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Medical research on aciclovir
J Med Virol. 2008 Nov 21; 81(1): 42-48
Archimbaud C, Chambon M, Bailly JL, Petit I, Henquell C, Mirand A, Aublet-Cuvelier B, Ughetto S, Beytout J, Clavelou P, Labbé A, Philippe P, Schmidt J, Regagnon C, Traore O, Peigue-Lafeuille H
Enteroviruses (EV) are the main etiological agents of aseptic meningitis. Diagnosis is made by detecting the genome using RT-PCR. The aim of the study was to evaluate the impact of a positive diagnosis on the management of infants, children, and adults. During 2005, 442 patients were admitted to hospital with suspected meningitis. Clinical and laboratory data and initial treatment were recorded for all patients with enteroviral meningitis. The turnaround time of tests and the length of hospital stay were analyzed. The results showed that EV-PCR detected EV in 69 patients (16%), 23% (16/69) were adults. About 18% of CSF samples had no pleocytosis. After positive PCR results, 63% of children were discharged immediately (mean 2 hr 30 min) and 95% within 24 hr. Infants and adults were discharged later (after 1.8 and 2 days, respectively). The use of antibiotics was significantly lower in children than in infants and adults. The PCR results allowed discontinuation of antibiotics in 50-60% of all patients treated. Patients received acyclovir in 16% of cases (7% children vs. 50% adults) and 23% (11% vs. 69%) underwent a CT scan. Clinical data were compared between patients whose positive EV-PCR results were available within 24 hr (n = 32) and those whose results were available > 24 hr after collection of CSF (n = 14). Duration of antibiotic treatment (difference: 2.3 days; P = 0.05) was reduced between the two groups. No statistical difference in the length of stay was observed. The EV-PCR assay should be performed daily in hospital laboratory practice and considered as part of the initial management of meningitis. J. Med. Virol. 81:42-48, 2009. (c) 2008 Wiley-Liss, Inc.
Inhibitory activity of Melissa officinalis L. extract on Herpes simplex virus type 2 replication.
Nat Prod Res. 2008; 22(16): 1433-40
Mazzanti G, Battinelli L, Pompeo C, Serrilli AM, Rossi R, Sauzullo I, Mengoni F, Vullo V
Melissa officinalis L. (Lamiaceae) (lemon balm) is used in folk medicine for nervous complaints, lower abdominal disorders and, more recently, for treating Herpes simplex lesions. In this work the antiviral activity of a hydroalcoholic extract of lemon balm leaves against the Herpes simplex virus type 2 (HSV-2) was assessed by the cytopathic effect inhibition assay on Vero cells (ATCC CCL-81), in comparison with acyclovir. The cytotoxicity of the extract on Vero cells was previously tested by evaluating the cellular death and was confirmed by the Trypan blue test. Lemon balm showed to reduce the cytopathic effect of HSV-2 on Vero cells, in the range of non-toxic concentrations of 0.025-1 mg mL(-1) (with reference to the starting crude herbal material). The maximum inhibiting effect (60%) was obtained with 0.5 mg mL(-1). The viral binding assay showed that the extract does not prevent the entry of HSV-2 in the cells, thus suggesting a mechanism of action subsequent to the penetration of the virus in the cell. The extract was also chemically characterised by NMR and HPLC analysis; it showed to contain cinnamic acid-like compounds, mainly rosmarinic acid (4.1% w/w). Our experiments support the use of lemon balm for treating Herpes simplex lesions and encourage clinical trials on this medicinal plant.
J Inorg Biochem. 2008 Nov 1;
Gómez-Segura J, Caballero S, Moreno V, Prieto MJ, Bosch A
Cytotoxicity and herpes simplex virus (HSV-1) inhibitory activity of acyclovir (ACV), 9-[(2-hydroxyethoxy)methyl]guanine, and the palladium(II) coordination complex cis-[PdCl(2)(H(2)O)(N7-ACV)].ACV.xH(2)O have been tested in African green monkey kidney (Vero line) epithelial cell cultures. The N(7) position of ACV represents the preferred binding site to afford a pseudo-chelate N7/O6 Pd(II) complex involving H-bonds with the cis H(2)O molecule. The Pd(II)-ACV complex has been structurally characterized by FTIR and (1)H NMR spectroscopy techniques, chemical composition was measured by elemental analysis, and the thermoanalytical study was performed by TG/DTA. The recognition of secondary ACV molecules by the Pd(II) derivative promotes cooperatively potent HSV-1 inhibitory activity which, in turn, strongly depends on concentration conditions. At the optimal concentration of 10muM, this complex exhibits antiviral efficiency in vitro, approximately hundred-fold (ca. 1.87log(10)) more effective in herpes-infected cells when compared with that of the parent ACV molecules. The molecular-level observation of noticeable modifications caused by the complex on the morphology of the plasmid pBR322 DNA was monitored by AFM, whose mutual interaction evolves to eventually afford DNA condensates upon increasing the period of incubation.
