1
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Bastard P, Galerne A, Lefevre-Utile A, Briand C, Baruchel A, Durand P, Landman-Parker J, Gouache E, Boddaert N, Moshous D, Gaudelus J, Cohen R, Deschenes G, Fischer A, Blanche S, de Pontual L, Neven B. Different Clinical Presentations and Outcomes of Disseminated Varicella in Children With Primary and Acquired Immunodeficiencies. Front Immunol 2021; 11:595478. [PMID: 33250898 PMCID: PMC7674974 DOI: 10.3389/fimmu.2020.595478] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 10/09/2020] [Indexed: 11/13/2022] Open
Abstract
Primary infection with varicella-zoster virus (VZV) causes chickenpox, a benign and self-limited disease in healthy children. In patients with primary or acquired immunodeficiencies, primary infection can be life-threatening, due to rapid dissemination of the virus to various organs [lung, gastrointestinal tract, liver, eye, central nervous system (CNS)]. We retrospectively described and compared the clinical presentations and outcomes of disseminated varicella infection (DV) in patients with acquired (AID) (n= 7) and primary (PID) (n= 12) immunodeficiencies. Patients with AID were on immunosuppression (mostly steroids) for nephrotic syndrome, solid organ transplantation or the treatment of hemopathies, whereas those with PID had combined immunodeficiency (CID) or severe CID (SCID). The course of the disease was severe and fulminant in patients with AID, with multiple organ failure, no rash or a delayed rash, whereas patients with CID and SICD presented typical signs of chickenpox, including a rash, with dissemination to other organs, including the lungs and CNS. In the PID group, antiviral treatment was prolonged until immune reconstitution after bone marrow transplantation, which was performed in 10/12 patients. Four patients died, and three experienced neurological sequelae. SCID patients had the worst outcome. Our findings highlight substantial differences in the clinical presentation and course of DV between children with AID and PID, suggesting differences in pathophysiology. Prevention, early diagnosis and treatment are required to improve outcome.
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Affiliation(s)
- Paul Bastard
- Service de Pédiatrie, Hôpital Jean Verdier, Bondy, AP-HP (Assistance-Publique-Hôpitaux de Paris), France.,Service d'Immunologie et Hématologie Pédiatrique, Hôpital Necker Enfants Malades, AP-HP, Paris, France
| | - Aurélien Galerne
- Service de Pédiatrie, Hôpital Jean Verdier, Bondy, AP-HP (Assistance-Publique-Hôpitaux de Paris), France
| | - Alain Lefevre-Utile
- Service de Pédiatrie, Hôpital Jean Verdier, Bondy, AP-HP (Assistance-Publique-Hôpitaux de Paris), France.,INSERM U976-Human Systems Immunology and Inflammatory Networks, Institut de Recherche de Saint Louis, Paris, France.,Université de Paris, Paris, France
| | - Coralie Briand
- Service de Pédiatrie, Hôpital Jean Verdier, Bondy, AP-HP (Assistance-Publique-Hôpitaux de Paris), France
| | - André Baruchel
- Université de Paris, Paris, France.,Département d'Hématologie Pédiatrique, Hôpital Robert-Debré, AP-HP, Paris, France
| | - Philippe Durand
- Service de Réanimation Pédiatrique, Hôpital du Kremlin-Bicêtre, Kremlin-Bicêtre, France.,Université Paris XI, AP-HP, Paris.,Université Paris Saclay, Saint-Aubin, France
| | - Judith Landman-Parker
- Sorbonne Université, Service de d'Hématologie Oncologie Pédiatrique, Hôpital Armand Trousseau, AP-HP, Paris, France
| | - Elodie Gouache
- Sorbonne Université, Service de d'Hématologie Oncologie Pédiatrique, Hôpital Armand Trousseau, AP-HP, Paris, France
| | - Nathalie Boddaert
- Université de Paris, Paris, France.,Service de Radiologie Pédiatrique, Hôpital Necker Enfants Malades, AP-HP, Université de Paris, Paris, France.,INSERM U1163, Institut IMAGINE, Paris, France
| | - Despina Moshous
- Service d'Immunologie et Hématologie Pédiatrique, Hôpital Necker Enfants Malades, AP-HP, Paris, France.,Université de Paris, Paris, France.,INSERM U1163, Institut IMAGINE, Paris, France
| | - Joel Gaudelus
- Service de Pédiatrie, Hôpital Jean Verdier, Bondy, AP-HP (Assistance-Publique-Hôpitaux de Paris), France.,Sorbonne Paris Nord University, Bobigny, France
| | - Robert Cohen
- ACTIV Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Georges Deschenes
- Service de Néphrologie Pédiatrique, Hôpital Robert-Debré, AP-HP, Paris, France
| | - Alain Fischer
- Service d'Immunologie et Hématologie Pédiatrique, Hôpital Necker Enfants Malades, AP-HP, Paris, France.,Université de Paris, Paris, France.,INSERM U1163, Institut IMAGINE, Paris, France.,Experimental Medicine, Collège de France, Paris, France
| | - Stéphane Blanche
- Service d'Immunologie et Hématologie Pédiatrique, Hôpital Necker Enfants Malades, AP-HP, Paris, France.,Université de Paris, Paris, France
| | - Loïc de Pontual
- Service de Pédiatrie, Hôpital Jean Verdier, Bondy, AP-HP (Assistance-Publique-Hôpitaux de Paris), France.,Sorbonne Paris Nord University, Bobigny, France
| | - Bénédicte Neven
- Service d'Immunologie et Hématologie Pédiatrique, Hôpital Necker Enfants Malades, AP-HP, Paris, France.,Université de Paris, Paris, France.,INSERM U1163, Institut IMAGINE, Paris, France
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2
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El Mansouri AE, Oubella A, Dânoun K, Ahmad M, Neyts J, Jochmans D, Snoeck R, Andrei G, Morjani H, Zahouily M, Lazrek HB. Discovery of novel furo[2,3-d]pyrimidin-2-one-1,3,4-oxadiazole hybrid derivatives as dual antiviral and anticancer agents that induce apoptosis. Arch Pharm (Weinheim) 2021; 354:e2100146. [PMID: 34128255 DOI: 10.1002/ardp.202100146] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/19/2021] [Accepted: 05/22/2021] [Indexed: 01/12/2023]
Abstract
A new series of furo[2,3-d]pyrimidine-1,3,4-oxadiazole hybrid derivatives were synthesized via an environmentally friendly, multistep synthetic tool and a one-pot Songoashira-heterocyclization protocol using, for the first time, nanostructured palladium pyrophosphate (Na2 PdP2 O7 ) as a heterogeneous catalyst. Compounds 9a-c exhibited broad-spectrum activity with low micromolar EC50 values toward wild and mutant varicella-zoster virus (VZV) strains. Compound 9b was up to threefold more potent than the reference drug acyclovir against thymidine kinase-deficient VZV strains. Importantly, derivative 9b was not cytostatic at the maximum tested concentration (CC50 > 100 µM) and had an acceptable selectivity index value of up to 7.8. Moreover, all synthesized 1,3,4-oxadiazole hybrids were evaluated for their cytotoxic activity in four human cancer cell lines: fibrosarcoma (HT-1080), breast (MCF-7 and MDA-MB-231), and lung carcinoma (A549). Data showed that compound 8f exhibits moderate cytotoxicity, with IC50 values ranging from 13.89 to 19.43 µM. Besides, compound 8f induced apoptosis through caspase 3/7 activation, cell death independently of the mitochondrial pathway, and cell cycle arrest in the S phase for HT1080 cells and the G1/M phase for A549 cells. Finally, the molecular docking study confirmed that the anticancer activity of the synthesized compounds is mediated by the activation of caspase 3.
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Affiliation(s)
- Az-Eddine El Mansouri
- Laboratory of Biomolecular and Medicinal Chemistry, Chemistry Department, Faculty of Science Semlalia, University Cadi Ayyad, Marrakesh, Morocco.,Laboratoire de Matériaux, Catalyse & Valorisation des Ressources Naturelles, URAC 24, Department de chimie, Faculté des Sciences et Techniques, Université Hassan II, Casablanca, Morocco
| | - Ali Oubella
- Laboratoire de Synthese Organique et de Physico-Chimie Moleculaire, Departement de Chimie, Faculté des Sciences Semlalia, Marrakech, Morocco
| | - Karim Dânoun
- MASCIR Foundation, Rabat Design, Rue Mohamed El Jazouli, Madinat El Irfane, 10100 Rabat, Morocco, Rabat, Morocco
| | - Mehdi Ahmad
- ICGM, Université Montpellier, CNRS, ENSCM, Montpellier, France
| | - Johan Neyts
- Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Dirk Jochmans
- Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Robert Snoeck
- Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | | | | | - Mohamed Zahouily
- Laboratoire de Matériaux, Catalyse & Valorisation des Ressources Naturelles, URAC 24, Department de chimie, Faculté des Sciences et Techniques, Université Hassan II, Casablanca, Morocco
| | - Hassan B Lazrek
- Laboratory of Biomolecular and Medicinal Chemistry, Chemistry Department, Faculty of Science Semlalia, University Cadi Ayyad, Marrakesh, Morocco
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3
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Kłysik K, Pietraszek A, Karewicz A, Nowakowska M. Acyclovir in the Treatment of Herpes Viruses – A Review. Curr Med Chem 2020. [DOI: 10.2174/0929867325666180309105519] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background:
Herpes Simplex (HSV) viruses are widely spread, highly contagious
human pathogens. The statistics indicate that 50-90% of adults worldwide are seropositive for
these viruses, mainly HSV-1 and HSV-2. The primary infection results in the appearance of
watery blisters (cold sores) on the skin, lips, tongue, buccal mucosa or genitals. The ocular
infection is the major cause of corneal blindness in the Western World. Once the HSV virus
enters human body, it cannot be completely eradicated because HSV viruses are able to
change into their latent form which can survive the treatment. The viron resides in trigeminal
ganglia of the host, who becomes vulnerable to the reoccurrence of the disease during the
whole lifespan. The neurotropic and neuro-invasive properties of HSV are responsible for
neurodegenerative illnesses, such as Alzheimer's disease. Acyclovir and its analogues, being
the inhibitors of the viral DNA replication, are the only approved medicines for HSV infection
therapies.
