Oral uridine to treat mitochondrial toxicity

Graham McKerrow, HIV i-Base

A case report of a 54-year-old Caucasian man in Germany indicates that oral uridine may be effective in life-threatening mitochondrial toxicity related to pyrimidine nucleoside analogues such as zalcitabine (ddC, Hivid) or stavudine (d4T, Zerit).

Several investigators have found beneficial effects of uridine in vitro and in animals, but Ulrich Walker and colleagues report in the 30 April issue of AIDS the case of a man who has been on antiretroviral medication since being diagnosed with HIV-1/AIDS four years ago. He was on a stavudine-containing regimen, which was then switched to lamivudine 150 mg twice a day, stavudine 40 mg twice a day, abacavir 300 mg twice a day and efavirenz 600 mg a day. His initial CD4+ count of 25 cells/mm3 had risen to 682 two years ago. HIV was undetectable in the blood.

The authors report that after several months, he developed myalgias and a continuous increase in creatine kinase, lactate and transaminases. Abdominal ultrasound revealed signs of massive liver steatosis. The patient was started on NucleomaxX, a food supplement consisting of Mitocnol, an extract from sugar cane with a high content (17%) of nucleosides, for suspected stavudine-related mitichondrial toxicity. Drinking the contents of a single 36g sachet of NucleomaxX increases physiological serum concentration of uridine in humans from approximately 5 uM to more than 100 uM. The patient had 3 sachets a day for 4 days. At his next visit two weeks later, liver and muscle enzymes, and the myalgias, had improved, despite unchanged medication. Lactate had normalised after 7 weeks. Stavudine was then switched to tenofovir. There were no subsequent clinical or laboratory abnormalities, viral load remained below the limit of detection at < 50 copies/ml, and ultrasound showed substantial improvement of steatotic signs.


Walker U, Langmann P, Miehle N et al. Beneficial effects of oral uridine in mitochondrial toxicity. AIDS: Volume 18(7) 30 April 2004 pp 1085-1086


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