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Sullivan AC, Zuniga G, Ramirez P, Fernandez R, Wang CP, Li J, Davila L, Pelton K, Gomez S, Sohn C, Gonzalez E, Lopez-Cruzan M, Gonzalez DA, Parker A, Zilli E, de Erausquin GA, Seshadri S, Espinoza S, Musi N, Frost B. A pilot study to investigate the safety and feasibility of antiretroviral therapy for Alzheimer's disease (ART-AD). MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.26.24303316. [PMID: 38464267 PMCID: PMC10925371 DOI: 10.1101/2024.02.26.24303316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Retrotransposons are viral-like DNA sequences that constitute approximately 41% of the human genome. Studies in Drosophila, mice, cultured cells, and human brain indicate that retrotransposons are activated in settings of tauopathy, including Alzheimer's disease, and causally drive neurodegeneration. The anti-retroviral medication 3TC (lamivudine), a nucleoside analog reverse transcriptase inhibitor, limits retrotransposon activation and suppresses neurodegeneration in tau transgenic Drosophila, two mouse models of tauopathy, and in brain assembloids derived from patients with sporadic Alzheimer's disease. We performed a 24-week phase 2a open-label clinical trial of 300 mg daily oral 3TC (NCT04552795) in 12 participants aged 52-83 years with a diagnosis of mild cognitive impairment due to suspected Alzheimer's disease. Primary outcomes included feasibility, blood brain barrier penetration, effects of 3TC on reverse transcriptase activity in the periphery, and safety. Secondary outcomes included changes in cognition and fluid-based biomarkers of neurodegeneration and neuroinflammation. All participants completed the six-month trial; one event of gastrointestinal bleeding due to a peptic ulcer was reported. 3TC was detected in blood and cerebrospinal fluid (CSF) of all participants, suggestive of adherence to study drug and effective brain penetration. Cognitive measures remained stable throughout the study. Glial fibrillary acidic protein (GFAP) (P=0.03) and Flt1 (P=0.05) were significantly reduced in CSF over the treatment period; Aβ42/40 (P=0.009) and IL-15 (P=0.006) were significantly elevated in plasma. While this is an open label study of small sample size, the significant decrease of some neurodegeneration- and neuroinflammation-related biomarkers in CSF, significantly elevated levels of plasma Aβ42/40, and a trending decrease of CSF NfL after six months of 3TC exposure suggest a beneficial effect on subjects with mild cognitive impairment due to suspected Alzheimer's disease. Feasibility, safety, tolerability, and central nervous system (CNS) penetration assessments further support clinical evaluation of 3TC in a larger placebo-controlled, multi-dose clinical trial.
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Affiliation(s)
- A. Campbell Sullivan
- Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, University of Texas Health San Antonio
- Department of Neurology, University of Texas Health San Antonio
| | - Gabrielle Zuniga
- Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, University of Texas Health San Antonio
- Barshop Institute for Longevity and Aging Studies, University of Texas Health San Antonio
- Department of Cell Systems and Anatomy, University of Texas Health San Antonio
| | - Paulino Ramirez
- Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, University of Texas Health San Antonio
- Barshop Institute for Longevity and Aging Studies, University of Texas Health San Antonio
- Department of Cell Systems and Anatomy, University of Texas Health San Antonio
| | - Roman Fernandez
- Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, University of Texas Health San Antonio
- Department of Population Health Sciences, University of Texas Health San Antonio
| | - Chen-Pin Wang
- Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, University of Texas Health San Antonio
- Department of Population Health Sciences, University of Texas Health San Antonio
| | - Ji Li
- Barshop Institute for Longevity and Aging Studies, University of Texas Health San Antonio
| | - Lisa Davila
- Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, University of Texas Health San Antonio
- Barshop Institute for Longevity and Aging Studies, University of Texas Health San Antonio
- Department of Cell Systems and Anatomy, University of Texas Health San Antonio
| | - Kristine Pelton
- Brown University Center for Alzheimer’s Disease Research, Providence, RI
| | - Sandra Gomez
- Barshop Institute for Longevity and Aging Studies, University of Texas Health San Antonio
- Department of Medicine, Cedars-Sinai Medical Center
| | - Claira Sohn
- Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, University of Texas Health San Antonio
- Barshop Institute for Longevity and Aging Studies, University of Texas Health San Antonio
- Department of Cell Systems and Anatomy, University of Texas Health San Antonio
| | - Elias Gonzalez
- Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, University of Texas Health San Antonio
- Barshop Institute for Longevity and Aging Studies, University of Texas Health San Antonio
- Department of Cell Systems and Anatomy, University of Texas Health San Antonio
| | - Marisa Lopez-Cruzan
- Barshop Institute for Longevity and Aging Studies, University of Texas Health San Antonio
- Department of Psychiatry and Behavioral Sciences, University of Texas Health San Antonio
| | - David A. Gonzalez
- Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, University of Texas Health San Antonio
- Department of Neurology, University of Texas Health San Antonio
- Department of Neurological Sciences, Rush University Medical Center
| | - Alicia Parker
- Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, University of Texas Health San Antonio
- Department of Neurology, University of Texas Health San Antonio
| | - Eduardo Zilli
- Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, University of Texas Health San Antonio
- Department of Neurology, University of Texas Health San Antonio
| | - Gabriel A. de Erausquin
- Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, University of Texas Health San Antonio
- Department of Neurology, University of Texas Health San Antonio
| | - Sudha Seshadri
- Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, University of Texas Health San Antonio
- Department of Neurology, University of Texas Health San Antonio
| | | | - Nicolas Musi
- Department of Medicine, Cedars-Sinai Medical Center
| | - Bess Frost
- Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, University of Texas Health San Antonio
- Barshop Institute for Longevity and Aging Studies, University of Texas Health San Antonio
- Department of Cell Systems and Anatomy, University of Texas Health San Antonio
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Arnouk S, Whitsett M, Papadopoulos J, Stewart Lewis Z, Dagher NN, Feldman DM, Park JS. Successful Treatment of Tenofovir Alafenamide-Induced Lactic Acidosis: A Case Report. J Pharm Pract 2023; 36:1260-1263. [PMID: 35635046 DOI: 10.1177/08971900221105042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Nucleoside or nucleotide analogues (NAs) have the potential to cause lactic acidosis by inhibiting DNA polymerase-γ of human mitochondria and impairing aerobic metabolism. Patients may be asymptomatic, have mild non-specific symptoms, or present in multisystem organ failure. There is a paucity of data to guide management of life-threatening lactic acidosis due to NA therapy. Here we describe a case of a 60-year old critically ill male with decompensated cirrhosis secondary to hepatitis B virus (HBV) infection who developed severe lactic acidosis (13.8 mmol/L) 2 days after initiation of tenofovir alafenamide (TAF). All other possible etiologies for the elevated lactate were ruled out. Lactic acidosis resolved rapidly with TAF discontinuation and supplementation with cofactors supporting mitochondrial oxidative phosphorylation, including coenzyme Q10, levocarnitine, riboflavin, and thiamine. This case highlights the ability of TAF to cause lactic acidosis early after therapy initiation, especially in susceptible hosts, and reviews the potential role for cofactor supplementation for drug-induced mitochondrial injury.