Objective:
The current paper presents the up-to-date overview of the important pharmacological
features of acyclovir, its analogues and their delivery systems including the mechanism of
action, routes of administration, absorption and metabolism, as well as side effects of the therapy.
Conclusion:
Acyclovir remains the gold standard in the treatment of herpes virus infections,
mainly due to the emerging of the new delivery systems improving considerably its bioavailability.
The analogues of acyclovir, especially their esters, characterized by significantly
higher bioavailability and safety, may gradually replace acyclovir in selected applications.
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Affiliation(s)
- Katarzyna Kłysik
- Faculty of Chemistry, Jagiellonian University, Gronostajowa 2, 30-387 Krakow, Poland
| | - Aneta Pietraszek
- Faculty of Chemistry, Jagiellonian University, Gronostajowa 2, 30-387 Krakow, Poland
| | - Anna Karewicz
- Faculty of Chemistry, Jagiellonian University, Gronostajowa 2, 30-387 Krakow, Poland
| | - Maria Nowakowska
- Faculty of Chemistry, Jagiellonian University, Gronostajowa 2, 30-387 Krakow, Poland
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4
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Yasui R, Yoshida C, Yamaguchi T, Inoue N. Characterization of an anti-varicella-zoster virus compound that targets the portal protein encoded by ORF54. Microbiol Immunol 2018; 61:398-402. [PMID: 28833387 DOI: 10.1111/1348-0421.12507] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 07/05/2017] [Accepted: 08/12/2017] [Indexed: 12/01/2022]
Abstract
An anti-varicella-zoster virus compound, a 5-chlorobenzo[b]thiophen derivative (45B5), was characterized. Its 50% effective concentration against the cell-free vaccine Oka strain and 50% cytotoxic concentration in human fibroblasts were 16.9 µM and more than 100 µM, respectively. Treatment with 45B5 decreased viral DNA synthesis and IE62 expression weakly but significantly. All 45B5-resistant viral clones isolated were found to have at least one mutation in ORF54 that encodes the portal protein. There were no effects on interaction between the portal and scaffold proteins. Thus, 45B5 may inhibit nuclear delivery of viral DNA.
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Affiliation(s)
- Ruka Yasui
- Department of Microbiology and Immunology, Gifu Pharmaceutical University, 1-25-4 Daigaku-nishi, Gifu-Shi, Gifu 501-1196, Japan
| | - Chinatsu Yoshida
- Department of Microbiology and Immunology, Gifu Pharmaceutical University, 1-25-4 Daigaku-nishi, Gifu-Shi, Gifu 501-1196, Japan
| | - Toyofumi Yamaguchi
- Department of Biosciences, Teikyo University of Science, 2-2-1 Senju-Sakuragi, Adachi-ku, Tokyo 120-0045, Japan
| | - Naoki Inoue
- Department of Microbiology and Immunology, Gifu Pharmaceutical University, 1-25-4 Daigaku-nishi, Gifu-Shi, Gifu 501-1196, Japan
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5
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Shimizu R, Ohwada C, Nagao Y, Togasaki E, Kawajiri C, Muto T, Tsukamoto S, Sakai S, Takeda Y, Mimura N, Takeuchi M, Sakaida E, Iseki T, Nakaseko C. The Successful Treatment of a Cord Blood Transplant Recipient with Varicella Zoster Virus Meningitis, Radiculitis and Myelitis with Foscarnet. Intern Med 2017; 56:353-356. [PMID: 28154282 PMCID: PMC5348462 DOI: 10.2169/internalmedicine.56.6930] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Infections of the central nervous system (CNS) with varicella zoster virus (VZV) is a rare occurrence after allogeneic hematopoietic stem cell transplantation. We herein report a case of VZV meningitis, radiculitis and myelitis that developed 8 months after cord blood transplantation, shortly after the cessation of cyclosporine and low-dose acyclovir. Although treatment with acyclovir did not achieve a satisfactory response, the patient was successfully treated with foscarnet. Our report indicates that VZV infection should be considered in allo-hematopoietic stem cell transplantation (HSCT) patients with CNS symptoms and that foscarnet may be effective for the treatment of acyclovir-resistant VZV infections of the CNS. The development of optimal prophylactic strategies and vaccination schedules may eradicate post-transplant VZV disease.
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Affiliation(s)
- Ryo Shimizu
- Department of Hematology, Chiba University Hospital, Japan
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6
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Musella S, di Sarno V, Ciaglia T, Sala M, Spensiero A, Scala MC, Ostacolo C, Andrei G, Balzarini J, Snoeck R, Novellino E, Campiglia P, Bertamino A, Gomez-Monterrey IM. Identification of an indol-based derivative as potent and selective varicella zoster virus (VZV) inhibitor. Eur J Med Chem 2016; 124:773-781. [PMID: 27639368 PMCID: PMC7115581 DOI: 10.1016/j.ejmech.2016.09.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 08/11/2016] [Accepted: 09/03/2016] [Indexed: 12/11/2022]
Abstract
We report the synthesis and antiviral activity of a new family of non-nucleoside antivirals, derived from the indole nucleus. Modifications of this template through Mannich and Friedel-Crafts reactions, coupled with nucleophilic displacement and reductive aminations led to 23 final derivatives, which were pharmacologically tested. Tryptamine derivative 17a was found to have a selective inhibitory activity against human varicella zoster virus (VZV) replication in vitro, being inactive against a variety of other DNA and RNA viruses. A structure-activity relationship (SAR) study showed that the presence of a biphenyl ethyl moiety and the acetylation at the amino group of tryptamine are a prerequisite for anti-VZV activity. The novel compound shows the same activity against thymidine kinase (TK)-competent (TK+) and TK-deficient (TK−) VZV strains, pointing to a novel mechanism of antiviral action. A library of indole-based derivatives has been designed and synthesized as potential antiviral agents. Friedel-Crafts and Mannich reactions were used for the synthesis of different indole derivatives. Tryptamine derivative 17a displays significant inhibitory activity against VZV replication. A mechanism of action independent from the virus-encoded thymidine kinase is suggested.
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Affiliation(s)
- Simona Musella
- Department of Pharmacy, University of Salerno, Via Giovanni Paolo II 132, 84084, Fisciano, SA, Italy
| | - Veronica di Sarno
- Department of Pharmacy, University of Salerno, Via Giovanni Paolo II 132, 84084, Fisciano, SA, Italy
| | - Tania Ciaglia
- Department of Pharmacy, University of Salerno, Via Giovanni Paolo II 132, 84084, Fisciano, SA, Italy
| | - Marina Sala
- Department of Pharmacy, University of Salerno, Via Giovanni Paolo II 132, 84084, Fisciano, SA, Italy
| | - Antonia Spensiero
- Department of Pharmacy, University of Salerno, Via Giovanni Paolo II 132, 84084, Fisciano, SA, Italy
| | - Maria Carmina Scala
- Department of Pharmacy, University of Salerno, Via Giovanni Paolo II 132, 84084, Fisciano, SA, Italy
| | - Carmine Ostacolo
- Department of Pharmacy, University of Naples "Federico II", Via D. Montesano 49, 80131, Napoli, Italy
| | - Graciela Andrei
- Department of Microbiology and Immunology, Rega Institute for Medical Research, Leuven, Belgium
| | - Jan Balzarini
- Department of Microbiology and Immunology, Rega Institute for Medical Research, Leuven, Belgium
| | - Robert Snoeck
- Department of Microbiology and Immunology, Rega Institute for Medical Research, Leuven, Belgium
| | - Ettore Novellino
- Department of Pharmacy, University of Naples "Federico II", Via D. Montesano 49, 80131, Napoli, Italy
| | - Pietro Campiglia
- Department of Pharmacy, University of Salerno, Via Giovanni Paolo II 132, 84084, Fisciano, SA, Italy
| | - Alessia Bertamino
- Department of Pharmacy, University of Salerno, Via Giovanni Paolo II 132, 84084, Fisciano, SA, Italy.
| | - Isabel M Gomez-Monterrey
- Department of Pharmacy, University of Naples "Federico II", Via D. Montesano 49, 80131, Napoli, Italy.
