Feature: West Nile, SARS cure overlooked?

By STEVE MITCHELL, Medical Correspondent  |  Dec. 4, 2003 at 5:00 PM
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WASHINGTON, Dec. 4 (UPI) -- Earlier this summer, an 80-year-old woman lay in a hospital bed in Pueblo, Colo., suffering from weakness, fatigue and life-threatening swelling of the brain brought on by West Nile virus.

Usually in cases like this, there is little doctors can do. There is no treatment for the disease, which has sickened nearly 13,000 people and killed more than 500 since it first emerged in the United States in 1999.

In a last-ditch effort, Dr. John Lieberman, an infectious disease expert at St. Mary-Corwin Medical Center, gave the woman a drug commonly used to treat high blood pressure. Within 24 hours, the woman's symptoms resolved and her energy levels returned to normal.

Patients can and do recover from West Nile complications, but usually not this rapidly, so Lieberman thinks the blood-pressure drug may have played a role in helping the woman recover.

"It's unusual to see a patient recover so quickly," Lieberman told United Press International. "From my own personal experience I haven't seen that," he added. Lieberman has treated at least 80 patients suffering from West Nile-related problems.

The idea of using blood-pressure drugs to treat West Nile is the brainchild of Dr. David W. Moskowitz, chief medical and executive officer of GenoMed in St. Louis.

Much of the damage to the body caused by the West Nile virus is not due to the pathogen, but is a result of the body's immune system overreacting, which leads to inflammation, Moskowitz told UPI. He reasoned that blocking the body's inflammation response -- rather than attacking the virus -- could avert the more serious complications of the disease and reduce it from a life-threatening illness to a minor nuisance.

Moskowitz's protocol calls for a specific class of blood-pressure drugs called sartans. There are several of these drugs on the market, including Merck's Cozaar (losartan), Novartis' Diovan (valsartan), and Bristol-Myers Squibb's Avapro (irbesartan), among others.

Sartans block a protein in the body called angiotensin II, which is involved in constricting blood vessels, but also plays an important role in stimulating inflammation.

Although Moskowitz's therapy has not been tested in a large clinical trial, Lieberman's experience with his 80-year old patient appears to support the benefit of the concept. Five additional patients, infected with West Nile this summer in Omaha, Neb., recovered after receiving the treatment at the city's Methodist Hospital.

Dr. Robert Penn, an infectious-disease expert in private practice in Omaha, treated the five patients, who ranged in age from 50 to 73 and were suffering from brain-swelling, fever and tremors. All five showed improvement -- some in as little as 12 hours.

Moskowitz, who holds several patents on the use of sartans for treating West Nile and several other conditions, also claims the drugs could work equally as well for treating SARS, the virus that rapidly spread around the world last winter, infecting more than 8,000 people and killing more than 750.

The blood-pressure drugs have never been used to treat a person with SARS, but Moskowitz said the mechanism behind the disease is similar to West Nile's, involving an overresponse by the immune system, so the sartan medications should help reduce some of the severe complications of SARS, including breathing problems and death.

Despite the positive indications -- albeit in a handful of West Nile patients -- health officials and the companies that make the drugs seem uninterested in Moskowitz's idea. Instead, the public health agencies remain focused on the development of new drugs and vaccines, which could be years away from commercialization.

"None of the eight companies that make sartans had any interest whatsoever nor have the public health entities," Moskowitz said. "The Centers for Disease Control and Prevention won't return my calls. The World Health Organization won't return my calls."

Officials at the National Institutes of Health -- the lead agency in the U.S. efforts to find treatments for West Nile and SARS -- acknowledged Moskowitz's idea may have merit, but added they had no plans to fund studies that would help determine if blood-pressure drugs are beneficial for treating West Nile or SARS.

"There may be a role for an immunosuppressant as a therapy or part of a therapy" for treating SARS and West Nile, Catherine Laughlin, chief of the virology branch in the division of microbiology and infectious diseases at the NIH's National Institute of Allergy and Infectious Diseases in Bethesda, Md., told UPI.

Laughlin noted, however, the exact disease process of SARS and West Nile remains to be worked out and an overreaction of the immune system may be only part of the problem. "Right now, that certainly could be a component of both West Nile and SARS," she said, "but we don't understand either of them entirely."

WHO officials in charge of efforts to find SARS treatments were unavailable for comment, but the global health agency's focus has been largely on developing a vaccine, which could take several years.

A spokesman for one of the pharmaceutical companies that makes a sartan said the company was unaware of Moskowitz's treatment protocol until UPI brought it to their attention. The spokesman, who did not want to be identified, said the company probably would not pursue studies that might support using their medication in this manner, but he added Moskowitz's initial results looked interesting.

Penn and Lieberman -- the two physicians involved in treating the West Nile patients -- also remained skeptical about the treatment, but they conceded it showed enough promise to merit further study.

"It's worthy of more research," Penn told UPI. "But is it truly benefiting the patients? I don't think we have enough to conclude that right now."

Lieberman said he does not know if using sartans can reverse these symptoms, but added he would use the medications again in West Nile patients who are doing poorly and whose treatment options have been exhausted. "The next time West Nile comes around, I'm planning on using this therapy again and hopefully planning on logging up some successful cases," he said.

Moskowitz remains confident his therapy will catch on for both West Nile and SARS, particularly if the latter reemerges this winter. "What's going to happen is word will get out that there's actually a treatment for SARS ... and physicians within quarantine facilities will start to use my therapy and the mortality rate will go down," he said. "That's all it will take really" to induce other physicians to start using the treatment, he added.


Steve Mitchell is UPI's Medical Correspondent. E-mail sciencemail@upi.com

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