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Alameer RM, Yamani A, Al-Saud A, Alsobayeg S, Alamro B, Alali A, Hammad E, Shendi AM, Almaghrabi RS. The successful treatment of mpox with brincidofovir in renal transplant recipients-a report of 2 cases. Int J Infect Dis 2024; 143:107015. [PMID: 38521447 DOI: 10.1016/j.ijid.2024.107015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/18/2024] [Accepted: 03/18/2024] [Indexed: 03/25/2024] Open
Abstract
An mpox outbreak was declared in July 2022 by the world health organization (WHO). It causes a mild self-limiting disease however; in immunosuppressed hosts, it tends to cause severe disseminated infection. Most cases of mpox in sold organ transplant (SOT) recipients reported in the literature were treated with tecovirimat. Here we report two cases of severe disseminated mpox infection in renal transplant recipients that were successfully treated with brincidofovir. Both patients were discharged from the hospital with no immediate significant side effects from brincidofovir reported until the submission of this report.
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Affiliation(s)
- Reem M Alameer
- Section of Transplant Infectious Diseases, Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
| | - Amani Yamani
- Section of Transplant Infectious Diseases, Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Abdulrahman Al-Saud
- Section of Transplant Infectious Diseases, Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Sultan Alsobayeg
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Bayan Alamro
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Alaa Alali
- Department of Infectious Diseases, King Saud Medical City, Riyadh, Saudi Arabia
| | - Ehab Hammad
- Kidney and Pancreas Health Center, Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ali M Shendi
- Kidney and Pancreas Health Center, Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Reem S Almaghrabi
- Section of Transplant Infectious Diseases, Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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2
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Grosenbach DW, Russo AT, Blum ED, Hruby DE. Emerging pharmacological strategies for treating and preventing mpox. Expert Rev Clin Pharmacol 2023; 16:843-854. [PMID: 37592723 DOI: 10.1080/17512433.2023.2249820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/10/2023] [Accepted: 08/16/2023] [Indexed: 08/19/2023]
Abstract
INTRODUCTION Since May 2022, there have been nearly 87,000 documented cases of mpox worldwide, with 119 deaths. Pharmacological interventions for mpox include the MVA-BN smallpox vaccine, tecovirimat, cidofovir, its pro-drug brincidofovir, and vaccinia immune globulin intravenous (VIGIV). AREAS COVERED The literature search and information gathering for this review included the PubMed database focusing on mpox and monkeypox, in combination with tecovirimat, brincidofovir, cidofovir, VIGIV, and smallpox vaccine. WHO.int, CDC.gov, FDA.gov, and ClinicalTrials.gov websites were accessed for the most recent information on the mpox outbreak. Mechanisms for deployment and access to treatment including expanded access, emergency use, and clinical trials will be discussed. Treatment outcomes with safety data will be presented. EXPERT OPINION The vaccine as a preventive measure, along with numerous treatment options, largely controlled the outbreak, although deployment of each could be improved upon to hasten and broaden access. More widespread coverage by the vaccine is necessary to prevent future resurgence of mpox. Tecovirimat has emerged as a safe frontline treatment for mpox, while brincidofovir use has been limited by safety concerns. VIGIV and cidofovir should be reserved for the most severe cases in which other options are not fully effective.
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Nyame J, Punniyakotti S, Khera K, Pal RS, Varadarajan N, Sharma P. Challenges in the treatment and prevention of Monkeypox infection; a comprehensive review. Acta Trop 2023:106960. [PMID: 37276922 PMCID: PMC10239200 DOI: 10.1016/j.actatropica.2023.106960] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 06/07/2023]
Abstract
Human monkeypox (HMPX) is a zoonotic disease, literally meaning that it can be passed on from animals (non-primate) to human (primate). All the reported and recorded cases have been traced back either to international travel or import of African animals. In the Unites states, sporadic monkeypox cases have been reported in specific over the past 50 years, starting its first identification in the Democratic Republic of the Congo (D.R.C.) in 1970. Due to its extreme versatility, this disease poses threat as a serious public health issue that needs to be monitored, researched and prevented. Data indicate that prior immunization with the smallpox vaccine is beneficial and may provide protection against the monkeypox virus. JYNNEOSTM is a live viral vaccine that has been approved to improve clinical manifestations of the infection. On the other hand, public ignorance about safety precaution towards monkeypox post-COVID is another challenge that needs to be overcome in tackling HMPX as a possible re-emergent infection. This review is a collation of the epidemiology, etiology, transmission, clinical features and treatment of human monkeypox (HMPX).
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Affiliation(s)
- Jennifer Nyame
- Lovely Institute of Technology, Lovely School of Pharmaceutical Sciences, Lovely Professional University, Punjab, 144411, India
| | - Saranya Punniyakotti
- Department of Pharmacy Practice, Lovely Institute of Technology, Lovely School of Pharmaceutical Sciences, Lovely Professional University, Punjab, 144411, India.
| | - Kanav Khera
- Department of Pharmacy Practice, Lovely Institute of Technology, Lovely School of Pharmaceutical Sciences, Lovely Professional University, Punjab, 144411, India
| | - Rashmi Saxena Pal
- Department of Pharmacognosy, Lovely Institute of Technology, Lovely School of Pharmaceutical Sciences, Lovely Professional University, Punjab, 144411, India
| | - Nithya Varadarajan
- Department of Pharmacy Practice, Saveetha College of Pharmacy, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai
| | - Prachi Sharma
- Department of Pharmacology, Lovely Institute of Technology, Lovely School of Pharmaceutical Sciences Lovely Professional University, Punjab, 144411, India
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Shamim MA, Padhi BK, Satapathy P, Veeramachaneni SD, Chatterjee C, Tripathy S, Akhtar N, Pradhan A, Dwivedi P, Mohanty A, Rodriguez-Morales AJ, Sah R, Al-Tammemi AB, Al-Tawfiq JA, Nowrouzi-Kia B, Chattu VK. The use of antivirals in the treatment of human monkeypox outbreaks: a systematic review. Int J Infect Dis 2023; 127:150-161. [PMID: 36470502 PMCID: PMC9719850 DOI: 10.1016/j.ijid.2022.11.040] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/27/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Human monkeypox virus (MPXV) infection is a recently declared public health emergency of international concern by the World Health Organization. Besides, there is scant literature available on the use of antivirals in MPXV infection. This systematic review compiles all evidence of various antivirals used on their efficacy and safety and summarizes their mechanisms of action. METHODS A review was done of all original studies mentioning individual patient data on the use of antivirals in patients with MPXV infection. RESULTS Of the total 487 non-duplicate studies, 18 studies with 71 individuals were included. Tecovirimat was used in 61 individuals, followed by cidofovir in seven and brincidofovir (BCV) in three individuals. Topical trifluridine was used in four ophthalmic cases in addition to tecovirimat. Of the total, 59 (83.1%) were reported to have complete resolution of symptoms; one was experiencing waxing and waning of symptoms, only one (1.8%) had died, and the others were having a resolution of symptoms. The death was thought unrelated to tecovirimat. Elevated hepatic panels were reported among all individuals treated with BCV (leading to treatment discontinuation) and five treated with tecovirimat. CONCLUSION Tecovirimat is the most used and has proven beneficial in several aggravating cases. No major safety concerns were detected upon its use. Topical trifluridine was used as an adjuvant treatment option along with tecovirimat. BCV and cidofovir were seldom used, with the latter often being used due to the unavailability of tecovirimat. BCV was associated with treatment discontinuation due to adverse events.