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7
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De Paschale M, Clerici P. Microbiology laboratory and the management of mother-child varicella-zoster virus infection. World J Virol 2016; 5:97-124. [PMID: 27563537 PMCID: PMC4981827 DOI: 10.5501/wjv.v5.i3.97] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 07/08/2016] [Accepted: 07/22/2016] [Indexed: 02/05/2023] Open
Abstract
Varicella-zoster virus, which is responsible for varicella (chickenpox) and herpes zoster (shingles), is ubiquitous and causes an acute infection among children, especially those aged less than six years. As 90% of adults have had varicella in childhood, it is unusual to encounter an infected pregnant woman but, if the disease does appear, it can lead to complications for both the mother and fetus or newborn. The major maternal complications include pneumonia, which can lead to death if not treated. If the virus passes to the fetus, congenital varicella syndrome, neonatal varicella (particularly serious if maternal rash appears in the days immediately before or after childbirth) or herpes zoster in the early years of life may occur depending on the time of infection. A Microbiology laboratory can help in the diagnosis and management of mother-child infection at four main times: (1) when a pregnant woman has been exposed to varicella or herpes zoster, a prompt search for specific antibodies can determine whether she is susceptible to, or protected against infection; (2) when a pregnant woman develops clinical symptoms consistent with varicella, the diagnosis is usually clinical, but a laboratory can be crucial if the symptoms are doubtful or otherwise unclear (atypical patterns in immunocompromised subjects, patients with post-vaccination varicella, or subjects who have received immunoglobulins), or if there is a need for a differential diagnosis between varicella and other types of dermatoses with vesicle formation; (3) when a prenatal diagnosis of uterine infection is required in order to detect cases of congenital varicella syndrome after the onset of varicella in the mother; and (4) when the baby is born and it is necessary to confirm a diagnosis of varicella (and its complications), make a differential diagnosis between varicella and other diseases with similar symptoms, or confirm a causal relationship between maternal varicella and malformations in a newborn.
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8
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Nawrot B, Michalak O, De Clercq E, Stec WJ. Analogues of Acyclic Nucleosides Derived from Tris-(Hydroxymethyl)Phosphine Oxide or Bis-(Hydroxymethyl)Phosphinic Acid Coupled to DNA Nucleobases. ACTA ACUST UNITED AC 2016; 15:319-28. [PMID: 15646645 DOI: 10.1177/095632020401500604] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A series of novel acyclic nucleoside analogues containing bis-(hydroxymethyl)phosphinic acid (BHPA) or tris(hydroxymethyl)phosphine oxide (THPO) coupled with DNA nucleobases or with 5-fluorouracil were prepared and their antiviral activity was studied against cytomegalovirus (CMV), varicella-zoster virus (VZV), parainfluenza-virus type 3, reovirus-type 1, sindbis, coxsackie B4, punta toro, vesicular stomatitis and respiratory syncytial virus, herpes simplex virus-type 1 (KOS) and type 2 (G), vaccinia virus and herpes simplex virus-1 (TK-KOS ACVr). No specific antiviral effects were noted for any of test compounds against viruses evaluated, except thymine, cytosine and adenine derivatives of BHPA exerting borderline activity against respiratory syncytial virus at the 80 mg/ml concentration.
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Affiliation(s)
- Barbara Nawrot
- Department of Bioorganic Chemistry, Centre of Molecular and Macromolecular Studies, Polish Academy of Sciences, Lodz, Poland.
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9
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10
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Identification of a varicella-zoster virus replication inhibitor that blocks capsid assembly by interacting with the floor domain of the major capsid protein. J Virol 2012; 86:12198-207. [PMID: 22933294 DOI: 10.1128/jvi.01280-12] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A novel anti-varicella-zoster virus compound, a derivative of pyrazolo[1,5-c]1,3,5-triazin-4-one (coded as 35B2), was identified from a library of 9,600 random compounds. This compound inhibited both acyclovir (ACV)-resistant and -sensitive strains. In a plaque reduction assay under conditions in which the 50% effective concentration of ACV against the vaccine Oka strain (V-Oka) in human fibroblasts was 4.25 μM, the 50% effective concentration of 35B2 was 0.75 μM. The selective index of the compound was more than 200. Treatment with 35B2 inhibited neither immediate-early gene expression nor viral DNA synthesis. Twenty-four virus clones resistant to 35B2 were isolated, all of which had a mutation(s) in the amino acid sequence of open reading frame 40 (ORF40), which encodes the major capsid protein (MCP). Most of the mutations were located in the regions corresponding to the "floor" domain of the MCP of herpes simplex virus 1. Treatment with 35B2 changed the localization of MCP in the fibroblasts infected with V-Oka but not in the fibroblasts infected with the resistant clones, although it did not affect steady-state levels of MCP. Overexpression of the scaffold proteins restored the normal MCP localization in the 35B2-treated infected cells. The compound did not inhibit the scaffold protein-mediated translocation of MCP from the cytoplasm to the nucleus. Electron microscopic analysis demonstrated the lack of capsid formation in the 35B2-treated infected cells. These data indicate the feasibility of developing a new class of antivirals that target the herpesvirus MCPs and inhibit normal capsid formation by a mechanism that differs from those of the known protease and encapsidation inhibitors. Further biochemical studies are required to clarify the precise antiviral mechanism.
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11
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Brink AATP, van Gelder M, Wolffs PF, Bruggeman CA, van Loo IHM. Compartmentalization of acyclovir-resistant varicella zoster virus: implications for sampling in molecular diagnostics. Clin Infect Dis 2011; 52:982-7. [PMID: 21460310 DOI: 10.1093/cid/cir079] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Acyclovir resistance of varicella zoster virus (VZV) may arise in stem cell transplant (SCT) recipients with VZV disease and is usually a result of mutations in VZV thymidine kinase (TK), which is the target protein of acyclovir. Early detection of such mutations is necessary to enable timely therapy adaptation, for example, to foscarnet. We aimed to investigate whether TK mutations arise over time, and what sample types might be the most useful for this method. METHODS Spatially and temporally distinct samples from 3 SCT recipients with VZV disease unresponsive to acyclovir treatment were retrospectively investigated for the presence of TK mutations by polymerase chain reaction and sequence analysis. RESULTS In all 3 patients, a mutation in the VZV TK coding region was found resulting in an amino acid substitution. TK mutations were not only temporally but also spatially compartmentalized. In particular, plasma samples frequently showed wild-type TK sequences, whereas cerebrospinal fluid or skin vesicle fluid acquired on the same day contained mutant sequences. CONCLUSIONS This study shows the importance of careful sampling for molecular diagnostics of acyclovir resistance in VZV disease. All affected body sites should be sampled and plasma samples may not be representative for the viral mutation status.
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Affiliation(s)
- Antoinette A T P Brink
- Department of Medical Microbiology, Maastricht University Medical Center, Maastricht, The Netherlands.
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12
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Mustafa MB, Arduino PG, Porter SR. Varicella zoster virus: review of its management. J Oral Pathol Med 2009; 38:673-88. [DOI: 10.1111/j.1600-0714.2009.00802.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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13
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Al Quntar AAA, Dembitsky VM, Srebnik M. α-, β-,γ- AND ω-CYCLOPROPYLPHOSPHONATES. PREPARATION AND BIOLOGICAL ACTIVITY. ORG PREP PROCED INT 2008. [DOI: 10.1080/00304940809458117] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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14
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Abstract
Many functional, demographic, and immunologic changes associated with aging are responsible for increasing the incidence and severity of infectious diseases in the elderly. Management is complicated by age-related organ system changes. Because many of the elderly are on multiple medications for underlying illnesses, antimicrobial therapy needs to be chosen keeping drug interactions and adverse events in mind. Common infections seen in the elderly are infections of skin and soft tissue, urinary tract, respiratory tract, and gastrointestinal tract. Organized and well-funded programs to address infectious disease issues in the elderly are the only way to improve care.
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Affiliation(s)
- Tin Han Htwe
- Division of Infectious Diseases, Southern Illinois University School of Medicine, Post Box 19636, Springfield, IL 62794-9636, USA
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15
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Sengupta N, Booy R, Schmitt HJ, Peltola H, Van-Damme P, Schumacher RF, Campins M, Rodrigo C, Heikkinen T, Seward J, Jumaan A, Finn A, Olcén P, Thiry N, Weil-Olivier C, Breuer J. Varicella vaccination in Europe: are we ready for a universal childhood programme? Eur J Pediatr 2008; 167:47-55. [PMID: 17334784 DOI: 10.1007/s00431-007-0424-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2006] [Accepted: 01/15/2007] [Indexed: 01/30/2023]
Abstract
Safe and effective vaccines against varicella zoster virus (VZV), the aetiological agent of varicella and shingles, have been available in Europe for the last 5-10 years. The USA has had a universal childhood vaccination policy since 1995 and this has resulted in a dramatic decrease in the incidence, morbidity and mortality related to varicella. The economic and medical burden of VZV has led to discussions regarding both the desirability and feasibility of a similar routine immunisation policy for all European children. This article examines the epidemiology of varicella in Europe and how the data emerging from the USA can be used to achieve adequate prevention of the disease. It looks into the current evidence of the health economic evaluation of universal varicella vaccination and explores the concerns surrounding such a policy, including the postulated impact on the incidence of zoster. In conclusion, the Society of Independent European Vaccination Experts (SIEVE) recommends that the immunisation of susceptible adolescents needs to be urgently implemented, in addition to the current recommendations targeting high-risk patients, their close contacts with a negative history of varicella and seronegative health-care workers. A universal policy, optimally incorporating a two-dose schedule, will be needed to finally reduce the burden of disease of varicella from a societal point of view. The SIEVE recommends the implementation of such a policy as soon as financially and practically possible.
