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Antimicrobial Agents and Chemotherapy, July 1998, p. 1629-1635, Vol. 42, No. 7
0066-4804/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.
Antiviral Activity of a Selective Ribonucleotide Reductase
Inhibitor against Acyclovir-Resistant Herpes Simplex Virus Type 1 In Vivo
Jianmin
Duan,*
Michel
Liuzzi,
William
Paris,
Michelle
Lambert,
Carol
Lawetz,
Neil
Moss,
Jorge
Jaramillo,
Jean
Gauthier,
Robert
Déziel, and
Michael G.
Cordingley
Bio-Méga Research Division, Boehringer
Ingelheim (Canada) Ltd., Laval, Québec, Canada H7S 2G5
Received 17 December 1997/Returned for modification 31 March
1998/Accepted 1 May 1998
 |
ABSTRACT |
The present study reports the activity of BILD 1633 SE against
acyclovir (ACV)-resistant herpes simplex virus (HSV) infections in
athymic nude (nu/nu) mice. BILD 1633 SE is a novel
peptidomimetic inhibitor of HSV ribonucleotide reductase (RR). In
vitro, it is more potent than ACV against several strains of wild-type
as well as ACV-resistant HSV mutants. Its in vivo activity was tested against cutaneous viral infections in athymic nude mice infected with
the ACV-resistant isolates HSV type 1 (HSV-1) dlsptk and PAAr5, which contain mutations in the viral
thymidine kinase gene and the polymerase gene, respectively. Following
cutaneous infection of athymic nude mice, both HSV-1 dlsptk
and PAAr5 induced significant, reproducible, and persistent
cutaneous lesions that lasted for more than 2 weeks. A 10-day treatment regimen with ACV given topically four times a day as a 5% cream or
orally at up to 5 mg/ml in drinking water was partially effective against HSV-1 PAAr5 infection with a reduction of the area
under the concentration-time curve (AUC) of 34 to 48%. The effects of
ACV against HSV-1 dlsptk infection were not significant
when it was administered topically and were only marginal when it was
given in drinking water. Treatment under identical conditions with 5%
topical BILD 1633 SE significantly reduced the cutaneous lesions caused
by both HSV-1 dlsptk and PAAr5 infections. The
effect of BILD 1633 SE against HSV-1 PAAr5 infections was
more prominent and was inoculum and dose dependent, with AUC reductions
of 96 and 67% against infections with 106 and
107 PFU per inoculation site, respectively. BILD 1633 SE
also significantly decreased the lesions caused by HSV-1
dlsptk infection (28 to 51% AUC reduction). Combination
therapy with topical BILD 1633 SE (5%) and ACV in drinking water (5 mg/ml) produced an antiviral effect against HSV-1 dlsptk
and PAAr5 infections that was more than the sum of the
effects of both drugs. This is the first report that a selective HSV RR
subunit association inhibitor can be effective against ACV-resistant
HSV infections in vivo.
