http://www.nj.com/news/ledger/index.ssf?/base/news-5/1143702291297030.xml&coll=1&thispage=2A common and inexpensive treatment for vaginal yeast infections could protect women from HIV, according to an intriguing discovery by New Jersey researchers, including a husband and wife who collaborated on the breakthrough.
Hartmut M. Hanauske, a pediatric endocrinologist and molecular researcher, spent two decades investigating an ancient protein found in humans, as well as many other forms of life -- from rabbits to slime mold. The protein is crucial to HIV's ability to multiply.
Hanauske showed some pictures of the protein, known as eIF5A, to his wife of 17 years, Bernadette Cracchiolo, a gynecological oncologist who treats women with HIV.
The two doctors at the University of Medicine and Dentistry of New Jersey talked about what the research could mean in the real world.
"I said, 'It's possible this could have a vaginal use,'" Cracchiolo recalled. The hope is that a vaginal preparation could stop male-to-female spread of HIV, which last year infected nearly 5 million people around the world.
Hanauske set out to test compounds that could knock out the protein. He looked at drugs already on the market in an effort to bypass the lengthy drug approval process and get protection to women more quickly.
He tested hundreds of compounds in computer models until he came upon ciclopirox, a drug available in Europe and elsewhere -- though not in the U.S. -- to treat vaginal yeast infections. The find was fortuitous: The drug already is available in a cream that is safe to use vaginally.
Two years ago, work moved to the Newark laboratory headed by Paul E. Palumbo, a physician known for his HIV clinical trials. Researchers infected human blood cells with actual virus isolated from patients.
In the presence of ciclopirox, the virus did not multiply. The drug totally blocked the virus from infecting cells. In control samples, however, the virus grew wildly. The drug also killed cells newly infected with HIV.
"It was almost to the point we couldn't believe our own data," Hanauske said.
The discovery was presented Friday at a conference of the Society for Gynecologic Investigation in Toronto. National Institutes of Health researchers also collaborated on the discovery.
Cracchiolo said she has tempered her enthusiasm, knowing the road from petri dish to real-world success is littered with failures.
"We know other drugs used for this purpose have failed," she said. "But we think this could be a chance."
The drug now joins other potential so-called microbials, drugs that may prevent transmission of HIV from men to women. Five are now being tested in late-stage human studies.
AIDS is an increasingly female disease. In Africa, 57 percent of infected adults and 75 percent of infected adolescents are women, according to world health experts.
In some African countries, such as South Africa and Zimbabwe, young women have infection rates six times higher than men. Many women are infected by their husbands in societies where male promiscuity is accepted, according to the United Nations Program on HIV/AIDS.
Michael Harper, director of the Global Microbicides Project, based in Arlington, Va., welcomed the news about ciclopirox.
"Whether this new discovery is going to be the best thing, nobody at this point can know," he said. "The trick is to get it into clinical trials, and that is terribly expensive."
Cracchiolo said no one should attempt to purchase the drug overseas and use it to stop HIV until scientists thoroughly test the medication's value.
So far, no successful vaccine has emerged, and HIV remains difficult to treat. There is no cure.
HIV enters the bloodstream and hijacks human cells. The virus uses proteins in the cells to multiply. Current AIDS treatments directly attack the virus. But HIV is a moving target, continually mutating. The researchers in Newark tried a different tactic. By hitting the protein HIV needs, they can stop the virus from setting up shop in human cells.
Cracchiolo said that understanding the mechanism behind the eIF5A protein could lead to potential treatments for people already infected with the deadly virus. She also said it could lead to drugs to fight certain gynecological cancers, such as cervical cancers.
"We need more research," she said.