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Ando Y, Noshi T, Sato K, Ishibashi T, Yoshida Y, Hasegawa T, Onishi M, Kitano M, Oka R, Kawai M, Yoshida R, Sato A, Shishido T, Naito A. Pharmacokinetic and pharmacodynamic analysis of baloxavir marboxil, a novel cap-dependent endonuclease inhibitor, in a murine model of influenza virus infection. J Antimicrob Chemother 2021; 76:189-198. [PMID: 33035324 PMCID: PMC7729387 DOI: 10.1093/jac/dkaa393] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 08/11/2020] [Indexed: 11/23/2022] Open
Abstract
Background Baloxavir acid, the active form of the orally available prodrug baloxavir marboxil, is a novel cap-dependent endonuclease inhibitor of influenza virus. Baloxavir marboxil has been shown to rapidly reduce virus titres compared with oseltamivir in clinical studies. Objectives We investigated the relationship between pharmacokinetic (PK) parameters and antiviral activity of baloxavir acid based on virus titre reduction in lungs of infected mice. Methods BALB/c mice infected with a sub-lethal dose of influenza A(H1N1), A(H1N1)pdm09, A(H3N2) or type B virus were treated on day 5 with oral baloxavir marboxil (0.5–50 mg/kg q12h), subcutaneous baloxavir acid (0.25–8 mg/kg/day), oseltamivir phosphate (5 or 50 eq mg/kg q12h) or other antivirals for 1 day. Lung virus titres were assessed 24 h after initial antiviral dosing. PK testing was performed at up to 24 h post-dosing of baloxavir marboxil or baloxavir acid in A/WSN/33-infected mice and the PK/pharmacodynamic (PD) relationship was evaluated for baloxavir acid. Results Oral baloxavir marboxil administration showed dose-dependent virus titre reductions in lungs of mice infected with the different types/subtypes of influenza viruses 24 h post-dosing. Baloxavir marboxil at 15 mg/kg q12h resulted in ≥100-fold and ≥10-fold reductions in influenza A and B virus titres, respectively, compared with oseltamivir phosphate. PK/PD analysis showed that the plasma concentration at the end of the dosing interval (Cτ) or the plasma concentration at 24 h after initial dosing (C24) was the PK parameter predicting the virus titres at 24 h post-dosing of baloxavir acid. Conclusions PK/PD analysis of baloxavir acid based on virus titre reduction in this mouse model could be helpful in predicting and maximizing virological outcomes in clinical settings.
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Affiliation(s)
- Yoshinori Ando
- Shionogi Pharmaceutical Research Center, Shionogi & Co., Ltd, 3-1-1, Futaba-cho, Toyonaka, Osaka 561-0825, Japan
| | - Takeshi Noshi
- Shionogi Pharmaceutical Research Center, Shionogi & Co., Ltd, 3-1-1, Futaba-cho, Toyonaka, Osaka 561-0825, Japan
| | - Kenji Sato
- Shionogi Pharmaceutical Research Center, Shionogi & Co., Ltd, 3-1-1, Futaba-cho, Toyonaka, Osaka 561-0825, Japan
| | - Toru Ishibashi
- Project Management Department, Shionogi & Co., Ltd, 12F, Hankyu Terminal Bldg, 1-4, Shibata 1-chome, Kita-ku, Osaka 530-0012, Japan
| | - Yuki Yoshida
- Data Science Office, Shionogi & Co., Ltd, 12F, Hankyu Terminal Bldg, 1-4, Shibata 1-chome, Kita-ku, Osaka 530-0012, Japan
| | - Takahiro Hasegawa
- Biostatistics Center, Shionogi & Co., Ltd, 12F, Hankyu Terminal Bldg, 1-4, Shibata 1-chome, Kita-ku, Osaka 530-0012, Japan
| | - Motoyasu Onishi
- Shionogi Pharmaceutical Research Center, Shionogi & Co., Ltd, 3-1-1, Futaba-cho, Toyonaka, Osaka 561-0825, Japan
| | - Mitsutaka Kitano
- Shionogi Pharmaceutical Research Center, Shionogi & Co., Ltd, 3-1-1, Futaba-cho, Toyonaka, Osaka 561-0825, Japan
| | - Ryoko Oka
- Shionogi Pharmaceutical Research Center, Shionogi & Co., Ltd, 3-1-1, Futaba-cho, Toyonaka, Osaka 561-0825, Japan
| | - Makoto Kawai
- Shionogi Pharmaceutical Research Center, Shionogi & Co., Ltd, 3-1-1, Futaba-cho, Toyonaka, Osaka 561-0825, Japan
| | - Ryu Yoshida
- Shionogi Pharmaceutical Research Center, Shionogi & Co., Ltd, 3-1-1, Futaba-cho, Toyonaka, Osaka 561-0825, Japan
| | - Akihiko Sato
- Shionogi Pharmaceutical Research Center, Shionogi & Co., Ltd, 3-1-1, Futaba-cho, Toyonaka, Osaka 561-0825, Japan
| | - Takao Shishido
- Shionogi Pharmaceutical Research Center, Shionogi & Co., Ltd, 3-1-1, Futaba-cho, Toyonaka, Osaka 561-0825, Japan
| | - Akira Naito
- Shionogi Pharmaceutical Research Center, Shionogi & Co., Ltd, 3-1-1, Futaba-cho, Toyonaka, Osaka 561-0825, Japan
