- Open Access
Biochemical prevention and treatment of viral infections – A new paradigm in medicine for infectious diseases
© Le Calvez et al; licensee BioMed Central Ltd. 2004
- Received: 10 November 2004
- Accepted: 23 November 2004
- Published: 23 November 2004
For two centuries, vaccination has been the dominating approach to develop prophylaxis against viral infections through immunological prevention. However, vaccines are not always possible to make, are ineffective for many viral infections, and also carry certain risk for a small, yet significant portion of the population. In the recent years, FDA's approval and subsequent market acceptance of Synagis, a monoclonal antibody indicated for prevention and treatment of respiratory syncytial virus (RSV) has heralded a new era for viral infection prevention and treatment. This emerging paradigm, herein designated "Biochemical Prevention and Treatment", currently involves two aspects: (1) preventing viral entry via passive transfer of specific protein-based anti-viral molecules or host cell receptor blockers; (2) inhibiting viral amplification by targeting the viral mRNA with anti-sense DNA, ribozyme, or RNA interference (RNAi). This article summarizes the current status of this field.
- viral mRNA
- anti-sense oligonucleotide
- RNA interference
- viral infectious disease
- blocking antibody
- soluble receptor
1. Biochemical Prevention and Treatment via Protein targeting
Monoclonal Antibodies in Clinical Trials
Genital Warts HPV
Protein Design Labs
XTL Biopharmaceuticals Ltd.
Immune Network Ltd.
Hepatitis C, HIV/AIDS
AbNovo Inc., Immune Network Ltd.
Roche Holding Progenics Pharmaceuticals
Tanox, Inc., Biogen, Inc. (Massachusetts)
OraSure Technologies, Inc.
CytoDyn Amerimmune Pharmaceuticals, Inc.
AAI International, AnaaiPharma Company
Herpes Simplex Virus type 2
Human B19 parvovirus
Respiratory Syncytial Virus
Approved in 1998
Respiratory Syncytial Virus
Rhinovirus (common cold)
Biochemical Prevention and Treatment of Respiratory Syncytial Virus Infection
The respiratory syncytial virus (RSV) is a major cause of lower respiratory tract infection in infants and young children producing bronchiolitis and pneumonia worldwide. RSV infection leads to more than 90,000 hospitalizations and a 2% mortality rate among infants nationwide [2–5]. Approximately two-thirds of infants are infected with RSV during the first year of life and approximately 95% of children test seropositive for RSV by the age of two . Unfortunately, even natural RSV infection produces limited immunity at best. In fact, an inactivated RSV vaccine paradoxically resulted in more severe disease instead of protection .
The most successful approach to date has been Biochemical Prevention and Treatment with anti-viral antibodies. In 1996, RespiGam™ (respiratory syncytial virus immune globulin or RSV-IG) became available for use in children less than two years of age with high-risk factors [8–10]. The use of RespiGam™ was largely supplanted with the approval of Synagis™ (Palivizumab) in 1998. Palivizumab is an IgG1 MAb administered IM monthly that selectively binds to the RSV surface glycoprotein F [1, 51]. The drug specifically inhibits RSV replication by preventing the virus from fusing with the respiratory endothelial cell membrane. Palivizumab has been shown to reduce the rate of hospitalization of at-risk infants by about 55% in clinical studies and now serves as the primary medical means of RSV prevention [11–13].
Prevention of Human Rhinovirus infections
Human rhinovirus (HRV) causes over 80% of the common cold in the fall . Developing vaccines against HRV is unfeasible because HRVs have at least 115 antigenically distinct serotypes [15, 16]. One of the proven methods to prevent and inhibit viral infections is to block host cell receptors that are used by viruses to gain cell entry. Receptor blockage is commonly achieved via application of MAbs that bind to specific epitopes on the receptor molecules. A plethora of in vitro studies have reported effective viral inhibition by receptor-blocking MAbs. However, these works have not yielded yet any approved drug on the market.