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Affiliation(s)
- Serena Arnouk
- Department of Pharmacy, NYU Langone Health, New York, NY, USA
| | - Maureen Whitsett
- Department of Transplant Hepatology, Cleveland Clinic, Cleveland, OH, USA
| | | | | | - Nabil N Dagher
- Transplant Institute, NYU Langone Health, New York, NY, USA
| | - David M Feldman
- Department of Medicine, Division of Gastroenterology & Hepatology - NYU Langone Health, New York, NY, USA
| | - James S Park
- Department of Medicine, Division of Gastroenterology & Hepatology - NYU Langone Health, New York, NY, USA
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Ding H, George S, Leng XI, Ihnat M, Ma JX, Jiang G, Margolis D, Dumond J, Zhang Y. Silk fibers assisted long-term 3D culture of human primary urinary stem cells via inhibition of senescence-associated genes: Potential use in the assessment of chronic mitochondrial toxicity. MATERIALS TODAY. ADVANCES 2022; 15:100261. [PMID: 36212078 PMCID: PMC9542430 DOI: 10.1016/j.mtadv.2022.100261] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Despite being widely applied in drug development, existing in vitro 2D cell-based models are not suitable to assess chronic mitochondrial toxicity. A novel in vitro assay system mimicking in vivo microenvironment for this purpose is urgently needed. The goal of this study is to establish a 3D cell platform as a reliable, sensitive, cost-efficient, and high-throughput assay to predict drug-induced mitochondrial toxicity. We evaluated a long-term culture of human primary urine-derived stem cells (USC) seeded in 3D silk fiber matrix (3D USC-SFM) and further tested chronic mitochondrial toxicity induced by Zalcitabine (ddC, a nucleoside reverse transcriptase inhibitor) as a test drug, compared to USC grown in spheroids. The numbers of USC remain steady in 3D spheroids for 4 weeks and 3D SFM for 6 weeks. However, the majority (95%) of USC survived in 3D SFM, while cell numbers significantly declined in 3D spheroids at 6 weeks. Highly porous SFM provides large-scale numbers of cells by increasing the yield of USC 125-fold/well, which enables the carrying of sufficient cells for multiple experiments with less labor and lower cost, compared to 3D spheroids. The levels of mtDNA content and mitochondrial superoxide dismutase2 [SOD2] as an oxidative stress biomarker and cell senescence genes (RB and P16, p21) of USC were all stably retained in 3D USC-SFM, while those were significantly increased in spheroids. mtDNA content and mitochondrial mass in both 3D culture models significantly decreased six weeks after treatment of ddC (0.2, 2, and 10 μM), compared to 0.1% DMSO control. Levels of complexes I, II, and III significantly decreased in 3D SFM-USC treated with ddC, compared to only complex I level which declined in spheroids. A dose- and time-dependent chronic MtT displayed in the 3D USC-SFM model, but not in spheroids. Thus, a long-term 3D culture model of human primary USC provides a cost-effective and sensitive approach potential for the assessment of drug-induced chronic mitochondrial toxicity.
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Affiliation(s)
- Huifen Ding
- Wake Forest Institute for Regenerative Medicine, Wake Forest University Health Sciences, Winston-Salem, NC, USA
- Stomatological Hospital of Chongqing Medical University, Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Sunil George
- Wake Forest Institute for Regenerative Medicine, Wake Forest University Health Sciences, Winston-Salem, NC, USA
| | - Xiaoyan Iris Leng
- Division of Public Health Sciences, Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Michael Ihnat
- Department of Pharmaceutical Sciences, University of Oklahoma College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Jian-Xing Ma
- Department of Biochemistry, Wake Forest University Health Sciences, Winston-Salem, NC, USA
| | - Guochun Jiang
- University of North Carolina HIV Cure Center, UNC Chapel Hill, Chapel Hill, NC, USA
| | - David Margolis
- University of North Carolina HIV Cure Center, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Julie Dumond
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Yuanyuan Zhang
- Wake Forest Institute for Regenerative Medicine, Wake Forest University Health Sciences, Winston-Salem, NC, USA
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Khan F, Ali H, Musharraf SG. Tenofovir disoproxil fumarate-mediated γ-globin induction is correlated with the suppression of trans-acting factors in CD34 + progenitor cells: A role in the reactivation of fetal hemoglobin. Eur J Pharmacol 2022; 927:175036. [PMID: 35618038 DOI: 10.1016/j.ejphar.2022.175036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 05/07/2022] [Accepted: 05/12/2022] [Indexed: 11/19/2022]
Abstract
Sickle-cell disease (SCD) and β-thalassemia are public health issues that affect people all over the world. Fetal hemoglobin (HbF) induction is a molecular intervention, including hydroxyurea, which has made an effort to improve current treatment. Tenofovir disoproxil fumarate (TDF) is formerly reported with improving levels of hemoglobin, mean corpuscular hemoglobin (MCH), and mean corpuscular volume (MCV). Hence, in this preclinical investigation, human peripheral whole blood-derived CD34+ progenitor cells were cultured to prove the efficacy of TDF on erythroid proliferation, differentiation, γ-globin gene expression regulation, and ultimately HbF production. We observed that TDF increased the proliferation of immature erythroid cells, delayed the terminal erythroid maturation without cytotoxicity as correlated with other HbF inducers. Here, the presented data show that TDF can induce HbF expression by up-regulating the γ-globin gene transcription up to 7.1 ± 0.46-fold and subsequently increased the F-cells (10.79 ± 1.9-fold) population in terminally differentiated erythroid cells. Furthermore, our findings demonstrated that TDF-mediated γ-globin gene induction and HbF production was associated with down-fold regulation of BCL11A and SOX6, and their corresponding trans-acting regulators, FOP, KLF1, and GATA1. Collectively, our findings suggest TDF as an effective inducer of HbF in CD34+ cells and pave the way to put forward the assessment of TDF as a new potential therapy in treating β-hemoglobinopathies.