 |
INTRODUCTION |
Herpes simplex virus (HSV)
encodes a ribonucleotide reductase (RR) that catalyzes the
synthesis of the deoxyribonucleotide precursors required
for DNA synthesis. This enzyme shares many similarities with
the host cellular RR but differs markedly from the
latter in terms of primary amino acid sequences and allosteric regulation (24, 26, 35). Both RRs consist of two subunits (26, 35). The larger subunit contains redox-active thiols that provide the hydrogen for nucleotide reduction (24, 29, 31,
35). The smaller subunit contains a binuclear µ-oxo
bridged iron center associated with a tyrosyl free radical (1, 17, 26, 32, 35). The carboxy terminus of the RR small subunit is
critical for subunit association and for the catalytic activity of the
enzyme (3, 13, 26). Although HSV RR is not required for
virus replication in exponentially growing cells, it is necessary in
nondividing cells (18) and is required for the full
expression of pathogenicity of HSV in animal models of primary
infection (3, 20, 21, 42) and for reactivation from latency
(20, 21). Therefore, HSV RR represents an interesting target
for antiherpesvirus therapy (3, 13, 21, 26). It has been reported that nonselective RR inhibitors, such as
2'-fluoromethylene-2'-deoxycytidine and A1110U,
potentiate the activity of acyclovir (ACV) both in vitro and in vivo
against wild-type and ACV-resistant HSV infections (6, 14, 28,
39). However, these RR inhibitors have not been shown to
be useful as monotherapy, and therefore, the combination therapy
has not been clearly validated due in part to the lack of specificity
and the toxicity of these agents (14, 26, 28, 39). Our group
has developed a class of selective HSV RR subunit association
inhibitors that act as mimics of the carboxy terminus of the small
subunit (4, 27, 30). We have recently reported the in
vivo activity of one of the earliest lead compounds, BILD 1263, as
a monotherapy against HSV type 1 (HSV-1)-induced ocular disease in mice
(4, 27). In the present study, we examined the effects of
BILD 1633 SE, a more potent HSV RR inhibitor, against cutaneous
ACV-resistant HSV-1 infections in the athymic nude mouse model when
BILD 1633 SE was used either alone or in combination with ACV. The
athymic nude mouse was chosen because ACV-resistant HSV-1 fails to
induce significant disease in normal mice (3, 14). A lack of
functional T cells renders athymic nude mice more susceptible to
cutaneous infections by ACV-resistant HSV-1 and more suitable for drug
evaluation (14, 15). In addition, since ACV-resistant HSV
infections cause significant disease mainly in immunocompromised
patients (7, 8, 23), information obtained from these
immunodeficient animals may be clinically relevant (14, 15).
Our results indicate that BILD 1633 SE is effective in the treatment of
ACV-resistant HSV infections in this model when it is used either alone
or in combination with ACV. Therefore, selective inhibition of HSV RR
by peptidomimetic subunit association inhibitors may offer a potential
alternative topical therapy for the treatment of ACV-resistant HSV
infections in humans.
 |
MATERIALS AND METHODS |
Viruses.
Four different laboratory strains of HSV-1 were
used in the present study. These include two wild-type strains, HSV-1 F
and KOS, and two ACV-resistant strains, dlsptk
(11) and PAAr5 (9, 16). Both
wild-type HSV-1 strains have been described elsewhere (27).
The ACV-resistant, thymidine kinase (TK)-deficient HSV-1 strain
dlsptk and the DNA polymerase mutant PAAr5 were
kindly provided by D. Coen (9, 11). Virus stocks were routinely grown in Vero (African green monkey kidney) cells, and virus
titers were determined by a standard plaque assay with confluent Vero
cells.
Compounds.
The preparation of BILD 1633 SE was based on our
previously published procedure (30). The
[
-(R)-methyl-3-cyclohexyl]-propionyl functionality of
the N-terminal part of BILD 1633 SE is introduced in the last stage of
the synthesis by condensation of the corresponding acid chloride.
In vitro antiviral assay.
Antiviral assays were performed
essentially as described previously (27). Baby hamster
kidney (BHK)-21/C13 (ATCC CCL 10) cells were seeded in 96-well culture
plates at a density of 5,000 cells per well in
-minimal essential
medium containing 8% (vol/vol) fetal bovine serum (Gibco), and the
plates were incubated at 37°C with 5% CO2. After 6 h, the concentration of fetal bovine serum was reduced to 0.5%
(vol/vol) and the cells were serum starved for 3 days. Serum-starved
cell monolayers were infected with HSV-1 F, KOS, PAAr5, and
dlsptk at a multiplicity of infection of 0.05 in defined medium (5). The defined medium (5) consisted of
F-12 medium, Dulbecco's modified Eagle medium, and BGjb medium (6:3:1;
vol/vol) with 2 g of bovine serum albumin per liter, 2.38 g
of HEPES per liter, 50 mg of garamycin per liter, 100 µg of cortisol
per liter, 1 µg of insulin per liter, 0.4 µg of triiodothyromine
per liter, 0.2 µg of parathyroid hormone per liter, 10 µg of
glucagon per liter, 0.1 µg of epidermal growth factor per liter, 0.2 µg of fibroblast growth factor per liter, and 10 mg of transferrin
per liter. After 1 h, the HSV-infected cells were rinsed with
defined medium and were then incubated with test compounds for 24 h for strains F and KOS and 44 h for strains PAAr5 and
dlsptk. The extent of replication was assessed by a novel enzyme-linked immunosorbent assay (ELISA). The cells were fixed with
0.063% glutaraldehyde in phosphate-buffered saline (PBS) for 30 min
and were blocked with 0.5% casein in PBS for 1 h. Thereafter, mouse monoclonal antibody C11 that recognizes the HSV-1 late
glycoprotein C (41) was added to each well for 2 h.