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Fukao K, Ando Y, Noshi T, Kitano M, Noda T, Kawai M, Yoshida R, Sato A, Shishido T, Naito A. Baloxavir marboxil, a novel cap-dependent endonuclease inhibitor potently suppresses influenza virus replication and represents therapeutic effects in both immunocompetent and immunocompromised mouse models. PLoS One 2019; 14:e0217307. [PMID: 31107922 PMCID: PMC6527232 DOI: 10.1371/journal.pone.0217307] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 05/08/2019] [Indexed: 02/06/2023] Open
Abstract
Baloxavir marboxil (BXM) is an orally available small molecule inhibitor of cap-dependent endonuclease (CEN), an essential enzyme in the initiation of mRNA synthesis of influenza viruses. In the present study, we evaluated the efficacy of BXM against influenza virus infection in mouse models. Single-day oral administration of BXM completely prevented mortality due to infection with influenza A and B virus in mice. Moreover, 5-day repeated administration of BXM was more effective for reducing mortality and body weight loss in mice infected with influenza A virus than oseltamivir phosphate (OSP), even when the treatment was delayed up to 96 hours post infection (p.i.). Notably, administration of BXM, starting at 72 hours p.i. led to significant decrease in virus titers of >2-log10 reduction compared to the vehicle control within 24 hours after administration. Virus reduction in the lung was significantly greater than that observed with OSP. In addition, profound and sustained reduction of virus titer was observed in the immunocompromised mouse model without emergence of variants possessing treatment-emergent amino acid substitutions in the target protein. In our immunocompetent and immunocompromised mouse models, delayed treatment with BXM resulted in rapid and potent reduction in infectious virus titer and prevention of signs of influenza infection, suggesting that BXM could extend the therapeutic window for patients with influenza virus infection regardless of the host immune status.
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Affiliation(s)
| | | | | | | | - Takahiro Noda
- Shionogi Techno Advance Research Co., Ltd., Osaka, Japan
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Marathe BM, Mostafa HH, Vogel P, Pascua PNQ, Jones JC, Russell CJ, Webby RJ, Govorkova EA. A pharmacologically immunosuppressed mouse model for assessing influenza B virus pathogenicity and oseltamivir treatment. Antiviral Res 2017; 148:20-31. [PMID: 29100887 DOI: 10.1016/j.antiviral.2017.10.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 09/26/2017] [Accepted: 10/30/2017] [Indexed: 01/19/2023]
Abstract
Immunocompromised patients are highly susceptible to influenza virus infections. Although neuraminidase inhibitor (NAI) therapy has proved effective in these patients, the treatment regimens require optimization, which can be partly addressed via animal models. Here, we describe a pharmacologically immunosuppressed mouse model for studying the pathogenesis of influenza B viruses and evaluating the efficacy of antiviral treatment. We modeled clinical regimens for dexamethasone and cyclophosphamide to immunosuppress BALB/c mice that were then inoculated with B/Phuket/3073/2013 (Yamagata lineage) or B/Brisbane/60/2008 (BR/08, Victoria lineage) virus. Although both viruses caused morbidity and mortality in immunosuppressed mice, BR/08 was more virulent, consistently inducing greater morbidity and 100% lethality in mice inoculated with at least 103 TCID50/mouse. The replication of both viruses was prolonged in the lungs of immunosuppressed mice, but the extent of pulmonary inflammation in these mice was markedly less than that in immunocompetent animals. Most of the examined cytokines, including IFN-γ, IL-1β, and RANTES, were significantly decreased in the lungs of immunosuppressed mice, as compared to immunocompetent animals, until at least 10 days post-infection. Treatment with the NAI oseltamivir for 8 or 16 days increased the mean survival time and reduced virus spread in the lungs of immunosuppressed mice challenged with a lethal dose of BR/08 but did not completely provide protection or decrease the virus titers. Our data suggests that the synergy of the viral load and aberrant immune responses is a key contributor to the severity of infection, as well as the limited efficacy of oseltamivir, which in immunosuppressed mice curtails virus release without clearing infected cells.
