Discovery of N-arylsulfonyl-3-acylindole benzoyl hydrazone derivatives as anti-HIV-1 agents

The discovery and development of novel inhibitors with activity against variants of human immunodeficiency virus type 1 (HIV-1) is pivotal for overcoming treatment failure. As our ongoing work on research of anti-HIV-1 inhibitors, 32 N-arylsulfonyl-3-acylindole benzoyl hydrazone derivatives were prepared by introduction of the hydrazone fragments on the N-arylsulfonyl-3-acylindolyl skeleton and preliminarily screened in vitro as HIV-1 inhibitors for the first time. Among of all the reported analogues, eight compounds exhibited significant anti-HIV-1 activity, especially N-(3-nitro)phenylsulfonyl-3-acetylindole benzoyl hydrazone (18) and N-(3-nitro)phenylsulfonyl-3-acetyl-6-methylindole benzoyl hydrazone (23) displayed the most potent anti-HIV-1 activity with EC50 values of 0.26 and 0.31 µg/mL, and TI values of >769.23 and >645.16, respectively. It is noteworthy that introduction of R3 as the methyl group and R2 as the hydrogen group could result in more potent compounds. This suggested that introduction of R3 as the methyl group could be taken into account for further preparation of these kinds of compounds as anti-HIV-1 agents

Peptidic HIV-1 fusion inhibitor VIR576 as a potential dual- functional microbicide inhibits antigen-specific CD4(+) T-cell activation / 南方医科大学学报

<p><b>OBJECTIVE</b>To observe if VIR576, an 20-mer peptide derived from the C-proximal subfragment of a1-antitrypsin (a1-AT) which inhibits human immunodeficiency virus type 1 (HIV-1) entry into the target cells by interacting with fusion peptide (FP), can also directly inhibit CD4(+) T cell activation in vitro.</p><p><b>METHODS</b>Splenocytes isolated from DO11.10 OVA Tg mice were stimulated with ovalbumin or concanavalin A to test the effects of VIR576 on antigen-specific or non-antigen-specific T cell activation. Both primary CD4(+)CD25(-) T cells from DO11.10 mice and CD4(+) T cell line A2b were activated with specific antigens to evaluate the effects of VIR576.</p><p><b>RESULTS</b>VIR576 inhibited antigen-specific splenocyte activation but had no significant effect on non-antigen-specific T-cell activation, which bypassed the crosstalk between the CD3-signaling complex and TCR. We furthermore observed that VIR576 could also down-regulate antigen-specific CD4(+) T-cell activation.</p><p><b>CONCLUSIONS</b>Given the high susceptibility of activated CD4(+) T cells in the mucosa to HIV-1 infection, the inhibitory effects of VIR576 on both HIV entry into the target cells and CD4(+) T-cell activation suggest the potential of VIR576 as a microbicide for prevention of sexual transmission of HIV.</p>

Design of small molecules with HIV fusion inhibitory property based on Gp41 interaction assay

Gp41 of HIV [Human Immunodeficiency Virus] is a protein that mediates fusion between viral and cellular membranes. The agent, T-20, which has been approved for HIV inhibition, can restrain Gp41 function in the fusion process; nevertheless, it has disadvantages like instability, high cost of production and injection form to be delivered twice a day. Several molecules like NB-2 and NB-64 have been discovered that can inhibit HIV infection. These molecules were used as template compounds to design and develop more effective small molecules functioning as HIV-1 fusion inhibitors targeting Gp41. The process included in silico docking protocols using HEX and ArgusLab applications. A multisource database was created, after choosing the best molecules; they were tested in vitro for inhibitory activity by HIV-1 single-cycle model, transfected in HEK cells [293T]. Computational analysis and experimental data were combined to explore molecular properties and the most potent ones were found, with the best suitable criteria for interaction with Gp41. Several examples [DAA-6, DAA-9 and DAA-12] could inhibit infection in vitro as effective as NB-2, NB- 64. Since disadvantages of available fusion inhibitor [T-20], it seems necessary to find similar molecules to be approved and have small size providing suitable bioactivity profile. The molecules explored in this study can be good candidates for further investigations to be used as oral HIV fusion inhibitors in the future