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Affiliation(s)
- Faisal Khan
- Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75270, Pakistan
| | - Hamad Ali
- Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75270, Pakistan; Department of Basic Medical Sciences, Shifa College of Pharmaceutical Sciences, Shifa Tameer-e-Millat University, Islamabad 44000, Pakistan
| | - Syed Ghulam Musharraf
- Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75270, Pakistan; H.E.J. Research Institute of Chemistry, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75270, Pakistan.
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Krečmerová M, Majer P, Rais R, Slusher BS. Phosphonates and Phosphonate Prodrugs in Medicinal Chemistry: Past Successes and Future Prospects. Front Chem 2022; 10:889737. [PMID: 35668826 PMCID: PMC9163707 DOI: 10.3389/fchem.2022.889737] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 04/26/2022] [Indexed: 12/25/2022] Open
Abstract
Compounds with a phosphonate group, i.e., -P(O)(OH)2 group attached directly to the molecule via a P-C bond serve as suitable non-hydrolyzable phosphate mimics in various biomedical applications. In principle, they often inhibit enzymes utilizing various phosphates as substrates. In this review we focus mainly on biologically active phosphonates that originated from our institute (Institute of Organic Chemistry and Biochemistry in Prague); i.e., acyclic nucleoside phosphonates (ANPs, e.g., adefovir, tenofovir, and cidofovir) and derivatives of non-nucleoside phosphonates such as 2-(phosphonomethyl) pentanedioic acid (2-PMPA). Principal strategies of their syntheses and modifications to prodrugs is reported. Besides clinically used ANP antivirals, a special attention is paid to new biologically active molecules with respect to emerging infections and arising resistance of many pathogens against standard treatments. These new structures include 2,4-diamino-6-[2-(phosphonomethoxy)ethoxy]pyrimidines or so-called "open-ring" derivatives, acyclic nucleoside phosphonates with 5-azacytosine as a base moiety, side-chain fluorinated ANPs, aza/deazapurine ANPs. When transformed into an appropriate prodrug by derivatizing their charged functionalities, all these compounds show promising potential to become drug candidates for the treatment of viral infections. ANP prodrugs with suitable pharmacokinetics include amino acid phosphoramidates, pivaloyloxymethyl (POM) and isopropoxycarbonyloxymethyl (POC) esters, alkyl and alkoxyalkyl esters, salicylic esters, (methyl-2-oxo-1,3-dioxol-4-yl) methyl (ODOL) esters and peptidomimetic prodrugs. We also focus on the story of cytostatics related to 9-[2-(phosphonomethoxy)ethyl]guanine and its prodrugs which eventually led to development of the veterinary drug rabacfosadine. Various new ANP structures are also currently investigated as antiparasitics, especially antimalarial agents e.g., guanine and hypoxanthine derivatives with 2-(phosphonoethoxy)ethyl moiety, their thia-analogues and N-branched derivatives. In addition to ANPs and their analogs, we also describe prodrugs of 2-(phosphonomethyl)pentanedioic acid (2-PMPA), a potent inhibitor of the enzyme glutamate carboxypeptidase II (GCPII), also known as prostate-specific membrane antigen (PSMA). Glutamate carboxypeptidase II inhibitors, including 2-PMPA have been found efficacious in various preclinical models of neurological disorders which are caused by glutamatergic excitotoxicity. Unfortunately its highly polar character and hence low bioavailability severely limits its potential for clinical use. To overcome this problem, various prodrug strategies have been used to mask carboxylates and/or phosphonate functionalities with pivaloyloxymethyl, POC, ODOL and alkyl esters. Chemistry and biological characterization led to identification of prodrugs with 44-80 fold greater oral bioavailability (tetra-ODOL-2-PMPA).
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Affiliation(s)
- Marcela Krečmerová
- Institute of Organic Chemistry and Biochemistry, Academy of Sciences of the Czech Republic (ASCR), Prague, Czechia
- *Correspondence: Marcela Krečmerová,
| | - Pavel Majer
- Institute of Organic Chemistry and Biochemistry, Academy of Sciences of the Czech Republic (ASCR), Prague, Czechia
| | - Rana Rais
- Departments of Neurology, Pharmacology and Molecular Sciences, Johns Hopkins Drug Discovery, Baltimore, MD, United States
| | - Barbara S. Slusher
- Departments of Neurology, Pharmacology and Molecular Sciences, Psychiatry and Behavioral Sciences, Neuroscience, Medicine, Oncology, Johns Hopkins Drug Discovery, Baltimore, MD, United States
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Kovari H, Surial B, Tarr PE, Cavassini M, Calmy A, Schmid P, Bernasconi E, Rauch A, Wandeler G, Ledergerber B. Changes in alanine aminotransferase levels after switching from tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide (TAF) in HIV-positive people without viral hepatitis in the Swiss HIV Cohort Study. HIV Med 2021; 22:623-628. [PMID: 33880839 DOI: 10.1111/hiv.13106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We previously demonstrated an association between tenofovir disoproxil fumarate (TDF) and chronic liver enzyme elevation in the D:A:D study. The objective of the study was to assess changes in alanine aminotransferase (ALT) levels after switching from TDF to tenofovir alafenamide (TAF). METHODS We included Swiss HIV Cohort Study participants who switched from TDF to TAF with two or more ALT values in the 24 months before and two or more values in the 24 months after replacing TDF with TAF. Individuals with replicating viral hepatitis were excluded. Uni- and multivariable linear mixed models were used to explore changes in ALT values associated with switching from TDF to TAF, and to assess potential modifying effects. RESULTS A total of 1712 participants were included, contributing 6169 ALT values before and 5482 after switching. Median (interquartile range, IQR) age was 50 (42-57) years, and 75% were male. Median (IQR) ALT was 28 (22-38) U/L before and 24 (19-32) U/L after replacing TDF with TAF. ALT values decreased by 3.7 U/L (95% confidence interval: 3.2-4.2) after the switch. The median drop was larger in patients with chronic ALT elevation (defined as two or more elevated values for ≥ 6 months) compared with patients with normal ALT values (17.8 vs. 3.3 U/L, P < 0.001). We did not identify any major effect modifications of the ALT change with any of the potential variables studied. CONCLUSIONS Replacing TDF with TAF in HIV-monoinfected people led to a significant decrease in ALT values. Findings were not significantly affected by known risk factors for hepatotoxicity.