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Affiliation(s)
- Bindumadhav M Marathe
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Heba H Mostafa
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Peter Vogel
- Veterinary Pathology Core, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Philippe Noriel Q Pascua
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Jeremy C Jones
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Charles J Russell
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Richard J Webby
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Elena A Govorkova
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN 38105, USA.
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Nakamura S, Miyazaki T, Izumikawa K, Kakeya H, Saisho Y, Yanagihara K, Miyazaki Y, Mukae H, Kohno S. Efficacy and Safety of Intravenous Peramivir Compared With Oseltamivir in High-Risk Patients Infected With Influenza A and B Viruses: A Multicenter Randomized Controlled Study. Open Forum Infect Dis 2017; 4:ofx129. [PMID: 28761899 PMCID: PMC5534217 DOI: 10.1093/ofid/ofx129] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 06/16/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Clinical studies comparing the different neuraminidase inhibitors for treatment of at-risk patients with influenza have not been performed. To optimize such treatments, we assessed the efficacy and safety of intravenous peramivir compared with oral oseltamivir in treating seasonal influenza A or B virus infection. METHODS A multicenter, randomized, controlled clinical trial was conducted from December 2012 to May 2014 in high-risk patients infected with seasonal influenza. A total of 92 adult inpatients and outpatients with high risk factors (HRFs) were treated by either a single intravenous infusion of peramivir (600 mg) or oral administration of oseltamivir (75 mg, twice per day for 5 days). RESULTS The median times to clinical stability (time to reach <37°C) were 40.0 hours (95% confidence interval [CI] = 23.3-64.5) and 37.8 hours (95% CI = 26.3-45.3) in the peramivir and oseltamivir groups, respectively; these values did not reveal a significant difference. The virus titer and change of mean total symptom scores decreased similarly with both treatments. Results of step-wise regression suggested that virus type was a significantly effective prognostic factor with respect to illness resolution. Adverse events (AEs) with peramivir and oseltamivir occurred in 2.2% (n = 1/46) and 13.0% (n = 6/46) of patients, respectively. The severity of AEs was mild in all cases except 2 patients who showed pneumonia or COPD aggravation; both were in the oseltamivir group. CONCLUSIONS Intravenous peramivir was effective based on the result of direct comparison with oral oseltamivir. Thus our data show that peramivir is a useful option for the treatment of influenza-infected patients with HRFs.
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Affiliation(s)
- Shigeki Nakamura
- Department of Respiratory Diseases, Nagasaki University Hospital
- Department of Chemotherapy and Mycoses, National Institute of Infectious Diseases, Tokyo, Japan
| | - Taiga Miyazaki
- Department of Respiratory Diseases, Nagasaki University Hospital
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences
| | - Koichi Izumikawa
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences
| | - Hiroshi Kakeya
- Department of Infection Control Science, Graduate School of Medicine, Osaka City University
| | | | - Katsunori Yanagihara
- Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, and
| | - Yoshitsugu Miyazaki
- Department of Chemotherapy and Mycoses, National Institute of Infectious Diseases, Tokyo, Japan
| | - Hiroshi Mukae
- Department of Respiratory Diseases, Nagasaki University Hospital
| | - Shigeru Kohno
- Department of Respiratory Diseases, Nagasaki University Hospital
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5
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Li Z, Li R, Li J, Xie H, Hao Y, Du Q, Chen T, Li Y, Chen R, Yang Z, Zhong N. Efficacy of delayed treatment of China-made Peramivir with repeated intravenous injections in a mouse influenza model: from clinical experience to basal experiment. BMC Infect Dis 2016; 16:325. [PMID: 27392915 PMCID: PMC4939023 DOI: 10.1186/s12879-016-1589-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Accepted: 05/21/2016] [Indexed: 11/26/2022] Open
Abstract
Background China-made Peramivir, an anti-influenza neuraminidase inhibitor drug, is manufactured and widely used in China. Although effective if initiated within 48 h of the onset of symptoms, yet we observed that this drug shows an inconclusive efficacy if treatment is delayed in clinical. Thus we evaluated the efficacy of delayed treatment of China-made Peramivir in a mouse model. Methods The mouse model of influenza infection was made and Peramivir was administered intravenously for 5 days following infection, and weight loss, lung index, viral shedding and survival rates were monitored. Results Peramivir (60 mg/kg · d, repeated intravenous injections, quaque die (QD) × 5 days) enhanced survival rate and suppressed weight loss when treatment was initiated 24, 36, 48, or even 60 h post-infection (p.i.) (p < 0.01), compared with the virus-untreated group, and efficacy was abolished at 72 h p.i.. However the efficacy of delayed treatment was dose dependent, with the highest dose (90 mg/kg · d) even showing efficacy at 72 h p.i.. Furthermore, Peramivir (60 mg/kg · d, repeated intravenous injections, QD × 5 days) also reduced the lung virus titer 24 and 36 h p.i. on day 5, and even at 48 and 60 h p.i. on day 7 after infection, and the lung index was also improved. What is interesting that the concentration of the drug was maintained in blood after infected. Conclusions Delayed treatment with China-made Peramivir can reduce the severity of influenza disease, accelerate viral clearance and enhance the survival rate. This drug therefore shows good efficacy and is a promising candidate to control the influenza epidemic in China.
