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Treatment with interferon-alpha 2b and ribavirin improves outcome in MERS-CoV-infected rhesus macaques

Identifieur interne : 000023 ( Hal/Curation ); précédent : 000022; suivant : 000024

Treatment with interferon-alpha 2b and ribavirin improves outcome in MERS-CoV-infected rhesus macaques

Auteurs : Darryl Falzarano ; Emmie Wit ; Angela L. Rasmussen ; Friederike Feldmann ; Atsushi Okumura ; Dana P. Scott ; Doug Brining ; Trenton Bushmaker ; Cynthia Martellaro ; Laura Baseler ; Arndt G. Benecke [France] ; Michael G. Katze ; Vincent J. Munster ; Heinz Feldmann

Source :

RBID : Hal:hal-01543320

Abstract

The emergence of Middle East respiratory syndrome coronavirus (MERS-CoV) is of global concern: the virus has caused severe respiratory illness, with 111 confirmed cases and 52 deaths1 at the time of this article's publication. Therapeutic interventions have not been evaluated in vivo; thus, patient management relies exclusively on supportive care, which, given the high case-fatality rate, is not highly effective. The rhesus macaque is the only known model organism for MERS-CoV infection, developing an acute localized to widespread pneumonia with transient clinical disease(2,3) that recapitulates mild to moderate human MERSCoV cases(4,5). The combination of interferon-alpha 2b and ribavirin was effective in reducing MERS-CoV replication in vitro(6); therefore, we initiated this treatment 8 h after inoculation of rhesus macaques. In contrast to untreated, infected macaques, treated animals did not develop breathing abnormalities and showed no or very mild radiographic evidence of pneumonia. Moreover, treated animals showed lower levels of systemic (serum) and local (lung) proinflammatory markers, in addition to fewer viral genome copies, distinct gene expression and less severe histopathological changes in the lungs. Taken together, these data suggest that treatment of MERS-CoV infected rhesus macaques with IFN-alpha 2b and ribavirin reduces virus replication, moderates the host response and improves clinical outcome. As these two drugs are already used in combination in the clinic for other infections, IFN-alpha 2b and ribavirin should be considered for the management of MERS-CoV cases.