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Affiliation(s)
| | - Bijaya Kumar Padhi
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India,Corresponding authors
| | - Prakasini Satapathy
- Department of Virology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | - Snehasish Tripathy
- Department of Preventive Oncology, Homi Bhabha Cancer Hospital and Research Centre, Muzaffarpur, India
| | - Naushaba Akhtar
- Indian Council of Medical Research - Regional Medical Research Centre, Bhubaneswar, India
| | - Anindita Pradhan
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India
| | - Pradeep Dwivedi
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India,Centre of Excellence for Tribal Health, All India Institute of Medical Sciences, Jodhpur, India
| | - Aroop Mohanty
- All India Institute of Medical Sciences, Gorakhpur, India
| | - Alfonso J. Rodriguez-Morales
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas, Pereira, Colombia,Institución Universitaria Visión de las Américas, Pereira, Colombia,Clinical Epidemiology and Biostatistics, Universidad Cientifica del Sur, Lima, Peru
| | - Ranjit Sah
- Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal,Harvard Medical School, Boston, USA,Dr. D.Y. Patil Medical College, Hospital and Research Center, Dr. D.Y. Patil Vidyapeeth, Pune, Maharashtra, India,Corresponding authors
| | - Ala'a B. Al-Tammemi
- Migration Health Division, International Organization for Migration (IOM), Amman, Jordan
| | - Jaffar A. Al-Tawfiq
- Infectious Diseases Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, USA,Infectious Disease Division, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA,Specialty Internal Medicine and Quality Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Behdin Nowrouzi-Kia
- ReSTORE Lab, Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Vijay Kumar Chattu
- ReSTORE Lab, Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada,Center for Transdisciplinary Research, Saveetha Institute of Medical and Technological Sciences, Saveetha University, Chennai, India,Department of Community Medicine, Faculty of Medicine, Datta Meghe Institute of Medical Sciences, Wardha, India,Corresponding authors
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De Clercq E, Jiang Y, Li G. Therapeutic strategies for human poxvirus infections: Monkeypox (mpox), smallpox, molluscipox, and orf. Travel Med Infect Dis 2022; 52:102528. [PMID: 36539022 DOI: 10.1016/j.tmaid.2022.102528] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/01/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022]
Abstract
Therapeutic and vaccine development for human poxvirus infections (e.g., monkeypox (mpox) virus, variola virus, molluscum contagiosum virus, orf virus) has been largely deserted, especially after the eradication of smallpox by 1980. Human mpox is a self-limited disease confined to Central and West Africa for decades. However, since April 2022, mpox has quickly emerged as a multi-country outbreak, urgently calling for effective antiviral agents and vaccines to control mpox. Here, this review highlights possible therapeutic options (e.g., tecovirimat, brincidofovir, cidofovir) and other strategies (e.g., vaccines, intravenous vaccinia immune globulin) for the management of human poxvirus infections worldwide.
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Sukhdeo S, Mishra S, Walmsley S. Human monkeypox: a comparison of the characteristics of the new epidemic to the endemic disease. BMC Infect Dis 2022; 22:928. [PMID: 36503476 PMCID: PMC9742013 DOI: 10.1186/s12879-022-07900-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/25/2022] [Indexed: 12/14/2022] Open
Abstract
In May 2022, a new global outbreak of mpox (formerly, human monkeypox) emerged that was declared a public health emergency of international concern by the World Health Organization on July 23, 2022. With new patterns of person-to-person spread within sexual networks in nonendemic countries and several differences from the classic disease course, we performed a comprehensive review of existing literature on human monkeypox to discuss epidemiology, modes of transmission, clinical presentation and asymptomatic infection, diagnostics, therapeutics, and vaccines with the primary aim to identify important areas for future research of this new epidemic form of the disease. A comprehensive literature search was performed of all published literature to August 15, 2022. Historically, in regions of monkeypox virus endemicity, human outbreaks have occurred related to discrete zoonotic events. The animal reservoir is unknown, but the virus has been isolated from rodents. Traditionally, transmission occurred by direct or indirect contact with an infected animal. In nonendemic countries affected in the 2022 outbreak, almost exclusive person-to-person spread has been observed, and most cases are connected to sexual networks of gay, bisexual, and other men who have sex with men. After an incubation period of approximately 13 days, in traditional human cases affected persons developed a febrile prodrome preceding a rash that started on the face and body, spread centrifugally to the palms and soles and healed monomorphically over two to four weeks. However, in the 2022 outbreak, the febrile illness is often absent or occurs after the onset of the rash. The rash presents primarily in the anogenital region and face before disseminating throughout the body, with lesions displaying regional pleomorphism. There is a paucity of data for the role of antiviral agents or vaccines. The epidemiology and clinical course of mpox has changed in the 2022 epidemic from that observed with the endemic disease. There is an urgent need to establish rapid and collaborative research platforms to diagnose, treat and prevent disease and inform important public health and other strategies to stop the spread of disease.
