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Antimicrobial Agents and Chemotherapy, February 2007, p. 689-695, Vol. 51, No. 2
0066-4804/07/$08.00+0 doi:10.1128/AAC.00879-06
Copyright © 2007, American Society for Microbiology. All Rights Reserved.
University of Alabama School of Medicine, Birmingham, Alabama,1 Department of Molecular Microbiology and Immunology, Saint Louis University, St. Louis, Missouri,2 SIGA Technologies, Inc., Corvallis, Oregon3
Received 17 July 2006/ Returned for modification 28 August 2006/ Accepted 7 November 2006
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Previous evaluation of ST-246 for activity against orthopoxviruses has shown both in vitro and in vivo efficacies (13). When evaluated in vitro against vaccinia virus (VV), cowpox virus (CV), ectromelia virus (ECTV), monkeypox virus, camelpox virus, and variola virus, ST-246 inhibited virus replication by 50% at a concentration (50% effective concentration [EC50]) of
0.07 µM. In animal models using lethal infections with ECTV or VV, ST-246 was reported to be nontoxic and effective against mortality when given orally twice daily at 50 mg/kg of body weight for 14 days beginning before or shortly after infection. ST-246 was also evaluated in the nonlethal mouse tail lesion model by use of intravenous VV to mimic the primary viremic phase of viral infection and systemic lesional disease. When ST-246 was administered by oral gavage at 15 or 50 mg/kg twice daily for 5 days, the tail lesions were significantly reduced (13).
The current studies expand upon the previous in vitro and in vivo findings and further define parameters regarding time intervals postexposure and minimum length of time necessary for efficacy, as well as dose responses against CV in addition to VV and ECTV. Efficacy using delayed initiation of treatment after viral inoculation is an important determining factor for the selection of antiviral compounds to pursue in development. The results of these additional animal models for CV, VV, and ECTV using delayed treatment add valuable insight into the utility of this particular compound for use in treatment of orthopoxvirus infections in humans.
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Ectromelia virus, strain Moscow (ECTV-MOS), was derived from a plaque-purified isolate (ATCC, VR-1374) as previously described (2). In vitro susceptibility studies using ST-246 against ECTV in Vero cells have been reported previously (13).
Antiviral compounds. CDV (Vistide; Gilead Sciences, Inc., Foster City, CA) was diluted in sterile saline to yield the desired dosages within a 0.1-ml volume. It was administered intraperitoneally (i.p.) as a single dose or once daily for 5 days as the positive control, depending on the protocol. ST-246 was synthesized and supplied by SIGA Technologies (Corvallis, OR) through NIAID, NIH. It was suspended in aqueous 0.75% methylcellulose (Sigma, St. Louis, MO) containing 1% Tween 80 (Sigma) to yield the desired dosage of 100, 50, 30, or 10 mg/kg within a 0.2-ml volume for VV or CV infections. For ECTV infections, ST-246 was given in a 0.1- or 0.2-ml volume daily at a dosage of 100 or 20 mg/kg. ST-246 was administered by oral gavage once daily for 5 to 14 days beginning 4, 24, 48, or 72 h after viral inoculation.
Mice. Female BALB/c mice, 3 to 4 weeks of age, were obtained from Charles River Laboratories (CRL, Raleigh, NC). BALB/c mice were utilized in models of systemic infection of VV or CV. Mice were housed in microisolator cages and utilized at 15 mice per group. Mice were obtained, housed, utilized, and euthanized according to policies of the USDA and the Association for Assessment and Accreditation of Laboratory Animal Care, International. All animal procedures were approved by the University of Alabama at Birmingham Institutional Animal Care and Use Committee prior to the initiation of studies.
Male or female A/NCr mice were obtained from the National Cancer Institute (Frederick, MD) and used at 6 to 11 weeks of age for ECTV models. Mice were utilized at four to eight mice per treatment group for efficacy or pathogenesis studies using ECTV-MOS. All animal procedures were approved by Saint Louis University School of Medicine's Institutional Animal Care and Use Committee prior to initiation of studies.