After the cells were washed three times with PBS containing 0.05%
Tween 20, the bound monoclonal antibody was detected with sheep
anti-mouse immunoglobulin G horseradish peroxidase for 1 h in the
dark. The plates were washed three times with PBS and once with 0.1 M
sodium citrate (pH 4.5). ortho-Phenylenediamine
dihydrochloride (Gibco) was used as a substrate for 30 min in the dark,
and color development in individual wells was monitored at 450 nm with
a Titertek microplate spectrophotometer. For inhibition studies,
compounds were tested in threefold serial dilutions. Stock solutions of
compounds were prepared by dissolving each compound in dimethyl
sulfoxide (DMSO) and diluting the solution with defined medium to a 1%
DMSO final concentration. Stock solutions were routinely sonicated for
20 min in ice-cold water and were filtered through 0.22-µm-pore-size Millex (Millipore) filters. The 50% effective concentrations
(EC50s) were determined from plots of inhibition of virus
replication as a function of compound concentration. The cytotoxicity
of BILD 1633 SE for serum-starved cells was determined by a
3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT)
assay (12).
In vitro drug combination studies.
The antiviral activity of
BILD 1633 SE in combination with ACV against wild-type and
ACV-resistant HSV-1 was assessed by the 96-well ELISA described above.
Evaluation of drug interactions was performed by the isobole method
(40). In this method, selected concentrations of BILD 1633 SE were tested in combination with various doses of ACV, and average
EC50s of ACV were determined from duplicate dose-response
curves. These values were used to calculate FEC50 (ACV),
which represents the ratio of the concentration of ACV required to
inhibit HSV-1 replication by 50% in the presence of a fixed
concentration of BILD 1633 SE to the concentration of ACV required to
inhibit HSV-1 replication by 50% in the absence of BILD 1633 SE. The
isobologram representation is obtained by plotting FEC50
(ACV) as a function of the ratio of the fixed concentration of
BILD 1633 SE to the EC50 of BILD 1633 SE in the absence of ACV. In this representation when experimental datum points for the
drugs used in combination fall on the hypotenuse, the effects of the
two drugs are additive. If experimental datum points fall below the
theoretical line for noninteracting drugs, the effects of the two drugs
are considered synergistic.
Animals.
Athymic nude mice (female nu/nu CD1 mice
from Charles River Canada, St. Constant, Quebec, Canada) at 5 to 6 weeks of age were used for all experiments. Animals were housed in
microisolator cages inside semirigid isolators with sterile food,
water, and bedding. All manipulations were carried out within class
II-type safety cabinets (Nuaire, Plymouth, Minn.), according to the
protocols approved by the Canadian Council on Animal Care (Ottawa,
Ontario, Canada).
Cutaneous inoculation.
Animals were inoculated with
ACV-resistant HSV-1 dlsptk or PAAr5 mutants
under halothane anesthesia by scarification and rubbing 10 µl of the
desired virus stock on an area of about 1 cm2 on each side
of the dorsal skin for 10 s.
Treatments and drug evaluation.
Both ACV and BILD 1633 SE
were topically administered in a cream vehicle containing 16% DMSO,
5% linoleic acid, 16% Cremophor EL, and 63% polyvinyl alcohol (25%
solution in 100 mM HEPES buffer [pH 8.5]). All topical treatments
were started at 3 h postinoculation and continued for 10 days
(four times per day between 8:30 a.m. and 5:30 p.m.). In some
experiments, ACV was administered orally in drinking water immediately
following inoculation. Topical lesions and systemic diseases were
observed daily. The following criteria were applied to score topical
lesions: 0, no lesions; 1, discrete vesicles; 2, two or more open
lesions; 3, separate ulcerations; and 4, zoster band formations. The
onset and time course of topical lesions are dependent on the titer of
the inoculum. Under current experimental conditions, topical lesions
became visible within 2 to 3 days and peaked within about 10 to 13 days; this was dependent on the titer of the inoculum. Although some
degree of spontaneous regression occurred in animals infected with
PAAr5 mutants, topical lesions persisted over the whole
duration of experiment. Only a few (fewer than 10%) of the
PAAr5-infected mice developed systemic disease
(disseminated infections, neurological and physical abnormalities, and
mortality) following the appearance of severe topical lesions.