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Affiliation(s)
- Sharon Sukhdeo
- Department of Medicine, University of Toronto, Toronto, Canada.
| | - Sharmistha Mishra
- grid.17063.330000 0001 2157 2938Division of Infectious Diseases, Department of Medicine, St. Michael’s Hospital, MAP Centre for Urban Health Solutions, University of Toronto, Toronto, Canada
| | - Sharon Walmsley
- grid.231844.80000 0004 0474 0428Department of Medicine, Division of Infectious Diseases, University Health Network, University of Toronto, Toronto, Canada
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Talarmin JP, Rezig S, Tran-Minoui A, Berthou C, Eveillard JR. Failure of antiviral therapy with brincidofovir in non-HIV progressive multifocal leukoencephalopathy. Acta Neurol Belg 2020; 120:1225-1226. [PMID: 32072465 DOI: 10.1007/s13760-020-01301-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 02/09/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Jean-Philippe Talarmin
- Department of Internal Medicine and Infectious Diseases, Centre Hospitalier de Cornouaille, Quimper, France.
| | - Schéhérazade Rezig
- Department of Infectious Diseases, Centre Hospitalier Universitaire, Brest, France
| | | | - Christian Berthou
- Department of Hematology, Centre Hospitalier Universitaire, Brest, France
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8
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Chan SY, Prockop SE, Boulad F, Papanicolaou GA, Lee YJ. Rapid Virologic Response to Brincidofovir in Children with Disseminated Adenovirus Infection. Infect Chemother 2020; 53:572-577. [PMID: 32869551 PMCID: PMC8511378 DOI: 10.3947/ic.2020.0204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 08/14/2018] [Indexed: 11/29/2022] Open
Abstract
Disseminated adenovirus infections (d-ADV) after hematopoietic cell transplant (HCT) are often fatal with limited treatment options. Brincidofovir (BCV) a lipid ester of cidofovir is developed for this indication. We report four pediatric HCT recipients with d-ADV treated successfully with BCV.
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Affiliation(s)
- Shuk Ying Chan
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong, China.,Infectious Diseases Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Susan E Prockop
- Pediatric Bone Marrow Transplantation Service, Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, USA.,Weill Cornell Medical College, Cornell University, New York, USA
| | - Farid Boulad
- Pediatric Bone Marrow Transplantation Service, Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, USA.,Weill Cornell Medical College, Cornell University, New York, USA
| | - Genovefa A Papanicolaou
- Infectious Diseases Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA.,Weill Cornell Medical College, Cornell University, New York, USA.
| | - Yeon Joo Lee
- Infectious Diseases Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA.,Weill Cornell Medical College, Cornell University, New York, USA.
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Salmona M, Feghoul L, Mercier-Delarue S, Diaz E, Splitberger M, Armero A, Dalle JH, Dutrieux J, LeGoff J. Effect of brincidofovir on adenovirus and A549 cells transcriptome profiles. Antiviral Res 2020; 182:104872. [PMID: 32768412 DOI: 10.1016/j.antiviral.2020.104872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Human adenovirus (HAdV) infections are associated with a high morbidity and mortality in transplant patients requiring the use of antiviral treatments. Brincidofovir (BCV), a cytidine analog, inhibits HAdV replication through viral DNA elongation termination and likely through other mechanisms. To elucidate if BCV regulates cellular antiviral pathways, we analyzed its impact on HAdV-infected and non-HAdV-infected lung epithelial cells. METHODS We assessed the cellular and viral transcriptome of A549 cells infected and non-infected with HAdV C5 and treated or non-treated with BCV by RNAseq after 72 h. RESULTS BCV treatment of HAdV infected cells resulted in a profound decrease of viral transcription associated with a relative overexpression of the early genes E1A and E4 and of the late gene L1. BCV had also a profound impact on A549 cells' transcriptome. Ontologic analysis revealed an effect of BCV on several pathways known to interact with adenovirus replication as mTor signalling and Wnt pathways. A549 cells treated with BCV demonstrated a significant inhibition of the biological function of "viral replication" including 25 dysregulated genes involved in inflammation pathways. CONCLUSION We demonstrated that BCV alters viral gene expression and promotes the expression of antiviral cellular pathways in A549 cells. These results provide new insights how to interfere with cellular pathways to control HAdV infections.
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Affiliation(s)
- Maud Salmona
- Université de Paris, INSERM U976, Insight Team, F-75010, Paris, France; Assistance-Publique des Hôpitaux de Paris, Microbiology Department, Virology Unit, Saint Louis Hospital, F-75010, Paris, France.
| | - Linda Feghoul
- Assistance-Publique des Hôpitaux de Paris, Microbiology Department, Virology Unit, Saint Louis Hospital, F-75010, Paris, France.
| | - Séverine Mercier-Delarue
- Assistance-Publique des Hôpitaux de Paris, Microbiology Department, Virology Unit, Saint Louis Hospital, F-75010, Paris, France.
| | - Elise Diaz
- Université de Paris, INSERM U976, Insight Team, F-75010, Paris, France.
| | - Marion Splitberger
- Assistance-Publique des Hôpitaux de Paris, Microbiology Department, Virology Unit, Saint Louis Hospital, F-75010, Paris, France.
| | - Alix Armero
- Université de Paris, INSERM U976, Insight Team, F-75010, Paris, France.
| | - Jean-Hugues Dalle
- Université de Paris, INSERM U976, Insight Team, F-75010, Paris, France; Assistance-Publique des Hôpitaux de Paris, Department of Pediatric Hemato-Immunology, Hospital Robert Debré, F-75019, Paris, France.
| | - Jacques Dutrieux
- Université de Paris, Institut Cochin, INSERM U1016, CNRS UMR8104, Paris, France.
| | - Jérôme LeGoff
- Université de Paris, INSERM U976, Insight Team, F-75010, Paris, France; Assistance-Publique des Hôpitaux de Paris, Microbiology Department, Virology Unit, Saint Louis Hospital, F-75010, Paris, France.