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Affiliation(s)
- Zhengtu Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated hospital of Guangzhou Medical University, (Guangzhou Medical University), Guangzhou, 510120, People's Republic of China
| | - Runfeng Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated hospital of Guangzhou Medical University, (Guangzhou Medical University), Guangzhou, 510120, People's Republic of China
| | - Jing Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated hospital of Guangzhou Medical University, (Guangzhou Medical University), Guangzhou, 510120, People's Republic of China
| | - Hui Xie
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated hospital of Guangzhou Medical University, (Guangzhou Medical University), Guangzhou, 510120, People's Republic of China
| | - Yanbing Hao
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated hospital of Guangzhou Medical University, (Guangzhou Medical University), Guangzhou, 510120, People's Republic of China
| | - Qiuling Du
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated hospital of Guangzhou Medical University, (Guangzhou Medical University), Guangzhou, 510120, People's Republic of China
| | - Tingting Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated hospital of Guangzhou Medical University, (Guangzhou Medical University), Guangzhou, 510120, People's Republic of China
| | - Yimin Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated hospital of Guangzhou Medical University, (Guangzhou Medical University), Guangzhou, 510120, People's Republic of China
| | - Rongchang Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated hospital of Guangzhou Medical University, (Guangzhou Medical University), Guangzhou, 510120, People's Republic of China.
| | - Zifeng Yang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated hospital of Guangzhou Medical University, (Guangzhou Medical University), Guangzhou, 510120, People's Republic of China. .,Macau University of Science and Technology, Avenida Wai Long, Taipa, Macau, 519020, People's Republic of China.
| | - Nanshan Zhong
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated hospital of Guangzhou Medical University, (Guangzhou Medical University), Guangzhou, 510120, People's Republic of China.,Macau University of Science and Technology, Avenida Wai Long, Taipa, Macau, 519020, People's Republic of China
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Abstract
Oseltamivir is recommended for the treatment and prophylaxis of influenza in persons at higher risk for influenza complications such as individuals with diabetes, neuropsychiatric illnesses, and respiratory, cardiac, renal, hepatic or haematological diseases. However, a recent Cochrane review reported that reduction of antibody production, renal disorders, hyperglycaemia, psychiatric disorders, and QT prolongation may be related to oseltamivir use. The underlying mechanisms are reviewed. There is decisive evidence that administration of a clinically compatible dose of oseltamivir in mice challenged by a respiratory syncytial virus (RSV) that lacks a neuraminidase gene showed symptom-relieving effects and inhibition of viral clearance. These effects were accompanied by decreased level of T cell surface sialoglycosphingolipid (ganglioside) GM1 that is regulated by the endogenous neuraminidase in response to viral challenge. Clinical and non-clinical evidence supports the view that the usual dose of oseltamivir suppresses pro-inflammatory cytokines such as interferon-gamma, interleukin-6, and tumour necrosis factor-alpha almost completely with partial suppression of viral shedding in human influenza virus infection experiment. Animal toxicity tests support the clinical evidence with regard to renal and cardiac disorders (bradycardia and QT prolongation) and do not disprove the metabolic effect. Reduction of antibody production and cytokine induction and renal, metabolic, cardiac, and prolonged psychiatric disorders after oseltamivir use may be related to inhibition of the host’s endogenous neuraminidase. While the usual clinical dose of zanamivir may not have this effect, a higher dose or prolonged administration of zanamivir and other neuraminidase inhibitors may induce similar delayed reactions, including reduction of the antibody and/or cytokine production.
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Affiliation(s)
- Rokuro Hama
- a Non-Profit Organization, Japan Institute of Pharmacovigilance , Osaka , Japan
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7
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Alame MM, Massaad E, Zaraket H. Peramivir: A Novel Intravenous Neuraminidase Inhibitor for Treatment of Acute Influenza Infections. Front Microbiol 2016; 7:450. [PMID: 27065996 PMCID: PMC4815007 DOI: 10.3389/fmicb.2016.00450] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 03/21/2016] [Indexed: 12/20/2022] Open
Abstract
Peramivir is a novel cyclopentane neuraminidase inhibitor of influenza virus. It was approved by the Food and Drug Administration in December 2014 for treatment of acute uncomplicated influenza in patients 18 years and older. For several months prior to approval, the drug was made clinically available under Emergency Use authorization during the 2009 H1N1 influenza pandemic. Peramivir is highly effective against human influenza A and B isolates as well as emerging influenza virus strains with pandemic potential. Clinical trials demonstrated that the drug is well-tolerated in adult and pediatric populations. Adverse events are generally mild to moderate and similar in frequency to patients receiving placebo. Common side effects include gastrointestinal disorders and decreased neutrophil counts but are self-limiting. Peramivir is administered as a single-dose via the intravenous route providing a valuable therapeutic alternative for critically ill patients or those unable to tolerate other administration routes. Successful clinical trials and post-marketing data in pediatric populations in Japan support the safety and efficacy of peramivir in this population where administration of other antivirals might not be feasible.