Therefore, systemic disease was not used for drug evaluation. Topical
lesion data are presented in terms of the mean and the standard error
of the mean (SEM). Daily lesion scores and the areas under the curve (AUC) of the lesion scores are compared for statistical significance by
the analysis of variance followed by Student-Newman-Keuls multiple comparisons with SAS software (SAS Institute, Cary, N.C.). A
P value of <0.05 was considered statistically significant.
 |
RESULTS |
Comparative in vitro activities of BILD 1633 SE and ACV against
several strains of HSV-1.
Figure 1
shows the structure of the HSV RR subunit association inhibitor BILD
1633 SE. This compound inhibits HSV RR with a 50% inhibitory
concentration of 3 nM, as determined by a competitive binding assay
(24). Like previously published inhibitors in this class, it
does not affect the activity of the human RR at a concentration up to
250 µM, on the basis of the enzyme assay. Therefore, this compound
represents a highly selective HSV RR inhibitor. As indicated in Table
1, BILD 1633 SE is about 10 times more
potent than ACV in inhibiting the replication of the wild-type strains
HSV-1 F and KOS (EC50 = 0.4 µM) and is about 100 times
more potent then ACV against both ACV-resistant strains. In addition,
this compound is about three times more active against the
ACV-resistant mutant PAAr5 than against both wild-type
strains and the dlsptk HSV-1 strains. The 50 percent
cytotoxic concentration of BILD 1633 SE is 14 µM, as measured by the
in vitro MTT assay, yielding a selectivity index of 35. Compared with
the potency of BILD 1263 published previously (3, 27), BILD
1633 SE is about 5 to 10 times more potent in vitro against all the
viruses studied (Table 1) and in vivo against HSV-1 infection in the
mouse ocular model (unpublished data).
When BILD 1633 SE was tested in vitro in combination with ACV, the
antiviral activity of ACV against HSV-1 F, KOS, and
dlsptk
was potentiated without producing any toxicity to the confluent
BHK
cells. The synergistic effect of BILD 1633 SE is clearly evident
in
Fig.
2A, B, and C, which shows the
isobologram representation
derived from an ELISA-based antiviral assay.
At a concentration
of BILD 1633 SE that produced 30% inhibition of
viral replication,
the EC
50 of ACV for each virus decreased
by about 10- to 20-fold.
No synergy of ACV with BILD 1633 SE was
observed against ACV-resistant
virus strain PAA
r5. As
illustrated by the isobologram representation (Fig.
2D),
both drugs
acted in an additive manner to inhibit the replication
of this
ACV-resistant strain of HSV.

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FIG. 2.
Effect of ACV in combination with BILD 1633 SE against
wild-type and ACV-resistant HSV in vitro. Selected concentrations of
BILD 1633 SE were tested in combination with various doses of ACV, and
the EC50s for HSV KOS, F, PAAr5, and
dlsptk were determined by the ELISA-based antiviral assay as
described in Materials and Methods. These values were used to calculate
FEC50 (ACV), and FEC50 (ACV) was plotted as a
function of the ratio of the fixed concentration of BILD 1633 SE to the
EC50 of BILD 1633 SE for the respective viruses to generate
the isobologram. (A) HSV-1 F; (B) HSV-1 KOS; (C) HSV-1
dlsptk; (D) HSV-1 PAAr5.
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Monotherapy with BILD 1633 SE or ACV against HSV-1
PAAr5 infection.
As shown in Fig.
