{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T05:14:46Z","timestamp":1778130886169,"version":"3.51.4"},"reference-count":104,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T00:00:00Z","timestamp":1778112000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cytomegalovirus (CMV) is a prevalent opportunistic pathogen associated with significant morbidity and mortality in immunocompromised individuals, particularly transplant recipients and neonates. Current antiviral therapies are often constrained by substantial toxicity and the emergence of drug resistance. Artesunate (ART), a proven antimalarial agent with established safety profiles, has been explored for potential repurposing against CMV infection, though its anti-CMV pharmacodynamics remain incompletely elucidated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This systematic review synthesized evidence from 46 studies published through December 2025, covering\n                      <jats:italic>in vitro<\/jats:italic>\n                      ,\n                      <jats:italic>in vivo<\/jats:italic>\n                      , and clinical studies, to evaluate the efficacy, mechanisms of action, and translational challenges of ART-based anti-CMV strategies.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      ART exhibits potent anti-CMV activity\n                      <jats:italic>in vitro<\/jats:italic>\n                      , with no reported cross-resistance to conventional antiviral agents. Structure\u2013activity relationship analysis indicates that the endoperoxide bridge and hemisuccinate side chain may contribute to its antiviral effects. While optimized ART derivatives show improved potency, they remain in the preclinical research stage. Clinical evidence for ART is limited, primarily derived from small-scale and combination therapy studies, with inconsistent outcomes typically marked by an initial reduction in viral load rather than sustained complete clearance. Mechanistically, ART may exert anti-CMV effects through multiple host-regulated pathways, including NF-\u03baB inhibition, G0\/G1 cell cycle arrest, and modulation of mitochondrial dynamics.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The short plasma half-life of ART may represent a pharmacokinetic limitation to its clinical application. Further research, including formulation optimization, targeted pharmacokinetic\/pharmacodynamic studies, and well-controlled clinical trials, is warranted to evaluate the potential role of ART in CMV management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcimb.2026.1815679","type":"journal-article","created":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T04:56:43Z","timestamp":1778129803000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Artesunate repurposing for cytomegalovirus management: a systematic review of efficacy, mechanisms, and perspectives"],"prefix":"10.3389","volume":"16","author":[{"given":"Haohao","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Clinical Pharmacy, Guangzhou First People\u2019s Hospital, Guangzhou Medical University","place":["Guangzhou, China"]},{"name":"Artemisinin Research Center, Guangzhou University of Chinese Medicine","place":["Guangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fanchao","family":"Zhou","sequence":"additional","affiliation":[{"name":"Artemisinin Research Center, Guangzhou University of Chinese Medicine","place":["Guangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianping","family":"Song","sequence":"additional","affiliation":[{"name":"Artemisinin Research Center, Guangzhou University of Chinese Medicine","place":["Guangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Changsheng","family":"Deng","sequence":"additional","affiliation":[{"name":"Artemisinin Research Center, Guangzhou University of Chinese Medicine","place":["Guangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiao","family":"He","sequence":"additional","affiliation":[{"name":"Artemisinin Research Center, Guangzhou University of Chinese Medicine","place":["Guangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suiqin","family":"Ni","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, Guangzhou First People\u2019s Hospital, Guangzhou Medical University","place":["Guangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,7]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0010370","article-title":"Artemisinin-derived dimers have greatly improved anti-cytomegalovirus activity compared to artemisinin monomers","volume":"5","author":"Arav-Boger","year":"2010","journal-title":"PloS One"},{"key":"B2","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1177\/004947550403400302","article-title":"Pharmacokinetics of artesunate following oral and rectal administration in healthy Sudanese volunteers","volume":"34","author":"Awad","year":"2004","journal-title":"Trop. doct"},{"key":"B3","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1016\/j.jcv.2016.02.006","article-title":"Effect of artemether-lumefantrine (Coartem) on cytomegalovirus urine viral load during and following treatment for malaria in children","volume":"77","author":"Barger-Kamate","year":"2016","journal-title":"J. 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