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Affiliation(s)
- Malak M Alame
- The School of Pharmacy, Lebanese International University Beirut, Lebanon
| | - Elie Massaad
- Department of Experimental Pathology, Immunology, and Microbiology, Faculty of Medicine, American University of Beirut Beirut, Lebanon
| | - Hassan Zaraket
- Department of Experimental Pathology, Immunology, and Microbiology, Faculty of Medicine, American University of BeirutBeirut, Lebanon; Center for Infectious Diseases Research, Faculty of Medicine, American University of BeirutBeirut, Lebanon
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Onishi M, Kitano M, Taniguchi K, Homma T, Kobayashi M, Yoshinaga T, Naito A, Sato A. Intravenous peramivir inhibits viral replication, and leads to bacterial clearance and prevention of mortality during murine bacterial co-infection caused by influenza A(H1N1)pdm09 virus and Streptococcus pneumoniae. Antiviral Res 2015; 117:52-9. [PMID: 25752738 DOI: 10.1016/j.antiviral.2015.02.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 02/25/2015] [Accepted: 02/27/2015] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Influenza virus infection increases susceptibility to bacterial infection and mortality in humans. Although the efficacy of approved intravenous peramivir, a neuraminidase (NA) inhibitor, against influenza virus infection has been reported, its efficacy against bacterial co-infection, which occurs during the period of viral shedding, was not fully investigated. To further understand the significance of treatment with peramivir, we assessed the efficacy of peramivir against a bacterial co-infection model in mice caused by clinically isolated influenza A(H1N1)pdm09 virus and Streptococcus pneumoniae. METHODS Mice were infected with influenza A(H1N1)pdm09. Peramivir was intravenously administered after the viral infection. At 2days post viral infection, the mice were infected with S. pneumoniae. Peramivir efficacy was measured by the survival rates and viral titers, bacterial titers, or proinflammatory cytokine concentrations in lung homogenates. RESULTS Peramivir treatment reduced the mortality of mice infected with influenza virus and S. pneumoniae. The survival rate in the peramivir-treated group was significantly higher than that in the oseltamivir-treated group. Viral titers and proinflammatory cytokine responses in the peramivir-treated group were significantly lower than those in the oseltamivir-treated group until at 2days post viral infection. Bacterial titer was significantly lower in the peramivir-treated group than in the oseltamivir-treated group at 4days post viral infection. CONCLUSION These results demonstrated that peramivir inhibits viral replication, consequently leading to bacterial clearance and prevention of mortality during severe murine bacterial co-infection, which occurs during the period of viral shedding, with the efficacy of peramivir being superior to that of oseltamivir.
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Affiliation(s)
- Motoyasu Onishi
- Infectious Diseases, Discovery Research Laboratory for Core Therapeutic Area, Shionogi & Co., Ltd., Osaka, Japan.