3, inoculation of mice with
106 PFU of HSV-1 PAAr5 per site induced
moderate lesions, with a maximum lesion score of 2.1 ± 0.4 on day
13 postinoculation (Fig. 3A). Vehicle treatment did not affect the
maximum lesion score or the AUC value (Fig. 3A and B). Topical
treatment with 5% ACV reduced the maximum lesion score
(P < 0.05), but the effect on the AUC value did not
reach statistical significance (P > 0.05). In
contrast, treatment with 5% BILD 1633 SE almost completely abolished
topical lesions (Fig. 3A and B).

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FIG. 3.
Comparative effects of ACV and BILD 1633 SE against
HSV-1 PAAr5 infection. Animals were cutaneously inoculated
with 106 PFU/site, as described in Materials and Methods.
ACV (5%) and BILD 1633 SE (5%) were applied topically four times per
day. (A) Mean lesion scores. The mean lesion score was significantly
reduced by ACV treatment on days 12-14 (n = 10;
P < 0.05) and was further reduced by BILD 1633 SE on
days 10 to 24 (n = 24; the result was significantly
different [P < 0.05] from those for all other
groups). (B) AUCs of the lesion scores. The AUCs of lesion scores are
presented as means ± SEMs. *, P < 0.05 compared with the results for all other groups.
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Increasing the virus inoculum to 10
7 PFU per inoculation
site induced more prominent topical lesions that reached a maximum
lesion score of 2.9 ± 0.3 on day 13 postinoculation (Fig.
4A and
B). Treatment with 5% topical ACV for 10 days reduced both the
maximum lesion score to 1.4 ± 0.3 and the
AUC value by 45% (
P < 0.05). Topical treatment of
infected mice with 5% BILD 1633
SE reduced the maximum lesion score to
1 ± 0.3 and the AUC value
by 66% (
P < 0.05).
This in vivo antiviral effect of BILD 1633
SE was highly reproducible,
as verified by three additional independent
experiments that showed
reductions of the AUC values of the lesion
scores of 60, 81, and 61%,
respectively (
n = 12 for both the vehicle-
and the
drug-treated groups;
P was <0.05 for all experiments).
The
dose-dependent effect of topical BILD 1633 SE against HSV-1
PAA
r5-induced topical lesions in athymic mice is shown
in Fig.
4C
and D.

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FIG. 4.
Effects of BILD 1633 SE and ACV against HSV-1
PAAr5 infection. Animals were cutaneously inoculated with
107 PFU/site, as described in Materials and Methods. (A and
B) BILD 1633 SE and ACV were applied in 5% topical formulation. (C and
D) BILD 1633 SE was applied four times a day at concentrations of 0, 0.8, 2, and 5%. The AUCs of the lesion scores are presented as
means ± SEMs (n = 12). *, P < 0.05 compared with the results for the vehicle group; ,
P < 0.05 compared with the results for the vehicle and
0.8% BILD 1633 SE groups.
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Combination therapy with oral ACV and topical BILD 1633 SE against
HSV-1 PAAr5 infection.
Since concomitant
administration of two compounds by the same route may lead to chemical
and/or physical interactions of the compounds, we administered ACV and
BILD 1633 SE by two different routes. Figure
5 shows the effect of oral ACV supplied
continuously in drinking water. When ACV was administered for 10 days
in drinking water at a concentration of 1 mg/ml, no protection from HSV
disease was seen (Fig. 5A and B). However, maximum protection was
achieved with a concentration of 3 mg/ml (daily dose, 871 ± 49 mg/kg of body weight), resulting in a reduction of the AUC of the
lesion score by 48%. This protection was similar to that achieved with topical ACV treatment, as described above. Increasing the ACV concentration to 5 mg/ml in drinking water (daily dose, 1,391 ± 29 mg/kg) did not improve the observed protection, perhaps because the
maximum efficacy has been achieved with the dose of 3 mg/ml under
current experimental conditions. At all doses tested, ACV did not
change the behaviors or the body weights of the treated mice.

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FIG. 5.
Antiviral effects of ACV in drinking water against HSV-1
PAAr5 infection. Animals were cutaneously inoculated with
107 PFU/site, as described in Materials and Methods. ACV
was given in the drinking water at 0, 1, 3, and 5 mg/ml. (A) Mean
lesion scores. (B) AUC of the lesion scores. The AUCs of the lesion
scores are presented as means ± SEMs (n = 12).
