xibao Zhang
- Institute of Dermatology, Guangzhou Medical University, Guangzhou, People's Republic of China.,Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, People's Republic of China
| | - Jingyao Liang
- Institute of Dermatology, Guangzhou Medical University, Guangzhou, People's Republic of China.,Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, People's Republic of China
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11
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Lozzi F, Lanna C, Mazzeo M, Garofalo V, Palumbo V, Mazzilli S, Diluvio L, Terrinoni A, Bianchi L, Campione E. Investigational drugs currently in phase II clinical trials for actinic keratosis. Expert Opin Investig Drugs 2019; 28:629-642. [PMID: 31232099 DOI: 10.1080/13543784.2019.1636030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Actinic keratoses (AKs) are limited areas of irregular epidermal growth on a background of excessive solar exposure. The entire sun-damaged skin is considered a field of cancerization with multiple visible and subclinical lesions. AK management requires field-directed therapies to block lesion relapse and prevent squamous cell carcinoma (SCC). AREAS COVERED In this review, we focused on phase II clinical trials for AKs, involving well-known agents and newer molecules such as proapoptotic drugs (VDA-1102, SR-T100, oleogel-S10, ICVT, eflornithine), immunomodulants (isotretinoin, tretinoin) and chemopreventive agents (nicotinamide, perillyl alcohol, liposomal T4N5). We used the website 'ClinicalTrials.Gov' as main reference. We selected and discussed completed and ongoing trials and analysed chemical structure and mechanism of action of the investigated molecules. EXPERT OPINION AK therapy should be tailored on the patient's profile considering first of all the age and site of the AKs, which are relevant parameters for local immune response. The new molecules could be combined to obtain a synergic effect blocking the different steps of skin tumorigenesis. Phase II trials highlight a new therapeutic opportunity to block selectively cell proliferation regulators and work both on the field of cancerization and on the AKs currently present.
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Affiliation(s)
- Flavia Lozzi
- a Department of Systems Medicine , University of Rome "Tor Vergata" , Rome , Italy
| | - Caterina Lanna
- a Department of Systems Medicine , University of Rome "Tor Vergata" , Rome , Italy
| | - Mauro Mazzeo
- a Department of Systems Medicine , University of Rome "Tor Vergata" , Rome , Italy
| | - Virginia Garofalo
- a Department of Systems Medicine , University of Rome "Tor Vergata" , Rome , Italy
| | - Vincenzo Palumbo
- a Department of Systems Medicine , University of Rome "Tor Vergata" , Rome , Italy
| | - Sara Mazzilli
- a Department of Systems Medicine , University of Rome "Tor Vergata" , Rome , Italy
| | - Laura Diluvio
- a Department of Systems Medicine , University of Rome "Tor Vergata" , Rome , Italy
| | - Alessandro Terrinoni
- b Department of Experimental Medicine and Biochemical Sciences , University of Rome "Tor Vergata" , Rome , Italy
| | - Luca Bianchi
- a Department of Systems Medicine , University of Rome "Tor Vergata" , Rome , Italy
| | - Elena Campione
- a Department of Systems Medicine , University of Rome "Tor Vergata" , Rome , Italy
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Rijsbergen M, Niemeyer-van der Kolk T, Hogendoorn G, Kouwenhoven S, Lemoine C, Klaassen ES, de Koning M, Beck S, Bouwes Bavinck JN, Feiss G, Burggraaf J, Rissmann R. A randomized controlled proof-of-concept trial of digoxin and furosemide in adults with cutaneous warts. Br J Dermatol 2019; 180:1058-1068. [PMID: 30580460 PMCID: PMC6850412 DOI: 10.1111/bjd.17583] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2018] [Indexed: 12/13/2022]
Abstract
Background Topical ionic contraviral therapy (ICVT) with digoxin and furosemide inhibits the potassium influx on which DNA viruses rely for replication. Therefore, ICVT was hypothesized to be a potential novel treatment for cutaneous warts. Objectives To assess the clinical efficacy, safety and tolerability of ICVT in adults with cutaneous warts. The secondary objective was to gain insight into the underlying working mechanism of ICVT. Methods Treatment with ICVT was assessed for efficacy, safety and tolerability in a single‐ centre, randomized, double‐blind, placebo‐controlled phase IIA trial. Eighty adult patients with at least two cutaneous warts (plantar or common) were randomized to one of four treatments: digoxin + furosemide (0·125%), digoxin (0·125%), furosemide (0·125%) or placebo. The gel was administered once daily for 42 consecutive days. Predefined statistical analysis was performed with a mixed‐model ancova. The trial was registered at ClinicalTrials.gov with number NCT02333643. Results Wart size and human papillomavirus (HPV) load reduction was achieved in all active treatment groups. A statistically significant reduction in wart diameter of all treated warts was shown in the digoxin + furosemide treatment group vs. placebo (−3·0 mm, 95% confidence interval −4·9 to −1·1, P = 0·002). There was a statistically significant reduction in the HPV load of all treated warts in the digoxin + furosemide group vs. placebo (−94%, 95% confidence interval −100 to −19, P = 0·03). With wart size reduction, histologically and immunohistochemically defined viral characteristics disappeared from partial and total responding warts. Conclusions This study demonstrates the proof of concept for the efficacy of topical ICVT in adults with cutaneous warts. What's already known about this topic? Cutaneous warts are caused by the human papillomavirus (HPV). Ionic contraviral therapy (ICVT) might be a potential treatment for cutaneous warts. A previous phase I/II open‐label study demonstrated the safety and efficacy of ICVT.
What does this study add? Proof of concept for the efficacy of topical ICVT in adults with cutaneous warts. Topical ICVT demonstrates a favourable safety profile, with the effects most pronounced when it is combined in a formulation for common warts. Wart size reduction was related to HPV load reduction measured by quantitative polymerase chain reaction (qPCR) in swabs. qPCR is a valuable disease biomarker for drug development in cutaneous warts.
https://doi.org/10.1111/bjd.17803 available online https://www.bjdonline.com/article/
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Affiliation(s)
- M Rijsbergen
- Center for Human Drug Research, Leiden, the Netherlands
| | | | - G Hogendoorn
- Center for Human Drug Research, Leiden, the Netherlands
| | - S Kouwenhoven
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
| | - C Lemoine
- Center for Human Drug Research, Leiden, the Netherlands
| | - E S Klaassen
- Center for Human Drug Research, Leiden, the Netherlands
| | - M de Koning
- DDL Diagnostic Laboratory, Rijswijk, the Netherlands
| | - S Beck
- DDL Diagnostic Laboratory, Rijswijk, the Netherlands
| | - J N Bouwes Bavinck
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
| | - G Feiss
- Cutanea Life Science, Wayne, PA, U.S.A
| | - J Burggraaf
- Center for Human Drug Research, Leiden, the Netherlands
| | - R Rissmann
- Center for Human Drug Research, Leiden, the Netherlands
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