De Clercq EAntiviral drugs in current clinical use. J Clin Virol 30: 115-133

Rega Institute for Medical Research, Katholieke Universiteit Leuven, Minderbroedersstraat 10, B-3000 Leuven, Belgium.
Journal of Clinical Virology (Impact Factor: 3.02). 07/2004; 30(2):115-33. DOI: 10.1016/j.jcv.2004.02.009
Source: PubMed


The current armamentarium for the chemotherapy of viral infections consists of 37 licensed antiviral drugs. For the treatment of human immunodeficiency virus (HIV) infections, 19 compounds have been formally approved: (i) the nucleoside reverse transcriptase inhibitors (NRTIs) zidovudine, didanosine, zalcitabine, stavudine, lamivudine, abacavir and emtricitabine; (ii) the nucleotide reverse transcriptase inhibitor (NtRTI) tenofovir disoproxil fumarate; (iii) the non-nucleoside reverse transcriptase inhibitors (NNRTIs) nevirapine, delavirdine and efavirenz; (iv) the protease inhibitors saquinavir, ritonavir, indinavir, nelfinavir, amprenavir, lopinavir (combined with ritonavir at a 4/1 ratio) and atazanavir; and the viral entry inhibitor enfuvirtide. For the treatment of chronic hepatitis B virus (HBV) infections, lamivudine as well as adefovir dipivoxil have been approved. Among the anti-herpesvirus agents, acyclovir, valaciclovir, penciclovir (when applied topically), famciclovir, idoxuridine and trifluridine (both applied topically) as well as brivudin are used in the treatment of herpes simplex virus (HSV) and/or varicella-zoster virus (VZV) infections; and ganciclovir, valganciclovir, foscarnet, cidofovir and fomivirsen (the latter upon intravitreal injection) have proven useful in the treatment of cytomegalovirus (CMV) infections in immunosuppressed patients (i.e. AIDS patients with CMV retinitis). Following amantadine and rimantadine, the neuraminidase inhibitors zanamivir and oseltamivir have recently become available for the therapy (and prophylaxis) of influenza virus infections. Ribavirin has been used (topically, as aerosol) in the treatment of respiratory syncytial virus (RSV) infections, and the combination of ribavirin with (pegylated) interferon-alpha has received increased acceptance for the treatment of hepatitis C virus (HCV) infections.

