The demonstrated utility of the nucleoside analog ribavirin in the treatment of certain viral diseases can be ascribed to its multiple distinct properties. These properties may vary in relative importance in differing viral disease conditions and include the direct inhibition of viral replication, the promotion of T-cell-mediated immune responses via an enhanced type 1 cytokine response, and a reduction of circulating alanine aminotransferase (ALT) levels associated with hepatic injury. Ribavirin also has certain known toxicities, including the induction of anemia upon chronic administration. To determine if all these properties are linked, we compared the D-nucleoside ribavirin to its L-enantiomer (ICN 17261) with regard to these properties. Strong similarities were seen for these two compounds with respect to induction of type 1 cytokine bias in vitro, enhancement of type 1 cytokine responses in vivo, and the reduction of serum ALT levels in a murine hepatitis model. In contrast, ICN 17261 had no in vitro antiviral activity against a panel of RNA and DNA viruses, while ribavirin exhibited its characteristic activity profile. Importantly, the preliminary in vivo toxicology profile of ICN 17261 is significantly more favorable than that of ribavirin. Administration of 180 mg of ICN 17261 per kg of body weight to rats by oral gavage for 4 weeks generated substantial serum levels of drug but no observable clinical pathology, whereas equivalent doses of ribavirin induced a significant anemia and leukopenia. Thus, structural modification of ribavirin can dissociate its immunomodulatory properties from its antiviral and toxicologic properties, resulting in a compound (ICN 17261) with interesting therapeutic potential.Ribavirin (1--D-ribofuranosyl-1,2,4-triazole-3-carboxamide) is a nucleoside analog that has demonstrated efficacy in treating viral disease as monotherapy (respiratory syncytial virus [RSV] [15]) and in combination with alpha interferon (IFN-␣) (hepatitis C virus [HCV] [27,36]). Ribavirin has multiple biologic properties that are favorable for treating viral diseases. It can directly inhibit the replication of many DNA and RNA viruses (38). More recently, studies have shown that it can also act as an immunomodulator and thus promote T-cell-mediated immunity against viral infection (18,25,30,39,40). The central focus of this effect of ribavirin is the augmentation of antiviral type 1 cytokine expression (interleukin-2 [IL-2], gamma interferon [IFN-␥], and tumor necrosis factor alpha [TNF-␣]) and concomitant suppression of type 2 cytokine levels by activated T cells in both human and murine systems. Finally, ribavirin, alone or in combination with IFN-␣, can lower serum alanine aminotransferase (ALT) levels during the course of treatment of HCV infection (11). Elevated serum ALT levels are a marker for liver damage and progressive hepatitis, and hence the ribavirin-mediated lowering of ALT levels is a distinct liver-specific effect of this nucleoside analog.The therapeutic use of ribavirin is restric...