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Affiliation(s)
- Nitu Sengupta
- Centre for Child Health, Royal London Hospital, 38 New Road, Whitechapel, London, E1 2AX, UK.
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16
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Foscarnet salvage therapy for acyclovir-resistant varicella zoster: report of a novel thymidine kinase mutation and review of the literature. Pediatr Infect Dis J 2008; 27:75-7. [PMID: 18162946 DOI: 10.1097/inf.0b013e3181598315] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The authors describe an acyclovir-resistant varicella zoster virus infection in a pediatric patient after hematopoietic stem cell transplant, the use of foscarnet as salvage therapy, and review the literature to clarify the pediatric experience with foscarnet in this setting. A novel thymidine kinase mutation is described, along with a new phenotypic assay for characterizing acyclovir resistance in varicella zoster virus.
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17
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Abstract
Herpes zoster, the latent descendent of the varicella zoster virus, commonly is seen in clinical practice. Healthcare providers must recognize and treat the virus to decrease the incidence of postherpetic neuralgic pain syndrome. Treatment with an antiviral medication regimen should be initiated rapidly for patients who have had lesions for up to 72 hours. Acyclovir has been the treatment of choice for herpes zoster in the past, but newer drugs, such as valacyclovir, a prodrug of acyclovir, and famciclovir, are as effective for treating the virus and have more convenient dosing regimens and decreased incidence of postherpetic neuralgia.
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18
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Wang GQ, Suzutani T, Yamamoto Y, Fukui Y, Nozawa N, Schmid DS, Kurane I, Inoue N. Generation of a reporter cell line for detection of infectious varicella-zoster virus and its application to antiviral studies. Antimicrob Agents Chemother 2006; 50:3142-5. [PMID: 16940113 PMCID: PMC1563536 DOI: 10.1128/aac.00342-06] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
To simplify the titration of infectious varicella-zoster virus (VZV), we generated a reporter cell line that produced luciferase in a dose-dependent manner upon infection with cell-free VZV. A few VZV-infected cells were detectable by coculturing with the cell line. We demonstrated the usefulness of the cell line for antiviral studies.
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Affiliation(s)
- Guan-Qing Wang
- Department of Virology I, National Institute of Infectious Diseases, Shinjuku-ku, Tokyo 162-8640, Japan
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19
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Choo H, Chen X, Yadav V, Wang J, Schinazi RF, Chu CK. Synthesis and anti-HIV activity of D- and L-thietanose nucleosides. J Med Chem 2006; 49:1635-47. [PMID: 16509580 PMCID: PMC2533431 DOI: 10.1021/jm050912h] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Various D- and L-thietanose nucleosides were synthesized from D- and L-xylose. The four-membered thietane ring was efficiently synthesized by the cyclization of 1-thioacetyl-3-mesylate (4/38) under basic conditions. Condensation with various heterocyclic bases was conducted via Pummerer-type rearrangement to afford various nucleoside derivatives. Among the synthesized nucleosides, D-uridine (23), D-cytidine (24), D-5-fluorocytidine (25), and L-cytidine (52) analogues showed moderate anti-HIV activity, with EC50 = 6.9, 1.3, 5.8, and 14.1 microM, respectively. However, these four nucleoside analogues are cytotoxic in peripheral blood mononuclear and CEM cells. The other nucleosides are neither active nor cytotoxic. Interestingly, the oxetanocin A analogue 33 was not active. Comparison of the minimized reverse transcriptases (RTs) complexed with the corresponding triphosphates of the cytidine analogue 24 and the adenosine analogue 33 by molecular modeling studies showed that there is no difference in the binding mode of the triphosphate of the cytidine analogue 24 to the active site of HIV-1 RT from that of the triphosphate of the adenosine analogue 33. Modeling studies on the initial monophosphorylation step by deoxycytidine kinase showed that the catalytic efficiency of phosphorylation through a nucleophilic attack of the 4'-hydroxyl group of thietanose on the gamma-phosphate of ATP is diminished in the case of L-cytidine analogue (52) due to the increased distance between the 4'-hydroxyl group and the gamma-phosphate.
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Affiliation(s)
- Hyunah Choo
- The University of Georgia, College of Pharmacy, Athens, GA 30602
| | - Xin Chen
- The University of Georgia, College of Pharmacy, Athens, GA 30602
| | - Vikas Yadav
- The University of Georgia, College of Pharmacy, Athens, GA 30602
| | - Jianing Wang
- The University of Georgia, College of Pharmacy, Athens, GA 30602
| | - Raymond F. Schinazi
- Emory University School of Medicine/Veterans Affairs Medical Center, Decatur, GA 30033
| | - Chung K. Chu
- The University of Georgia, College of Pharmacy, Athens, GA 30602
- Corresponding Author : Dr. C. K. Chu, Distinguished Research Professor, Department of Pharmaceutical and Biomedical Sciences, College of Pharmacy, The University of Georgia, Athens, GA 30602, USA, Tel : (706)-542-5379, Fax : (706)-542-5381, E-Mail :
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20
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Addressing the Physical and Mental Symptoms of Shingles. J Nurse Pract 2006. [DOI: 10.1016/j.nurpra.2006.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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21
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Andrei G, van den Oord J, Fiten P, Opdenakker G, De Wolf-Peeters C, De Clercq E, Snoeck R. Organotypic epithelial raft cultures as a model for evaluating compounds against alphaherpesviruses. Antimicrob Agents Chemother 2006; 49:4671-80. [PMID: 16251311 PMCID: PMC1280113 DOI: 10.1128/aac.49.11.4671-4680.2005] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The course of herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) and varicella-zoster virus (VZV) infections in squamous epithelial cells cultured in a three-dimensional organotypic raft culture was tested. In these raft cultures, normal human keratinocytes isolated from neonatal foreskins grown at the air-liquid interface stratified and differentiated, reproducing a fully differentiated epithelium. Typical cytopathic changes identical to those found in the squamous epithelium in vivo, including ballooning and reticular degeneration with the formation of multinucleate cells, were observed throughout the raft following infection with HSV and VZV at different times after lifting the cultures to the air-liquid interface. For VZV, the aspects of the lesions depended on the stage of differentiation of the organotypic cultures. The activity of reference antiviral agents, acyclovir (ACV), penciclovir (PCV), brivudin (BVDU), foscarnet (PFA), and cidofovir (CDV), was evaluated against wild-type and thymidine kinase (TK) mutants of HSV and VZV in the raft cultures. ACV, PCV, and BVDU protected the epithelium against cytopathic effect induced by wild-type viruses in a concentration-dependent manner, while treatment with CDV and PFA proved protective against the cytodestructive effects induced by both TK+ and TK- strains. The quantification of the antiviral effects in the rafts were accomplished by measuring viral titers by plaque assay for HSV and by measuring viral DNA load by real-time PCR for VZV. A correlation between the degree of protection as determined by histological examination and viral quantification could be demonstrated The three-dimensional epithelial raft culture represents a novel model for the study of antiviral agents active against HSV and VZV. Since no animal model is available for the evaluation of antiviral agents against VZV, the organotypic cultures may be considered a model to evaluate the efficacy of new anti-VZV antivirals before clinical trials.
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Affiliation(s)
- Graciela Andrei
- Rega Institute for Medical Research, Catholic University of Leuven, Minderbroedersstraat 10, B-3000 Leuven, Belgium.
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22
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Hackanson B, Zeiser R, Bley TA, Pantazis G, Huzly D, Bertz H, Finke J. Fatal varicella zoster virus encephalitis in two patients following allogeneic hematopoietic stem cell transplantation. Clin Transplant 2005; 19:566-70. [PMID: 16008607 DOI: 10.1111/j.1399-0012.2005.00382.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Reduced cellular immunocompetence following allogeneic hematopoietic stem cell transplantation (aHSCT) increases susceptibility to viral infections. Varicella zoster virus (VZV) reactivation in this setting most commonly manifests as dermatomal herpes zoster but in some cases life-threatening VZV encephalitis occurs. STUDY DESIGN/RESULTS We describe the cases of two patients who presented with shingles 3 and 18 months, respectively, after HLA-matched peripheral blood stem cell transplantation (PBSCT). Unfortunately, in the further clinical course both patients developed fatal VZV encephalitis, despite initial high-dose intravenous therapy with acyclovir and in one case with additional VZV-immunoglobulin. CONCLUSION These two cases suggest that rapid intervention with systemic treatment is warranted and raise the question whether initial combination therapy with intravenous acyclovir and foscarnet, VZV vaccination or long-term low-dose acyclovir are needed to improve treatment and clinical outcome in immunocompromised patients, having undergone allogeneic HSCT.
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Affiliation(s)
- Björn Hackanson
- Department of Hematology/Oncology, Freiburg University Medical Center, Freiburg, Germany.
