Background: Cidofovir is currently being used off-licence to treat different viral infections, such as benign low-risk human papillomavirus (HPV)-related recurrent respiratory papillomatosis (RRP).There are concerns over the safety of this practice as rat studies demonstrated a high malignant transformation rate. As yet, there are no clinical reports of cidofovir-induced malignant changes in humans. Methods: Telomerase immortalised human keratinocytes (hTert) stably expressing E6 proteins from either low-risk HPV6b or high-risk HPV16 and vector control cells were treated with either low-dose (5 µg/ml) or higher dose (30 µg/ml) cidofovir for 2 days and the effects evaluated by clonogenic survival assays. Based on these results, gene expression microarray analysis was performed on cidofovirtreated low-risk E6 and vector cells before, during and after drug treatment, and the results verified by real-time PCR.
Results: Both low-risk and high-risk E6-expressing cellsshow significantly improved long-term survival compared with vector control cells when exposed to 5 µg/ml cidofovir for 2 days, (hTert T6E6 P=0.0007, hTert T16E6 P=0.00023 and hTert vector control P=0.62). Microarray and real-time PCR analyses of low-dose cidofovir-treated low-risk E6-expressing cells revealed changes in gene expression that are known to be associated with malignant progression, which were not observed in drug-treated vector control cells. Conclusions: This is the first report that cidofovir can both increase cell survival and induce alterations in gene expression that are known to be associated with malignant transformation in cells transduced only with the E6 gene from low-risk HPV. It is our belief that these data provide cause for concern over the off-license use of this drug to treat RRP.Cidofovir [(S)-1-(3-hydroxy-2-phosphonylmethoxypropyl)cytosine] is a nucleoside analogue of deoxycytidine monophosphate. It is a prodrug that undergoes a twostage phosphorylation that converts it into the active DNA nucleoside form, which then becomes incorporated into DNA. Accumulation of the activated drug in DNA produces toxicity, and cidofovir is active against a broad range of viruses [1]. It is not surprising that given this method of action, cidofovir is also non-specifically toxic to human cells [2].Cidofovir has been used to treat cytomegalovirus (CMV) retinitis of AIDS but has also been used offlicence to treat BK virus allograft nephropathy [3], recurrent Epstein-Barr virus-associated nasopharyngeal carcinoma [4] and adenovirus-infected paediatric allogeneic haematopoietic progenitor cell transplant recipients [5]. These conditions are clearly serious with threat to vision, transplant and life, respectively. Interestingly, cidofovir has also been used off-licence to treat less aggressive conditions, such as cutaneous warts in immunocompromised patients [6].Recurrent respiratory papillomatosis (RRP) can fall into either low or high categories of severity as it is a benign, albeit a potentially devastating, condition
Original articlePotentia...