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Hussien MA, Abdelaziz AEM. Molecular docking suggests repurposing of brincidofovir as a potential drug targeting SARS-CoV-2 ACE2 receptor and main protease. Netw Model Anal Health Inform Bioinform 2020; 9:56. [PMID: 32834922 PMCID: PMC7413836 DOI: 10.1007/s13721-020-00263-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/22/2020] [Accepted: 07/27/2020] [Indexed: 12/11/2022]
Abstract
ABSTRACT The current outbreak of the highly transmittable and life-threatening severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has evolved rapidly and posed a global health emergency. Many clinical trials are now being conducted to test possible therapies. To assist this, virtual screening via molecular docking was performed on several FDA-approved drugs, previously used in epidemics, and the top ten compounds were selected. These ten well-characterized drugs, previously used to treat malaria and Ebola infections, were screened based on their interactions with the SARS-CoV-2 ACE2 receptor and 3C-like protease. Compared to the other nine medicines, brincidofovir, an ether lipid ester analog of cidofovir with potent antiviral activity, showed the highest docking scores and binding interactions. Therefore, brincidofovir is worth further investigations and clinical trials as a possible therapeutic agent for the COVID-19 disease caused by the novel SARS-CoV-2. GRAPHIC ABSTRACT
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Affiliation(s)
- Mostafa A. Hussien
- Department of Chemistry, Faculty of Science, King Abdulaziz University, POB 80203, Jeddah, 21589 Saudi Arabia
- Faculty of Science, Port-Said University, 23 December Street, POB 42522, Port-Said, Egypt
| | - Ahmed E. M. Abdelaziz
- Faculty of Science, Port-Said University, 23 December Street, POB 42522, Port-Said, Egypt
- Department of Biological Sciences, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4 Canada
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Abstract
The natural history of cytomegalovirus (CMV) infection in transplant patients has been well established. This virus may originate from the recipient, the donor or both. When pre-transplant IgG antibodies in the recipient are taken into account, three types of infection are possible: primary, reactivation or reinfection. The risks of high viral load and end-organ disease are highest after primary infection and lowest after reactivation. Serial monitoring of patients by quantitative polymerase chain reaction for CMV DNA allows antiviral drugs to be deployed for pre-emptive therapy or an antiviral drug may be given prophylactically. Both of these strategies are effective, but pre-emptive therapy has the advantage that randomised allocation of a new drug or placebo given prophylactically may show a reduced need for pre-emptive valganciclovir. In this review, I will consider what has been learned from use of ganciclovir and valganciclovir and apply this information to clinical trials that have evaluated maribavir, brincidofovir and letermovir. In addition, pre-emptive therapy has the advantage of facilitating the discovery of vaccines against CMV using a pharmacodynamic approach. Briefly, patients awaiting transplantation are given vaccine or placebo pre-transplant. When they proceed to transplantation, various parameters of viral load can be compared to determine if the vaccine has an effect against CMV when compared to patients randomised to receive placebo. If there is evidence of control of CMV, this can be related to immune responses induced by the vaccine to define a correlate of protection. This review will summarise the published evidence available.
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Affiliation(s)
- Paul Griffiths
- Institute for Immunity & Transplantation, Royal Free Campus, UCL, London, NW3 2PF, United Kingdom.
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12
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Marty FM, Winston DJ, Chemaly RF, Mullane KM, Shore TB, Papanicolaou GA, Chittick G, Brundage TM, Wilson C, Morrison ME, Foster SA, Nichols WG, Boeckh MJ; SUPPRESS Trial Clinical Study Group. A Randomized, Double-Blind, Placebo-Controlled Phase 3 Trial of Oral Brincidofovir for Cytomegalovirus Prophylaxis in Allogeneic Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2019; 25:369-81. [PMID: 30292744 DOI: 10.1016/j.bbmt.2018.09.038] [Citation(s) in RCA: 130] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 09/27/2018] [Indexed: 12/16/2022]
Abstract
Cytomegalovirus (CMV) infection is a common complication of allogeneic hematopoietic cell transplantation (HCT). In this trial, we randomized adult CMV-seropositive HCT recipients without CMV viremia at screening 2:1 to receive brincidofovir or placebo until week 14 post-HCT. Randomization was stratified by center and risk of CMV infection. Patients were assessed weekly through week 15 and every third week thereafter through week 24 post-HCT. Patients who developed clinically significant CMV infection (CS-CMVi; CMV viremia requiring preemptive therapy or CMV disease) discontinued the study drug and began anti-CMV treatment. The primary endpoint was the proportion of patients with CS-CMVi through week 24 post-HCT; patients who discontinued the trial or with missing data were imputed as primary endpoint events. Between August 2013 and June 2015, 452 patients were randomized at a median of 15 days after HCT and received study drug. The proportion of patients who developed CS-CMVi or were imputed as having a primary endpoint event through week 24 was similar between brincidofovir-treated patients and placebo recipients (155 of 303 [51.2%] versus 78 of 149 [52.3%]; odds ratio, .95 [95% confidence interval, .64 to 1.41]; P = .805); fewer brincidofovir recipients developed CMV viremia through week 14 compared with placebo recipients (41.6%; P < .001). Serious adverse events were more frequent among brincidofovir recipients (57.1% versus 37.6%), driven by acute graft-versus-host disease (32.3% versus 6.0%) and diarrhea (6.9% versus 2.7%). Week 24 all-cause mortality was 15.5% among brincidofovir recipients and 10.1% among placebo recipients. Brincidofovir did not reduce CS-CMVi by week 24 post-HCT and was associated with gastrointestinal toxicity.
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O'Brien MS, Markovich KC, Selleseth D, DeVita AV, Sethna P, Gentry BG. In vitro evaluation of current and novel antivirals in combination against human cytomegalovirus. Antiviral Res 2018; 158:255-263. [PMID: 30153445 DOI: 10.1016/j.antiviral.2018.08.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 08/22/2018] [Accepted: 08/24/2018] [Indexed: 02/07/2023]
Abstract
Human cytomegalovirus (HCMV) can cause severe disease in patients with compromised or immature immune systems. Currently approved pharmacotherapies for the treatment of systemic HCMV infections [ganciclovir (GCV), cidofovir (CDV), foscarnet] are limited by a high incidence of adverse effects and/or the development of drug resistance. Given that many of these drugs have the same viral target (HCMV-encoded DNA polymerase), cross-resistance is relatively common. The primary means to combat drug resistance is combination pharmacotherapy using therapeutics with different molecular mechanisms of action with the expectation that those combinations result in an additive or synergistic enhancement of effect; combinations that result in antagonism can, in many cases, be detrimental to the outcome of the patient. We therefore tested select combinations of approved (GCV, CDV, letermovir (LMV)) and experimental (brincidofovir (BCV), cyclopropavir (CPV), maribavir (MBV), BDCRB) drugs with the hypothesis that combinations of drugs with different and distinct molecular mechanisms of action will produce an additive and/or synergistic enhancement of antiviral effect against HCMV in vitro. Using MacSynergy II (a statistical package that measures enhancement or lessening of effect relative to zero/additive), select drug combination studies demonstrated combination indices ranging from 160 to 372 with 95% confidence intervals greater than zero indicating that these combinations elicit a synergistic enhancement of effect against HCMV in vitro. These data suggest that administration of a viral DNA polymerase inhibitor, MBV, and/or a viral terminase inhibitor in combination has the potential to address the resistance/cross-resistance problems associated with currently available therapeutics.