| | - Mitsutaka Kitano
- Infectious Diseases, Discovery Research Laboratory for Core Therapeutic Area, Shionogi & Co., Ltd., Osaka, Japan
| | - Keiichi Taniguchi
- Infectious Diseases, Discovery Research Laboratory for Core Therapeutic Area, Shionogi & Co., Ltd., Osaka, Japan
| | - Tomoyuki Homma
- Infectious Diseases, Discovery Research Laboratory for Core Therapeutic Area, Shionogi & Co., Ltd., Osaka, Japan
| | - Masanori Kobayashi
- Infectious Diseases, Discovery Research Laboratory for Core Therapeutic Area, Shionogi & Co., Ltd., Osaka, Japan
| | - Tomokazu Yoshinaga
- Infectious Diseases, Discovery Research Laboratory for Core Therapeutic Area, Shionogi & Co., Ltd., Osaka, Japan
| | - Akira Naito
- Infectious Diseases, Discovery Research Laboratory for Core Therapeutic Area, Shionogi & Co., Ltd., Osaka, Japan
| | - Akihiko Sato
- Infectious Diseases, Discovery Research Laboratory for Core Therapeutic Area, Shionogi & Co., Ltd., Osaka, Japan
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9
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Onishi M, Ozasa K, Kobiyama K, Ohata K, Kitano M, Taniguchi K, Homma T, Kobayashi M, Sato A, Katakai Y, Yasutomi Y, Wijaya E, Igarashi Y, Nakatsu N, Ise W, Inoue T, Yamada H, Vandenbon A, Standley DM, Kurosaki T, Coban C, Aoshi T, Kuroda E, Ishii KJ. Hydroxypropyl-β-cyclodextrin spikes local inflammation that induces Th2 cell and T follicular helper cell responses to the coadministered antigen. THE JOURNAL OF IMMUNOLOGY 2015; 194:2673-82. [PMID: 25681338 DOI: 10.4049/jimmunol.1402027] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cyclodextrins are commonly used as a safe excipient to enhance the solubility and bioavailability of hydrophobic pharmaceutical agents. Their efficacies and mechanisms as drug-delivery systems have been investigated for decades, but their immunological properties have not been examined. In this study, we reprofiled hydroxypropyl-β-cyclodextrin (HP-β-CD) as a vaccine adjuvant and found that it acts as a potent and unique adjuvant. HP-β-CD triggered the innate immune response at the injection site, was trapped by MARCO(+) macrophages, increased Ag uptake by dendritic cells, and facilitated the generation of T follicular helper cells in the draining lymph nodes. It significantly enhanced Ag-specific Th2 and IgG Ab responses as potently as did the conventional adjuvant, aluminum salt (alum), whereas its ability to induce Ag-specific IgE was less than that of alum. At the injection site, HP-β-CD induced the temporary release of host dsDNA, a damage-associated molecular pattern. DNase-treated mice, MyD88-deficient mice, and TBK1-deficient mice showed significantly reduced Ab responses after immunization with this adjuvant. Finally, we demonstrated that HP-β-CD-adjuvanted influenza hemagglutinin split vaccine protected against a lethal challenge with a clinically isolated pandemic H1N1 influenza virus, and the adjuvant effect of HP-β-CD was demonstrated in cynomolgus macaques. Our results suggest that HP-β-CD acts as a potent MyD88- and TBK1-dependent T follicular helper cell adjuvant and is readily applicable to various vaccines.
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Affiliation(s)
- Motoyasu Onishi
- Laboratory of Adjuvant Innovation, National Institute of Biomedical Innovation, Osaka 567-0085, Japan; Laboratory of Vaccine Science, Immunology Frontier Research Center, World Premier Institute, Osaka University, Osaka 565-0871, Japan; Infectious Diseases, Medicinal Research Laboratories, Shionogi & Co., Ltd., Osaka 561-0825, Japan
| | - Koji Ozasa
- Laboratory of Adjuvant Innovation, National Institute of Biomedical Innovation, Osaka 567-0085, Japan
| | - Kouji Kobiyama
- Laboratory of Adjuvant Innovation, National Institute of Biomedical Innovation, Osaka 567-0085, Japan; Laboratory of Vaccine Science, Immunology Frontier Research Center, World Premier Institute, Osaka University, Osaka 565-0871, Japan
| | - Keiichi Ohata
- Laboratory of Adjuvant Innovation, National Institute of Biomedical Innovation, Osaka 567-0085, Japan; Laboratory of Vaccine Science, Immunology Frontier Research Center, World Premier Institute, Osaka University, Osaka 565-0871, Japan
| | - Mitsutaka Kitano
- Infectious Diseases, Medicinal Research Laboratories, Shionogi & Co., Ltd., Osaka 561-0825, Japan
| | - Keiichi Taniguchi
- Infectious Diseases, Medicinal Research Laboratories, Shionogi & Co., Ltd., Osaka 561-0825, Japan
| | - Tomoyuki Homma
- Infectious Diseases, Medicinal Research Laboratories, Shionogi & Co., Ltd., Osaka 561-0825, Japan
