Auranofin is a gold salt classified by the

World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level o ...

as an

antirheumatic agent Disease-modifying antirheumatic drugs (DMARDs) comprise a category of otherwise unrelated disease-modifying drugs defined by their use in rheumatoid arthritis to slow down disease progression. The term is often used in contrast to nonsteroidal ...

. It has the brand name Ridaura.

Use

Auranofin is used to treat

rheumatoid arthritis Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and hands are inv ...

. It improves arthritis symptoms including painful or tender and swollen joints and morning stiffness. Auranofin is a safer treatment compared to the more common injectable gold thiolates (

gold sodium thiomalate Sodium aurothiomalate (INN, known in the United States as gold sodium thiomalate) is a gold compound that is used for its immunosuppressive anti-rheumatic effects. Along with an orally-administered gold salt, auranofin, it is one of only two go ...

and

gold thioglucose Aurothioglucose, also known as gold thioglucose, is a chemical compound with the formula AuSC6H11O5. This derivative of the sugar glucose was formerly used to treat rheumatoid arthritis. History Throughout history, gold was used to cure diseases ...

), but

meta-analysis A meta-analysis is a statistical analysis that combines the results of multiple scientific studies. Meta-analyses can be performed when there are multiple scientific studies addressing the same question, with each individual study reporting m ...

of 66 clinical trials concluded that it is somewhat less effective. The drug was approved for the treatment of rheumatoid arthritis in 1985. No longer a first-line treatment for rheumatoid arthritis, due to its adverse effects, "most of which are associated with long-term use for chronic disease. The most common adverse effects are gastrointestinal complaints such as loose stools, abdominal cramping and watery diarrhea, which can develop in the early months of treatment. The development of loose stools occurs in 40 % of patients, while watery diarrhea is reported in just 2–5 % of patients, and in most cases these symptoms were alleviated by reducing or splitting the dose".

Research

HIV infection

Auranofin is under investigation as a means of reducing the viral reservoir of HIV that lies latent in the body's

T-cell A T cell is a type of lymphocyte. T cells are one of the important white blood cells of the immune system and play a central role in the adaptive immune response. T cells can be distinguished from other lymphocytes by the presence of a T-cell r ...

s despite treatment with

antiretroviral therapy The management of HIV/AIDS normally includes the use of multiple antiretroviral drugs as a strategy to control HIV infection. There are several classes of antiretroviral agents that act on different stages of the HIV life-cycle. The use of multi ...

. The drug was shown to reduce the amount of latent virus in monkey trials. A human study testing auranofin and other investigational treatments is ongoing in Brazil. Preliminary results show that auranofin contributed to a decrease in the viral reservoir.

Amebiasis

Auranofin has been identified in a high-throughput drug screen as 10 times more potent than

metronidazole Metronidazole, sold under the brand name Flagyl among others, is an antibiotic and antiprotozoal medication. It is used either alone or with other antibiotics to treat pelvic inflammatory disease, endocarditis, and bacterial vaginosis. It is ...

against ''

Entamoeba histolytica ''Entamoeba histolytica'' is an anaerobic parasitic amoebozoan, part of the genus ''Entamoeba''. Predominantly infecting humans and other primates causing amoebiasis, ''E. histolytica'' is estimated to infect about 35-50 million people worldwid ...

'', the protozoan agent of human

amebiasis Amoebiasis, or amoebic dysentery, is an infection of the intestines caused by a parasitic amoeba ''Entamoeba histolytica''. Amoebiasis can be present with no, mild, or severe symptoms. Symptoms may include lethargy, loss of weight, colonic u ...

. Assays of

thioredoxin reductase Thioredoxin reductases (TR, TrxR) () are enzymes that reduce thioredoxin (Trx). Two classes of thioredoxin reductase have been identified: one class in bacteria and some eukaryotes and one in animals. In bacteria TrxR also catalyzes the reduction ...

and transcriptional profiling suggest that the effect of auranofin on the enzyme enhances the sensitivity of the trophozoites to reactive oxygen-mediated killing in mouse and hamster models; the results are marked reductions of the number of parasites, the inflammatory reaction to the infestation, and the damage to the liver.

Acanthamoeba Keratitis and Primary Amoebic Meningoencephalitis

Auranofin may be useful in the prevention and control of ''

Acanthamoeba ''Acanthamoeba'' is a genus of amoebae that are commonly recovered from soil, fresh water, and other habitats. ''Acanthamoeba'' has two evolutive forms, the metabolically active trophozoite and a dormant, stress-resistant cyst. Trophozoites are ...

'' infections, and in the treatment of primary amoebic meningoencephalitis, caused by pathogenic free-living amoebae ''Acanthamoeba'' spp. and '' Naegleria fowleri'', respectively.

Tuberculosis

In a cell-based screen, auranofin showed potent activity against replicating and non-replicating '' M. tuberculosis'' as well as other gram-positive bacteria. Auranofin protected mice from an otherwise lethal infection with methicillin-resistant ''S. aureus'' (MRSA). The drug acts in a similar manner in bacteria as in parasites by inhibiting thioredoxin reductase (TrxR). Studies in humans are needed to evaluate the potential of this drug to treat Gram-positive bacterial infections in humans.

Ovarian cancer

Drug-screening reveals auranofin induces apoptosis in

ovarian cancer Ovarian cancer is a cancerous tumor of an ovary. It may originate from the ovary itself or more commonly from communicating nearby structures such as fallopian tubes or the inner lining of the abdomen. The ovary is made up of three different ...

cells ''

in vitro ''In vitro'' (meaning in glass, or ''in the glass'') studies are performed with microorganisms, cells, or biological molecules outside their normal biological context. Colloquially called " test-tube experiments", these studies in biology a ...

''.

COVID-19

Auranofin may inhibit replication of SARS-CoV-2, the virus responsible for causing

COVID-19 Coronavirus disease 2019 (COVID-19) is a contagious disease caused by a virus, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first known case was identified in Wuhan, China, in December 2019. The disease quick ...

in cell culture. Inflammation may also be reduced.

Etymology

The brand name ''Ridaura'' was coined from the phrase '' Remission-Inducing Drug + Auranofin''.

References

External links

* * {{Gold compounds Gold(I) compounds Antirheumatic products Acetate esters Metal-containing drugs Gold–sulfur compounds Disease-modifying antirheumatic drugs

Use