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Affiliation(s)
- H Kovari
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital, University of Zurich, Zurich, Switzerland
| | - B Surial
- Department of Infectious Diseases, Bern University Hospital, University of Berne, Berne, Switzerland
| | - P E Tarr
- Department of Medicine and Division of Infectious Diseases and Hospital Epidemiology, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
| | - M Cavassini
- Division of Infectious Diseases, University Hospital, Lausanne, Switzerland
| | - A Calmy
- Division of Infectious Diseases, University Hospital Geneva, University of Geneva, Geneva, Switzerland
| | - P Schmid
- Division of Infectious Diseases, Cantonal Hospital, St Gall, Switzerland
| | - E Bernasconi
- Division of Infectious Diseases, Ospedale Regionale, Lugano, Switzerland
| | - A Rauch
- Department of Infectious Diseases, Bern University Hospital, University of Berne, Berne, Switzerland
| | - G Wandeler
- Department of Infectious Diseases, Bern University Hospital, University of Berne, Berne, Switzerland
| | - B Ledergerber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital, University of Zurich, Zurich, Switzerland
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Zulu SS, Abboussi O, Simola N, Mabandla MV, Daniels WMU. Effects of combination antiretroviral drugs (cART) on hippocampal neuroplasticity in female mice. J Neurovirol 2021; 27:325-333. [PMID: 33710598 DOI: 10.1007/s13365-021-00967-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 02/04/2021] [Accepted: 02/28/2021] [Indexed: 10/21/2022]
Abstract
The incidence of HIV-associated neurocognitive disorder (HAND) continues despite the introduction of combination antiretroviral drugs (cART). Several studies have reported the neurotoxicity of individual antiretroviral drugs (monotherapy), while the common approach for HIV treatment is through cART. Hence, the current study investigated the effects of long-term exposure to cART on cognitive function, oxidative damage, autophagy, and neuroplasticity in the hippocampus of mice. Female Balb/c mice received a once-a-day oral dose of cART composed of emtricitabine + tenofovir disoproxil fumarate or vehicle for 8 weeks. On week 7 of drug administration, all mice were assessed for spatial learning in the Morris water maze (MWM), and then on week 8, mice were sacrificed, and hippocampal tissue dissected from the brain. For biochemical analyses, we measured the concentration of 4-hydroxynonenal, and the expression of autophagic marker LC3B, synaptophysin, and brain-derived neurotrophic factor (BDNF) in the hippocampus. Our results showed that cART exposure increased escape latency in the MWM test. The cART-treated mice also showed increased 4-hydroxynonenal concentration and expression of LC3B. Furthermore, cART treatment decreased the expression of synaptophysin and BDNF. These findings further support the evidence that cART may be neurotoxic and therefore may play a role in the neuropathogenesis of HAND.
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Affiliation(s)
- Simo Siyanda Zulu
- School of Laboratory Medicine , and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Westville Campus, Private Bag X54001, Durban, 4000, South Africa. .,Department of Human Biology, Faculty of Health Sciences, Nelson Mandela University, Port Elizabeth, South Africa.
| | - Oualid Abboussi
- Physiology and Physiopathology Team, Faculty of Sciences, Genomic of Human Pathologies Research Centre, Mohammed V University, Rabat, Morocco
| | - Nicola Simola
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Musa Vuyisile Mabandla
- School of Laboratory Medicine , and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Westville Campus, Private Bag X54001, Durban, 4000, South Africa
| | - William Mark Uren Daniels
- School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Yadavar-Nikravesh MS, Milani A, Vahabpour R, Khoobi M, Bakhshandeh H, Bolhassani A. In vitro Anti-HIV-1 Activity of the Recombinant HIV-1 TAT Protein Along With Tenofovir Drug. Curr HIV Res 2021; 19:138-146. [PMID: 33045968 DOI: 10.2174/1570162x18666201012152600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/19/2020] [Accepted: 09/01/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND HIV-1 TAT protein is essential for the regulation of viral genome transcription. The first exon of TAT protein has a fundamental role in the stimulation of the extrinsic and intrinsic apoptosis pathways, but its anti-HIV activity is not clear yet. METHODS In the current study, we firstly cloned the first exon of the TAT coding sequence in the pET-24a expression vector and then protein expression was done in the Rosetta expression host. Next, the expressed TAT protein was purified by Ni-NTA column under native conditions. After that, the protein yield was determined by Bradford kit and NanoDrop spectrophotometry. Finally, the cytotoxicity effect and anti-Scr-HIV-1 activity of the recombinant TAT protein alone and along with Tenofovir drug were assessed by MTT and ELISA, respectively. RESULTS The recombinant TAT protein was successfully generated in E. coli, as confirmed by 13.5% SDS-PAGE and western blotting. The protein yield was ~150-200 μg/ml. In addition, the recombinant TAT protein at a certain dose with low toxicity could suppress Scr-HIV replication in the infected HeLa cells (~30%) that was comparable with a low toxic dose of Tenofovir drug (~40%). It was interesting that the recombinant TAT protein could enhance anti-HIV potency of Tenofovir drug up to 66%. CONCLUSION Generally, a combination of TAT protein and Tenofovir drug could significantly inhibit HIV-1 replication. It will be required to determine their mechanism of action in the next studies.
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Affiliation(s)
| | - Alireza Milani
- Department of Hepatitis, AIDS and Blood Borne Diseases, Pasteur Institute of Iran, Tehran, Iran
| | - Rouhollah Vahabpour
- Department of Medical Lab Technology, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences; Tehran, Iran
| | - Mehdi Khoobi
- Department of Pharmaceutical Biomaterials and Medical Biomaterials Research Center (MBRC), Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Haleh Bakhshandeh
- Nanobiotechnology Department, New Technologies Research Group, Pasteur Institute of Iran, Tehran, Iran
| | - Azam Bolhassani
- Department of Hepatitis, AIDS and Blood Borne Diseases, Pasteur Institute of Iran, Tehran, Iran
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9
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Huang XS, Luo RH, Hu XL, Chen H, Xiang SY, Tang CR, Zhang CT, Shen XN, Zheng YT. The New NNRTI ACC007 Combined with Lamivudine and Tenofovir Disoproxil Fumarate Show Synergy Anti-HIV Activity In Vitro. Curr HIV Res 2020; 18:332-341. [PMID: 32562524 DOI: 10.2174/1570162x18666200620211922] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 04/11/2020] [Accepted: 05/06/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Acquired immunodeficiency syndrome can hardly be cured currently and people with human immunodeficiency virus (HIV) need lifelong treatment that may result in the emergence of drug resistance which leads to failed treatment. Thus, the development of new anti- HIV drugs and new treatment regimens are necessary. OBJECTIVE The aim of this study is to analyze the combined anti-HIV activity of tenofovir disoproxil fumarate, lamivudine and ACC007, a new non-nucleoside reverse transcriptase inhibitor. METHODS The antiviral activity of tenofovir disoproxil fumarate, lamivudine and ACC007 alone or in combination against different HIV-1 strains was determined by the detection of HIV-1 p24 level through enzyme-linked immunosorbent assay. RESULT ACC007 showed EC50 of nanomolar range (from 3.03 nM to 252.59 nM) against all HIV-1 strains used in this study except the HIV-1A17, with EC50 of 1.57 μM. The combined antiviral activity of ACC007, lamivudine and tenofovir disoproxil fumarate showed synergy antiviral activity against all HIV-1 strains used in this study. The three-drug combination showed moderate synergism against HIV-1A17, HIV-14755-5, HIV-1K103N and HIV-1V106M, with a combination index value ranging from 0.71 to 0.87, and showed synergism against the other HIV-1 strains with combination index value from 0.35 to 0.67. The combination with ACC007 significantly increases the dose reduction index value of lamivudine and tenofovir disoproxil fumarate, compared with two-drug combination. CONCLUSION ACC007 exhibits potent antiviral activity alone or with 3TC and TDF, and exerts synergistic effect against all HIV strains used in our investigation in vitro.
