Unpleasant cold sore outbreaks could soon be an ailment of the past.
Their cause, the herpes simplex virus 1, can lie dormant in the cells it invades, causing permanent infections, but Duke scientists have discovered a way to bring the virus out of dormancy so the outbreak can be treated.
Cold sores are a common infection in the U.S. and affect an estimated half million people annually, said Dr. Devdutta Sangvai, medical director of the Duke Student Health Center.
"They are such a common finding that many people don't even go to the doctor for treatment," Sangvai explained. "People know that this is something that may go away with time."
But although individual cold sores heal with time, HSV-1 infections do not. Current antiviral drugs, such as Acyclovir, simply clear cold sores and shorten the duration of symptoms but do not prevent future outbreaks, Sangvai said.
The new research may change all this.
"Our work provides, for the first time, a molecular understanding of how HSV-1 establishes a life-long latent infection," said Jennifer Umbach, a postdoctoral associate in the department of molecular genetics and microbiology.
Along with collaborators at Harvard University, Umbach and her mentor Bryan Cullen, a professor of molecular genetics and microbiology, spent three years developing an understanding of how the virus reactivates from dormancy to cause cold sores on the mouth and face. Their most recent paper explaining the mechanism was published in the July issue of Nature.
Umbach said the new knowledge provides a foundation for the development of drugs that may permanently cure HSV-1. If the mechanism that triggers this dormancy can somehow be interrupted, HSV-1 will be forced out of hiding. The virus can then be killed with current antiviral medications.
Despite these breakthroughs, Umbach is reluctant to declare success.
"There are no guarantees in science, and it is possible for the treatment to fail at any step of this testing process," she said.
Two years of experimentation in mice to test the "efficacy and toxicity" of their drug, plus a further year of experimentation in other animals, will be required to test the findings, Umbach estimated. Only then would the drug reach small studies in healthy volunteers before proceeding to clinical trials with HSV-1-infected patients.
New information about HSV-1 could also prove significant to related viruses, such as those responsible for genital herpes and chicken pox. Umbach, however, predicted it would likely take until the end of the year to determine whether lessons learned with HSV-1 can be applied to these other viruses.
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