In HRV infection, about 90% of HRV serotypes utilize a single cell surface receptor exclusively, which is the intercellular adhesion molecule-1 (ICAM-1), for viral attachment and subsequent viral entry [17, 18]. As such, ICAM-1 has become a very promising target for biochemical prevention. A receptor blocking approach has shown that the soluble ICAM-1 and an anti-ICAM-1 monoclonal antibody, Mab 1A6, could prevent infections by a broad spectrum of rhinovirus serotypes in human cells in vitro [19–21]. Administration of soluble ICAM-1 and MAbs in human clinical trials had indeed achieved reduction in symptoms, but did not prevent the incidence of the disease [22–24]. For the MAbs, the limited efficacy is most likely due to its low functional affinity (or avidity) for ICAM-1 when compared to that of the multivalent HRV particles .
High avidity is achieved by multivalency. To improve avidity of HRV receptor blocking antibody, a novel tetravalent recombinant antibody, CFY196, has been generated against ICAM-1 . CFY196 is composed of Fab fragment of a humanized version of MAb 1A6 fused with a linker derived from human immunoglobulin D (IgD) hinge and a tetramerization domain derived from the coiled-coil sequence of human transcription factor ATFα. CFY196 is expressed in bacteria and purified as a homogenous tetrameric molecular complex. CFY196 exhibited almost two-orders-of-magnitude improvement in functional affinity compared with its bivalent counterpart based on the kinetic parameters measured by BIAcore analysis. Such kinetic improvement also directly leads to functional superiorities of CFY196. In in vitro assays, CFY196 consistently and significantly outpaced the best commercial anti-ICAM-1 MAbs in preventing HRV infection as measured by reduction of cytopathic effects and HRV viral titers . The preclinical findings of CFY196 bode well its efficacy in human since MAb 1A6, from which CFY196 is derived, has already exhibited positive effects in a human trial. Moreover, to prevent possible immunogenicity, CFY196 is humanized . Further pre-clinical and clinical development of CFY196 is warranted to fully evaluate its potential as a prophylaxis and therapeutics for the HRV induced common colds.
2. Biochemical Prevention and Treatment via targeting on viral mRNA
Targeting viral mRNA is one of the most active areas of research and development. Several strategies have emerged over the years and are being tested pre-clinically and clinically. They include: antisense-oligonucleotides (AS-ONs), ribozymes, and recently, RNA interference (RNAi). All these strategies share the features of conceptual simplicity, straightforward drug design and quick route to identify drug leads. However, the challenges have been to improve potency, pharmacokinetics and, most importantly, intracellular delivery of the drug candidates. As the oldest strategy, AS-ON technology has produced to date one drug in the market place, Vitravene®. A number of clinical trials of drug candidates from these technologies are currently ongoing.
Antisense-oligonucleotides (AS-ONs) are short synthetic oligonucleotides that form complementary pair with specific viral mRNA targets. AS-ONs inhibit viral protein production by both blocking viral mRNA translation and triggering its degradation. Since the discovery of viral inhibition effect of AS-ONs by Zamecnik and Stephenson in 1978 , antisense technology has been developed as a powerful tool for target validation and therapeutic purposes.
Clinical trials and an approved therapy based on AS-ON technologies [31-33].
Approved in 1998
Affinitac (ISIS 3521)
Alicaforsen (ISIS 2302)
Psoriasis, Crohn's disease, Ulcerative colitis
DNA methyl transferase
Adenosine A1 receptor
Ribonucleotide reductase (R2)
Rheumatoid Arthritis, Psoriasis
Restenosis, cancer, Polycystic kidney disease
Ribonucleotide reductase (R1)
Metabolic redirection of approved drugs
Phosphorothioate (PS) oligodeoxynucleotides are the 'first generation' DNA analogs. The 'second generation' ONs contain nucleotides with alkyl modifications at the 2' position of the ribose. They are less toxic than PS-DNAs and have a slightly enhanced affinity. DNA and RNA analogs with modified phosphate linkages, or different sugar residues substituting the furanose ring have been referred as 'third generation' . For instance, peptide nucleic acids and their analogs display superior sequence specificity and are resistant to nuclease degradation. These third generation AS-ON have limited non-specific interactions with other genes and, therefore, have shown great potentials in clinical trials.