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Affiliation(s)
- M Shea O'Brien
- Department of Pharmaceutical and Administrative Sciences, Drake University College of Pharmacy and Health Sciences, 2507 University Ave., Des Moines, IA, 50311, USA.
| | - Kylie C Markovich
- Department of Pharmaceutical and Administrative Sciences, Drake University College of Pharmacy and Health Sciences, 2507 University Ave., Des Moines, IA, 50311, USA.
| | - Dean Selleseth
- Chimerix, 2505 Meridian Parkway, Suite 100, Durham, NC, 27713, USA.
| | - Alexa V DeVita
- Department of Pharmaceutical and Administrative Sciences, Drake University College of Pharmacy and Health Sciences, 2507 University Ave., Des Moines, IA, 50311, USA.
| | - Phiroze Sethna
- Chimerix, 2505 Meridian Parkway, Suite 100, Durham, NC, 27713, USA.
| | - Brian G Gentry
- Department of Pharmaceutical and Administrative Sciences, Drake University College of Pharmacy and Health Sciences, 2507 University Ave., Des Moines, IA, 50311, USA.
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Frange P, Leruez-Ville M. Maribavir, brincidofovir and letermovir: Efficacy and safety of new antiviral drugs for treating cytomegalovirus infections. Med Mal Infect 2018; 48:495-502. [PMID: 29650261 DOI: 10.1016/j.medmal.2018.03.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 09/22/2017] [Accepted: 03/16/2018] [Indexed: 12/15/2022]
Abstract
Cytomegalovirus (CMV) infection is a common complication in immunocompromised patients, especially after hematopoietic stem cell or solid organ transplantation. Therapeutic antiviral options [(val)ganciclovir, foscarnet, cidofovir] are still limited and can expose to severe toxicities. Moreover, prolonged antiviral drug exposure and ongoing viral replication are key factors in the development of antiviral drug resistance. After many years of few tangible advances in terms of new antiviral drugs, we are now experiencing an exciting period characterized by a series of phase III clinical trials incorporating three novel agents: maribavir, brincidofovir, and letermovir. This article summarizes the current state of the prevention and treatment of CMV infections as well as data of investigational drugs in clinical development.
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Affiliation(s)
- P Frange
- Laboratoire de microbiologie clinique, hôpital Necker-Enfants-Malades, Assistance publique-Hôpitaux de Paris (AP-HP), 149, rue de Sèvres, 75015 Paris, France; Unité d'immunologie, hématologie et rhumatologie pédiatriques, hôpital Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France; EA7327, université Paris Descartes, Sorbonne Paris Cité, 12, rue de l'École-de-Médecine, 75006 Paris, France.
| | - M Leruez-Ville
- Laboratoire de microbiologie clinique, hôpital Necker-Enfants-Malades, Assistance publique-Hôpitaux de Paris (AP-HP), 149, rue de Sèvres, 75015 Paris, France; EA7328, université Paris Descartes, Sorbonne Paris Cité, 12, rue de l'École-de-Médecine, 75006 Paris, France; CNR cytomégalovirus, laboratoire associé, 149, rue de Sèvres, 75015 Paris, France
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15
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Ramsay ID, Attwood C, Irish D, Griffiths PD, Kyriakou C, Lowe DM. Disseminated adenovirus infection after allogeneic stem cell transplant and the potential role of brincidofovir - Case series and 10 year experience of management in an adult transplant cohort. J Clin Virol 2017; 96:73-79. [PMID: 29017084 DOI: 10.1016/j.jcv.2017.09.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 08/23/2017] [Accepted: 09/30/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Adenovirus infection is a recognized complication following haematopoietic stem cell transplantation. We present a review of our experience of these infections in our transplant cohort over 10 years including 3 patients treated with the novel antiviral brincidofovir. OBJECTIVES We aimed to describe the presentation, response to treatment and outcomes of adult stem cell transplant patients with disseminated adenovirus infection. STUDY DESIGN All adult cases of disseminated adenovirus infection following haematopoietic stem cell transplant in our unit between 2005 and 2015 were identified. Transplant details and data on timing of diagnosis, course of infection, viral co-infection and treatment were collected. RESULTS Of 733 patients transplanted, 10 patients had disseminated infection, including 4 male and 6 female patients with median age of 36.5 (range 19-59) years. 6/10 received an allograft from an unrelated donor. Median post-transplant time to detection of viraemia was 67days (range 20-1140days). Median peak viral load was 3133 copies/ml (352-11,000,000) in survivors received cidofovir alone, one cidofovir then brincidofovir and two brincidofovir alone. 8/10 p and 1,580,000 copies/ml (41,999-3,000.000) in those who died. Five patientsatients had a decrease in viral load following antivirals and/or reduction in immunosuppression including all on brincidofovir. Three died on treatment. CONCLUSIONS Disseminated adenovirus infection is uncommon in adult transplant patients and uncertainties remain surrounding effective treatment. In our cohort, brincidofovir has shown promise in treatment of adenoviral infection. However, randomized controlled studies are required to confirm this impression.
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Affiliation(s)
| | | | - Dianne Irish
- Department of Virology, Royal Free Hospital London, UK
| | - Paul D Griffiths
- Department of Virology, Royal Free Hospital London, UK; Institute of Immunity and Transplantation, Royal Free Campus, University College London, UK
| | | | - David M Lowe
- Institute of Immunity and Transplantation, Royal Free Campus, University College London, UK; Department of Immunology, Royal Free Hospital London, UK.