A reduced grade of liver fibros-steatosis after raltegravir, maraviroc and fosamprenavir in an HIV/HCV co-infected patient with chronic hepatitis, cardiomyopathy, intolerance to nelfinavir and a marked increase of serum creatine phosphokinase levels probably related to integrase inhibitor use / Grado reducido de fibroesteatosis tras la administración de raltegravir, maraviroc y fosamprenavir en un paciente co-infectado de VIH/VHC con hepatitis crónica, cardiomiopatía, intolerancia al nelfinavir y un aumento pronunciado de los niveles de creatina fosfoquinasa sérica probablemente debido al uso del inhibidor de la integrasa

The use of new antiretroviral drugs in HIV infection is particularly important in patients with intolerance or resistance to other antiretroviral agents. Raltegravir and maraviroc represent new, important resources in salvage regimens. A reduced grade of liver fibro-steatosis after a combination of raltegravir and maraviroc (second-line) has not been studied and the mechanism by which these new drug classes induced a marked reduction of grade of liver diseases is currently unknown. In the present case report, nested in an ongoing multicentre observational study on the use of new antiretroviral inhibitors in heavy treatment-experienced HIV patients, we evaluated the correlation between a "short therapeutic regimen" raltegravir, maraviroc and fosamprenavir and liver diseases. The aim of this report is to describe the use of a three-drug regimen based on two novel-class antiretroviral agents (raltegravir and maraviroc) plus the protease inhibitor fosamprenavir, in an experienced HIV-infected patient with chronic progressive hepatitis C complicated by liver fibrosis; an overwhelming increased serum creatine kinase level occurred during treatment, and is probably related to integrase inhibitor administration. At present no information is available regarding this correlation.

El uso de nuevos medicamentos antiretrovirales para la infección por VIH es particularmente importante en los pacientes con intolerancia o resistencia a otros agentes antiretrovirales. Raltegravir (RTV) y maraviroc (MRV) representan nuevos e importantes recursos en las terapias de salvamento. Un grado reducido de fibroesteatosis hepática después de una combinación de raltegravir y maraviroc (terapia de segunda línea) no ha sido estudiado, y el mecanismo por el cual estas nuevas clases de droga indujeron una marcada reducción de grado de las enfermedades hepáticas se desconoce hasta el momento. Como parte de la realización en curso de un estudio observacional multicentro acerca del uso de nuevos inhibidores antiretrovirales en pacientes de VIH altamente experimentados en el tratamiento, en el presente reporte de caso se evalúa la correlación entre un "régimen terapéutico corto" (raltegravir, maraviroc y fosamprenavir) y las enfermedades del hígado. El objetivo de este reporte es describir el uso de un régimen de tres medicamentos - basado en dos agentes antiretrovirales de nuevo tipo (raltegravir y maraviroc) además del fosamprenavir inhibidor de la proteasa - en un paciente de VIH experimentado. El paciente también sufre de hepatitis C evolutiva, progresiva, crónica, complicada por fibrosis hepática. Durante el tratamiento, se produjo un aumento extraordinario del nivel de creatina quinasa sérica, el cual probablemente esta relacionado con la administración del inhibidor de la integrasa. Actualmente no hay información disponible con respecto a esta correlación.

Tratamiento antirretroviral en pacientes coinfectados por HIV/HCV / Antiretroviral treatment for HIV/HCV co-infected patients

La hepatotoxicidad asociada al tratamiento antirretroviral complica el manejo de los pacientes coinfectados por HIV y HCV. Existen diferentes patrones de toxicidad hepática asociadas a las drogas antirretrovirales que deben ser reconocidos por los médicos tratantes, como así también las interacciones con las drogas utilizadas para el tratamiento de la infección por HCV. En la presente revisión se describen la toxicidad hepática de las drogas antirretrovirales, incluyendo las incorporadas recientemente, y las indicaciones de tratamiento y esquemas más convenientes para esta población de personas viviendo con HIV/sida

Antiretroviral therapy-related hepatotoxicity complicates the management of HIV/HCV co-infected patients. There are different patterns of antiretroviral associated liver toxicity, which should be recognized by the physicians. Updated information regarding antiretroviral related hepatotoxicity (including the most recently licensed), treatment indication and the most convenient drugs combination for HIV/HCV patients are presented in this review

Enfuvirtida para o tratamento do paciente com aids: o divisor de águas / Enfuvirtide in the treatment of AIDS patient: the turning point