| | - Masanori Kobayashi
- Infectious Diseases, Medicinal Research Laboratories, Shionogi & Co., Ltd., Osaka 561-0825, Japan
| | - Akihiko Sato
- Infectious Diseases, Medicinal Research Laboratories, Shionogi & Co., Ltd., Osaka 561-0825, Japan
| | - Yuko Katakai
- Corporation for the Production and Research of Laboratory Primates, Tsukuba, Ibaraki 305-0843, Japan
| | - Yasuhiro Yasutomi
- Tsukuba Primate Research Center, National Institute of Biomedical Innovation, Tsukuba, Ibaraki 305-0843, Japan
| | - Edward Wijaya
- System Immunology Laboratory, Immunology Frontier Research Center, World Premier Institute, Osaka University, Osaka 565-0871, Japan
| | - Yoshinobu Igarashi
- Toxicogenomics Project, National Institute of Biomedical Innovation, Osaka 567-0085, Japan
| | - Noriyuki Nakatsu
- Toxicogenomics Project, National Institute of Biomedical Innovation, Osaka 567-0085, Japan
| | - Wataru Ise
- Laboratory of Lymphocyte Differentiation, Immunology Frontier Research Center, World Premier Institute, Osaka University, Osaka 565-0871, Japan
| | - Takeshi Inoue
- Laboratory of Lymphocyte Differentiation, Immunology Frontier Research Center, World Premier Institute, Osaka University, Osaka 565-0871, Japan
| | - Hiroshi Yamada
- Toxicogenomics Project, National Institute of Biomedical Innovation, Osaka 567-0085, Japan
| | - Alexis Vandenbon
- System Immunology Laboratory, Immunology Frontier Research Center, World Premier Institute, Osaka University, Osaka 565-0871, Japan
| | - Daron M Standley
- System Immunology Laboratory, Immunology Frontier Research Center, World Premier Institute, Osaka University, Osaka 565-0871, Japan
| | - Tomohiro Kurosaki
- Laboratory of Lymphocyte Differentiation, Immunology Frontier Research Center, World Premier Institute, Osaka University, Osaka 565-0871, Japan; Laboratory for Lymphocyte Differentiation, RIKEN Center for Integrative Medical Sciences, Kanagawa 230-0045, Japan; and
| | - Cevayir Coban
- Laboratory of Malaria Immunology, Immunology Frontier Research Center, World Premier Institute, Osaka University, Osaka 565-0871, Japan
| | - Taiki Aoshi
- Laboratory of Adjuvant Innovation, National Institute of Biomedical Innovation, Osaka 567-0085, Japan; Laboratory of Vaccine Science, Immunology Frontier Research Center, World Premier Institute, Osaka University, Osaka 565-0871, Japan
| | - Etsushi Kuroda
- Laboratory of Adjuvant Innovation, National Institute of Biomedical Innovation, Osaka 567-0085, Japan; Laboratory of Vaccine Science, Immunology Frontier Research Center, World Premier Institute, Osaka University, Osaka 565-0871, Japan
| | - Ken J Ishii
- Laboratory of Adjuvant Innovation, National Institute of Biomedical Innovation, Osaka 567-0085, Japan; Laboratory of Vaccine Science, Immunology Frontier Research Center, World Premier Institute, Osaka University, Osaka 565-0871, Japan;
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10
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Liu B, Zhang X, Deng W, Liu J, Li H, Wen M, Bao L, Qu J, Liu Y, Li F, An Y, Qin C, Cao B, Wang C. Severe influenza A(H1N1)pdm09 infection induces thymic atrophy through activating innate CD8(+)CD44(hi) T cells by upregulating IFN-γ. Cell Death Dis 2014; 5:e1440. [PMID: 25275588 PMCID: PMC4649502 DOI: 10.1038/cddis.2014.323] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 07/02/2014] [Accepted: 07/02/2014] [Indexed: 11/12/2022]
Abstract
Thymic atrophy has been described as a consequence of infection by several pathogens including highly pathogenic avian influenza virus and is induced through diverse mechanisms. However, whether influenza A(H1N1)pdm09 infection induces thymic atrophy and the mechanisms underlying this process have not been completely elucidated. Our results show that severe infection of influenza A(H1N1)pdm09 led to progressive thymic atrophy and CD4+CD8+ double-positive (DP) T-cells depletion due to apoptosis. The viruses were present in thymus, where they activated thymic innate CD8+CD44hi single-positive (SP) thymocytes to secrete a large amount of IFN-γ. Milder thymic atrophy was observed in innate CD8+ T-cell-deficient mice (C57BL/6J). Neutralization of IFN-γ could significantly rescue the atrophy, but peramivir treatment did not significantly alleviate thymic atrophy. In this study, we demonstrated that thymic innate CD8+CD44hi SP T-cells have critical roles in influenza A(H1N1)pdm09 infection-induced thymic atrophy through secreting IFN-γ. This exceptional mechanism might serve as a target for the prevention and treatment of thymic atrophy induced by influenza A(H1N1)pdm09.