J Med Case Reports. 2008 Nov 20; 2(1): 356
Lakhan SE, Harle L
ABSTRACT: INTRODUCTION: Herpes simplex infection is most commonly a benign, self-limiting disease with mucocutaneous lesions and mild viremia. Immunosuppressed patients are at a higher risk of disseminated infection, as are neonates and pregnant women. The incidence of fulminant herpes simplex virus hepatitis is extremely low, and the diagnosis is often missed due to the lack of specific signs or symptoms. CASE PRESENTATION: We present the case of an immunocompetent, previously healthy young woman who contracted herpes simplex virus, presumably through a recent tongue piercing, which progressed to fulminant hepatitis and death. CONCLUSION: Despite aggressive medical therapy, fulminant herpes simplex virus hepatitis is fatal in the majority of patients. We present a review of the literature, which shows that immunocompetent adults have rarely been affected by fulminant herpes simplex virus hepatitis. Initiation of empirical therapy is warranted in patients with progressive hepatic failure with no other underlying cause. Acyclovir therapy has proven effective in some patients, but is less effective in patients who present in advanced stages of infection.
Relapsing Herpes simplex virus encephalitis despite high-dose acyclovir therapy: a case report.
Turk J Pediatr. 2008 Jul-Aug; 50(4): 380-2
Devrim I, Tezer H, Haliloğlu G, Kara A, Seçmeer G
Central nervous system infection of Herpes simplex virus (HSV) is the most common etiologic agent of the non-epidemic fatal form of encephalitis. Relapse of HSV encephalitis is rare in childhood. In this report, we present our experience in a 36-month-old child with relapse of HSV encephalitis after 14-day acyclovir therapy. A 36-month-old boy who was presented with deterioration in speech and motor functions and fluctuation of consciousness was treated with acyclovir for 14 days for HSV encephalitis. He was discharged since his cerebrospinal fluid findings returned to normal range and clinical improvement was seen. Ten days later, he was readmitted to our clinic with acute fever, focal convulsions and choreoathetoid movements, and altered consciousness. Acyclovir was started immediately, but he died on the 17th day because of respiratory failure. Relapses due to HSV encephalitis are rare and limited to a small number of case reports in the literature. Persistence of HSV, detection of high viral load or detection of HSV by polymerase chain reaction, prior corticosteroid therapy, low total dosage of acyclovir (especially for children under 2 years of age) and short duration of therapy were suspected risk factors. Even absence of pleocytosis and normal cerebrospinal fluid biochemistry in our patient after treatment did not indicate eradication of HSV. In our opinion, treatment duration of HSV encephalitis, especially in small children, must be at least 21 days. Clinical and experimental studies are required since only case reports on this topic exist.
J Neurol Neurosurg Psychiatry. 2008 Dec; 79(12): 1408-9
Kaut O, Urbach H, Klockgether T
Spinal dural arteriovenous fistulae (SDAVF) are acquired spinal vascular malformations, in which a small connection between a radicular artery and radicular vein causes venous hypertension, congestive myelopathy and infarction of the spinal cord. Here the case of a 47-year-old man is presented who had pain in his back irradiating to his right leg, numbness of his right leg as well as weakness of both legs. Urination was disturbed with detection of residual urine. Six weeks later he developed a progressive paraparesis of the legs. A T2 weighted MRI of the lower back showed intramedullary hyperintensity. A myelitis was assumed and treatment with acyclovir and dexamethasone was started. Nevertheless, he developed total paralysis of his legs. Six years later, re-evaluation of the initial MRI and a new MRI showed abnormal blood vessels on the dorsal side of the spinal cord, which had been overlooked at the first MRI examination. Spinal angiography demonstrated an arteriovenous fistula. Fistula obliteration was performed. Six months later he was able to stand with canes for 2 min and showed improvement in sensibility. The remarkable aspect of this case of SDAVF is the relevant improvement of complete paraplegia by surgical obliteration 78 months after onset of symptoms. The delay of more than 6 years between onset of first symptoms and final diagnosis underlines the difficulties in making a correct diagnosis of SDAVF. However, even after delayed diagnosis, surgical obliteration should be done, as improvement of neurological function can still be achieved.