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23
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Andrei G, Sienaert R, McGuigan C, De Clercq E, Balzarini J, Snoeck R. Susceptibilities of several clinical varicella-zoster virus (VZV) isolates and drug-resistant VZV strains to bicyclic furano pyrimidine nucleosides. Antimicrob Agents Chemother 2005; 49:1081-6. [PMID: 15728906 PMCID: PMC549231 DOI: 10.1128/aac.49.3.1081-1086.2005] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Varicella-zoster virus (VZV) is responsible for primary infections as well as reactivations after latency in the dorsal root ganglia. The treatment of such infections is mandatory for immunocompromised patients and highly recommended for elderly patients with herpes zoster infections (also called zona or shingles). The treatment of choice is presently based on four molecules, acyclovir (ACV), valaciclovir, famciclovir, and (in Europe) brivudine (BVDU). We present here our data on the antiviral activity of a new class of potent and selective anti-VZV compounds, bicylic pyrimidine nucleoside analogues (BCNAs), against a broad variety of clinical isolates and different drug-resistant virus strains. The results show that the BCNAs are far more potent inhibitors than ACV and BVDU against clinical VZV isolates as well as the VZV reference strains Oka and YS. The BCNAs were not active against ACV- and BVDU-resistant VZV strains bearing mutations in the viral thymidine kinase gene but kept their inhibitory potential against virus strains with mutations in the VZV DNA polymerase gene. Mutant virus strains selected in the presence of the BCNAs were solely cross-resistant to drugs, such as ACV and BVDU, that depend for their antiviral action on metabolic activation by the viral thymidine kinase.
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Affiliation(s)
- Graciela Andrei
- Rega Institute for Medical Research, Minderbroedersstraat 10, B-3000 Leuven, Belgium.
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24
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Affiliation(s)
- N Julian Holland
- Department of Otolaryngology, Royal Devon and Exeter NHS Foundation Trust, Exeter EX2 5DW.
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25
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Breton G, Bouldouyre MA, Gervais A, Duval X, Longuet P, Leport C, Vildé JL. Failure of valacyclovir for herpes zoster in a moderately immunocompromised HIV-infected patient. AIDS Patient Care STDS 2004; 18:255-7. [PMID: 15186709 DOI: 10.1089/108729104323075990] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Whereas valacyclovir is widely used and is recommended by some authors in moderately immunocompromised HIV-infected patients, its use has not been validated by clinical studies. We report a case of herpes zoster in an HIV-infected patient for whom neurologic complication was not avoided despite valacyclovir therapy. Clinical outcome was favorable after intravenous acyclovir. This case suggests careful monitoring of valacyclovir in HIV-infected patients is necessary.
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Affiliation(s)
- G Breton
- Department of Infectious and Tropical Diseases Bichat Claude Bernard Hospital, Paris, France.
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26
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Taylor SL, Kinchington PR, Brooks A, Moffat JF. Roscovitine, a cyclin-dependent kinase inhibitor, prevents replication of varicella-zoster virus. J Virol 2004; 78:2853-62. [PMID: 14990704 PMCID: PMC353735 DOI: 10.1128/jvi.78.6.2853-2862.2004] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Understanding the interactions between varicella-zoster virus (VZV) and host cells can be addressed by using small molecule inhibitors of cellular enzymes. Roscovitine (Rosco) is a purine derivative that inhibits cyclin-dependent kinase 1 (cdk1), cdk2, cdk5, cdk7, and cdk9, which are key regulators of the cell cycle and transcription. Herpesviruses are known to interact with cell cycle proteins; thus, the antiviral effects of Rosco on VZV growth were evaluated. In a plaque reduction assay, 25 micro M Rosco prevented VZV replication, and the antiviral effect was reversible for at least up to 24 h posttreatment. Rosco also reduced expression of the major transactivator, IE62, over 48 h. Confocal microscopy studies indicated that Rosco caused the immediate-early proteins ORF4 and IE62 to abnormally localize in infected cells and prevented cell-cell spread of VZV over 48 h. Rosco was found to inhibit VZV DNA synthesis as measured by real-time PCR, and this technique was used to estimate the 50% effective concentration (EC(50)) of 14 micro M. This value was close to the EC(50) estimate of 12 micro M determined from plaque reduction assays. At 25 micro M, Rosco was not cytotoxic over 48 h in a neutral red uptake assay, and proliferation was slowed as the cells accumulated in a G(2)-like state. These results demonstrate the importance of cdk's in VZV replication and suggest that cdk inhibitors could serve as useful VZV antivirals.
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Affiliation(s)
- Shannon L Taylor
- Department of Microbiology and Immunology, State University of New York Upstate Medical University, Syracuse, New York, USA
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27
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Visalli RJ. Novel compounds for the treatment of varicella–zoster virus infections. Expert Opin Ther Pat 2004. [DOI: 10.1517/13543776.14.3.355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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28
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Andrei G, De Clercq E, Snoeck R. In vitro selection of drug-resistant varicella-zoster virus (VZV) mutants (OKA strain): differences between acyclovir and penciclovir? Antiviral Res 2004; 61:181-7. [PMID: 15168799 DOI: 10.1016/j.antiviral.2003.10.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2002] [Accepted: 10/09/2003] [Indexed: 11/17/2022]
Abstract
Varicella-zoster virus (VZV) mutants were isolated under the pressure of different classes of antiviral compounds: (i) drugs that depend on the viral thymidine kinase (TK) for their activation, i.e. acyclovir (ACV), brivudin (BVDU), penciclovir (PCV) and sorivudine (BVaraU); (ii) drugs that are independent of the viral TK for their activation, i.e. 2-phosphonylmethoxyethyl (PME) derivatives of adenine (PMEA, adefovir) and 2,6-diaminopurine (PMEDAP); and (iii) drugs that do not require any metabolism to inhibit the viral DNA polymerase, i.e. foscarnet (PFA). Drug-resistant virus strains were obtained by serial passage of the OKA strain in human embryonic lung (HEL) fibroblasts and the different drug-resistant mutants were subsequently evaluated for their in vitro susceptibility to a broad range of antiviral drugs. Virus strains emerging under the pressure of ACV, BVDU and BVaraU were cross-resistant to all drugs that depend on the viral TK for activation, but remained susceptible to the acyclic nucleoside phosphonates (i.e. PMEA, PMEDAP and the 3-hydroxy-2-phosphonylmethoxypropyl derivatives of adenine (HPMPA) and cytosine (HPMPC, cidofovir)) and PFA. In contrast, the virus strains selected under pressure of PCV were resistant to PCV, ACV, PMEA and PFA; but not BVDU, BVaraU, GCV, HPMPC or HPMPA. Similar patterns of drug susceptibility were noted for the virus strains selected under the pressure of PMEA or PFA, pointing to an alteration in the viral DNA polymerase as basis for the resistant phenotype selected by PCV, as well as PMEA and PFA. In contrast, the resistant phenotype selected by ACV as well as BVDU and BVaraU may be attributed primarily to mutations in the viral TK gene. Our data thus indicate that ACV and PCV select in vitro for different drug-resistant VZV phenotypes; whether this is also the situation in vivo remains to be investigated.
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Affiliation(s)
- G Andrei
- Rega Institute for Medical Research, K. U. Leuven, 3000 Leuven, Belgium.
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29
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Moffat JF, McMichael MA, Leisenfelder SA, Taylor SL. Viral and cellular kinases are potential antiviral targets and have a central role in varicella zoster virus pathogenesis. BIOCHIMICA ET BIOPHYSICA ACTA-PROTEINS AND PROTEOMICS 2004; 1697:225-31. [PMID: 15023363 DOI: 10.1016/j.bbapap.2003.11.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2003] [Accepted: 11/12/2003] [Indexed: 10/26/2022]
Abstract
Herpesviruses utilize viral and cellular kinases for replication, and these mediate essential functions that are important for viral pathogenesis. Elucidating the roles of kinases in herpesvirus infections may highlight virus-host interactions that are possible targets for kinase inhibitors with antiviral activity. Varicella zoster virus (VZV) encodes two kinases that phosphorylate viral proteins involved in regulation, assembly, and virulence. VZV infection also induces the activity of host cell cyclin-dependent kinases (cdk4 and cdk2) in nondividing cells, causing a disregulation of the cell cycle. Roscovitine and Purvalanol, kinase inhibitors that target cdks, prevent VZV replication at concentrations with few cytotoxic effects. Cdk inhibitors therefore have potential as antivirals that may extend to a broad range of viruses and have the added advantage that resistance does not arise easily.
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Affiliation(s)
- Jennifer F Moffat
- Department of Microbiology and Immunology, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA.
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30
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Andrade L, Rebouças NA, Seguro AC. Down-regulation of Na+ transporters and AQP2 is responsible for acyclovir-induced polyuria and hypophosphatemia. Kidney Int 2004; 65:175-83. [PMID: 14675048 DOI: 10.1111/j.1523-1755.2004.00359.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Acyclovir (ACY) is a useful therapeutic agent for the systemic treatment of herpes virus infection. An increase in urinary phosphate excretion and polyuria has been described. The objective of this study was to analyze the exact mechanism of the urinary-concentrating dysfunction and the increase in phosphaturia associated with ACY. METHODS We first analyzed 7 (adult and pediatric) non-AIDS cases of encephalitis receiving 15 mg/kg bw/d of intravenous ACY. Fractional phosphate and sodium excretion, urinary potassium volume, and plasma phosphate concentrations were analyzed. Additional studies in rats treated with intraperitoneal ACY (100 mg/kg bw) were also conducted. Animals were maintained in metabolic cages and 24-hour urine samples were collected to measure volume, osmolality, and sodium/potassium/phosphate excretion. Treated rats were also evaluated after 24 hours and 48 hours of water deprivation. Northern hybridization and semiquantitative immunoblotting were performed to evaluate (in both control and treated animals) expression of the cotransporters Na-Pi type IIa (Na-Pi-IIa) and Na-K-2Cl (NKCC2). Semiquantitative immunoblotting was carried out in the kidneys of ACY rats and control rats in order to analyze aquaporin 2 (AQP2) protein expression. RESULTS Patients started on ACY developed polyuria and hyperphosphatemia after 48 hours. In rats, ACY-induced hyperphosphaturia and hypophosphatemia were accompanied by increased excretion of sodium, potassium, and magnesium, increased urine output, lower urinary osmolality, and a partial urinary concentrating defect. Concurrent downregulation of Na-Pi-IIa and NKCC2 expression was observed. There was also a decrease in medullar expression of the AQP2 collecting duct water channel. CONCLUSION Downregulation of Na-Pi-IIa appears to play a crucial role in the downregulation of ACY-induced hyperphosphaturia. The accompanying polyuria and urinary-concentrating defect can in part be explained by the downregulation of NKCC2 and AQP2.