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Affiliation(s)
- B Liu
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China
| | - X Zhang
- Department of Immunology, School of Basic Medical Sciences, Capital Medical University, Beijing, China
| | - W Deng
- Institute of Laboratory Animal Sciences, Chinese Academy of Medical Sciences, Beijing, China
| | - J Liu
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention (China CDC), Beijing, China
| | - H Li
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China
| | - M Wen
- Department of Immunology, School of Basic Medical Sciences, Capital Medical University, Beijing, China
| | - L Bao
- Institute of Laboratory Animal Sciences, Chinese Academy of Medical Sciences, Beijing, China
| | - J Qu
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China
| | - Y Liu
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China
| | - F Li
- Institute of Laboratory Animal Sciences, Chinese Academy of Medical Sciences, Beijing, China
| | - Y An
- Department of Immunology, School of Basic Medical Sciences, Capital Medical University, Beijing, China
| | - C Qin
- Institute of Laboratory Animal Sciences, Chinese Academy of Medical Sciences, Beijing, China
| | - B Cao
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China
| | - C Wang
- 1] Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China [2] Department of Respiratory Medicine, Capital Medical University, Beijing, China [3] Beijing Institute of Respiratory Medicine, Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, China [4] Beijing Institute of Respiratory Medicine, Beijing Hospital, Ministry of Heath, P. R. China, Beijing, China
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11
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Efficacy of repeated intravenous administration of peramivir against highly pathogenic avian influenza A (H5N1) virus in cynomolgus macaques. Antimicrob Agents Chemother 2014; 58:4795-803. [PMID: 24913156 DOI: 10.1128/aac.02817-14] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Highly pathogenic avian influenza A (H5N1) viruses cause severe and often fatal disease in humans. We evaluated the efficacy of repeated intravenous dosing of the neuraminidase inhibitor peramivir against highly pathogenic avian influenza virus A/Vietnam/UT3040/2004 (H5N1) infection in cynomolgus macaques. Repeated dosing of peramivir (30 mg/kg/day once a day for 5 days) starting immediately after infection significantly reduced viral titers in the upper respiratory tract, body weight loss, and cytokine production and resulted in a significant body temperature reduction in infected macaques compared with that of macaques administered a vehicle (P < 0.05). Repeated administration of peramivir starting at 24 h after infection also resulted in a reduction in viral titers and a reduction in the period of virus detection in the upper respiratory tract, although the body temperature change was not statistically significant. The macaque model used in the present study demonstrated that inhibition of viral replication at an early time point after infection by repeated intravenous treatment with peramivir is critical for reduction of the production of cytokines, i.e., interleukin-6 (IL-6), tumor necrosis factor α, gamma interferon, monocyte chemotactic protein 1, and IL-12p40, resulting in amelioration of symptoms caused by highly pathogenic avian influenza virus infection.
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12
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Tanaka A, Nakamura S, Seki M, Iwanaga N, Kajihara T, Kitano M, Homma T, Kurihara S, Imamura Y, Miyazaki T, Izumikawa K, Kakeya H, Yanagihara K, Kohno S. The effect of intravenous peramivir, compared with oral oseltamivir, on the outcome of post-influenza pneumococcal pneumonia in mice. Antivir Ther 2014; 20:11-9. [PMID: 24517996 DOI: 10.3851/imp2744] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Pneumococcal pneumonia often occurs secondary to influenza infection and accounts for a large proportion of the morbidity and mortality associated with seasonal and pandemic influenza outbreaks. Peramivir is a novel, intravenous neuraminidase inhibitor that exhibits potent antiviral activity against influenza A and B viruses. We investigated the efficacy of peramivir for modulating the severity of secondary pneumococcal pneumonia. METHODS CBA/JNCrlj mice, infected with influenza virus and superinfected with Streptococcus pneumoniae, were treated with either intravenous peramivir (single or multiple doses of 60 mg/kg/day) or oral oseltamivir at doses of 10 or 40 mg/kg/day in divided doses. The survival rate, viable bacterial count and virus titre in the lungs, as well as cytokine/chemokine concentration and histopathological findings were compared between both groups. RESULTS The median duration of survival of coinfected mice was significantly prolonged by treatment with multiple doses of peramivir, relative to mice treated with oseltamivir at either dose. Viable bacterial counts and virus titres in the lungs were significantly reduced by intravenous peramivir treatment compared with no treatment or oral oseltamivir treatment. The production of inflammatory cytokines/chemokines was also significantly suppressed by multiple dosing of peramivir compared with oseltamivir. Increased survival appeared to be mediated by decreased inflammation, manifested as lower levels of inflammatory cells and proinflammatory cytokines in the lungs and less severe histopathological findings. The lungs of mice treated with multiple doses of peramivir showed mild inflammatory changes compared to oseltamivir. CONCLUSIONS This study demonstrated that a multiple-dose regimen of intravenous peramivir was more efficacious than a single peramivir dose or multiple doses of oseltamivir for improving outcomes in pneumococcal pneumonia following influenza virus infection in mice.
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Affiliation(s)
- Akitaka Tanaka
- Department of Molecular Microbiology and Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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13
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De Clercq E. Dancing with chemical formulae of antivirals: A panoramic view (Part 2). Biochem Pharmacol 2013; 86:1397-410. [DOI: 10.1016/j.bcp.2013.09.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 09/12/2013] [Accepted: 09/12/2013] [Indexed: 12/11/2022]
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