Experimental inoculations. Systemic CV or VV infections were initiated by intranasal (i.n.) inoculation of BALB/c mice as described previously (7). Mice were anesthetized using ketamine-xylazine and infected with an approximate 90% lethal dose of CV, strain BR (9 x 105 PFU/mouse), or VV, strain WR (1 x 104 PFU/mouse), by use of a micropipettor and a total volume of 40 µl per animal. To determine the extent of viral replication in tissues, three animals from each treated and untreated group were euthanized on days 1, 3, 5, 7, and 10. Lung, liver, spleen, and kidney samples were removed aseptically, weighed, homogenized in minimal essential medium with 10% fetal bovine serum (10%, wt/vol) and frozen at 70°C until assayed for virus. Samples were thawed and assayed on Vero cells by use of an agarose-containing plaque assay to determine CV or VV titers (7). Briefly, samples of organ homogenates were diluted serially and a 0.2-ml volume was placed into 2 of 12 wells of Vero cell monolayers and incubated for 1 h. A 0.5% agar (SeaKem ME agarose; FMC BioProducts, Rockland, ME) in minimal essential medium solution was added to each well, and the cultures were incubated for 3 days. Cultures were stained with neutral red (Sigma) for approximately 6 h prior to enumeration of viral plaques.
Systemic infections of ECTV were initiated by i.n. inoculation of anesthetized A/NCr mice with approximately 11 50% lethal doses (LD50) of ECTV in a total volume of 5 or 10 µl unless otherwise indicated. Mice were monitored daily after infection for clinical signs. Body weights were recorded three times weekly. To determine the extent of viral replication in tissues, five animals from selected treated and untreated groups were euthanized on days 4, 6, and 8 after viral inoculation. Lung, liver, spleen, esophagus, trachea, and nasal wash samples were obtained aseptically for virus quantitation as described previously (13).
Statistical evaluation. Groups of mice treated with antivirals were compared to vehicle-treated groups for statistical evaluation. Mortality rates were analyzed by Fisher's exact test. The mean day of death data were analyzed by the Mann-Whitney U rank sum test, which compares the median values nonparametrically. A P value of 0.05 or less was considered significant.
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TABLE 1. Cytotoxicity and efficacy of ST-246 against VV or CV in HFF cells
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0.001). All dosing regimens of 7 or more days in duration resulted in statistically significant decreases in mortality (P
0.001) when ST-246 was given once daily at the 100-mg/kg dose. CDV was administered i.p. at 15 mg/kg for 5 days beginning 24 h after viral inoculation and was effective in preventing mortality (P < 0.001). |
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TABLE 2. Effect of duration of treatment with ST-246 on the mortality of BALB/c mice inoculated intranasally with cowpox virus, strain BR, or vaccinia virus, strain WR
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0.001) if treatments were initiated at 4, 24, 48, or 72 h after viral inoculation. If ST-246 was given at 30 mg/kg, mortality was significantly reduced if treatments were initiated at 4 h postinfection (P
0.01) and at 24, 48, or 72 h (P
0.001). When ST-246 was given at 10 mg/kg, mortality was not reduced when treatments were initiated at 4 or 24 h postinfection; however, ST-246 beginning at 48 or 72 h did reduce mortality to statistically significant levels (P
0.01). CDV was administered i.p. at 15 mg/kg for 5 days beginning 24, 48, or 72 h after viral inoculation and was effective in preventing mortality (P < 0.001). |
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TABLE 3. Dose effect of delayed treatment with ST-246 on the mortality of BALB/c mice inoculated intranasally with cowpox virus
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0.001). CDV was administered i.p. at 15 mg/kg for 5 days beginning 24 h after viral inoculation and was effective in preventing mortality (P < 0.001).
To determine the effect of ST-246 treatment on viral replication in target organs, ST-246 was administered orally to CV- or VV-infected mice for 9 days at 50 mg/kg beginning 24 h postinfection. Mortality was significantly reduced (data not shown) (P
0.001) and virus titers were reduced in target organs, in most cases below the levels detected in vehicle-treated mice (Fig. 1 and 2). CDV was administered i.p. at 15 mg/kg for 5 days beginning 24 h postinfection and was effective in preventing mortality (data not shown) (P < 0.001) and in reducing viral replication in liver, spleen, and kidney. Lung titers are not usually reduced by antiviral therapy in these models, even CDV, since the models are initiated by rather large inocula of virus administered intranasally in comparison to the ECTV models using very few PFU/mouse to initiate lethal infections. A consistent and important finding in these studies is the time of systemic spread to target organs of liver, spleen, or kidney. With CV-infected mice, target organs are positive for virus only on days 5 to 7 or later, whereas VV-infected mice have virus detected on days 3 to 5 postinoculation. Detection of virus in target organs of liver, spleen, or kidney is predictive of mortality in these models.