Ribozymes (Rz) are catalytically active ONs that both bind and cleave target RNAs. They were discovered after the AS-ON technology. Initial findings on ribozymes raised the hope that they may offer a more potent alternative to AS-ONs. Many cell based and animal tests have performed on anti-viral effects of ribozymes, including HIV, hepatitis B, hepatitis C, influenza, etc. Results from these tests have shown that ribozymes are promising viral inhibitors [35–38]. However, further progress in the field has been hampered by difficulties to achieve satisfactory potency and efficient intracellular delivery of ribozymes in vivo. HEPTAZYME is a modified ribozyme that cleaves the internal ribosome entry site of the Hepatitis C virus. The Rz was demonstrated to inhibit viral replication up to 90% in cell culture . HEPTAZYME was tested in a Phase II clinical trial, but was later withdrawn from further clinical trials due to insufficient efficacy. So far, there is no anti-viral ribozymes that are being actively tested in advanced clinical trials.
RNA Interference (RNAi)
RNA interference, or RNAi, is the inhibition of expression of specific genes by double-stranded RNAs (dsRNAs). It is becoming the method of choice to knockdown gene expression rapidly and robustly in mammalian cells. Comparing to the traditional antisense method, RNAi technology has the advantage of significantly enhanced potency; therefore, only lower concentrations may be needed to achieve same level of gene knockdown. RNAi gained rapid acceptance by researchers after Tuschl and coworkers discovered that in vitro synthesized small interfering RNAs (siRNAs) of 21 to 23 nucleotides in length can effectively silence targeted genes in mammalian cells without triggering interferon production [40, 41]. In mammalian cells, the level of gene inhibition mediated by siRNA routinely reaches an impressive 90% .
Several initial studies, which test the potential application of synthetic siRNAs as antiviral agents, have shown very promising results. To date, RNAi has been used effectively to inhibit the replication of several different pathogenic viruses in culture, including: RSV (respiratory syncytial virus) , influenza virus , poliovirus  and HIV-1 [46–48]. In the case of HIV-1, several specific mRNAs have been successfully targeted for siRNA-mediated silencing, including those that encode Gag, Pol, Vif and the small regulatory proteins Tat and Rev. These studies show that RNAi can effectively trigger the degradation of not only viral mRNAs, but also genomic RNAs at both the pre- and post-integration stages of the viral lifecycle. In addition to targeting viruses directly, alternative strategies have employed siRNAs that silence the expression of essential host factors including Tsg101, required for vacuolar sorting and efficient budding of HIV-1 progeny , and the chemokine receptor CCR5, required as a co-receptor for HIV-1 cell entry .
The authors wish to thank Kosi Gramatikoff for graphic assistance and helpful discussions. They are grateful to Libby Weber for the critical assistance on the completion of this manuscript.
- Anderson LJ, Bingham P, Hierholzer J: Neutralization of respiratory syncytial virus by individual and mixtures of F and G protein monoclonal antibodies. J Virol 1988, 62: 4232-4238.PubMed CentralPubMedGoogle Scholar
- Chanock RM, Kim HW, Vargosko AJ, Deleva A, Johnson KM, Cumming C, Parrot RH: Respiratory syncytial virus: I. Virus recovery and other observations during 1960 outbreak of bronchiolitis, pneumonia, and minor respiratory diseases in children. JAMA 1961, 176: 647-653.View ArticlePubMedGoogle Scholar