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16
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Grossi IM, Foster SA, Gainey MR, Krile RT, Dunn JA, Brundage T, Khouri JM. Efficacy of delayed brincidofovir treatment against a lethal rabbitpox virus challenge in New Zealand White rabbits. Antiviral Res 2017; 143:278-286. [PMID: 28392420 DOI: 10.1016/j.antiviral.2017.04.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 04/04/2017] [Indexed: 10/19/2022]
Abstract
In the event of a bioterror attack with variola virus (smallpox), exposure may only be identified following onset of fever. To determine if antiviral therapy with brincidofovir (BCV; CMX001) initiated at, or following, onset of fever could prevent severe illness and death, a lethal rabbitpox model was used. BCV is in advanced development as an antiviral for the treatment of smallpox under the US Food and Drug Administration's 'Animal Rule'. This pivotal study assessed the efficacy of immediate versus delayed treatment with BCV following onset of symptomatic disease in New Zealand White rabbits intradermally inoculated with a lethal rabbitpox virus (RPXV), strain Utrecht. Infected rabbits with confirmed fever were randomized to blinded treatment with placebo, BCV, or BCV delayed by 24, 48, or 72 h. The primary objective evaluated the survival benefit with BCV treatment. The assessment of reduction in the severity and progression of clinical events associated with RPXV were secondary objectives. Clinically and statistically significant reductions in mortality were observed when BCV was initiated up to 48 h following the onset of fever; survival rates were 100%, 93%, and 93% in the immediate treatment, 24-h, and 48-h delayed treatment groups, respectively, versus 48% in the placebo group (p < 0.05 for each vs. placebo). Significant improvements in clinical and virologic parameters were also observed. These findings provide a scientific rationale for therapeutic intervention with BCV in the event of a smallpox outbreak when vaccination is contraindicated or when diagnosis follows the appearance of clinical signs and symptoms.
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17
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Chittick G, Morrison M, Brundage T, Nichols WG. Short-term clinical safety profile of brincidofovir: A favorable benefit-risk proposition in the treatment of smallpox. Antiviral Res 2017; 143:269-77. [PMID: 28093339 DOI: 10.1016/j.antiviral.2017.01.009] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/06/2017] [Accepted: 01/11/2017] [Indexed: 11/20/2022]
Abstract
Brincidofovir (BCV, CMX001) is an orally available, long-acting, broad-spectrum antiviral that has been evaluated in healthy subjects in Phase I studies and in hematopoietic cell transplant recipients and other immunocompromised patients in Phase II/III clinical trials for the prevention and treatment of cytomegalovirus and adenovirus infections. BCV has also shown in vitro activity against orthopoxviruses such as variola (smallpox) virus, and is under advanced development as a treatment for smallpox under the US FDA's 'Animal Rule'. The anticipated treatment regimen for smallpox is a total weekly dose of 200 mg administered orally for 3 consecutive weeks. To assess the benefit-to-risk profile of BCV for the treatment of smallpox, we evaluated short-term safety data associated with comparable doses from Phase I studies and from adult and pediatric subjects in the cytomegalovirus and adenovirus clinical programs. When administered at doses and durations similar to that proposed for the treatment of smallpox, BCV was generally well tolerated in both adults and pediatric subjects. The most common adverse events were mild gastrointestinal events and asymptomatic, transient, and reversible elevations in serum transaminases. The data presented herein indicate a favorable safety profile for BCV for the treatment of smallpox, and support its continued development for this indication.
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18
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Grimley MS, Chemaly RF, Englund JA, Kurtzberg J, Chittick G, Brundage TM, Bae A, Morrison ME, Prasad VK. Brincidofovir for Asymptomatic Adenovirus Viremia in Pediatric and Adult Allogeneic Hematopoietic Cell Transplant Recipients: A Randomized Placebo-Controlled Phase II Trial. Biol Blood Marrow Transplant 2017; 23:512-21. [PMID: 28063938 DOI: 10.1016/j.bbmt.2016.12.621] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 07/07/2016] [Indexed: 11/24/2022]
Abstract
Adenovirus infection in immunocompromised patients contributes to significant morbidity and mortality, especially after allogeneic hematopoietic cell transplantation (HCT). Brincidofovir (BCV, CMX001) is an orally bioavailable lipid conjugate of cidofovir that has in vitro activity against adenoviruses and other double-stranded DNA viruses. This randomized placebo-controlled phase II trial evaluated pre-emptive treatment with BCV for the prevention of adenovirus disease in pediatric and adult allogeneic HCT recipients with asymptomatic adenovirus viremia. Allogeneic HCT recipients with adenovirus viremia were randomized 1:1:1 to receive oral BCV 100 mg (2 mg/kg if <50 kg) twice weekly (BIW), BCV 200 mg (4 mg/kg if <50 kg) once weekly (QW), or placebo for 6 to 12 weeks, followed by 4 weeks of post-treatment follow-up. For randomization, subjects were stratified by screening absolute lymphocyte count (<300 cells/mm3 versus ≥300 cells/mm3). Assignment to BCV or placebo was double blinded; dose frequency was unblinded. The primary endpoint was the proportion of subjects experiencing treatment failure, defined as either progression to probable or definitive adenovirus disease or confirmed increasing adenovirus viremia (≥1 log10 copies/mL) during randomized therapy. Between June 2011 and December 2012, 48 subjects were randomized to the BCV BIW (n = 14), BCV QW (n = 16), or placebo (n = 18) groups. The proportion of subjects with treatment failure in the BCV BIW group was 21% (odds ratio, .53; 95% confidence interval [CI], .11 to 2.71; P = .45), 38% (odds ratio, 1.23; 95% CI, .30 to 5.05, P = .779) in the BCV QW group, and 33% in the placebo group. All-cause mortality was lower in the BCV BIW (14%) and BCV QW groups (31%) relative to the placebo group (39%), but these differences were not statistically significant. After 1 week of therapy, 8 of 12 subjects (67%) randomized to BCV BIW had undetectable adenovirus viremia (<100 copies/mL), compared with 4 of 14 subjects (29%) randomized to BCV QW and 5 of 15 subjects (33%) randomized to placebo. In a post hoc analysis of subjects with viremia ≥1000 copies/mL at baseline, 6 of 7 BCV BIW subjects (86%) achieved undetectable viremia compared with 2 of 8 placebo subjects (25%; P = .04). Early treatment discontinuation because of adverse events was more common in subjects treated with BCV than with placebo. Diarrhea was the most common event in all groups (57% BCV BIW, 38% BCV QW, 28% placebo), but it led to treatment discontinuation in only 1 subject receiving BCV QW. Events diagnosed as acute graft-versus-host disease, primarily of the gastrointestinal tract, were more frequent in the BCV BIW group (50%) than in the BCV QW (25%) and placebo (17%) groups. There was no evidence of myelotoxicity or nephrotoxicity in BCV-treated subjects. The results of this trial confirm the antiviral activity of BCV against adenoviruses. Further investigation is ongoing to define the optimal treatment strategy for HCT recipients with serious adenovirus infection and disease.
