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Anti-Infective Agents
Published in Keith Struthers, Clinical Microbiology, 2017
Foscarnet is a pyrophosphate that acts as an analogue, blocking the pyrophosphate site of the DNA polymerase of CMV and EBV. Cidofovir is an analogue of deoxycytidine monophosphate, which is converted to the diphosphate form by a cellular enzyme. In this form it competes with the cellular triphosphate deoxycytidine for the active site of the DNA polymerase of HSV, CMV and EBV. When two consecutive cidofovir molecules are incorporated, viral DNA synthesis is abrogated. Cidofovir also has activity against adenovirus.
Recurrent respiratory papillomatosis
Published in Declan Costello, Guri Sandhu, Practical Laryngology, 2015
Cidofovir [(S)-1-(3-hydroxy-2-phosphonylmethoxypropyl) cytosine] is a nucleoside analogue of deoxycytidine monophosphate and as such is a prodrug. Once inside a cell it undergoes a two-stage phosphorylation process. At this point the chemical structure resembles that of a nucleotide (which is the building block of DNA). It may then be incorporated into host cell or virus DNA synthesis. Once two molecules have been incorporated, DNA synthesis stops.34
Viral Infections in HIV Disease
Published in Clay J. Cockerell, Antoanella Calame, Cutaneous Manifestations of HIV Disease, 2012
Wei Su, Cindy Berthelot, Clay J. Cockerell
While destructive treatment is the mainstay, several topical agents have demonstrated efficacy in treating MC. Daily topical tretinoin application may serve as an adjunctive therapy to local destructive treatment42 and studies have also reported success with cantharidin with or without curettage for resistant lesions.43 Although tretinoin appears to diminish the appearance of new lesions and helps eliminate older lesions, its use is limited by local irritation. Trichloroacetic acid peels yielded an average reduction in MC lesion counts of 40.5% in seven HIV-infected individuals.44 Immune therapy with systemic and intralesional interferon (IFN) has been used with moderate success in treating AIDS patients with MC.45 Topical application of imiquimod enhances functional maturation of Langerhans cells and their migration to regional lymph nodes, thereby enhancing cutaneous adaptive responses, as well as innate and adaptive immunologic response.46 It has been studied for treatment of MC in AIDS patients and has shown moderate success although its use is limited by local inflammation.47 Podophyllin is also effective but may be a poor choice in patients with HIV given their predisposition for development of cancer and its being mutagenic.48 If applied, it should be left on for only a minimal period (1–4 hours) and then thoroughly washed off. Because podophyllin is caustic and causes irritation, only a small area should be treated at one time. A nucleotide analog of deoxycytidine monophosphate, cidofovir, is an antiviral with activity against a broad variety of DNA viruses, including MCV. It is most commonly used for the treatment of CMV retinitis in AIDS patients, and is useful as topical or intravenous treatment for recalcitrant MC although it is quite expensive. Patients with concurrent MC and CMV treated with intravenous cidofovir have experienced clearance of MC lesions.49 Finally, several case reports have described the reduction in MC after beginning antiretroviral treatment.50
An overview of letermovir: a cytomegalovirus prophylactic option
Published in Expert Opinion on Pharmacotherapy, 2019
Giuseppe Gerna, Daniele Lilleri, Fausto Baldanti
CDV is a deoxycytidine monophosphate analog active against most DNA viruses [19]; as such, it does not require an initial phosphorylation step by the UL97 gene product and its conversion to active deoxycytidine diphosphate (a deoxycytidine triphosphate analog) is produced by multiple cellular kinases [20]. Furthermore, its incorporation into the nascent DNA strand acts as a non-obligate chain terminator [21]. CDV is available as parenteral formulation and has an intracellular half-life of over 24 h, which allows it to be administered every 1–2 weeks. The major AE of CDV is nephrotoxicity, causing CDV accumulation in the renal cortex, which can be reduced by hydration. CDV resistance occurs with a frequency similar to that of GCV [17] and can induce cross-resistance to GCV [22]. CDV use is often restricted to treatment of GCV-resistant HCMV infections in both patients with HIV and SOT recipients [23]. In a lung transplant recipient with primary HCMV infection, treatment with GCV of repeated re-activation episodes for over a year resulted in the selection of a GCV-resistant HCMV strain with the A594V mutation in the UL97 kinase. Subsequent FOS therapy was discontinued because of renal toxicity, and a further course of GCV led to the development of a new mutation in both UL97 (A520Q) and UL54 (P522S) ORFs with final emergence of double resistance to both GCV and CDV [24].
Current biochemical treatments of mitochondrial respiratory chain disorders
Published in Expert Opinion on Orphan Drugs, 2019
Robert Heaton, Lauren Millichap, Fatima Saleem, Jennifer Gannon, Gemma Begum, Iain P. Hargreaves
In mtDNA depletion syndrome resulting from a deficiency in the enzyme, thymidine kinase 2 (TK2), supplementation with deoxynucleotides, deoxycytidine monophosphate and deoxythymidine monophosphate has shown some promise in the treatment of a mouse model of this disorder with a delay in disease onset and increased life span being reported [67]. Furthermore, a recent open‐label study has indicated the beneficial therapeutic effects of deoxynucleoside monophosphate and deoxynucleoside therapies in the treatment of TK2 deficiency in both children and adult patients [68].