Therapeutic and prevention strategies against human enterovirus 71 infection

Abstract

Human enterovirus 71 (HEV71) is the cause of hand, foot and mouth disease and associated neurological complications in children under five years of age. There has been an increase in HEV71 epidemic activity throughout the Asia-Pacific region in the past decade, and it is predicted to replace poliovirus as the extant neurotropic enterovirus of highest global public health significance. To date there is no effective antiviral treatment and no vaccine is available to prevent HEV71 infection. The increase in prevalence, virulence and geographic spread of HEV71 infection over the past decade provides increasing incentive for the development of new therapeutic and prevention strategies against this emerging viral infection. The current review focuses on the potential, advantages and disadvantages of these strategies. Since the explosion of outbreaks leading to large epidemics in China, research in natural therapeutic products has identified several groups of compounds with anti-HEV71 activities. Concurrently, the search for effective synthetic antivirals has produced promising results. Other therapeutic strategies including immunotherapy and the use of oligonucleotides have also been explored. A sound prevention strategy is crucial in order to control the spread of HEV71. To this end the ultimate goal is the rapid development, regulatory approval and widespread implementation of a safe and effective vaccine. The various forms of HEV71 vaccine designs are highlighted in this review. Given the rapid progress of research in this area, eradication of the virus is likely to be achieved. Core tip: This review focuses on therapeutic and prevention strategies for the control of human enterovirus 71 infection. Therapeutic strategies highlighted include natural products, synthetic antivirals, immunotherapy, and the use of olignucleotides. Prevention strategies such as surveillance, physical prevention, and vaccine development form the second part of the review.Kok CC. Therapeutic and prevention strategies against human enterovirus 71 infection. World J Virol 2015; 4(2): 78-95 Available from:

Enterovirus Infections of the Central Nervous System in Children

“…21 Recently, studies demonstrated both the presence and the in vitro effectiveness of virus-specific antibodies within currently available IVIG preparations. 22,23 However, there are currently no high-quality clinical studies to prove the effectiveness of IVIG in EV CNS disease.…”

“…Also, varying amounts of virus-specific neutralizing antibodies can lead to complete ineffectiveness of IVIG in some cases, which leaves the use of IVIG in enteroviral infection controversial to date. 21 Passive immunotherapy based on monoclonal antibodies-ie, similar to the humanized monoclonal antibodies used to prevent respiratory syncytial virus infection-could be 1 option to improve therapy in the future. 21 Currently, there are no specific treatment options available.…”

“…21 Passive immunotherapy based on monoclonal antibodies-ie, similar to the humanized monoclonal antibodies used to prevent respiratory syncytial virus infection-could be 1 option to improve therapy in the future. 21 Currently, there are no specific treatment options available. The only 2 agents that inhibit viral attachment or cell entry tested so far in vivo are pleconaril and lactoferrin, whereas newer drugs such as pyridyl imidazolidinones, soluble anti-SCARB2/PSGL-1 antibodies, Suramins and SP40-peptides are still under investigation.…”

“…The only 2 agents that inhibit viral attachment or cell entry tested so far in vivo are pleconaril and lactoferrin, whereas newer drugs such as pyridyl imidazolidinones, soluble anti-SCARB2/PSGL-1 antibodies, Suramins and SP40-peptides are still under investigation. 21 Pleconaril is well absorbed after oral administration and has shown the ability to prevent virus attachment to cells. 21 In neonates with suspected enteroviral sepsis, enhanced viral clearance and increased survival among pleconaril recipients was recently demonstrated.…”

“…21 Pleconaril is well absorbed after oral administration and has shown the ability to prevent virus attachment to cells. 21 In neonates with suspected enteroviral sepsis, enhanced viral clearance and increased survival among pleconaril recipients was recently demonstrated. 24 Unfortunately, because of cytochrome P-450 induction and side effects such as nausea and diarrhea, pleconaril has not been licensed by the US Food and Drug Administration.…”