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    • "Obviously, sorting out an aberrant cellular component for drug targeting in the midst of a complex system is like finding a needle in a haystack. Even if a target is identified and a drug is developed to inhibit it, single drug treatment often leads to drug resistance [8] [9]. Furthermore, in many diseases it is common for there to be more than one disease causing target due to nonlinear interactions between signaling pathways. "
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    ABSTRACT: The cell is a complex system involving numerous components, which may often interact in a non-linear dynamic manner. Diseases at the cellular level are thus likely to involve multiple cellular constituents and pathways. As some drugs, or drug combinations, may act synergistically on these multiple pathways, they might be more effective than the respective single target agents. Optimizing a drug mixture for a given disease in a particular patient is particularly challenging due to both the difficulty in the selection of the drug mixture components to start out with, and the all-important doses of these drugs to be applied. For n concentrations of m drugs, in principle, n(m) combinations will have to be tested. As this may lead to a costly and time-consuming investigation for each individual patient, we have developed a Feedback System Control (FSC) technique which can rapidly select the optimal drug-dose combination from the often millions of possible combinations. By testing this FSC technique in a number of experimental systems representing different disease states, we found that the response of cells to multiple drugs is well described by a low order, rather smooth, drug-mixture-input/drug-effect-output multidimensional surface. The main consequences of this are that optimal drug combinations can be found in a surprisingly small number of tests, and that translation from in vitro to in vivo is simplified. This points to the possibility of personalized optimal drug mixtures in the near future. This unexpectedly simple input-output relationship may also lead to a simple solution for handling the issue of human diversity in cancer therapeutics.
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    • "A remarkable feature of the members of this family is their ability to cause and reactivate latent infections in their hosts, and this is important for the control of the disease (Hübner et al., 2005). Among the drugs that possess inhibitory action against herpesvirus replication, the most used in the human medicine are the nucleoside analogues (De Clercq, 2012) and there is evidence of resistance to some of them (De Clercq, 2004). Likewise it is necessary to search for new compounds with alternative mechanisms of action. "
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    ABSTRACT: P34 is an antimicrobial peptide produced by a Bacillus sp. strain isolated from the intestinal contents of a fish in the Brazilian Amazon basin with reported antibacterial activity. The aim of this work was to evaluate the peptide P34 for its in vitro antiviral properties against canine adenovirus type 2 (CAV-2), canine coronavirus (CCoV), canine distemper virus (CDV), canine parvovirus type 2 (CPV-2), equine arteritis virus (EAV), equine influenza virus (EIV), feline calicivirus (FCV) and feline herpesvirus type 1 (FHV-1). The results showed that the peptide P34 exhibited antiviral activity against EAV and FHV-1. The peptide P34 inhibited the replication of EAV by 99.9% and FHV-1 by 94.4%. Virucidal activity was detected only against EAV. When P34 and EAV were incubated for 6 h at 37 °C the viral titer reduced from 10(4.5) TCID50 to 10(2.75) TCID50, showing a percent of inhibition of 98.6%. In conclusion, our results demonstrated that P34 inhibited EAV and FHV-1 replication in infected cell cultures and it showed virucidal activity against EAV. Since there is documented resistance to the current drugs used against herpesviruses and there is no treatment for equine viral arteritis, it is advisable to search for new antiviral compounds to overcome these infections.
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    • "BVU in turn inhibits dihydropyrimidine dehydrogenase, which is involved in the degradation of thymidine, uracil, and the commonly used cancer drug 5-fluorouracil (5-FU). Patients receiving this chemotherapy regimen should not be given BVdU as it may cause toxic accumulation of 5-FU and result in death (De Clercq, 2004, 2005; Diasio, 1998; Keizer et al., 1994). The serious possible adverse effects of BVdU are the main reason why alternative antiviral uridine compounds have been sought. "
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    ABSTRACT: The alphaherpesvirus varicella-zoster virus (VZV) causes chickenpox and shingles. Current treatments are acyclovir (ACV) and its derivatives, foscarnet and brivudine (BVdU). Additional antiviral compounds with increased potency and specificity are needed to treat VZV, especially to treat post-herpetic neuralgia. We evaluated β-L-1-[5-(E-2-Bromovinyl)-2-(hydroxymethyl)-1,3-dioxolan-4-yl)] uracil (L-BHDU, 1) and 5′-O-valyl-L-BHDU (2) in three models of VZV replication: primary human foreskin fibroblasts (HFFs), skin organ culture (SOC) and in SCID-Hu mice with skin xenografts. The efficacy of L-BHDU in vivo and its drug-drug interactions were previously not known. In HFFs, 200 μM L-BHDU was noncytotoxic over 3 days, and L-BHDU treatment reduced VZV genome copy number and cell to cell spread. The EC50 in HFFs for L-BHDU and valyl-L-BHDU were 0.22 and 0.03 μM, respectively. However, L-BHDU antagonized the activity of ACV, BVdU and foscarnet in cultured cells. Given its similar structure to BVdU, we asked if L-BHDU, like BVdU, inhibits 5-fluorouracil catabolism. BALB/c mice were treated with 5-FU alone or in combination with L-BHDU or BVdU. L-BHDU did not interfere with 5-FU catabolism. In SCID-Hu mice implanted with human skin xenografts, L-BHDU and valyl-L-BHDU were superior to ACV and valacyclovir. The maximum concentration (Cmax) levels of L-BHDU were determined in mouse and human tissues at 2 h after dosing, and comparison of concentration ratios of tissue to plasma indicated saturation of uptake at the highest dose. For the first time, an L-nucleoside analog, L-BHDU, was found to be effective and well tolerated in mice.
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