*, P < 0.05 compared with the results for the
vehicle group.
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To determine the effectiveness of the combination therapy in the
treatment of HSV-1 PAA
r5-induced topical lesions, ACV was
administered orally in drinking
water at a concentration of 1.5 mg/ml
in combination with 0.8%
BILD 1633 SE in a topical cream. As
illustrated in Fig.
6, treatment
with ACV
alone did not significantly affect the infection, while
treatment with
BILD 1633 SE alone reduced the mean disease score
significantly for 7 days starting on day 4. Combination therapy
was more effective than
therapy with each agent alone. As shown
in Fig.
6, the AUC values and
the mean disease score for the combination
of ACV and BILD 1633 SE were
reduced significantly on days 8 to
11 compared to those for either
treatment alone.

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FIG. 6.
Antiviral effects of oral ACV and topical BILD 1633 SE
against HSV-1 PAAr5 infection. Animals were cutaneously
inoculated with 107 PFU/site, as described in Materials and
Methods. ACV was given in the drinking water at a dose of 1.5 mg/ml.
BILD 1633 SE (0.8%) was applied topically four times per day. (A) Mean
lesion scores. (B) AUC of the lesion scores. The AUCs of the lesion
scores are presented as means ± SEMs (n = 24).
*, P < 0.05 compared with the results for the
vehicle groups.
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Monotherapy and combination therapy with ACV and BILD 1633 SE
against HSV-1 dlsptk infection.
Reproducible and
persistent topical lesions were induced by inoculating athymic nude
mice with 107 PFU of HSV-1 dlsptk per
inoculation site (Fig. 7). Infected
animals that did not receive any treatment had a mean maximum lesion
score of 3 ± 0.1 on day 12 postinoculation, with a mean
AUC over 24 days of 50 ± 3 (n = 12).
Vehicle-treated animals had a maximum lesion score of 2.8 ± 0.1, with an AUC of 50 ± 2 (n = 24; P > 0.05). Treatment with 5% topical ACV did not significantly affect the maximum lesion score or the AUC value (Fig. 7). However, topical treatment with 5% BILD 1633 SE for 10 days resulted in statistically significant reductions in the maximum disease score and the AUC value
(Fig. 7).

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FIG. 7.
Comparative effects of oral ACV and topical BILD 1633 SE
against HSV-1 dlsptk infection. Animals were cutaneously
inoculated with 107 PFU/site, as described in Materials and
Methods. ACV (5%) and BILD 1633 SE (5%) were applied topically four
times per day. (A) Mean lesion scores. (B) AUCs of the lesion scores.
ACV only transiently (n = 12; P < 0.05) reduced the mean lesion score on days 13 to 15 compared with the
scores for the no-treatment group (n = 12) and the
vehicle group (n = 24). BILD 1633 SE more effectively
reduced the mean lesion score (n = 24;
P < 0.05 on days 8 to 24). The AUCs of the lesion
scores are presented as means ± SEMs. *, P < 0.05 compared with the results for the vehicle groups.
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Figure
8 shows the effect of the
combination therapy of oral ACV with topical BILD 1633 SE compared to
the effect of treatment
with either agent alone. Mice belonging to the
vehicle-treated
group had a mean maximum lesion score of 2.6 ± 0.1 and a mean
AUC of 43 ± 3 (
n = 24). Treatment
with oral ACV at a concentration
of 5 mg/ml in drinking water reduced
the AUC by only 19%. In comparison,
topical treatment with 5% BILD
1633 SE for 10 days reduced the
AUC by 51% (
P < 0.05)
(Fig.
8). The combination therapy of oral
ACV (5 mg/ml) and topical
BILD 1633 SE (5% cream) was more effective
than treatment with either
agent alone (Fig.
8). Only a few animals
in this group developed
observable vesicles.

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FIG. 8.
