It is accepted that herpes simplex virus type 1 (HSV-1) latency occurs in the trigeminal ganglion. However, our group 1,2 and several other groups have demonstrated latent virus presence in the cornea. Negative homogenate and positive coculture provide proof of latent infection. Conventional coculture tests demonstrated HSV-1 latency in ten of the 20 eyes (50%) with herpetic stromal keratitis in the quiescent phase we examined. 1 In addition, although conventional coculture detected 50% presence, polymerase chain reaction (PCR) demonstrated HSV-1 latency in the corneas of 80% of these cases. 1 Various methods have been tried to suppress HSV-1 reactivation. Studies have shown that acyclovir, 3 propranolol, 4 thymidine kinase inhibitor, 5 helicase-primase inhibitor, 6 bupropion, 7 and oral cyclooxygenase (COX) inhibitor 8,9 effectively lower HSV-1 recurrence rates. However, the improvements registered did not prove suffi cient.
Suppressing HSV-1 ReactivationIn our current study, 10,11 seven medications were investigated for their effi cacy in suppressing HSV-1 reactivation. These medications were oral etodolac, bromfenac sodium (Na) eye drops, pranoprofen eye drops, oral ascorbic acid, 12 oral zinc, 13 intramuscular adenosine monophosphate (AMP), 14 and intraperitoneal geldanamycin. 15 Etodolac, bromfenac Na eye drops, and pranoprofen are COX inhibitors. Oral etodolac is dominant in COX-2 inhibition, bromfenac Na eye drops, too, are dominant in COX-2 inhibition, 16 whereas pranoprofen eye drops are not COX-2-specifi c. 17 Ascorbic acid is vitamin C, and geldanamycin is a heat shock protein inhibitor.
MethodsMice corneas were inoculated with 2.5 × 10 4 plaque forming units (PFU) of HSV-1 strain McKrae. Four weeks later, mice confi rmed to have latent HSV-1 were treated with one of the following: oral etodolac (Hypen, Nihonshinyaku, Tokyo, Japan), bromfenac Na eye drops (Bronuck, Senjyu, Tokyo, Japan), pranoprofen eye drops (Proranon, Santen, Tokyo, Japan), oral ascorbic acid (Sigma, St Louis, MO, USA), oral zinc (Sigma), intramuscular AMP (Nacalai Tesque, Kyoto, Japan), and intraperitoneal geldanamycin (InvivoGen, San Diego, CA, USA) for 4 days. As controls, saline solution eye drops (saline solution injection, Otsuka Pharmaceutical, Tokushima, Japan), oral saline solution, intramuscular saline solution, and intraperitoneal dimethyl sulfoxide (DMSO, Wako, Osaka, Japan) were used. These treatments continued from postinfection (PI) day 31 to 34 (PI day 25 to 29 in the ascorbic acid, zinc, AMP, and geldanamycin groups). The mice were given an intravenous injection of cyclophosphamide on PI day 32 (PI day 28 in the ascorbic acid, zinc, AMP, and geldanamycin groups) Jpn