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Affiliation(s)
- Xu-Sheng Huang
- Key Laboratory of Bioactive Peptides of Yunnan Province/Key Laboratory of Animal Models and Human Disease
Mechanisms of the Chinese Academy of Sciences, KIZ-CUHK Joint Laboratory of Bioresources and Molecular Research
in Common Diseases, Center for Biosafety Mega-Science, Kunming Institute of Zoology, Chinese Academy of
Sciences, Kunming 650223, Yunnan, China,Kunming College of Life Science, University of Chinese Academy of Sciences, Kunming 650204, Yunnan, China
| | - Rong-Hua Luo
- Key Laboratory of Bioactive Peptides of Yunnan Province/Key Laboratory of Animal Models and Human Disease
Mechanisms of the Chinese Academy of Sciences, KIZ-CUHK Joint Laboratory of Bioresources and Molecular Research
in Common Diseases, Center for Biosafety Mega-Science, Kunming Institute of Zoology, Chinese Academy of
Sciences, Kunming 650223, Yunnan, China
| | - Xiong-Lin Hu
- Nanjing Accelas Pharmaceutical Co. Ltd. Nanjing 210046, Jiangsu, China
| | - Huan Chen
- Key Laboratory of Bioactive Peptides of Yunnan Province/Key Laboratory of Animal Models and Human Disease
Mechanisms of the Chinese Academy of Sciences, KIZ-CUHK Joint Laboratory of Bioresources and Molecular Research
in Common Diseases, Center for Biosafety Mega-Science, Kunming Institute of Zoology, Chinese Academy of
Sciences, Kunming 650223, Yunnan, China
| | - Si-Ying Xiang
- Key Laboratory of Bioactive Peptides of Yunnan Province/Key Laboratory of Animal Models and Human Disease
Mechanisms of the Chinese Academy of Sciences, KIZ-CUHK Joint Laboratory of Bioresources and Molecular Research
in Common Diseases, Center for Biosafety Mega-Science, Kunming Institute of Zoology, Chinese Academy of
Sciences, Kunming 650223, Yunnan, China
| | - Cheng-Run Tang
- Key Laboratory of Bioactive Peptides of Yunnan Province/Key Laboratory of Animal Models and Human Disease
Mechanisms of the Chinese Academy of Sciences, KIZ-CUHK Joint Laboratory of Bioresources and Molecular Research
in Common Diseases, Center for Biosafety Mega-Science, Kunming Institute of Zoology, Chinese Academy of
Sciences, Kunming 650223, Yunnan, China
| | - Chun-Tao Zhang
- Key Laboratory of Bioactive Peptides of Yunnan Province/Key Laboratory of Animal Models and Human Disease
Mechanisms of the Chinese Academy of Sciences, KIZ-CUHK Joint Laboratory of Bioresources and Molecular Research
in Common Diseases, Center for Biosafety Mega-Science, Kunming Institute of Zoology, Chinese Academy of
Sciences, Kunming 650223, Yunnan, China
| | - Xiao-Ning Shen
- Jiangsu Aidea Pharmaceutical Co. Ltd. Nanjing 210046, Jiangsu, China
| | - Yong-Tang Zheng
- Key Laboratory of Bioactive Peptides of Yunnan Province/Key Laboratory of Animal Models and Human Disease
Mechanisms of the Chinese Academy of Sciences, KIZ-CUHK Joint Laboratory of Bioresources and Molecular Research
in Common Diseases, Center for Biosafety Mega-Science, Kunming Institute of Zoology, Chinese Academy of
Sciences, Kunming 650223, Yunnan, China
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10
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Gerasi M, Frakolaki E, Papadakis G, Chalari A, Lougiakis N, Marakos P, Pouli N, Vassilaki N. Design, synthesis and anti-HBV activity evaluation of new substituted imidazo[4,5-b]pyridines. Bioorg Chem 2020; 98:103580. [DOI: 10.1016/j.bioorg.2020.103580] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 12/18/2019] [Accepted: 01/10/2020] [Indexed: 02/08/2023]
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11
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Ghaem Maghami M, Dey S, Lenz AK, Höbartner C. Repurposing Antiviral Drugs for Orthogonal RNA-Catalyzed Labeling of RNA. Angew Chem Int Ed Engl 2020; 59:9335-9339. [PMID: 32162405 PMCID: PMC7318677 DOI: 10.1002/anie.202001300] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 02/29/2020] [Indexed: 12/16/2022]
Abstract
In vitro selected ribozymes are promising tools for site-specific labeling of RNA. Previously known nucleic acid catalysts attached fluorescently labeled adenosine or guanosine derivatives through 2',5'-branched phosphodiester bonds to the RNA of interest. Herein, we report new ribozymes that use orthogonal substrates, derived from the antiviral drug tenofovir, and attach bioorthogonal functional groups, as well as affinity handles and fluorescent reporter units through a hydrolytically more stable phosphonate ester linkage. The tenofovir transferase ribozymes were identified by in vitro selection and are orthogonal to nucleotide transferase ribozymes. As genetically encodable functional RNAs, these ribozymes may be developed for potential cellular applications. The orthogonal ribozymes addressed desired target sites in large RNAs in vitro, as shown by fluorescent labeling of E. coli 16S and 23S rRNAs in total cellular RNA.