Antiviral effects of oral ACV and topical BILD 1633 SE
against HSV-1 dlsptk infection. Animals were cutaneously
inoculated with 107 PFU/site, as described in Materials and
Methods. ACV was given in drinking water at a dose of 5 mg/ml. BILD
1633 SE (5%) was applied topically four times per day. (A) Mean lesion
scores. (B) AUCs of the lesion scores. ACV transiently
(P < 0.05) reduced the mean lesion score on days 12 to
15 compared with the scores for the vehicle control group. BILD 1633 SE
more effectively reduced the mean lesion score (P < 0.05 on days 4 to 24 versus both the vehicle and the ACV groups).
Combination therapy further reduced the mean lesion scores
significantly from those for all other groups on days 3 to 24. The AUCs
of lesion scores are presented as means ± SEMs (n = 24). *, P < 0.05 compared with the results for all
other groups.
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 |
DISCUSSION |
The present study reports for the first time an effective therapy
against ACV-resistant HSV infections in athymic nude mice with a
selective HSV RR subunit association inhibitor, BILD 1633 SE.
Consistent with its in vitro antiviral properties, BILD 1633 SE was
more effective against HSV-1 PAAr5-induced lesions than
against HSV-1 dlsptk-induced lesions, with inoculum-dependent AUC reductions ranging from 67 to 96% and 28 to
51%, respectively. Although BILD 1633 SE was less effective against
HSV-1 dlsptk-induced infections, it should be pointed out
that the scoring system for topical lesions is based upon subjective
criteria and that a 50% reduction of the disease lesion score from 3 to 1.5 is associated with significant abolition of HSV-induced
ulceration.
Inhibition of HSV RR has previously been suggested as a potential
strategy for therapy against both ACV-sensitive and ACV-resistant HSV
infections (3, 13, 21, 26). However, a significant in vivo
efficacy of specific RR inhibitors against ACV-resistant HSV infections
has, to our knowledge, not been reported. Spector et al. (36,
39) have demonstrated the in vitro and limited in vivo
antiherpesvirus effects of thiosemicarbazone derivatives, a series
of compounds that disrupt the integrity of the free radical and/or iron
center of the small subunit of the enzyme. Since the human RR also
contains similar chemical features, those compounds do not
appear to be very selective against HSV RR (26, 36). In
addition, the in vivo efficacy of this class of RR inhibitors seems to
be limited to potentiating the effects of ACV rather than acting as
effective monotherapeutic antiherpesvirus agents (14, 28,
39). In a different study, Bridges et al. (6) have
investigated the possibility of treating cutaneous HSV infections with
an inhibitor of mammalian RR, MDL 101731. Although those investigators demonstrated the potent in vitro activity of this compound against both ACV-sensitive and ACV-resistant HSV, they failed
to observe in vivo activity against ACV-resistant HSV infections (6). The lack of efficacy of these agents as monotherapy has in part been attributed to poor tissue penetration and to the fact that
the viral RR may be dispensable in these infections because of elevated
deoxynucleoside triphosphate (dNTP) pools. Our results clearly
demonstrate that specific HSV RR inhibitors are effective as
monotherapy in the athymic nude mouse model, implying that the viral RR
is important for pathogenesis in this model.
Studies of ACV in combination with RR inhibitors have been
designed previously to increase the efficacy of ACV. A number of studies have demonstrated that decreasing the dGTP pool levels with RR inhibitors increases the apparent potency of ACV by increasing the ACV triphosphate/dGTP ratio (36-38). Mechanism-based
synergy between an RR inhibitor and ACV is also supported by the
demonstration that HSV RR null mutants are hypersensitive to ACV
(10). As expected, the combination of ACV and BILD 1633 SE
also synergistically inhibited the replication of wild-type HSV strains
and the ACV-resistant strain dlsptk. However, both drugs
acted only in an additive manner against the polymerase mutant,
ACV-resistant strain PAAr5, consistent with previous
observation with nonspecific RR inhibitors (28). The precise
reason for the lack of synergy of BILD 1633 SE and ACV in vitro against
the HSV-1 polymerase mutant PAAr5 is unclear. It has been
suggested that ACV-resistant polymerase mutants display lower
affinities for normal dNTPs in their HSV DNA polymerase (19)
than that in the wild-type virus. Therefore, a decrease in the dNTP
concentration below the Km should occur at
a lower concentration of an RR inhibitor and should enhance its
antiviral effect. Because of this increased efficacy of BILD 1633 SE
alone against this mutant virus, the synergistic effect of the
combination may be less pronounced and is therefore difficult to
observe experimentally in vitro. Nevertheless, the in vivo data
indicate that combination therapy with ACV with BILD 1633 SE is more
than additive against both ACV-resistant mutants. Thus, combination
therapy may not have to be synergistic in vitro to achieve more than
additive in vivo effects.