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Affiliation(s)
- Lúcia Andrade
- Department of Nephrology, Laboratory of Basic Research, University of São Paulo School of Medicine, São Paulo, Brazil.
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31
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Zhang N, Chen HM, Koch V, Schmitz H, Liao CL, Bretner M, Bhadti VS, Fattom AI, Naso RB, Hosmane RS, Borowski P. Ring-expanded ("fat") nucleoside and nucleotide analogues exhibit potent in vitro activity against flaviviridae NTPases/helicases, including those of the West Nile virus, hepatitis C virus, and Japanese encephalitis virus. J Med Chem 2003; 46:4149-64. [PMID: 12954067 DOI: 10.1021/jm030842j] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A series of ring-expanded ("fat") heterocycles, nucleoside and nucleotide analogues (RENs) containing the imidazo[4,5-e][1,3]diazepine ring system (9, 14, 15, 18, 24-26, 28, 31, and 33) and imidazo[4,5-e][1,2,4]triazepine ring systems (30b, 30c, 32, and 34), have been synthesized as potential inhibitors of NTPases/helicases of Flaviviridae, including the West Nile virus (WNV), hepatitis C virus (HCV), and Japanese encephalitis virus (JEV). An amino-terminal truncated form of human enzyme Suv3(delta1-159) was also included in the study so as to assess the selectivity of RENs against the viral enzymes. The analogues of RENs included structural variations at position 1 of the heterocyclic base and contained changes in both the type of sugar moieties (ribo, 2'-deoxyribo, and acyclic sugars) and the mode of attachment (alpha versus beta anomeric configuration) of those sugars to the heterocyclic base. The target RENs were biochemically screened separately against the helicase and ATPase activities of the viral NTPases/helicases. A number of RENs inhibited the viral helicase activity with IC50 values that ranged in micromolar concentrations and exhibited differential selectivity between the viral enzymes. In view of the observed tight complex between some nucleosides and RNA and/or DNA substrates of a helicase, the mechanism of action of RENs might involve their interaction with the appropriate substrate through binding to the major or minor groove of the double helix. The REN-5'-triphosphates, on the other hand, did not influence the above unwinding reaction, but instead exerted the inhibitory effect on the ATPase activity of the enzymes. The activity was found to be highly dependent upon the low concentration levels of the substrate ATP. At concentrations >500 microM of RENs and the ATP concentrations >10 times the Km value of the enzyme, a significant activation of NTPase activity was observed. This activating effect underwent further dramatic enhancement (>1000%) by further increases in ATP concentration in the reaction mixture. A tentative mechanistic model has been proposed to explain the observed results, which includes an additional allosteric binding site on the viral NTPases/helicases that can be occupied by nucleoside/nucleotide-type molecules such as RENs.
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Affiliation(s)
- Ning Zhang
- Laboratory for Drug Design and Synthesis, Department of Chemistry and Biochemistry, University of Maryland, Baltimore County, Baltimore, Maryland 21250, USA
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32
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Li P, Dobrikov M, Liu H, Shaw BR. Synthesis of acyclothymidine triphosphate and alpha-P-boranotriphosphate and their substrate properties with retroviral reverse transcriptase. Org Lett 2003; 5:2401-3. [PMID: 12841740 DOI: 10.1021/ol034538w] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
[reaction: see text] The first example of an acyclonucleoside alpha-P-boranotriphosphate has been synthesized via a phosphoramidite approach in a one-pot reaction with good yield. The presence of the alpha-P-BH(3) in 5b results in a 9-fold increase in efficiency of incorporation by MMLV retroviral reverse transcriptase relative to non-boronated 5a in pre-steady-state conditions. The preliminary results indicate that acyclonucleoside alpha-P-boranotriphosphates may have promising applications as a probe of enzyme mechanisms and in the design of new antiviral drugs.
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Affiliation(s)
- Ping Li
- Department of Chemistry, Box 90346, Duke University, Durham, North Carolina 27708-0346, USA
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33
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Mulhall BP, Wong RKH. Infectious Esophagitis. CURRENT TREATMENT OPTIONS IN GASTROENTEROLOGY 2003; 6:55-70. [PMID: 12521573 DOI: 10.1007/s11938-003-0034-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Infectious esophagitis can have significant implications in an impaired host. Described most commonly in immunocompromised patients, infectious esophagitis can also occasionally be discovered in immunocompetent individuals in several unique clinical settings. Evaluation of the typical presenting complaints, such as dysphagia or odynophagia, are especially important in immunocompetent patients, and therapy should be directed at the appropriate predisposing condition and resultant infectious agent. In immunocompromised patients, however, clinical experience supports the use of empiric therapy in patients without concomitant systemic complaints. Especially in AIDS patients or those with lymphoma or leukemia, the initial approach to infectious esophagitis complaints (ie, dysphagia or odynophagia) is to begin an empiric trial of oral systemic fluconazole for presumed candidal esophagitis. If the individual remains symptomatic after 3 to 7 days or has any associated systemic complaints or concerning clinical findings (eg, hematemesis), then upper endoscopy with biopsies is indicated. If an etiologic agent other than Candida is defined by histologic, immunohistochemical, or culture methods, then appropriate therapy can be initiated. There are many important and pathologic agents implicated in infectious esophagitis. Thus, directed therapy needs to be administered appropriately and in a timely fashion to avoid poor short-term problems or long-term sequelae.
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Affiliation(s)
- Brian P. Mulhall
- Gastroenterology Service, Walter Reed Army Medical Center, 6900 Georgia Avenue NW, Washington, DC 20307-5000, USA.
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Visalli RJ, Fairhurst J, Srinivas S, Hu W, Feld B, DiGrandi M, Curran K, Ross A, Bloom JD, van Zeijl M, Jones TR, O'Connell J, Cohen JI. Identification of small molecule compounds that selectively inhibit varicella-zoster virus replication. J Virol 2003; 77:2349-58. [PMID: 12551972 PMCID: PMC141108 DOI: 10.1128/jvi.77.4.2349-2358.2003] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A series of nonnucleoside, N-alpha-methylbenzyl-N'-arylthiourea analogs were identified which demonstrated selective activity against varicella-zoster virus (VZV) but were inactive against other human herpesviruses, including herpes simplex virus. Representative compounds had potent activity against VZV early-passage clinical isolates and an acyclovir-resistant isolate. Resistant viruses generated against one inhibitor were also resistant to other compounds in the series, suggesting that this group of related small molecules was acting on the same virus-specific target. Sequencing of the VZV ORF54 gene from two independently derived resistant viruses revealed mutations in ORF54 compared to the parental VZV strain Ellen sequence. Recombinant VZV in which the wild-type ORF54 sequence was replaced with the ORF54 gene from either of the resistant viruses became resistant to the series of inhibitor compounds. Treatment of VZV-infected cells with the inhibitor impaired morphogenesis of capsids. Inhibitor-treated cells lacked DNA-containing dense-core capsids in the nucleus, and only incomplete virions were present on the cell surface. These data suggest that the VZV-specific thiourea inhibitor series block virus replication by interfering with the function of the ORF54 protein and/or other proteins that interact with the ORF54 protein.
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Affiliation(s)
- Robert J Visalli
- Infectious Diseases Section, Department of Molecular Biology/Virology, Wyeth Vaccines, Pearl River, NY 1096, USA.
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35
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Bernal I, Domènech E, García-Planella E, Cabré E, Gassull MA. [Opportunistic infections in patients with inflammatory bowel disease undergoing immunosuppressive therapy]. GASTROENTEROLOGIA Y HEPATOLOGIA 2003; 26:19-22. [PMID: 12525323 DOI: 10.1016/s0210-5705(03)70335-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Immunosuppressive agents (azathioprine, methotrexate) are increasingly being used in the treatment of inflammatory bowel disease. The use of immunosuppressive agents is associated with a greater risk of opportunistic infections, the most frequent of which are those caused by cytomegalovirus and varicella zoster virus. We present four cases of opportunistic infections due to Herpesviruses in patients undergoing immunosuppressive treatment with azathioprine for Crohn's disease. We also review the literature published on this topic. Two patients presented cutaneous varicella complicated by pneumonia and esophagitis respectively, one patient had cutaneous herpes zoster and the other had fatal pneumonia possibly caused by the Herpesvirus. In the first three the clinical course of the infection was favorable after withdrawing immunosuppressant treatment and initiating treatment with aziclovir. In patients Crohn's disease azathioprine treatment increases the risk of opportunistic infection by Herpesvirus. However, in the absence of other factors that increase immunosuppression, these infections usually have a benign course with specific antiviral therapy.