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19
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Crump R, Korom M, Buller RM, Parker S. Buccal viral DNA as a trigger for brincidofovir therapy in the mousepox model of smallpox. Antiviral Res 2016; 139:112-116. [PMID: 28039021 DOI: 10.1016/j.antiviral.2016.12.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 12/16/2016] [Accepted: 12/22/2016] [Indexed: 11/15/2022]
Abstract
Orthopoxviruses continue to pose a significant threat to the population as potential agents of bioterrorism. An intentional release of natural or engineered variola virus (VARV) or monkeypox viruses would cause mortality and morbidity in the target population. To address this, antivirals have been developed and evaluated in animal models of smallpox and monkeypox. One such antiviral, brincidofovir (BCV, previously CMX001), has demonstrated high levels of efficacy against orthopoxviruses in animal models and is currently under clinical evaluation for prevention and treatment of diseases caused by cytomegaloviruses and adenoviruses. In this study we use the mousepox model of smallpox to evaluate the relationship between the magnitude of the infectious virus dose and an efficacious BCV therapy outcome when treatment is initiated concomitant with detection of ectromelia virus viral DNA (vDNA) in mouse buccal swabs. We found that vDNA could be detected in buccal swabs of some, but not all infected mice over a range of challenge doses by day 3 or 4 postexposure, when initiation of BCV treatment was efficacious, suggesting that detection of vDNA in buccal swabs could be used as a trigger to initiate BCV treatment of an entire potentially exposed population. However, buccal swabs of some mice did not become positive until 5 days postexposure, when initiation of BCV therapy failed to protect mice that received high doses of virus. And finally, the data suggest that the therapeutic window for efficacious BCV treatment decreases as the virus infectious dose increases. Extrapolating these findings to VARV, the data suggest that treatment should be initiated as soon as possible after exposure and not rely on a diagnostic tool such as the measurement of vDNA in buccal cavity swabs; however, consideration should be given to the fact that the behavior/disease-course of VARV in humans is different from that of ectromelia virus in the mouse.
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Affiliation(s)
- Ryan Crump
- Saint Louis University School of Medicine, 1100 S. Grand Blvd, St. Louis, MO 63104, USA
| | - Maria Korom
- The George Washington University, School of Medicine and Health Sciences, Department of Microbiology, Immunology and Tropical Medicine, 2300 Eye Street, NW Washington, DC 20037, USA
| | - R Mark Buller
- Saint Louis University School of Medicine, 1100 S. Grand Blvd, St. Louis, MO 63104, USA
| | - Scott Parker
- Saint Louis University School of Medicine, 1100 S. Grand Blvd, St. Louis, MO 63104, USA.
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20
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Camargo JF, Morris MI, Abbo LM, Simkins J, Saneeymehri S, Alencar MC, Lekakis LJ, Komanduri KV. The use of brincidofovir for the treatment of mixed dsDNA viral infection. J Clin Virol 2016; 83:1-4. [PMID: 27513204 DOI: 10.1016/j.jcv.2016.07.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 07/28/2016] [Accepted: 07/31/2016] [Indexed: 11/28/2022]
Abstract
Double-stranded DNA (dsDNA) viral infections constitute a major complication following solid organ and stem cell transplantation. Few therapeutic options are currently available for the treatment of such infections in highly immunocompromised hosts. Brincidofovir is an oral investigational drug with broad antiviral activity against dsDNA viruses in vitro, but clinical experience is limited. Here we report a young female who developed a mixed infection with adenovirus, cytomegalovirus, Epstein-Barr virus and BK polyomavirus after an allogeneic stem cell transplant, and was successfully treated with brincidofovir.
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Affiliation(s)
- Jose F Camargo
- Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL 33136, United States.
| | - Michele I Morris
- Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL 33136, United States
| | - Lilian M Abbo
- Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL 33136, United States
| | - Jacques Simkins
- Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL 33136, United States
| | - Seyyedeh Saneeymehri
- Department of Pharmacy, Sylvester Cancer Center, University of Miami, 1475 NW 12th Ave, Miami, FL 33136, United States; Adult Stem Cell Transplant Program, Sylvester Cancer Center, University of Miami, 1475 NW 12th Ave, Miami, FL 33136, United States
| | - Maritza C Alencar
- Adult Stem Cell Transplant Program, Sylvester Cancer Center, University of Miami, 1475 NW 12th Ave, Miami, FL 33136, United States
| | - Lazaros J Lekakis
- Adult Stem Cell Transplant Program, Sylvester Cancer Center, University of Miami, 1475 NW 12th Ave, Miami, FL 33136, United States; Department of Medicine, Division of Hematology, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL 33136, United States
| | - Krishna V Komanduri
- Adult Stem Cell Transplant Program, Sylvester Cancer Center, University of Miami, 1475 NW 12th Ave, Miami, FL 33136, United States; Department of Medicine, Division of Hematology, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL 33136, United States
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21
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McMullan LK, Flint M, Dyall J, Albariño C, Olinger GG, Foster S, Sethna P, Hensley LE, Nichol ST, Lanier ER, Spiropoulou CF. The lipid moiety of brincidofovir is required for in vitro antiviral activity against Ebola virus. Antiviral Res 2016; 125:71-8. [PMID: 26526586 DOI: 10.1016/j.antiviral.2015.10.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 09/30/2015] [Accepted: 10/10/2015] [Indexed: 12/21/2022]
Abstract
Brincidofovir (BCV) is the 3-hexadecyloxy-1-propanol (HDP) lipid conjugate of the acyclic nucleoside phosphonate cidofovir (CDV). BCV has established broad-spectrum activity against double-stranded DNA (dsDNA) viruses; however, its activity against RNA viruses has been less thoroughly evaluated. Here, we report that BCV inhibited infection of Ebola virus in multiple human cell lines. Unlike the mechanism of action for BCV against cytomegalovirus and other dsDNA viruses, phosphorylation of CDV to the diphosphate form appeared unnecessary. Instead, antiviral activity required the lipid moiety and in vitro activity against EBOV was observed for several HDP-nucleotide conjugates.