O estudo, realizado em um Hospital de Referência em Doenças Infecciosas do Ceará, de fevereiro de 2006 a fevereiro de 2007, visou identificar o perfil sociodemográfico dos usuários de Enfuvirtida e as principais dificuldades e facilidades encontradas por eles durante o tratamento anterior e o atual. A amostra inicial teve 23 pacientes; destes, 18 concordaram em participar. A análise descritiva dos dados quantitativos foi realizada pela distribuição de frequências e os dados qualitativos, submetidos à análise de conteúdo. Observou-se que 83 por cento eram do sexo masculino, 78 por cento eram solteiros e a maioria tinha entre 30 e 52 anos e em média oito anos e meio de tratamento antirretroviral. Dos dados qualitativos, emergiram as categorias (1) Tratamento anterior: dificuldades e adversidades e (2) Tratamento atual: da cognição à habilidade. As dificuldades dos tratamentos anteriores eram o tamanho e a quantidade elevada de comprimidos e aos efeitos colaterais; a facilidade apontada foi o fácil manejo da medicação. Quanto ao tratamento atual, as dificuldades foram a autoadministração e os nódulos nos locais de aplicação da Enfuvirtida e as facilidades, a ausência de efeitos gastrointestinais e melhora da carga viral. É importante implementar um trabalho interdisciplinar que ajude os pacientes a vencer as dificuldades no tratamento, além de trabalhos em grupos para melhor abordar as dificuldades e ajudar a aumentar a adesão à terapêutica.

The study was carried out in a Hospital of Reference in Infectious Diseases of Ceará, from February 2006 to February 2007, and and aimed at identifying the socio-demographic profile of Enfuvirtide users and their main difficulties/facilities in previous and current treatment scheme. The initial sample analyzed the medical record of 23 patients;18 agreed to participate, comprising the final sample. The descriptive analysis of quantitative data was carried out through the distribution of frequencies and quantitative data, submitted for content analysis. It was observed that 83 percent were male, 78 percent were single and the majority was between 30 and 52 years old and, in average, eight years and a half of antiretroviral treatment. From qualitative data, two categories emerged: (1) Previous treatment: difficulties and adversities and (2) Current treatment: from cognition to ability. The difficulties to conduct previous treatments were related to the size and high amount of tablets and side effects. As for facility, the easy drug administration was indicated. Regarding the current treatment, the difficulties were self administration and nodules on the sites where Enfuvirtide was applied and the facilities were absence of gastrointestinal effects and improvement of viral load. It's important to implement an interdisciplinary work that helps patients overcome the difficulties of the treatment, in addition to works in groups in order to better address the difficulties and help increase adhesion to treatment.

HIV entry inhibitors: progress in development and application / 药学学报

This review discusses recent progress in the development of anti-HIV agents, with emphasis on small molecule HIV-1 entry inhibitors. The entry inhibitors primarily target HIV-1 envelope glycoproteins or the cellular receptors, CD4 and chemokine receptors. Two of the entry inhibitors, enfuvirtide and maraviroc, have been approved by the US FDA for AIDS therapy. The drug resistance associated with some of the entry inhibitors will also be discussed.

The development of anti-HIV-1 drugs / 药学学报

Human immunodeficiency virus type 1 (HIV-1) is the causative agent of acquired immunodeficiency disease syndrome (AIDS). After over 26 years of efforts, there is still not a therapeutic cure or an effective vaccine against HIV/AIDS. The clinical management of HIV-1 infected people largely relies on antiretroviral therapy (ART). Although highly active antiretroviral therapy (HAART) has provided an effective way to treat AIDS patients, the huge burden of ART in developing countries, together with the increasing incidence of drug resistant viruses among treated people, calls for continuous efforts for the development of anti-HIV-1 drugs. Currently, four classes of over 30 licensed antiretrovirals (ARVs) and combination regimens of these ARVs are in use clinically including: reverse transcriptase inhibitors (RTIs) (e.g. nucleoside reverse transcriptase inhibitors, NRTIs; and non-nucleoside reverse transcriptase inhibitors, NNRTIs), protease inhibitors (PIs), integrase inhibitors and entry inhibitors (e.g. fusion inhibitors and CCR5 antagonists). Here, we intend to provide updated information of currently available antiretroviral drugs for ART to promote the development of novel anti-HIV-1 drugs.

