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2006 ; 71
(1
): 53-63
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Enhancement of the infectivity of SARS-CoV in BALB/c mice by IMP dehydrogenase
inhibitors, including ribavirin
#MMPMID16621037
Barnard DL
; Day CW
; Bailey K
; Heiner M
; Montgomery R
; Lauridsen L
; Winslow S
; Hoopes J
; Li JK
; Lee J
; Carson DA
; Cottam HB
; Sidwell RW
Antiviral Res
2006[Aug]; 71
(1
): 53-63
PMID16621037
show ga
Because of the conflicting data concerning the SARS-CoV inhibitory efficacy of
ribavirin, an inosine monophosphate (IMP) dehydrogenase inhibitor, studies were
done to evaluate the efficacy of ribavirin and other IMP dehydrogenase inhibitors
(5-ethynyl-1-beta-D-ribofuranosylimidazole-4-carboxamide (EICAR), mizoribine, and
mycophenolic acid) in preventing viral replication in the lungs of BALB/c mice, a
replication model for severe acute respiratory syndrome (SARS) infections
(Subbarao, K., McAuliffe, J., Vogel, L., Fahle, G., Fischer, S., Tatti, K.,
Packard, M., Shieh, W.J., Zaki, S., Murphy, B., 2004. Prior infection and passive
transfer of neutralizing antibody prevent replication of severe acute respiratory
syndrome coronavirus (SARS-CoV) in the respiratory tract of mice. J. Virol. 78,
3572-3577). Ribavirin given at 75 mg/kg 4 h prior to virus exposure and then
given twice daily for 3 days beginning at day 0 was found to increase virus lung
titers and extend the length of time that virus could be detected in the lungs of
mice. Other IMP dehydrogenase inhibitors administered near maximum tolerated
doses using the same dosing regimen as for ribavirin were found to slightly
enhance virus replication in the lungs. In addition, ribavirin treatment seemed
also to promote the production of pro-inflammatory cytokines 4 days after
cessation of treatment, although after 3 days of treatment ribavirin inhibited
pro-inflammatory cytokine production in infected mice, significantly reducing the
levels of the cytokines IL-1alpha, interleukin-5 (IL-5), monocyte chemotactic
protein-1 (MCP-1), and granulocyte-macrophage colony stimulating factor (GM-CSF).
These findings suggest that ribavirin may actually contribute to the pathogenesis
of SARS-CoV by prolonging and/or enhancing viral replication in the lungs. By not
inhibiting viral replication in the lungs of infected mice, ribavirin treatment
may have provided a continual source of stimulation for the inflammatory response
thought to contribute to the pathogenesis of the infection. Our data do not
support the use of ribavirin or other IMP dehydrogenase inhibitors for treating
SARS infections in humans.