- Parrott RH, Vargosko AJ, Kim HW, Cumming C, Turner H, Huebner RJ, Chanock RM: Respiratory syncytial virus. II. Serologic studies over a 34-month period of children with bronchiolitis, pneumonia, and minor respiratory diseases. JAMA 1961, 176: 653-657.PubMedGoogle Scholar
- Prober CG, Wang EE: Reducing the morbidity of lower respiratory tract infections caused by respiratory syncytial virus: still no answer. Pediatrics 1997, 99: 454-61. 10.1542/peds.99.3.454View ArticleGoogle Scholar
- Simoes EAF, Rieger CHL: RSV infection in developed and developing countries. Infect Med 1999, 16: 11-17.Google Scholar
- Parrott RH, Kim HW, Arrobio JO, Hodes DS, Murphy BR, Brandt CD, Camargo E, Chanock RM: Epidemiology of respiratory syncytial virus infection in Washington D.C. II. Infection and disease with respect to age, immunological status, race and sex. J Epidemiol 1973, 98: 289-300.Google Scholar
- Levin MJ: Treatment and prevention options for respiratory syncytial virus infections. J Pediatrics 1994, 125: S22-S27.View ArticleGoogle Scholar
- Groothuis JR, Levin NJ, Rodriguez W, Hall CB, Long CE, Kim HW, Lauer BA, Hemming VG: Use of intravenous gamma globulin to passively immunize high-risk children against RSV: safety and pharmacokinetics. Antimicrob Agents Chemother 1991,35(7):1469-1473.PubMed CentralView ArticlePubMedGoogle Scholar
- Meissner HC, Fulton DR, Groothuis JR, Geggel RL, Marx GR, Hemming VG, Hougen T, Snydman DR: Controlled trial to evaluate protection of high-risk infants against RSV disease by using standard intravenous immune globulin. Antimicrob Agents Chemother 1993, 37: 1655-1658.PubMed CentralView ArticlePubMedGoogle Scholar
- MedImmune Inc: RespiGam™: Respiratory Syncytial Virus Immune Globulin Intravenous (Human), [RSV-IGIV]. Gaithersburg, MD 1996.Google Scholar
- The Impact-RSV Study Group. Palivizumab, a humanized respiratory syncytial virus monoclonal antibody, reduces hospitalization from respiratory syncytial virus infection in high-risk infants Pediatrics 1998, 102: 531-537. 10.1542/peds.102.3.531Google Scholar
- Cohen AH, Sorrentino M, Powers T: Effectiveness of palivizumab for preventing serious RSV disease. J Resp Dis 2000, 2: S30-S32.Google Scholar
- MedImmune Inc: Synagis™: Palivizumab for intramuscular administration. Gaithersburg, MD 1996.Google Scholar
- Arruda E, Pitkaranta A, Witek TJ Jr, Doyle CA, Hayden FG: Frequency and natural history of rhinovirus infections in adults during autumn. J Clin Microb 1997, 35: 2864-2868.Google Scholar
- Stanway G: Rhinoviruses. In: Webster RG ed. In Encyclopedia of Virology. New York: Academic Press; 1994:1253-1259.Google Scholar
- Skern T, Duechler M, Sommergruber W, Blaas D, Kuechler E: The molecular biology of human rhinoviruses. Biochem Soc Symp 1987, 53: 63-73.PubMedGoogle Scholar
- Staunton DE, Merluzzi VJ, Rothlein R, Barton R, Marlin SD, Springer TA: A cell adhesion molecule, ICAM-1, is the major surface receptor for rhinoviruses. Cel 1989, 56: 849-853. 10.1016/0092-8674(89)90689-2View ArticleGoogle Scholar
- Uncapher CR, Dewitt CM, Colonno RJ: The major and minor group receptor families contain all but one human rhinovirus serotype. Virology 1991, 180: 814-817. 10.1016/0042-6822(91)90098-VView ArticlePubMedGoogle Scholar
- Marlin SD, Ltaunton DE, Springer TA: A soluble form of intercellular adhesion molecule-1 inhibits rhinovirus infection. Nature 1990, 344: 70-72.View ArticlePubMedGoogle Scholar