Advances in novel anti-HIV-1 drugs and drug candidates: 2005-2008 / 药学学报

HIV and AIDS remain as the crucial global health concern, therefore, research and development of novel anti-HIV-1 chemical therapeutics is still of paramount significance, which may be illuminated by cases of successful marketed drugs. Herein, we document the discovery and biological profile of new anti-HIV-1 drugs approved by FDA between 2005 and 2008 and some drug candidates are also discussed.

The current progress in the development of HIV-1 fusion inhibitors / 药学学报

HIV-1 fusion inhibitors are a new class of anti-HIV compounds, which block the entry of HIV into target cells through preventing the fusion between viral and cell plasma membrane and thus interrupt the initial steps of viral replication. T-20 (enfuvirtide), which has been clinically approved as the first fusion inhibitor of HIV-1 by U.S. FDA in 2003, can suppress replication of HIV variants with multi-drug resistance to reverse transcriptase and protease inhibitors. Peptides and small molecules display potent anti-HIV fusion activities by targeting gp41 thus inhibit its fusogenic function. In recent years, with the development of studies on the molecular mechanism of HIV membrane fusion process and the function of gp41, many new fusion inhibitors are found and some have been in advanced clinical trials. This review discusses recent progress in the development of HIV-1 fusion inhibitors targeting the gp41.

The newest developments in anti-HIV-1 drugs / 药学学报

In the two decades since AZT was first approved for clinical use in 1987, 24 additional antiretroviral agents have been approved. They include 7 nucleoside analogs, a nucleotide analog and 4 non-nucleoside reverse transcriptase inhibitors, 10 protease inhibitors, 2 entry inhibitors and an integrase inhibitor. More than 20 investigational agents are currently being studied in clinical trials. Highly active antiretroviral therapy (HAART), which involves a combination of anti-HIV-1 drugs, is extremely effective in suppressing HIV-1 replication and increasing CD4+ number and results in substantial reductions in HIV-1-related morbidity and mortality. In last 20 years, much has been learned about resistance to antiretroviral drugs, drug interactions and metabolic complications of antiviral drug use. Drugs are now selected on the basis of resistance tests and on the risk of specific drug complications in individual patients. As a result, decisions about the therapy of HIV/AIDS have become personalized and are made on a patient-by-patient basis. With appropriate medical management, a person with HIV-1 now has the possibility of a nearly normal life expectancy.

A non-infectious and quantitative cell-based bioassay for screening HIV entry inhibitors targeting HIV envelope proteins / 南方医科大学学报

<p><b>OBJECTIVE</b>To develop an objective bioassay for quantitative detection of HIV-induced cell-cell fusion for screening HIV entry inhibitors.</p><p><b>METHODS</b>HL2/3 cells expressing HIV envelope proteins gp120/gp41, Tat, and other HIV proteins were co-cultured with HeLa-CD4-LTR-beta-gal cells expressing CD4 receptor and HIV LTR triggered reporter gene beta-galactosidase. The enzyme activities of beta-galactosidase were detected by a chromogenic substrate, chlorophenol red-beta-galactopyranoside (CPRG). Specific HIV entry inhibitors were used to validate the established detecting method.</p><p><b>RESULTS</b>No syncytium was formed by mixing HL2/3 and HeLa-CD4-LTR-beta-gal cells. However, the membrane could be fused and the Tat expressed by HL2/3 cells could bind to HIV LTR on HeLa-CD4-LTR-beta-gal cells and trigger the expression of beta-galactosidase. CPRG allowed quantitative and sensitive detection of the activity of beta-galactosidase. Further studies showed that HIV entry inhibitors could inhibit the activity of beta-galactosidase in a dose-dependent manner.</p><p><b>CONCLUSION</b>We have developed a simple, cheap, objective and quantitative non-infectious cell-cell fusion bioassay that can be used to screen for anti-HIV agents targeting the virus entry from natural and synthetic compound libraries.</p>

La segunda generación de inhibidores no nucleósidos de la transcriptasa reversa: Etravirina: [revisión] / The second generation of non-nucleoside reverse transcriptase inhibitors: Etravirine: [revision]