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Affiliation(s)
- Mohammad Ghaem Maghami
- Universität Würzburg, Institut für Organische Chemie, Am Hubland, 97074, Würzburg, Germany.,International Max Planck Research School Molecular Biology, University of Göttingen, Germany
| | - Surjendu Dey
- Universität Würzburg, Institut für Organische Chemie, Am Hubland, 97074, Würzburg, Germany
| | - Ann-Kathrin Lenz
- Universität Würzburg, Institut für Organische Chemie, Am Hubland, 97074, Würzburg, Germany
| | - Claudia Höbartner
- Universität Würzburg, Institut für Organische Chemie, Am Hubland, 97074, Würzburg, Germany.,International Max Planck Research School Molecular Biology, University of Göttingen, Germany
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12
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Ghaem Maghami M, Dey S, Lenz A, Höbartner C. Repurposing Antiviral Drugs for Orthogonal RNA‐Catalyzed Labeling of RNA. Angew Chem Int Ed Engl 2020. [DOI: 10.1002/ange.202001300] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Mohammad Ghaem Maghami
- Universität WürzburgInstitut für Organische Chemie Am Hubland 97074 Würzburg Germany
- International Max Planck Research School Molecular BiologyUniversity of Göttingen Germany
| | - Surjendu Dey
- Universität WürzburgInstitut für Organische Chemie Am Hubland 97074 Würzburg Germany
| | - Ann‐Kathrin Lenz
- Universität WürzburgInstitut für Organische Chemie Am Hubland 97074 Würzburg Germany
| | - Claudia Höbartner
- Universität WürzburgInstitut für Organische Chemie Am Hubland 97074 Würzburg Germany
- International Max Planck Research School Molecular BiologyUniversity of Göttingen Germany
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13
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Holec AD, Mandal S, Prathipati PK, Destache CJ. Nucleotide Reverse Transcriptase Inhibitors: A Thorough Review, Present Status and Future Perspective as HIV Therapeutics. Curr HIV Res 2019; 15:411-421. [PMID: 29165087 DOI: 10.2174/1570162x15666171120110145] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 11/02/2017] [Accepted: 11/15/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Human immunodeficiency virus type-1 (HIV-1) infection leads to acquired immunodeficiency syndrome (AIDS), a severe viral infection that has claimed approximately 658,507 lives in the US between the years 2010-2014. Antiretroviral (ARV) therapy has proven to inhibit HIV-1, but unlike other viral illness, not cure the infection. OBJECTIVE Among various Food and Drug Administration (FDA)-approved ARVs, nucleoside/ nucleotide reverse transcriptase inhibitors (NRTIs) are most effective in limiting HIV-1 infection. This review focuses on NRTIs mechanism of action and metabolism. METHODS A search of PubMed (1982-2016) was performed to capture relevant articles regarding NRTI pharmacology. RESULTS The current classical NRTIs pharmacology for HIV-1 prevention and treatment are presented. Finally, various novel strategies are proposed to improve the efficacy of NRTIs, which will increase therapeutic efficiency of present-day HIV-1 prevention/treatment regimen. CONCLUSION Use of NRTIs will continue to be critical for successful treatment and prevention of HIV-1.
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Affiliation(s)
- Ashley D Holec
- Creighton University Medical Microbiology and Immunology, Omaha, NE, United States
| | - Subhra Mandal
- Creighton University School of Pharmacy & Health Professions, Omaha, NE, United States
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14
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Carey I, Byrne R, Childs K, Horner M, Bruce M, Wang B, Dusheiko G, Agarwal K. Serum NGAL can act as an early renal safety biomarker during long-term nucleos(t)ide analogue antiviral therapy in chronic hepatitis B. J Viral Hepat 2018; 25:1139-1150. [PMID: 29660209 DOI: 10.1111/jvh.12916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 03/20/2018] [Indexed: 12/26/2022]
Abstract
Tubular renal toxicity is a side-effect of long-term therapy with nucleos(t)ide analogue(s) (NA) in chronic hepatitis B (CHB). There are no established surrogate markers in plasma of early NA-related toxicity. Neutrophil gelatinase-associated lipocalin (NGAL) is a protein produced by tubular cells following renal damage. We aimed therefore to retrospectively compare conventional renal markers (estimated glomerular filtration rates (eGFR) and urinary protein/creatinine ratio uPCR) with a sensitive biomarker (NGAL) in CHB patients on long-term NA therapy and assess the ability of new markers to predict NA-related renal toxicity (new onset of nonalbumin proteinuria). A total of 192 naïve CHB patients (median age 41 years, 78% males, 25% HBeAg+, 35% cirrhosis) were NA treated for at least 5 years (median 8.34 years, range 5.54-11.1 years). The eGFR and uPCR were compared at baseline and last clinical visit with serum NGAL concentrations measured by ELISA at same time-points and assessed according to the presence/absence of nonalbumin proteinuria at last visit. While baseline and last visit eGFR were similar (median:78 vs 84 mL/min), serum NGAL concentrations increased during therapy (median:9.4 vs 16.4 ng/mL, P < .05). The proportion of patients with proteinuria (uPCR > 15) increased between baseline and last visit (4.6% vs 21.4%, P < .05), with 30 (16%) patients having de novo nonalbumin proteinuria at last visit. High baseline NGAL concentrations were exclusive to patients with de novo nonalbumin proteinuria (median:31.7 vs 7.8 ng/mL, P < .01) and baseline NGAL levels >25 mg/mL were predictive of nonalbumin proteinuria at last visit (AUROC = 0.813). In conclusion, serum NGAL can act as a surrogate marker of early renal injury (de novo nonalbumin proteinuria) in CHB on long-term NA therapy.