- Huguenel ED, Cohn D, Dockum DP, Greve JM, Fournel MA, Hammond L, Irwin R, Mahoney J, McClelland A, Muchmore E, Ohlin AC, Scuderi P: Prevention of rhinovirus infection in chimpanzees by soluble intercellular adhesion molecule-1. Am J Resp Critical Care Med 1997, 155: 1206-1210.View ArticleGoogle Scholar
- Colonno RJ, Callahan PL, Long WJ: Isolation of a monoclonal antibody that blocks attachment of the major group of human rhinoviruses. J Virol 1986, 57: 7-12.PubMed CentralPubMedGoogle Scholar
- Turner RB, Wecker MT, Pohl G, Witek TJ, McNally E, St George R, Winther B, Hayden FG: Efficacy of tremacamra, a soluble intercellular adhesion molecule 1, for experimental rhinovirus infection: a randomized clinical trial. JAMA 1999, 281: 1797-1804. 10.1001/jama.281.19.1797View ArticlePubMedGoogle Scholar
- Colonno RJ: Virus receptors: the Achilles' heel of human rhinoviruses. Adv Exp Med Biol 1992, 312: 61-70.View ArticlePubMedGoogle Scholar
- Hayden FG, Gwaltney JM, Colonno RJ: Modification of experimental rhinovirus colds by receptor blockade. Antiviral Res 1988, 9: 233-247. 10.1016/0166-3542(88)90055-1View ArticlePubMedGoogle Scholar
- Casasnovas JM, Springer TA: Kinetics and thermodynamics of virus binding to receptor. Studies with rhinovirus, intercellular adhesion molecule-1 (ICAM-1), and surface plasmon resonance. J Biol Chem 1995, 270: 13216-13224. 10.1074/jbc.270.22.13216View ArticlePubMedGoogle Scholar
- Charles CH, Luo GX, Kohlstaedt LA, Gorfain E, Morantte I, Williams JH, Fang F: Prevention of Human Rhinovirus Infection by Multivalent Fab Molecules Directed against ICAM-1. Antimicrobial Agents and Chemotherapy 2003, 47: 1503-1508. 10.1128/AAC.47.5.1503-1508.2003PubMed CentralView ArticlePubMedGoogle Scholar
- Luo GX, Kohlstaedt LA, Charles CH, Gorfain E, Morantte I, Williams JH, Fang F: Humanization of an anti-ICAM-1 antibody with over 50-fold affinity and functional improvement. J Immunol Methods 2003, 275: 31-40. 10.1016/S0022-1759(02)00542-2View ArticlePubMedGoogle Scholar
- Zamecnik PC, Stephenson ML: Inhibition of Rous sarcoma virus replication and cell transformation by a specific oligodeoxynucleotide. Proc Natl Acad Sci USA 1978, 75: 280-284.PubMed CentralView ArticlePubMedGoogle Scholar
- Orr RM: Technology evaluation: fomivirsen. Isis Pharmaceuticals Inc/CIBA vision. Curr Opin Mol Ther 2001, 3: 288-294.PubMedGoogle Scholar
- Roehr B: Fomivirsen approved for CMV retinitis. J Int Assoc Physicians AIDS Care 1998, 4: 14-16.PubMedGoogle Scholar
- Dove A: Antisense and sensibility. Nat Biotechnol 2002, 20: 121-124. 10.1038/nbt0202-121View ArticlePubMedGoogle Scholar
- Braasch DA, Corey DR: Novel antisense and peptide nucleic acid strategies for controlling gene expression. Biochemistry 2002, 41: 4503-4509. 10.1021/bi0122112View ArticlePubMedGoogle Scholar
- Opalinska JB, Gewirtz AM: Nucleic acids therapeutics: Basic principles and recent applications. Nat Rev Drug Discov 2002, 1: 503-514. 10.1038/nrd837View ArticlePubMedGoogle Scholar
- Kurreck J: Antisense technologies: Improvement through novel chemical modifications. Eur J Biochem 2003, 270: 1628-1644.View ArticlePubMedGoogle Scholar
- Yu M, Ojwang J, Yamada O, Hampel A, Rappaport J, Looney D, Wong-Staal F: A Hairpin Ribozyme Inhibits Expression of Diverse Strains of HIV-1. Proc Natl Acad Sci USA 1993, 90: 6341.Google Scholar
- Welch P, Tritz R, Yei S, Barber JR, Yu M: Intracellular Application of Hairpin Ribozyme Genes Against Hepatitis B Virus. Gene Therapy 1997, 4: 736. 10.1038/sj.gt.3300441View ArticlePubMedGoogle Scholar
- Welch PJ, Tritz R, Yei S, Leavitt M, Yu M, Barber J: Apotential therapeutic application of hairpin ribozymes: In vitro and in vivo studies of gene therapy for hepatitis C virus infection. Gene Ther 1996, 3: 994.PubMedGoogle Scholar
