title: Novel mechanism of inhibition of cytomegalovirus by the experimental immunosuppressive agent leflunomide.
abstract: BACKGROUND
  Despite progress in antiviral chemotherapy, cytomegalovirus (CMV) remains a major cause of morbidity and mortality among pharmacologically immunosuppressed organ transplant recipients, frequently engaging the clinician in a struggle to balance graft preservation with control of CMV disease. Leflunomide, an inhibitor of protein kinase activity and pyrimidine synthesis, is an experimental immunosuppressive agent effective against acute and chronic allograft rejection in animal models. Because a number of CMV proteins are known to be phosphorylated, we tested the hypothesis that this agent might exert inhibitory activity against CMV.
  
  
  RESULTS
  Plaque assays demonstrated dramatic dose-dependent attenuation of production of multiple clinical CMV isolates in leflunomide-treated human fibroblasts and endothelial cells, common targets for CMV infection in vivo. As shown by Northern blot analysis and immunohistochemical staining, leflunomide neither interferes with transcription of immediate early or late viral genes, nor with expression of corresponding proteins. CMV-specific DNA dot blots and biochemical enzyme assays indicated that, in contrast to currently approved anti-CMV drugs, leflunomide exerts no inhibitory effect on the accumulation of viral DNA in infected cells, or on viral DNA polymerase activity. Rather, as visualized by transmission electron microscopy, this agent appears to act at a late stage in virion assembly by preventing tegument acquisition by viral nucleocapsids. Finally we have demonstrated equivalent inhibitory activity of leflunomide against multi-drug-resistant CMV isolates.
  
  
  CONCLUSIONS
  These findings imply that leflunomide, an effective immunosuppressive agent, shows potential to concurrently attenuate a major complication of immunosuppression, CMV disease, by a novel mechanism of antiviral activity.
authors.affiliation: Department of Pathology, The Ohio State University College of Medicine and Public Health, Columbus 43210-1218, USA.
authors.forename: W J
authors.initials: WJ
authors.lastname: Waldman
authors.forename: D A
authors.initials: DA
authors.lastname: Knight
authors.forename: N S
authors.initials: NS
authors.lastname: Lurain
authors.forename: D M
authors.initials: DM
authors.lastname: Miller
authors.forename: D D
authors.initials: DD
authors.lastname: Sedmak
authors.forename: J W
authors.initials: JW
authors.lastname: Williams
authors.forename: A S
authors.initials: AS
authors.lastname: Chong
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D015152:Blotting, Northern; D003587:Cytomegalovirus / Q000187:drug effects* / Q000235:genetics; D003586:Cytomegalovirus Infections / Q000188:drug therapy; D004279:DNA, Viral / Q000037:antagonists & inhibitors; D004259:DNA-Directed DNA Polymerase / Q000378:metabolism; D004305:Dose-Response Relationship, Drug; D004352:Drug Resistance, Microbial / Q000502:physiology; D004730:Endothelium, Vascular / Q000166:cytology / Q000821:virology; D005347:Fibroblasts / Q000821:virology; D017245:Foscarnet / Q000627:therapeutic use; D015870:Gene Expression; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology* / Q000627:therapeutic use; D007555:Isoxazoles / Q000494:pharmacology* / Q000627:therapeutic use; D000077339:Leflunomide; D008297:Male; D013997:Time Factors; D014158:Transcription, Genetic / Q000187:drug effects; D014471:Umbilical Veins / Q000166:cytology; D014764:Viral Proteins / Q000235:genetics; D014779:Virus Replication / Q000187:drug effects
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D007166:Immunosuppressive Agents; D007555:Isoxazoles; D014764:Viral Proteins; D017245:Foscarnet; D004259:DNA-Directed DNA Polymerase; D000077339:Leflunomide