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22
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Trost LC, Rose ML, Khouri J, Keilholz L, Long J, Godin SJ, Foster SA. The efficacy and pharmacokinetics of brincidofovir for the treatment of lethal rabbitpox virus infection: a model of smallpox disease. Antiviral Res 2015; 117:115-21. [PMID: 25746331 DOI: 10.1016/j.antiviral.2015.02.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 02/20/2015] [Accepted: 02/23/2015] [Indexed: 11/18/2022]
Abstract
Brincidofovir (BCV) has broad-spectrum in vitro activity against dsDNA viruses, including smallpox, and is being developed as a treatment for smallpox as well as infections caused by other dsDNA viruses. BCV has previously been shown to be active in multiple animal models of smallpox. Here we present the results of a randomized, blinded, placebo-controlled study of the efficacy and pharmacokinetics of a novel, "humanized" regimen of BCV for treatment of New Zealand White rabbits infected with a highly lethal inoculum of rabbitpox virus, a well characterized model of smallpox. Compared with placebo, a dose-dependent increase in survival was observed in all BCV-treatment groups. Concentrations of cidofovir diphosphate (CDV-PP), the active antiviral, in rabbit peripheral blood mononuclear cells (PBMCs) were determined for comparison to those produced in humans at the dose proposed for treatment of smallpox. CDV-PP exposure in PBMCs from rabbits given BCV scaled to human exposures at the dose proposed for treatment of smallpox, which is also currently under evaluation for other indications. The results of this study demonstrate the activity of BCV in the rabbitpox model of smallpox and the feasibility of scaling doses efficacious in the model to a proposed human dose and regimen for treatment of smallpox.
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Affiliation(s)
- Lawrence C Trost
- Chimerix, Inc., 2505 Meridian Pkwy, STE 340, Durham, NC 27713, USA.
| | - Michelle L Rose
- Chimerix, Inc., 2505 Meridian Pkwy, STE 340, Durham, NC 27713, USA
| | - Jody Khouri
- Chimerix, Inc., 2505 Meridian Pkwy, STE 340, Durham, NC 27713, USA
| | - Laurie Keilholz
- Chimerix, Inc., 2505 Meridian Pkwy, STE 340, Durham, NC 27713, USA
| | - James Long
- MRIGlobal, 425 Volker Boulevard, Kansas City, MO 64110-2241, USA(1)
| | - Stephen J Godin
- United Therapeutics Corp., 55 T W Alexander Dr, Research Triangle Park, NC 27709, USA(1)
| | - Scott A Foster
- Chimerix, Inc., 2505 Meridian Pkwy, STE 340, Durham, NC 27713, USA
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23
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Tollefson AE, Spencer JF, Ying B, Buller RM, Wold WS, Toth K. Cidofovir and brincidofovir reduce the pathology caused by systemic infection with human type 5 adenovirus in immunosuppressed Syrian hamsters, while ribavirin is largely ineffective in this model. Antiviral Res 2014; 112:38-46. [PMID: 25453340 DOI: 10.1016/j.antiviral.2014.10.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 10/07/2014] [Accepted: 10/08/2014] [Indexed: 11/23/2022]
Abstract
There are no drugs approved specifically to treat disseminated adenovirus (Ad) infections in humans. Cidofovir is active against Ad in cell culture, and it is used frequently in the clinic with disseminated infection in pediatric transplant patients; however, controlled clinical studies have not been conducted to prove the anti-Ad efficacy of cidofovir. Brincidofovir, a lipid-linked derivative of cidofovir, which has strong activity against Ad in cell culture and in animal models, is a promising new drug currently in clinical trials. Ribavirin, which has modest activity against some Ad types in cell culture, has been used in the clinic against disseminated Ad, but the efficacy of ribavirin is unknown. In the current study, we have examined the activity of cidofovir, brincidofovir, and ribavirin against disseminated Ad5 infection in the immunosuppressed Syrian hamster model. Hamsters are immunosuppressed by treatment with cyclophosphamide, then infected intravenously with Ad5, leading to disseminated Ad5 infection, especially in the liver. We found that cidofovir and brincidofovir have excellent activity against Ad5 pathology and replication in the liver, even when administered therapeutically starting at 3 days post-challenge with Ad5. Ribavirin did not have anti-Ad5 activity in our model. Our data support the use of cidofovir and brincidofovir in humans for the treatment of disseminated Ad infections in humans.
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Marcelin JR, Beam E, Razonable RR. Cytomegalovirus infection in liver transplant recipients: Updates on clinical management. World J Gastroenterol 2014; 20:10658-10667. [PMID: 25152570 PMCID: PMC4138447 DOI: 10.3748/wjg.v20.i31.10658] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 01/24/2014] [Accepted: 04/03/2014] [Indexed: 02/06/2023] Open
Abstract
Cytomegalovirus (CMV) infection is a common complication after liver transplantation, and it is associated with multiple direct and indirect effects. Management of CMV infection and disease has evolved over the years, and clinical guidelines have been recently updated. Universal antiviral prophylaxis and a pre-emptive treatment strategy are options for prevention. A currently-recruiting randomized clinical trial is comparing the efficacy and safety of the two prevention strategies in the highest risk D+R- liver recipients. Drug-resistant CMV infection remains uncommon but is now increasing in incidence. This highlights the currently limited therapeutic options, and the need for novel drug discoveries. Immunotherapy and antiviral drugs with novel mechanisms of action are being investigated, including letermovir (AIC246) and brincidofovir (CMX001). This article reviews the current state of CMV management after liver transplantation, including the updated practice guidelines, and summarizes the data on investigational drugs and vaccines in clinical development.
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