Although ACV has generally been successful in treating HSV
infections, chronic therapy with this drug in patients who are immunocompromised due to AIDS, organ transplantation, or cancer chemotherapy leads to an increase in the viral burden and the possible
emergence of resistance. It has recently been reported that
ACV-resistant mutants are responsible for HSV pneumonia, progressive whitlow, meningoencephalitis, and mucocutaneous
dissemination in AIDS patients (7, 8, 22-24, 34). The
unfulfilled clinical needs call for continued investigation to identify
novel therapeutic antiherpesvirus agents. In the present study,
BILD 1633 SE reduced both dlsptk- and
PAAr5-induced lesions more effectively than ACV did. In
addition, the combination of BILD 1633 SE with ACV achieved better
effects against dlsptk infection that did not respond to
topical treatment with ACV. Although most ACV-resistant clinical
isolates exhibit TK deficiency, some of them have been identified as
DNA polymerase mutants or heterogeneous mixtures containing polymerase
mutants (8, 24). Pathogenicity studies with mice and
clinical observations indicate that ACV-resistant mutants, especially
the TK-deficient mutants, usually have reduced virulence (8, 25,
33). In comparison, DNA polymerase mutants, especially
heterogeneous mixtures containing polymerase mutants, may have great
potential for causing dangerous ACV-resistant HSV infections (8,
25, 33, 34). Indeed, it has been shown that when a cell is
coinfected with a TK-deficient mutant and a wild-type virus, ACV
treatment will be effective. On the contrary, ACV has little effect on
cells coinfected with the wild type and an ACV-resistant polymerase mutant (33). Considering the antiviral efficacy of BILD 1633 SE against both TK and polymerase mutants tested in the
present study, alternative and/or combination therapy with
ACV and RR inhibitors such as BILD 1633 SE may provide a good approach
for the increasing challenge of ACV-resistant HSV infections. Due to
the poor systemic absorption of peptidomimetic compounds like BILD 1633 SE, the therapeutic potential with this class of inhibitors may be
limited to topical treatment only. Although HSV-1 isolates with
resistance to peptidomimetic RR inhibitors have been isolated in vitro,
these resistant isolates are more sensitive to ACV, possibly as a
consequence of the compromised activity of their RRs (2).
Therefore, combination therapy with ACV and RR inhibitors may be more
beneficial.
In summary, the present study demonstrated the activity of BILD 1633 SE
as monotherapy against both polymerase-altered and TK-deficient
ACV-resistant HSV-1 infections. The combination of BILD 1633 SE and ACV
almost abolished dlsptk-induced lesions that were not
affected by topical ACV. These results further support the hypothesis
that specific inhibition of the HSV RR subunit association is a valid
strategy for the development of new antiherpesvirus drugs.
 |
ACKNOWLEDGMENTS |
We acknowledge valuable discussions with P. Anderson and G. Bolger. We thank N. Lapeyre-Paquette, N. Dansereau, and G. Di Lella for
technical assistance. We also acknowledge D. Coen for providing
ACV-resistant mutants and S. Larouche for secretarial assistance.
 |
FOOTNOTES |
*
Corresponding author. Mailing address: Bio-Méga
Research Division, Boehringer Ingelheim (Canada) Ltd., 2100 rue Cunard,
Laval, Québec, Canada H7S 2G5. Phone: 514-682-4640. Fax:
514-682-8434. E-mail: jduan{at}bio-mega.boehringer-ingelheim.ca.
 |
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Antimicrobial Agents and Chemotherapy, July 1998, p. 1629-1635, Vol. 42, No. 7
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