Postinfection A77-1726 treatment improves cardiopulmonary function in H1N1 influenza-infected mice.
Acute respiratory disease is associated with significant morbidity and mortality in influenza. Because antiviral drugs are only effective early in infection, new agents are needed to treat nonvaccinated patients presenting with late-stage disease, particularly those who develop acute respiratory distress syndrome. We found previously that the de novo pyrimidine synthesis inhibitor A77-1726 reversed the influenza-induced impairment of alveolar fluid clearance. Patients with acute respiratory distress syndrome and intact alveolar fluid clearance demonstrate lower mortality than those with compromised fluid clearance. We therefore investigated the effects of treatment with nebulized A77-1726 (67.5 mg/kg) on indices of cardiopulmonary function relevant to the diagnosis of acute respiratory distress syndrome. BALB/cAnNCr mice (8-12 wk old) were inoculated intranasally with 10,000 plaque-forming units/mouse influenza A/WSN/33 (H1N1). Pulse oximetry was performed daily. Alveolar fluid clearance, lung water, and lung mechanics were measured at 2 and 6 days after inoculation in live, ventilated mice by BSA instillation, magnetic resonance imaging, and forced-oscillation techniques, respectively. A77-1726 treatment at 1 day after inoculation delayed mortality. Treatment on Days 1 or 5 reduced viral replication on Day 6, and improved alveolar fluid clearance, peripheral oxygenation, and cardiac function. Nebulized A77-1726 also reversed influenza-induced increases in lung water content and volume, improved pulmonary mechanics, reduced bronchoalveolar lavage fluid ATP and neutrophil content, and increased IL-6 concentrations. The ability of A77-1726 to improve cardiopulmonary function in influenza-infected mice and to reduce the severity of ongoing acute respiratory distress syndrome late in infection suggests that pyrimidine synthesis inhibitors are promising therapeutic candidates for the management of severe influenza.
Department of Veterinary Biosciences, Ohio State University, Columbus, OH 43210, USA.
Famke
F
Aeffner
Anna
A
Bratasz
Emilio
E
Flaño
Kimerly A
KA
Powell
Ian C
IC
Davis
D000280:Administration, Inhalation; D000403:Airway Resistance / Q000187:drug effects; D000814:Aniline Compounds / Q000008:administration & dosage* / Q000494:pharmacology; D000818:Animals; D000998:Antiviral Agents / Q000008:administration & dosage* / Q000494:pharmacology; D001992:Bronchoalveolar Lavage Fluid; D002339:Carotid Arteries / Q000503:physiopathology; D003437:Crotonates; D016207:Cytokines / Q000378:metabolism; D004353:Drug Evaluation, Preclinical; D006339:Heart Rate / Q000187:drug effects; D006885:Hydroxybutyrates / Q000008:administration & dosage* / Q000494:pharmacology; D053118:Influenza A Virus, H1N1 Subtype / Q000187:drug effects / Q000502:physiology*; D008168:Lung / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology; D051379:Mice; D008807:Mice, Inbred BALB C; D009504:Neutrophils / Q000276:immunology; D009570:Nitriles; D009976:Orthomyxoviridae Infections / Q000188:drug therapy* / Q000503:physiopathology / Q000821:virology; D010100:Oxygen / Q000097:blood; D011654:Pulmonary Edema / Q000276:immunology / Q000503:physiopathology / Q000517:prevention & control / Q000821:virology; D012128:Respiratory Distress Syndrome / Q000276:immunology / Q000503:physiopathology / Q000517:prevention & control* / Q000821:virology; D056152:Respiratory Rate / Q000187:drug effects; D014052:Toluidines; D014779:Virus Replication / Q000187:drug effects
D000814:Aniline Compounds; D000998:Antiviral Agents; D003437:Crotonates; D016207:Cytokines; D006885:Hydroxybutyrates; D009570:Nitriles; D014052:Toluidines; C527525:teriflunomide; D010100:Oxygen