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FIG. 1. Effects of once-daily oral dosing with 50 mg/kg ST-246 using a 9-day duration in BALB/c mice infected intranasally with cowpox virus, strain BR. Points indicate the values obtained from three pooled organ samples per time point. The limit of detection is 100 PFU/g.
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FIG. 2. Effects of once-daily oral dosing with 50 mg/kg ST-246 using a 9-day duration in BALB/c mice infected intranasally with vaccinia virus, strain WR. Points indicate the values obtained from three pooled organ samples per time point. The limit of detection is 100 PFU/g.
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0.001) for all dosing regimens using ST-246, and body weights were not significantly different from those of uninfected animals (data not shown). CDV was administered i.p. at 100 mg/kg as a single dose at 24, 48, or 72 h after viral inoculation and was effective in preventing mortality (P < 0.001) at all time points. When escalating infectious challenges were utilized, ST-246 given twice daily for 14 days at 100 mg/kg beginning 4 h postchallenge maintained efficacy by eliminating mortality in A/NCr mice (Table 5). CDV, included as a positive control at 100 mg/kg given as a single dose, was also effective. |
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TABLE 4. Effect of delayed treatment with ST-246 on the mortality of A/NCr mice inoculated intranasally with ECTV
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TABLE 5. Effect of twice-daily treatment with ST-246 on mortality of A/NCr mice inoculated intranasally with increasing doses of ECTV
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FIG. 3. Effects of once-daily oral dosing with 100 mg/kg ST-246 using a 14-day duration in A/NCr mice infected intranasally with ECTV. Five mice per group were euthanized, and tissue infectivities for liver, spleen, and lung were measured by plaque assay. Points indicate the mean values obtained from five organ samples per time point. The limit of detection is 10 PFU/ml in a 10% tissue homogenate.
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ST-246 proved to be highly effective in three different animal models of systemic orthopoxvirus disease even when treatment was delayed up to 72 h after viral inoculation and dosing was reduced to once daily. Uninfected animals treated with ST-246 using daily oral dosages of 100 mg/kg for extended times of 2 weeks showed no evidence of toxicity or weight loss. Regarding the duration of dosing on efficacy, the models vary rather strikingly when consideration is given to length of survival following infection of the vehicle-treated animals. When VV, strain WR, or VV, strain IHD, is administered intranasally, the mean day of death is approximately 5 to 6 days (6, 7, 8, 9, 10, 11, 12). When CV or ECTV is used, the mean day of death is extended to 9 to 10 days (1, 2, 6, 7, 8, 9, 10, 13). The approximate timing of viral detection in liver or spleen is day 3 to 5 postinoculation for VV or ECTV or day 5 to 7 postinoculation for CV. This difference in systemic distribution may explain the extra duration needed for protection in the CV model. Because the mode of action of ST-246 is to inhibit the extracellular virus formation, which precedes the systemic viremic spread to target organs, dosing is necessary for periods longer than 5 days (13). Cessation of drug at 5 days, prior to these events, allows mice to succumb to CV infection. In ordinary smallpox where deaths occur 20 to 24 days postexposure, it would seem likely that ST-246 would provide reasonable protection for periods longer than those afforded by postexposure vaccination (3).
The combined attributes of oral availability, little or no toxic side effects, and postexposure efficacy against CV, VV, and ECTV make ST-246 an excellent candidate for further development, including human clinical trials of safety and dose escalation studies. Potentially, ST-246 is suited for further investigation for treating adverse reactions to smallpox vaccination or monkeypox disease in humans, as well as stockpiling in the event of a bioweapon release of smallpox by bioterrorists.
Excellent technical assistance was kindly provided by Deborah J. Collins, Latisha R. Pettway, Shalisa Sanders, Jill Schriewer, and Erin Touchette.
Published ahead of print on 20 November 2006. ![]()
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, and E. R. Kern. 2003. Evaluation of nucleoside phosphonates and their analogs and prodrugs for inhibition of orthopoxvirus replication. Antimicrob. Agents Chemother. 47:2193-2198.This article has been cited by other articles:
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