Url:
DOI: 10.1038/nm.3362

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<p>The emergence of Middle East respiratory syndrome coronavirus (MERS-CoV) is of global concern: the virus has caused severe respiratory illness, with 111 confirmed cases and 52 deaths1 at the time of this article's publication. Therapeutic interventions have not been evaluated in vivo; thus, patient management relies exclusively on supportive care, which, given the high case-fatality rate, is not highly effective. The rhesus macaque is the only known model organism for MERS-CoV infection, developing an acute localized to widespread pneumonia with transient clinical disease(2,3) that recapitulates mild to moderate human MERSCoV cases(4,5). The combination of interferon-alpha 2b and ribavirin was effective in reducing MERS-CoV replication in vitro(6); therefore, we initiated this treatment 8 h after inoculation of rhesus macaques. In contrast to untreated, infected macaques, treated animals did not develop breathing abnormalities and showed no or very mild radiographic evidence of pneumonia. Moreover, treated animals showed lower levels of systemic (serum) and local (lung) proinflammatory markers, in addition to fewer viral genome copies, distinct gene expression and less severe histopathological changes in the lungs. Taken together, these data suggest that treatment of MERS-CoV infected rhesus macaques with IFN-alpha 2b and ribavirin reduces virus replication, moderates the host response and improves clinical outcome. As these two drugs are already used in combination in the clinic for other infections, IFN-alpha 2b and ribavirin should be considered for the management of MERS-CoV cases.</p>
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<surname>Bushmaker</surname>
</persName>
<idno type="halauthorid">1562556</idno>
</author>
<author role="aut">
<persName>
<forename type="first">Cynthia</forename>
<surname>Martellaro</surname>
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<idno type="halauthorid">1562560</idno>
</author>
<author role="aut">
<persName>
<forename type="first">Laura</forename>
<surname>Baseler</surname>
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<idno type="halauthorid">1562569</idno>
</author>
<author role="aut">
<persName>
<forename type="first">Arndt G.</forename>
<surname>Benecke</surname>
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<idno type="halauthorid">1194702</idno>
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<author role="aut">
<persName>
<forename type="first">Michael G.</forename>
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<idno type="halauthorid">1562515</idno>
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<author role="aut">
<persName>
<forename type="first">Vincent J.</forename>
<surname>Munster</surname>
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<idno type="halauthorid">1562563</idno>
</author>
<author role="aut">
<persName>
<forename type="first">Heinz</forename>
<surname>Feldmann</surname>
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<idno type="halauthorid">1562562</idno>
</author>
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<forename>Charlotte</forename>
<surname>Mazalérat</surname>
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<email type="md5">3c25cfc6a2d8cc3eb8d7bb58e513d1a3</email>
<email type="domain">upmc.fr</email>
</editor>
<funder>Intramural Research Program, NIAID, NIH</funder>
<funder> NIAID Regional Centers of Excellence [U54 AI081680]</funder>
<funder> Systems Virology (NIH/ NIAID) [HHSN272200800060C]</funder>
<funder> Washington National Primate Research Center [P51OD010425]</funder>
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<idno type="stamp" n="NPS" corresp="IBPS">Neuroscience Paris Seine</idno>
<idno type="stamp" n="UPMC" corresp="SORBONNE-UNIVERSITE">Université Pierre et Marie Curie</idno>
<idno type="stamp" n="CNRS">CNRS - Centre national de la recherche scientifique</idno>
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<title xml:lang="en">Treatment with interferon-alpha 2b and ribavirin improves outcome in MERS-CoV-infected rhesus macaques</title>
<author role="aut">
<persName>
<forename type="first">Darryl</forename>
<surname>Falzarano</surname>
</persName>
<idno type="halauthorid">1562555</idno>
</author>
<author role="aut">
<persName>
<forename type="first">Emmie</forename>
<forename type="middle">de</forename>
<surname>Wit</surname>
</persName>
<idno type="halauthorid">1562553</idno>
</author>
<author role="aut">
<persName>
<forename type="first">Angela L.</forename>
<surname>Rasmussen</surname>
</persName>
<idno type="halauthorid">1562554</idno>
</author>
<author role="aut">
<persName>
<forename type="first">Friederike</forename>
<surname>Feldmann</surname>
</persName>
<idno type="halauthorid">1562557</idno>
</author>
<author role="aut">
<persName>
<forename type="first">Atsushi</forename>
<surname>Okumura</surname>
</persName>
<idno type="halauthorid">1562561</idno>
</author>
<author role="aut">
<persName>
<forename type="first">Dana P.</forename>
<surname>Scott</surname>
</persName>
<idno type="halauthorid">1562565</idno>
</author>
<author role="aut">
<persName>
<forename type="first">Doug</forename>
<surname>Brining</surname>
</persName>
<idno type="halauthorid">1562568</idno>
</author>
<author role="aut">
<persName>
<forename type="first">Trenton</forename>
<surname>Bushmaker</surname>
</persName>
<idno type="halauthorid">1562556</idno>
</author>
<author role="aut">
<persName>
<forename type="first">Cynthia</forename>
<surname>Martellaro</surname>
</persName>
<idno type="halauthorid">1562560</idno>
</author>
<author role="aut">
<persName>
<forename type="first">Laura</forename>
<surname>Baseler</surname>
</persName>
<idno type="halauthorid">1562569</idno>
</author>
<author role="aut">
<persName>
<forename type="first">Arndt G.</forename>
<surname>Benecke</surname>
</persName>
<idno type="halauthorid">1194702</idno>
<affiliation ref="#struct-498235"></affiliation>
</author>
<author role="aut">
<persName>
<forename type="first">Michael G.</forename>
<surname>Katze</surname>
</persName>
<idno type="halauthorid">1562515</idno>
</author>
<author role="aut">
<persName>
<forename type="first">Vincent J.</forename>
<surname>Munster</surname>
</persName>
<idno type="halauthorid">1562563</idno>
</author>
<author role="aut">
<persName>
<forename type="first">Heinz</forename>
<surname>Feldmann</surname>
</persName>
<idno type="halauthorid">1562562</idno>
</author>
</analytic>
<monogr>
<idno type="halJournalId" status="VALID">7337</idno>
<idno type="issn">1078-8956</idno>
<idno type="eissn">1744-7933</idno>
<title level="j">Nature Medicine</title>
<imprint>
<publisher>Nature Publishing Group</publisher>
<biblScope unit="volume">19</biblScope>
<biblScope unit="issue">10</biblScope>
<biblScope unit="pp">1313+</biblScope>
<date type="datePub">2013-10</date>
</imprint>
</monogr>
<idno type="doi">10.1038/nm.3362</idno>
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<language ident="en">English</language>
</langUsage>
<textClass>
<classCode scheme="halDomain" n="sdv.neu">Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC]</classCode>
<classCode scheme="halTypology" n="ART">Journal articles</classCode>
</textClass>
<abstract xml:lang="en">
<p>The emergence of Middle East respiratory syndrome coronavirus (MERS-CoV) is of global concern: the virus has caused severe respiratory illness, with 111 confirmed cases and 52 deaths1 at the time of this article's publication. Therapeutic interventions have not been evaluated in vivo; thus, patient management relies exclusively on supportive care, which, given the high case-fatality rate, is not highly effective. The rhesus macaque is the only known model organism for MERS-CoV infection, developing an acute localized to widespread pneumonia with transient clinical disease(2,3) that recapitulates mild to moderate human MERSCoV cases(4,5). The combination of interferon-alpha 2b and ribavirin was effective in reducing MERS-CoV replication in vitro(6); therefore, we initiated this treatment 8 h after inoculation of rhesus macaques. In contrast to untreated, infected macaques, treated animals did not develop breathing abnormalities and showed no or very mild radiographic evidence of pneumonia. Moreover, treated animals showed lower levels of systemic (serum) and local (lung) proinflammatory markers, in addition to fewer viral genome copies, distinct gene expression and less severe histopathological changes in the lungs. Taken together, these data suggest that treatment of MERS-CoV infected rhesus macaques with IFN-alpha 2b and ribavirin reduces virus replication, moderates the host response and improves clinical outcome. As these two drugs are already used in combination in the clinic for other infections, IFN-alpha 2b and ribavirin should be considered for the management of MERS-CoV cases.</p>
</abstract>
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</hal>
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