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Affiliation(s)
- I Bernal
- Servicio de Aparato Digestivo. Hospital Universitari Germans Trias i Pujol. Badalona. Barcelona. España
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36
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Abstract
A wide variety of both DNA and RNA viruses affect the oral cavity. When considered in conjunction with cutaneous features, careful examination of the oral mucosa and oropharynx aids the clinician in making a diagnosis. Examination of the oral cavity should be incorporated as a regular component of the dermatologic examination because diagnostic clues are readily available to assist in the evaluation of infectious processes.
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Affiliation(s)
- Bethany R Hairston
- Department of Dermatology, Mayo Graduate School of Medicine, Rochester, MN 55905, USA
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37
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Abstract
Viral diseases in children can present with characteristic mucocutaneous manifestations. This article focuses, from a practical clinical point of view, on the laboratory and clinical diagnoses, and treatment of pediatric dermatological diseases that have specific antiviral therapies: herpes virus infections (including varicella), papillomavirus infections and molluscum contagiosum. Special issues, such as viral infections in pregnancy, therapy of viral infections in immunosuppressed children, as well as special problems associated with the epidemiology of genital herpes and papillomavirus infections in adolescents are discussed. The antivirals discussed in detail include: aciclovir, valaciclovir, famciclovir, penciclovir, cidofovir, foscarnet and the immune response modulator, imiquimod. Since these antiviral drugs generally have not been evaluated in children, caution should be exercised with their usage.
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Affiliation(s)
- Zoltan Trizna
- Department of Dermatology, Health Sciences Center, Texas Tech University, Mail Drop #9400, 3601 4th Street, Lubbock, TX 79416, USA.
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38
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McKelvie PA, Collins S, Thyagarajan D, Trost N, Sheorey H, Byrne E. Meningoencephalomyelitis with vasculitis due to varicella zoster virus: a case report and review of the literature. Pathology 2002; 34:88-93. [PMID: 11902456 DOI: 10.1080/00313020120105705] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Varicella zoster virus (VZV) encephalitis is associated with large or small vessel vasculopathy. We report the case of a 67-year-old woman with a history of non-Hodgkin's lymphoma and cancers of the breast and colon, who presented with a zosteriform rash and Brown-Sequard syndrome. Despite 10 days therapy with intravenous acyclovir, meningoencephalitis developed and the patient died 15 days after onset of neurological symptoms. Autopsy showed meningoencephalomyelitis with necrotising vasculitis of leptomeningeal vessels, which is a rare complication of VZV, and we review the literature of the nine similar published cases. Polymerase chain reaction of cerebrospinal fluid for VZV was negative 6 days after onset of neurological symptoms, but became positive by day 10. Only one multinucleated giant cell with intranuclear Cowdry type A inclusions was seen within an endothelial cell in a leptomeningeal vessel involved by vasculitis.
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Affiliation(s)
- Penelope A McKelvie
- Department of Anatomical Pathology, St Vincent's Hospital, Fitzroy, Victoria, Australia.
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39
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Domingo E, Mas A, Yuste E, Pariente N, Sierra S, Gutiérrez-Riva M, Menéndez-Arias L. Virus population dynamics, fitness variations and the control of viral disease: an update. PROGRESS IN DRUG RESEARCH. FORTSCHRITTE DER ARZNEIMITTELFORSCHUNG. PROGRES DES RECHERCHES PHARMACEUTIQUES 2002; 57:77-115. [PMID: 11728003 DOI: 10.1007/978-3-0348-8308-5_2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Viral quasispecies dynamics and variations of viral fitness are reviewed in connection with viral disease control. Emphasis is put on resistance of human immunodeficiency virus and some human DNA viruses to antiviral inhibitors. Future trends in multiple target antiviral therapy and new approaches based on virus entry into error catastrophe (extinction mutagenesis) are discussed.
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Affiliation(s)
- E Domingo
- Centro de Biologia Molecular Severo Ochoa, Consejo Superior de Investigaciones Científicas, Universidad Autónoma de Madrid, Cantoblanco, Spain.
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40
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Abstract
The control of the global expansion and proliferation of the AIDS pandemic has been complicated by the emergence of resistant strains of HIV-1 to the many new antiviral drugs directed to the genes coding for reverse transcriptase and protease enzymes of the virus. Similarly, new drug regimens for the management of chronic hepatitis B and C infections have been complicated by the lack of sustained clinical responses recently associated with either nucleotide mutation (HBV) or specific genotype of the virus (HCV). Commercial systems for performing and interpreting genotypic analysis will facilitate the recognition of informative mutations, standardize results between laboratories, and produce informative and interpretative result formats for optimal treatment of patients. Drug-resistant strains of herpesviruses (HSV, VZV, CMV) are generally associated with prolonged treatment of these infections in immunocompromised patients. Ultimate relevance of genotypic assays for routine clinical practice will require correlation with phenotypic results and the outcomes of long-term studies associating clinical improvement with antiviral drugs with specific mutation patterns of these viruses.
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Affiliation(s)
- T F Smith
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA.
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41
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Podzamczer D, Ramón Arribas J, Mallolas J, María Peña J, Pulido F. [Treatment of opportunistic infections among adult and adolescent patients infected with the human immunodeficiency virus in the era of highly active anti-retroviral therapy]. Enferm Infecc Microbiol Clin 2001; 19:376-92. [PMID: 11602139 DOI: 10.1016/s0213-005x(01)72670-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- D Podzamczer
- Ciutat Sanitària i Universitària de Bellvitge, Barcelona, Spain.
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Chen HM, Hosmane RS. Acyclic nucleoside/nucleotide analogues with an imidazole ring skeleton. NUCLEOSIDES, NUCLEOTIDES & NUCLEIC ACIDS 2001; 20:1599-614. [PMID: 11554548 DOI: 10.1081/ncn-100105250] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Syntheses of a few acyclic nucleoside and acyclic nucleoside phosphonate analogues containing an imidazole ring have been reported. These analogues include methyl 1-(2-hydroxyethoxymethyl)imidazole-4, 5-dicarbo-xylate (1), 4,5-dicarbamoyl-1-(2-hydroxyethoxymethyl)imidazole (2), 4,5-dicyano-1-(2-hydroxyethoxymethyl)imidazole (4), Methyl 1-(2-bromoethoxymethyl)imidazole-4,5-dicarboxylate (7), 4,5-dicyano-(2-bromoethoxymethyl)imidazole (8), and Methyl 1-(2-phosphonomethoxyethyl)imidazole (10). Also reported are a few potential prodrugs of the above compounds, including the acetyl derivatives 5 and 6 (of 1 and 4, respectively), and the diethyl phosphonate ester 9 (of 10). In addition, the corresponding benzyl-protected precursors 11 and 12 (of 1 and 4, respectively), along with their common hydrolysis product, 1-(2-benzyloxy-ethoxymethyl)-4,5-imidazoledicarboxylic acid (3), are reported. Another potential prodrug included in the list is 1-(2-acetoxyethyl)-4,5-dicyanoimidazole (15). The compounds were screened for in vitro antiviral activity against a wide variety of herpes and respiratory viruses. The most active compound was the phosphonate analogue 9 which exhibited an anti-measles virus activity with an EC50 of <2.5 microg/mL and an SI value of > 176.
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Affiliation(s)
- H M Chen
- Department of Chemistry & Biochemistry, University of Maryland, Baltimore County, Baltimore 21250, USA
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43
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Heald PW. Current treatment practice of herpes zoster. Expert Opin Pharmacother 2001; 2:1283-7. [PMID: 11584996 DOI: 10.1517/14656566.2.8.1283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The management of herpes zoster infection has been impacted by the development of oral and iv. antiviral therapies. There are clinical and historical features that help optimise the particular therapy course for a given patient. Additionally, there are common features of management in all patients with herpes zoster. In this review an understanding of the pathogenesis of herpes zoster is utilised as a starting point for the development of a rational approach to therapy. Clinical findings that impact decision making are emphasised and the appropriate goals for therapy are discussed.
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Affiliation(s)
- P W Heald
- Yale University School of Medicine, New Haven, Connecticut, USA.
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44
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Offidani M, Corvatta L, Olivieri A, Mele A, Brunori M, Montanari M, Rupoli S, Scalari P, Leoni P. A predictive model of varicella-zoster virus infection after autologous peripheral blood progenitor cell transplantation. Clin Infect Dis 2001; 32:1414-22. [PMID: 11317241 DOI: 10.1086/320157] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2000] [Revised: 09/15/2000] [Indexed: 11/03/2022] Open
Abstract
Varicella-zoster virus (VZV) frequently causes severe infections in patients who have undergone bone marrow transplantation. The frequency of, characteristics of, and risk factors for this infection were studied in 164 patients undergoing autologous peripheral blood progenitor cell transplantation (PBPCT). Twenty-six patients (15.8%) developed VZV infection, and the actuarial risk was 10% at 1 year. No patient had visceral dissemination or died because of VZV, although one-third of the patients developed postherpetic neuralgia. By multivariate analysis, a CD4(+) lymphocyte count of <200 cells/microL (P<.0001; odds ratio [OR], 2.0) and a CD8(+) lymphocyte count of <800 cells/microL (P=.0073; OR, 2.0) at day 30 after transplantation were factors associated with VZV infection. Patients with both these adverse factors had an actuarial risk of VZV of 48% at 1 year. Patients with deficiency in both CD4(+) and CD8(+) lymphocytes are at high risk of VZV infection. These patients should be considered as candidates for preventive therapy, but whether for antiviral therapy or vaccination remains to be investigated.