En el año 2007 tres nuevas drogas antirretrovirales, dos de ellas representando nuevas clases terapéuticas fueron aprobadas para el tratamiento de cepas del virus HIV con altos niveles de resistencia: el INNTR de segunda generación etravirina, el inhibidor de la integrasa raltegravir y el inhibidor del CCR5 maraviroc. La característica principal de etravirina es su actividad contra virus resistentes a efavirenz y nevirapina. Sin embargo, la respuesta a esta droga puede verse afectada si se permite la acumulación de mutaciones en número suficiente o éstas emergen en número suficiente o en ciertas combinaciones. El reemplazo oportuno de un regimen basado en INNTR en fallo por un regimen basado en etravirina es crucial para evitar la acumulación de mutaciones que pudieran afectar la respuesta virológica a esta droga.

During the past year, three new antiretrovirals, two of them representing novel drug classes, were approved for the treatment of highly resistant HIV - the second generation NNRTI etravirine, the integrase inhibitor raltegravir, and the CCR5 inhibitor maraviroc. The hallmark of the novel NNRTI etravirine is its activity against viruses that are resistant to both efavirenz and nevirapine. However, response to this drug can be impaired if NNRTI-resistance mutations accumulate in sufficient numbers or emerge in particular combinations. Timely switch from an NNRTI-failing regimen to an etravirine-bases is crucial in order to avoid accumulation of NNRTI mutations which may affect virological response.

1,2,6-tri-O-galloyl-beta-D-glucopyranose inhibits gp41-mediated HIV envelope fusion with target cell membrane / 南方医科大学学报

<p><b>OBJECTIVE</b>To observe the inhibitory effect of 1,2,6-Tri-O-galloyl-beta-D-glucopyranose (TGGP) from Balanophora japonica Makino on human immunodeficiency virus (HIV) entry into the host cells and explore the mechanisms.</p><p><b>METHODS</b>TGGP was purified from Balanophora japonica Makino by n-hexane and ethyl acetate extraction and column chromatography. The inhibitory activity of TGGP on HIV gp41 six-helix bundle formation was measured with ELISA, N-PAGE and SE-HPLC, and the inhibitory effect of TGGP on HIV envelope grlycoprotein-induced cell-cell fusion was detected using a non-infectious cell-based assay.</p><p><b>RESULTS</b>TGGP inhibited HIV gp41 six-helix bundle formation, with an IC50 of 1.37-/+0.19 microg/ml as determined by ELISA, and this activity was further confirmed by N-PAGE and SE-HPLC. TGGP at 25 microg/ml significantly inhibited syncytium formation between the effector (CHO-WT) and the target (MT-2) cells.</p><p><b>CONCLUSION</b>The HIV transmembrane subunit gp41 mediates the entry of HIV into the target cells. TGGP can inhibit HIV fusion and entry into the target cells by inhibiting the formation of gp41 six-helix bundles, suggesting the potential of TGGP as a microbicide to prevent sexual transmission of HIV.</p>

Enfuvirtide: el primer paso de una nueva estrategia de tratamiento antirretroviral / Enfuvirtide: the first step for a new strategy of antiretroviral therapy

Enfuvirtide (antes T-20) es el primer inhibidor de la entrada a la célula del HIV-1 en ser aprobado. Es un péptido análogo de la porción HR2 de la glucoproteína de superficie viral gp41. Su mecanismo de acción consiste en la unión competitiva a la porción HR1 de la gp41 para impedir los cambios conformacionales del complejo gp41-gp120 tras la unión del HIV-1 a los receptores celulares, impidiendo así el acercamiento y posterior fusión entre el virus y la célula. Se aplica por vía subcutánea. Los resultados de los principales estudios clínicos (TORO 1 y 2) llevados a cabo en pacientes con fallo virológico, tratamientos previos con antirretrovirales y portadores de cepas virales altamente resistentes, mostraron que quienes recibieron enfuvirtide + HAART optimizado, elegido mediante un test de resistencia, presentaron mayores beneficios que quienes sólo recibieron HAART optimizado, en términos de mejor recuperación inmune y mayor descenso de la carga viral de HIV. Los mejores resultados se observaron en el subgrupo de pacientes con más drogas útiles en el HAART según el test de resistencia, una menor carga viral de HIV y un mayor recuento de linfocitos CD4 basales. El principal efecto adverso es el desarrollo de lesiones por hipersensibilidad en los sitios de aplicación. El alto costo de enfuvirtide se vio compensado por una reducción en los costos de internación.