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Affiliation(s)
- I Carey
- Institute of Liver Studies, King's College Hospital, London, UK
| | - R Byrne
- Institute of Liver Studies, King's College Hospital, London, UK
| | - K Childs
- Institute of Liver Studies, King's College Hospital, London, UK
| | - M Horner
- Institute of Liver Studies, King's College Hospital, London, UK
| | - M Bruce
- Institute of Liver Studies, King's College Hospital, London, UK
| | - B Wang
- Institute of Liver Studies, King's College Hospital, London, UK
| | - G Dusheiko
- Institute of Liver Studies, King's College Hospital, London, UK
| | - K Agarwal
- Institute of Liver Studies, King's College Hospital, London, UK
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15
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Tomitaka A, Arami H, Huang Z, Raymond A, Rodriguez E, Cai Y, Febo M, Takemura Y, Nair M. Hybrid magneto-plasmonic liposomes for multimodal image-guided and brain-targeted HIV treatment. NANOSCALE 2017; 10:184-194. [PMID: 29210401 PMCID: PMC6450097 DOI: 10.1039/c7nr07255d] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Image-guided drug delivery is an emerging strategy in the field of nanomedicine. The addition of image guidance to a traditional drug delivery system is expected to achieve highly efficient treatment by tracking the drug carriers in the body and monitoring their effective accumulation in the targeted tissues. In this study, we developed multifunctional magneto-plasmonic liposomes (MPLs), a hybrid system combining liposomes and magneto-plasmonic nanoparticles for a triple-modality image-guided drug delivery. Tenofovir disoproxil fumarate, an antiretroviral drug used to treat human immunodeficiency virus type 1 (HIV-1), was encapsulated into the MPLs to enable the treatment in the brain microenvironment, which is inaccessible to most of the drugs. We found strong negative and positive contrasts originating from the magnetic core of MPLs in magnetic resonance imaging (MRI) and magnetic particle imaging (MPI), respectively. The gold shell of MPLs showed bright positive contrast in X-ray computed tomography (CT). MPLs achieved enhanced transmigration across an in vitro blood-brain barrier (BBB) model by magnetic targeting. Moreover, MPLs provided desired therapeutic effects against HIV infected microglia cells.
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Affiliation(s)
- Asahi Tomitaka
- Department of Immunology, Institute of NeuroImmune Pharmacology, Centre for Personalized Nanomedicine, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida 33199, USA.
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16
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de Moraes Filho AV, Carvalho CDJS, Carneiro CC, do Vale CR, Lima DCDS, Carvalho WF, Vieira TB, Silva DDME, Cunha KS, Chen-Chen L. Genotoxic and Cytotoxic Effects of Antiretroviral Combinations in Mice Bone Marrow. PLoS One 2016; 11:e0165706. [PMID: 27806085 PMCID: PMC5091838 DOI: 10.1371/journal.pone.0165706] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 10/17/2016] [Indexed: 01/10/2023] Open
Abstract
Commonly used guidelines for the management of human immunodeficiency virus (HIV) infection (highly active antiretroviral therapy, HAART) include drug combinations such as tenofovir disoproxil fumarate (TDF) + lamivudine (3TC) and combivir [zidovudine (AZT) + 3TC] + efavirenz (EFV). These combinations may enhance the genotoxic effects induced by such drugs individually, since the therapy requires lifelong adherence and the drugs have unknown effects during treatment. Thus, the evaluation of the benefits and risks of HAART is of great importance. In order to assess the cytotoxic and genotoxic potential of three concentrations of each of the antiretroviral combinations TDF + 3TC (800 + 400, 1600 + 800, and 3200 + 1600 mg/kg body weight, BW) and combivir + EFV (200 + 100 + 400, 400 + 200 + 800, and 800 + 400 + 1600 mg/kg BW) after two exposure periods (24 h and 48 h), in the present study the in vivo comet assay (single-cell gel electrophoresis) and the mouse bone marrow micronucleus test were used. Neither TDF + 3TC nor combivir + EFV induced DNA damage at any concentrations tested after 24 h or 48 h using the comet assay. After 24 h, both combinations increased the micronucleus frequency at all concentrations tested. After 48 h, combivir + EFV increased the micronucleated polychromatic erythrocyte (MNPCE) frequency at the two highest concentrations tested. Polychromatic erythrocytes (PCE)/normochromatic erythrocytes (NCE) ratio was high for both combinations, suggesting that they can be mitogenic. Since genotoxicity may be related to carcinogenesis, it is necessary to conduct further studies to verify the long-term mutagenic effects of these drugs.
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Affiliation(s)
- Aroldo Vieira de Moraes Filho
- Laboratório de Radiobiologia e Mutagênese, Departamento de Genética, Instituto de Ciências Biológicas (ICB), Campus Samambaia, Universidade Federal de Goiás (UFG), Caixa Postal 131, 74001–970, Goiânia, GO, Brazil
- * E-mail:
| | - Cláudia de Jesus Silva Carvalho
- Laboratório de Radiobiologia e Mutagênese, Departamento de Genética, Instituto de Ciências Biológicas (ICB), Campus Samambaia, Universidade Federal de Goiás (UFG), Caixa Postal 131, 74001–970, Goiânia, GO, Brazil
| | - Cristiene Costa Carneiro
- Laboratório de Radiobiologia e Mutagênese, Departamento de Genética, Instituto de Ciências Biológicas (ICB), Campus Samambaia, Universidade Federal de Goiás (UFG), Caixa Postal 131, 74001–970, Goiânia, GO, Brazil
| | - Camila Regina do Vale
- Laboratório de Radiobiologia e Mutagênese, Departamento de Genética, Instituto de Ciências Biológicas (ICB), Campus Samambaia, Universidade Federal de Goiás (UFG), Caixa Postal 131, 74001–970, Goiânia, GO, Brazil
| | - Débora Cristina da Silva Lima
- Laboratório de Radiobiologia e Mutagênese, Departamento de Genética, Instituto de Ciências Biológicas (ICB), Campus Samambaia, Universidade Federal de Goiás (UFG), Caixa Postal 131, 74001–970, Goiânia, GO, Brazil
| | - Wanessa Fernandes Carvalho
- Laboratório de Radiobiologia e Mutagênese, Departamento de Genética, Instituto de Ciências Biológicas (ICB), Campus Samambaia, Universidade Federal de Goiás (UFG), Caixa Postal 131, 74001–970, Goiânia, GO, Brazil
| | - Thiago Bernardi Vieira
- Programa de Pós-Graduação em Ecologia e Conservação, Universidade do Estado de Mato Grosso, Campus Universitário de Nova Xavantina, BR 158, Caixa Postal 8, 78.690–000, Nova Xavantina, MT, Brazil
| | - Daniela de Melo e Silva
- Laboratório de Radiobiologia e Mutagênese, Departamento de Genética, Instituto de Ciências Biológicas (ICB), Campus Samambaia, Universidade Federal de Goiás (UFG), Caixa Postal 131, 74001–970, Goiânia, GO, Brazil
| | - Kênya Silva Cunha