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Affiliation(s)
- M Offidani
- Department of Hematology, Ancona University School of Medicine, Ancona, Italy.
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45
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Abstract
Normal facial movement is required for chewing, swallowing, speaking, and protecting the eye. Bell's palsy causes most cases of acute, unilateral facial palsy; infection with herpes simplex virus (HSV) type 1 may be its major cause. Varicella zoster virus (VZV) reactivation (Ramsay Hunt syndrome) is less common, but may appear without skin lesions in a form indistinguishable from Bell's palsy. Symptoms improve in nearly all patients with Bell's palsy, and most patients with Ramsay Hunt syndrome, but many are left with functional and cosmetic deficits. Steroids are frequently used to optimize outcomes in Bell's palsy, but proof of their effectiveness is marginal. Oral prednisone has been studied extensively, although some reports have suggested a higher recovery rate with intravenous steroids. Given the existing data, we support the use of oral prednisone in those patients with complete facial palsy, and no contraindications to their use (Fig. 1). In this author's opinion, the greatly increased cost and inconvenience of intravenous steroids cannot be justified by the data available. Antiviral agents may also be effective in treatment of Bell's palsy; HSV is susceptible to acyclovir and related agents. There have been few investigations of acyclovir treatment in Bell's palsy, but one controlled study showed added benefit when the drug was used with prednisone. The risk and cost of acyclovir is low enough that we support its use, with oral steroids, in those patients with complete facial paralysis. Several small studies have implied that oral acyclovir improves the outcome of facial palsy for patients with Ramsay Hunt syndrome. Although these studies do not prove efficacy, evidence for the benefits of antiviral agents in other forms of zoster is strong enough to recommend their use when the facial nerve is involved. VZV is less sensitive to acyclovir than HSV, so higher doses are recommended to treat Ramsay Hunt syndrome. Because some Ramsay Hunt syndrome patients with partial facial palsy do not fully recover, we recommend oral antiviral agents in all patients suspected of having zoster. There is weak evidence to suggest additional benefit of oral steroids in facial zoster, and their use can be supported in immunocompetent individuals. Facial nerve decompression surgery for Bell's palsy and herpes zoster oticus has experienced varying levels of enthusiasm over the years. Recent work implies that early, extensive decompression of the nerve through a middle fossa craniotomy may benefit patients at high risk for persistent deficits. However, until this procedure is subjected to a rigorous, controlled trial comparing it with maximal medical therapy, it is difficult to justify the very high costs and risk.
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46
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Carrasco DA, Straten MV, Tyring SK. Treatment of varicella-zoster virus and postherpetic neuralgia. Dermatol Ther 2000. [DOI: 10.1046/j.1529-8019.2000.00027.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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47
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Landow K. Acute and Chronic Herpes Zoster: An Ancient Scourge Yields to Timely Therapy. Postgrad Med 2000. [DOI: 10.1080/19419260.2000.12277435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- Ken Landow
- Dr Landow is clinical professor of dermatology, University of Southern California School of Medicine, Los Angeles, and in private practice of dermatology, Las Vegas
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48
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Choi Y, Li L, Grill S, Gullen E, Lee CS, Gumina G, Tsujii E, Cheng YC, Chu CK. Structure-activity relationships of (E)-5-(2-bromovinyl)uracil and related pyrimidine nucleosides as antiviral agents for herpes viruses. J Med Chem 2000; 43:2538-46. [PMID: 10891113 DOI: 10.1021/jm990543n] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A series of (E)-5-(2-bromovinyl)uracil analogues and related nucleosides was synthesized, and their antiviral activities were evaluated. (E)-5-(2-Bromovinyl)-2'-deoxy-L-uridine (L-BVDU, 2), 1-(beta-L-arabinofuranosyl)-(E)-5-(2-bromovinyl)uracil (L-BVAU, 4), (E)-5-(2-bromovinyl)-1-(2-deoxy-2-fluoro-beta-L-ribofuranosyl)uracil (L-FBVRU, 8) and (E)-5-(2-bromovinyl)-1-(2-deoxy-2-fluoro-beta-L-arabinofuranosyl)urac il (L-FBVAU, 10) were synthesized via appropriate 5-iodouracil analogues from L-arabinose. D- and L-Oxathiolane and -dioxolane derivatives 13, 16, 20, 21, and 29-34 were prepared by glycosylation reaction of the oxathiolane and dioxolane intermediates with silylated uracil analogues using TMSI as the coupling agent. The synthesized compounds were evaluated in cell cultures infected with the following viruses: varicella zoster virus (VZV), Epstein Barr virus (EBV), and herpes simplex virus types 1 and 2 (HSV-1 and HSV-2). Among the tested compounds, beta-L-CV-OddU (29), beta-L-BV-OddU (31), and beta-L-IV-OddU (33) exhibited potent in vitro antiviral activity against VZV with EC(50) values of 0.15, 0. 07, and 0.035 microM, respectively, and against EBV with EC(50) values of 0.49, 0.59, and 3.91 microM, respectively.
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Affiliation(s)
- Y Choi
- Department of Pharmaceutical and Biomedical Sciences, College of Pharmacy, The University of Georgia, Athens 30602-2352, USA
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49
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Abstract
UNLABELLED Varicella zoster virus (VZV), the pathogen responsible for herpes zoster, belongs to the herpesvirus family and is sensitive to the antiviral drug aciclovir. However, the low oral bioavailability of aciclovir has to some extent limited its efficacy in the treatment of herpes zoster and has prompted the development of the more readily absorbed oral prodrug valaciclovir. In a large comparative study valaciclovir, (1000 mg 3 times daily for 7 days) was at least as effective as aciclovir (800 mg 5 times daily for 7 days) in controlling the symptoms of acute herpes zoster. Importantly, valaciclovir alleviated zoster-associated pain and postherpetic neuralgia significantly faster than aciclovir. A 14-day regimen of valaciclovir showed no significant advantage over the 7-day regimen. A smaller trial in Japanese patients focusing primarily on the cutaneous (rash) signs of herpes zoster confirmed the similar efficacy of valaciclovir and aciclovir in the 7-day regimen. This study did not follow all patients for a formal analysis of postherpetic neuralgia. Valaciclovir and aciclovir demonstrated similar efficacy for the control of cutaneous lesions and ocular complications in patients with zoster ophthalmicus. Preliminary results of a large controlled trial indicate that valaciclovir 1000 mg 3 times daily and famciclovir (the prodrug of penciclovir) 500 mg 3 times daily are of similar efficacy in speeding resolution of acute herpes zoster rash and shortening the duration of postherpetic neuralgia. Starting treatment later than 72 hours after rash onset did not significantly reduce the beneficial effect of valaciclovir on duration of zoster-associated pain (a continuum of pain that encompasses both acute pain and postherpetic neuralgia) in a large observational study, suggesting that valaciclovir might be effective when given later than previously thought. However, valaciclovir should ideally be given as soon as possible after symptoms appear. With the recommended regimen for the treatment of herpes zoster (1000 mg 3 times daily for 7 days) valaciclovir was well tolerated, with nausea and headache being the most commonly reported adverse events. The adverse events profile of the agent was similar to that seen with aciclovir or famciclovir. CONCLUSION The efficacy of valaciclovir for the treatment of herpes zoster has been confirmed and extended by follow-up studies in herpes zoster ophthalmicus, in Japanese patients, and in the wider primary care setting. Valaciclovir is at least equivalent to, and better in certain parameters than, aciclovir and appears to have similar efficacy to famciclovir 500 mg 3 times daily. Valaciclovir is a well tolerated first-line therapy with an established place in the treatment of immunocompetent patients with herpes zoster.
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Affiliation(s)
- D Ormrod
- Adis International Limited, Mairangi Bay, Auckland, New Zealand.
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50
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Amrhein I, Wurth C, Bohner T, Hofbauer R, Folkers G, Scapozza L. Highly purified recombinant varicella Zoster virus thymidine kinase is a homodimer. Protein Expr Purif 2000; 18:338-45. [PMID: 10733888 DOI: 10.1006/prep.2000.1201] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Recombinant varicella zoster virus (VZV) thymidine kinase (TK) was isolated in a fast and gentle two-step procedure from Escherichia coli. The TK was expressed as a PreScission-cleavable fusion protein and purified by glutathione and ATP affinity chromatography, yielding homogeneous, highly pure VZV TK. The purified enzyme displays enzymatic activities with K(m) values of 0.3 +/- 0.06 microM for the natural substrate thymidine and 11.6 +/- 3.2 microM for ATP, indicating the biochemical equivalence with the viral VZV TK expressed in infected cells. Determinations of the native molecular weight by size exclusion chromatography and native polyacrylamide gel electrophoresis revealed that the pure enzyme is biologically active as a homodimer.
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Affiliation(s)
- I Amrhein
- Department of Applied BioSciences, Institute of Pharmaceutical Sciences, Swiss Federal Institute of Technology, Winterthurerstrasse 190, Zürich, CH-8057, Switzerland
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