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Antimicrobial Agents and Chemotherapy, January 2009, p. 129-135, Vol. 53, No. 1
0066-4804/09/$08.00+0     doi:10.1128/AAC.00708-08
Copyright © 2009, American Society for Microbiology. All Rights Reserved.

Pharmacodynamics of Cidofovir for Vaccinia Virus Infection in an In Vitro Hollow-Fiber Infection Model System{triangledown}

James J. McSharry, Mark R. Deziel,{dagger} Kris Zager, Qingmei Weng, and George L. Drusano*

Antiviral Pharmacodynamics Laboratory, Emerging Infections and Host Defense Group, Ordway Research Institute, 150 New Scotland Avenue, Albany, New York 12208

Received 29 May 2008/ Returned for modification 18 August 2008/ Accepted 3 October 2008

Variola major virus remains a potent weapon of bioterror. There is currently an investigational-new-drug application for cidofovir for the therapy of variola major virus infections. Stittelaar and colleagues compared the levels of effectiveness of postexposure smallpox vaccination (Elstree-RIVM) and antiviral treatment with cidofovir or an acyclic nucleoside phosphonate analogue {6-[2-(phosphonomethoxy)alkoxy]-2,4-diaminopyrimidine (HPMPO-DAPy)} after lethal intratracheal infection of cynomolgus monkeys with monkeypox virus, a variola virus surrogate. Their results demonstrated that either compound was more effective than vaccination with the Ellstree vaccine (K. J. Stittelaar et al., Nature 439:745-748, 2006). An unanswered question is how to translate this information into therapy for poxvirus infections in people. In a proof-of-principle study, we used a novel in vitro hollow-fiber infection model system to determine the pharmacodynamics of vaccinia virus infection of HeLa-S3 cells treated with cidofovir. Our results demonstrate that the currently licensed dose of cidofovir of 5 mg/kg of body weight weekly with probenecid (which ameliorates nephrotoxicity) is unlikely to provide protection for patients intentionally exposed to Variola major virus. We further demonstrate that the antiviral effect is independent of the schedule of drug administration. Exposures (area under the concentration-time curve) to cidofovir that will have a robust protective effect will require doses that are 5 to 10 times that currently administered to humans. Such doses may cause nephrotoxicity, and therefore, approaches that include probenecid administration as well as schedules of administration that will help ameliorate the uptake of cidofovir into renal tubular epithelial cells need to be considered when addressing such treatment for people.

* Corresponding author. Mailing address: Ordway Research Institute, 150 New Scotland Avenue, Albany, NY 12208. Phone: (518) 641-6434. Fax: (518) 641-6304. E-mail: GDrusano{at}ordwayresearch.org

{triangledown} Published ahead of print on 13 October 2008.

{dagger} Deceased.

Antimicrobial Agents and Chemotherapy, January 2009, p. 129-135, Vol. 53, No. 1
0066-4804/09/$08.00+0     doi:10.1128/AAC.00708-08
Copyright © 2009, American Society for Microbiology. All Rights Reserved.



This article has been cited by other articles:

  • McSharry, J. J., Weng, Q., Brown, A., Kulawy, R., Drusano, G. L. (2009). Prediction of the Pharmacodynamically Linked Variable of Oseltamivir Carboxylate for Influenza A Virus Using an In Vitro Hollow-Fiber Infection Model System. Antimicrob. Agents Chemother. 53: 2375-2381 [Abstract] [Full Text]  


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