Enfuvirtide (T-20) is the first approved HIV-1 entry into cells' inhibitor. It is a peptide with an amino acid sequence analogue to HR2 region of the viral surface glycoprotein gp41. Its mechanism of action is the competitive binding to HR1 region of the gp41, preventing the interaction between HR1 and HR2 and impeding the conformational changes in gp41 necessary for fusion of the virus with the cell. Its application is by subcutaneous injection. The main clinical trials of enfuvirtide (TORO 1 and 2) were performed in HIV-infected patients with virological failure, high antiretroviral experience and highly resistant viral isolates. Those trials showed that the addition of enfuvirtide to an optimized HAART (chosen with a resistance test) provided better results than HAART alone, measured by drop in viral load and immunologic benefit. The best results were observed in the subgroup of patients with more useful drugs in HAART (according to the information of the resistance test), a lower viral load, and a higher CD4 cell count at baseline. The most important adverse event is the production of injection drug hypersensitivity reaction in 98% of patients. The high cost is compensated by a reduction in costs derived from admissions.

A prevalência de fatores de risco para baixa adesão na terapia com enfuvirtida, nos usuários soropositivos para o HIV em tratamento nos centros de referência em Porto Alegre - RS / The prevalence of risk factors for decreasing adhesion in the therapy with enfuvirtida in HIV infected users in treatment in centers of reference in Porto Alegre - RS

Introdução: Em 2005 o Ministério da Saúde do Brasil disponibilizou a enfuvirtida, o primeiro inibidor de fusão, uma nova classe de anti-retrovirais com ação extracelular. As dificuldades relatadas pelos primeiros usuários, em um dos centros de referência, e a carência de estudos envolvendo os usuários do Sistema Único de Saúde motivaram esta pesquisa. Objetivo: identificar os fatores de risco para baixa adesão ao tratamento com Enfuvirtida. Métodos: foram entrevistadas 37 pessoas de Porto Alegre, compreendendo a população total de usuários de enfuvirtida nesta cidade até o mês de outubro de 2006. Resultados: 27% dos pacientes já pensaram em desistir do tratamento, 22,2% referiram esquecimento de dose nos últimos 30 dias e 45,9% não souberam diferenciar HIV de aids. Os efeitos adversos locais ocorreram em todos os usuários, houve dor nos locais de aplicação em 81,1% dos casos, fato que não atrapalhou as atividades diárias (70,3%). Quanto às aplicações, 28,9% não tiveram a primeira dose supervisionada, 27% não realizaram massagem após as aplicações, 46% dos pacientes usavam regiões não orientadas pela enfermagem para aplicação, 29,7% acharam “difícil” encontrar um local para aplicar. Conclusão: o estudo reforça a necessidade do acompanhamento direto por um profissional de enfermagem para aplicação do medicamento, visto que os procedimentos podem parecer fáceis, mas requerem boa técnica para diluição, aspiração e aplicação a fim de diminuir os efeitos adversos locais, assim como as orientações sobre os cuidados após a aplicação.

Introduction: In 2005 the Ministry Health of Brazil provided Enfuvirtide, the first inhibitor of fusion, a new class of anti-retroviraes with extracellular action. The difficulties described by the first users, in one of the reference centers, and the lack of studies with the users of the Public Health Department, had motivated this research. Objective: to identify risk factors for low adhesion to the treatment with enfuvirtida. Methods: 37 people from Porto Alegre had been interviewed, the total population of users of enfuvirtide in this city until October, 2006. Results: had presented that 27% of the patients had already thought about giving up the treatment, 22,2% had forgotten to take the dose in the last 30 days and 45,9% do not know the difference between HIV and AIDS. The local adverse effect had occurred in all the users, pain in the application places were present in 81,1% of the cases, but it did not interfere in daily activities (70,3%). Concerning applications, 28,9% had not had a first supervised dose, 27% did not make a massage after the applications, 46% of the patients also used regions for application which were not guided by the nurses, 29,7% had had “difficulties” in finding a place to apply. Conclusion: the study strengthens the necessity of the direct accompaniment by a nursing professional, although the procedures can seem easy, they require good technique for dilution, aspiration and application to diminish the local adverse effects, as well as the orientation on the care after the application.