Bioorg Med Chem. 2008 Nov 5;
Schott H, Hamprecht K, Schott S, Schott TC, Schwendener RA
To prepare a new antiviral duplex drug linking Zidovudine (AZT) and Foscarnet (PFA) via a lipophilic octadecylglycerol residue we condensed 1-O-4-monomethoxytrityl-3-O-octadecyl-sn-glycerol-2-hydrogenphosphonate obtained from 3-O-octadecyl-sn-glycerol with AZT by the phosphonate method. The purified condensation product was de-tritylated resulting in 3'-azido-3'-deoxythymidylyl-(5'-->2-O)-3-O-octadecyl-sn-glycerol, followed by treatment with (ethoxycarbonyl)phosphoric dichloride. The resulting 3'-azido-3'-deoxy-thymidylyl-(5'-->2)-3-O-octadecyl-sn-glycerol-1-O-(ethoxycarbonyl)phosphonate was purified by preparative RP-18 column chromatography. The antiviral duplex drug 3'-azido-3'-deoxythymidylyl-(5'-->2-O)-3-O-octadecyl-sn-glycerol-1-O-phosphonoformate trisodium salt (AZT-lipid-PFA) was obtained after alkaline cleavage of the phosphonoformate ethylester residue. The overall yield of the five step synthesis performed at gram scale was about 30%. According to a supposed pathway AZT-lipid-PFA could be cleaved to yield a mixture of different antiviral compounds such as AZT, AZT-5'-monophosphate, octadecylglycerol-AZT, PFA and octadecylglycerol-PFA, possibly producing additive and/or synergistic antiviral effects. In vitro studies showed that the duplex drug exhibits antiviral activities against HIV and especially against drug-resistant strains and clinical isolates of HSV and HCMV. The E(50) values of AZT-lipid-PFA against HIV ranged between 170 and 200nM. The half-maximal inhibitory doses (IC(50)) against highly acyclovir (ACV)-resistant HSV isolates determined by a plaque reduction assay ranged between 1.87 and 4.59muM. Using ganciclovir (GCV)-sensitive, GCV resistant and drug cross-resistant HCMV strains the IC(50)-values of AZT-lipid-PFA were between 2.78 and 1.18muM. With regard to PFA, the IC(50)-value of AZT-lipid-PFA determined on a multi-drug-resistant HCMV strain was about 90-fold lower than that of PFA, demonstrating the superior antiviral effect of the duplex-drug.
[Cytomegalovirus colitis in an elderly polytraumatised patient]
Dtsch Med Wochenschr. 2008 Nov; 133(46): 2383-6
Wildenauer R, Suttorp AC, Kobbe P
HISTORY AND CLINICAL FINDINGS: During a long-term stay on a intensive-care unit a polytraumatised elderly patient developed hematochezia, which was refractory to blood transfusion. INVESTIGATIONS AND DIAGNOSIS: During colonoscopy, multiple ulcers were found in the right colon and rectum, and right hemicolectomy was performed after another massive anal blood loss. Histological findings showed characteristic intranuclear inclusions, positive Cytomegalovirus (CMV)-IgM titer and positive polymerase chain reaction (PCR) in blood. TREATMENT AND COURSE: After hemicolectomy, antiviral therapy with ganciclovir was initiated for two weeks intravenously, and no more gastrointestinal symptoms occurred. In the following days, enteral alimentation was continued without problems. CONCLUSIONS: CMV colitis should be considered in immunoincompetent patients after more common etiologies for severe diarrhea have been excluded. Timely diagnosis is essential to improve the outcome for elderly patients or patients with severe co-morbidities.
Evaluation of orally administered valacyclovir in experimentally EHV1-infected ponies.
Vet Microbiol. 2008 Sep 21;
Garré B, Gryspeerdt A, Croubels S, De Backer P, Nauwynck H
The purpose of the current study was to investigate the therapeutic efficacy of valacyclovir against EHV1 in a controlled study. Eight naïve Shetland ponies were inoculated with 10(6.5) TCID(50) of the neuropathogenic strain 03P37. Four ponies were treated with valacyclovir at a dosage of 40mg/kg bodyweight, 3 times daily, for 5 (n=2) or 7 (n=2) consecutive days, while the other four ponies served as untreated controls. The treatment regimen started 1h before inoculation. Ponies were monitored daily for clinical signs. At 0, 1, 2, 3, 4, 5, 7, 9, 11, 14, 17 and 21 days post inoculation (d pi), a nasopharyngeal mucus sample was taken to determine viral shedding. At the same time points, blood was collected and peripheral blood mononuclear cells (PBMC) were isolated to determine viremia. During the treatment, blood samples were collected 6 times daily, i.e. just before valacyclovir administration and 1h later, to determine the concentration of acyclovir in plasma. Also a nasopharyngeal swab was taken to measure the acyclovir concentration in nasal secretion. No differences could be noticed between valacyclovir-treated and untreated ponies. The clinical signs, the viral shedding and the viremia were similar in both the groups. Plasma acyclovir concentration could be maintained above the EC(50)-value of EHV1 during 50% of the entire treatment period in valacyclovir-treated ponies. Acyclovir could be detected in nasal swabs at concentrations varying from 50% to 100% of the corresponding plasma concentration. Although sufficiently high acyclovir levels could be reached in plasma and nasal mucus, no effect was seen of the treatment with valacyclovir on clinical signs, viral shedding and viremia of EHV1-infected ponies.
Expert Opin Drug Deliv. 2008 Nov; 5(11): 1217-30
Cortesi R, Esposito E
Herpes viruses (herpes simplex, varicella zoster, cytomegalovirus) are the main cause of a wide variety of human infections. Although the development of successful antiviral agents against infections caused by herpes viruses had been slow until the last decade, the production of delivery systems for acyclovir are a promising alternative. The present review summarizes the principal advances made in developing carriers for the delivery of acyclovir by different routes of administration.