- Tang XB, Hobom G, Luo D: Ribozyme mediated destruction of influenza A virus in vitro and in vivo . J Med Virol 1994, 42: 385.View ArticlePubMedGoogle Scholar
- Macejak D, Jensen KL, Jamison S, Domenico K, Roberts EC, Chaudhary N, von Carlowitz I, Bellon L, Tong MJ, Conrad A, Pavco PA, Blatt LM: Inhibition of Hepatitis C Virus (HCV)-RNA-dependent translation and replication of a chimeric HCV Poliovirus using synthetic stabilized ribozymes. Hepatology 2000, 31: 769-776. 10.1002/hep.510310331View ArticlePubMedGoogle Scholar
- McManus MT, Sharp PA: Gene silencing in mammals by small interfering RNAs. Nature Rev 2002, 3: 737-747. 10.1038/nrg908View ArticleGoogle Scholar
- Thompson JD: Applications of antisense and siRNAs during preclinical drug development. Drug Discovery Today 2002, 7: 912-917. 10.1016/S1359-6446(02)02410-8View ArticlePubMedGoogle Scholar
- Shi Y: Mammalian RNAi for the masses. Trends in Genetics 2003, 19: 9-12. 10.1016/S0168-9525(02)00005-7View ArticlePubMedGoogle Scholar
- Bitko V, Barik S: Phenotypic silencing of cytoplasmic genes using sequence-specific double-stranded short interfering RNA and its application in the reverse genetics of wild type negative-strand RNA viruses. BMC Microbiology 2001, 1: 34-46. 10.1186/1471-2180-1-34PubMed CentralView ArticlePubMedGoogle Scholar
- Ge O, McManus MT, Nguyen T, Shen CH, Sharp PA, Eisen HN: RNA interference of influenza virus production by directly targeting mRNA for degradation and indirectly inhibiting all viral RNA transcription. Proc Natl Acad Sci USA 2003, 100: 2718-2723. 10.1073/pnas.0437841100PubMed CentralView ArticlePubMedGoogle Scholar
- Gitlin L, Karelsky S, Andino R: Short interfering RNA confers intracellular antiviral immunity in human cells. Nature 2002, 418: 430-434. 10.1038/nature00873View ArticlePubMedGoogle Scholar
- Coburn GA, Cullen BR: Potent and specific inhibition of human immunodeficiency virus type 1 replication by RNA interference. Journal of Virology 2002, 76: 9225-9231. 10.1128/JVI.76.18.9225-9231.2002PubMed CentralView ArticlePubMedGoogle Scholar
- Jacque JM, Triques K, Stevenson M: Modulation of HIV-1 replication by RNA interference. Nature 2002, 418: 435-438. 10.1038/nature00896View ArticlePubMedGoogle Scholar
- Novina CD, Murray MF, Dykxhoorn DM, Beresford PJ, Riess J, Lee SK, Collman RG, Lieberman J, Shankar P, Sharp PA: siRNA-directed inhibition of HIV-1 infection. Nature Medicine 2002, 8: 681-686.PubMedGoogle Scholar
- Garrus JE, von Schwedler UK, Pornillos OW, Morham SG, Zavitz KH, Wang HE, Wettstein DA, Stray KM, Cote M, Rich RL, Myszka DG, Sundquist WI: Tsg101 and the vacuolar protein sorting pathway are essential for HIV-1 budding. Cell 2001, 107: 55-65. 10.1016/S0092-8674(01)00506-2View ArticlePubMedGoogle Scholar
- Martinez MA, Gutierrez A, Armand-Ugon M, Blanco J, Parera M, Gomez J, Clotet B, Este JA: Suppression of chemokine receptor expression by RNA interference allows for inhibition of HIV-1 replication. AIDS 2002, 16: 2385-2390. 10.1097/00002030-200212060-00002View ArticlePubMedGoogle Scholar
- Johnson S, Oliver C, Prince GA, Hemming VG, Pfarr DS, Wang SC, Dormitzer M, O'Grady J, Koenig S, Tamura JK, Woods R, Bansal G, Couchenour D, Tsao E, Hall WC, Young JF: Development of a humanized monoclonal antibody (MEDI-493) with potent in vitro and in vivo activity against respiratory syncytial virus. J Infect Dis 1997, 176: 1215-1224.View ArticlePubMedGoogle Scholar
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