- Laboratório de Radiobiologia e Mutagênese, Departamento de Genética, Instituto de Ciências Biológicas (ICB), Campus Samambaia, Universidade Federal de Goiás (UFG), Caixa Postal 131, 74001–970, Goiânia, GO, Brazil
| | - Lee Chen-Chen
- Laboratório de Radiobiologia e Mutagênese, Departamento de Genética, Instituto de Ciências Biológicas (ICB), Campus Samambaia, Universidade Federal de Goiás (UFG), Caixa Postal 131, 74001–970, Goiânia, GO, Brazil
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17
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Wu D, Ensinas A, Verrier B, Primard C, Cuvillier A, Champier G, Paul S, Delair T. Zinc-Stabilized Chitosan-Chondroitin Sulfate Nanocomplexes for HIV-1 Infection Inhibition Application. Mol Pharm 2016; 13:3279-91. [PMID: 27454202 DOI: 10.1021/acs.molpharmaceut.6b00568] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Polyelectrolyte complexes (PECs) constituted of chitosan and chondroitin sulfate (ChonS) were formed by the one-shot addition of default amounts of polyanion to an excess of polycation. Key variables of the formulation process (e.g., degree of depolymerization, charge mixing ratio, the concentration, and pH of polyelectrolyte solutions) were optimized based on the PECs sizes and polydispersities. The PECs maintained their colloidal stability at physiological salt concentration and pH thanks to the complexation of polyelectrolytes with zinc(II) ion during the nanoPECs formation process. The PECs were capable of encapsulating an antiretroviral drug tenofovir (TF) with a minimal alteration on the colloidal stability of the dispersion. Moreover, the particle interfaces could efficiently be functionalized with anti-OVA or anti-α4β7 antibodies with conservation of the antibody biorecognition properties over 1 week of storage in PBS at 4 °C. In vitro cytotoxicity studies showed that zinc(II) stabilized chitosan-ChonS nanoPECs were noncytotoxic to human peripheral blood mononuclear cells (PBMCs), and in vitro antiviral activity test demonstrated that nanoparticles formulations led to a dose-dependent reduction of HIV-1 infection. Using nanoparticles as a drug carrier system decreases the IC50 (50% inhibitory concentration) from an aqueous TF of 4.35 μmol·L(-1) to 1.95 μmol·L(-1). Significantly, zinc ions in this system also exhibited a synergistic effect in the antiviral potency. These data suggest that chitosan-ChonS nanoPECs can be promising drug delivery system to improve the antiviral potency of drugs to the viral reservoirs for the treatment of HIV infection.
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Affiliation(s)
- Danjun Wu
- Ingénierie des Matériaux Polymères, UMR CNRS 5223, Université Claude Bernard Lyon 1 , 15 Bd. André Latarjet, 69622 Villeurbanne Cedex, France
| | - Agathe Ensinas
- Institut de Biologie et Chimie des Protéines UMR 5305, CNRS/Université de Lyon , 69367 Lyon Cedex 07, France
| | - Bernard Verrier
- Institut de Biologie et Chimie des Protéines UMR 5305, CNRS/Université de Lyon , 69367 Lyon Cedex 07, France
| | | | | | - Gaël Champier
- B-Cell Design , 98 Rue Charles Legendre, 87000 Limoges, France
| | - Stephane Paul
- Groupe Immunité des Muqueuses et Agents Pathogènes, INSERM Centre d'Investigation Clinique en Vaccinologie 1408, Université de Lyon , 15 rue Ambroise Paré, 42023 Saint-Etienne Cedex 2, France
| | - Thierry Delair
- Ingénierie des Matériaux Polymères, UMR CNRS 5223, Université Claude Bernard Lyon 1 , 15 Bd. André Latarjet, 69622 Villeurbanne Cedex, France
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18
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Nagiah S, Phulukdaree A, Chuturgoon A. Mitochondrial and Oxidative Stress Response in HepG2 Cells Following Acute and Prolonged Exposure to Antiretroviral Drugs. J Cell Biochem 2015; 116:1939-46. [DOI: 10.1002/jcb.25149] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 02/27/2015] [Indexed: 12/29/2022]
Affiliation(s)
- Savania Nagiah
- Discipline of Medical Biochemistry; School of Laboratory Medicine and Medical Sciences; College of Health Sciences; University of KwaZulu Natal; Durban South Africa
| | - Alisa Phulukdaree
- Department of Physiology; Faculty of Health Science; University of Pretoria; Pretoria South Africa
| | - Anil Chuturgoon
- Discipline of Medical Biochemistry; School of Laboratory Medicine and Medical Sciences; College of Health Sciences; University of KwaZulu Natal; Durban South Africa
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19
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De Clercq E. Potential of acyclic nucleoside phosphonates in the treatment of DNA virus and retrovirus infections. Expert Rev Anti Infect Ther 2014; 1:21-43. [PMID: 15482100 DOI: 10.1586/14787210.1.1.21] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The acyclic nucleoside phosphonates [HPMPC: cidofovir, Vistide; PMEA: adefovir dipivoxil, Hepsera; and PMPA: tenofovir, Viread] have proven to be effective in vitro (cell culture systems) and in vivo (animal models and clinical studies) against a wide variety of DNA virus and retrovirus infections, for example, cidofovir against herpesvirus [herpes simplex virus type 1 and 2, varicella-zoster virus, cytomegalovirus, Epstein-Barr virus, human herpesvirus type 6, 7 and 8), polyoma-, papilloma-, adeno- and poxvirus (variola virus, cowpox virus, vaccinia virus, molluscum contagiosum virus and orf) infections; adefovir against herpesvirus, hepadnavirus [human hepatitis B virus] and retrovirus [HIV type-1 and 2, simian immunodeficiency virus and feline immunodeficiency virus] infections; and tenofovir against both hepadna- and retrovirus infections. Cidofovir has been officially approved for the treatment of cytomegalovirus retinitis in AIDS patients, tenofovir disoproxil fumarate (Viread) for the treatment of HIV infections (i.e., AIDS) and adefovir dipivoxil for the treatment of chronic hepatitis B.
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Affiliation(s)
- Eric De Clercq
- Rega Institute for Medical Research, Minderbroedersstraat 10, B-3000 Leuven, Belgium.
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20
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Romo FT, Aziz M, Livak B, Huesgen E, Colton B, Flanigan TP, Max B, Kessler H. Renal Function Recovery and HIV Viral Suppression Following Tenofovir Discontinuation for Renal Impairment. ACTA ACUST UNITED AC 2014; 5. [PMID: 26097776 DOI: 10.4172/2155-6113.1000379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Tenofovir associated nephrotoxicity (TDFN) is well recognized. This study describes the trend of renal function recovery and virologic consequences after cessation of tenofovir (TDF) for suspected TDFN. METHODS This was a retrospective chart review of 241 patients who underwent HLA-B*5701 allele testing between January 2007-December 2010. Demographics and clinical characteristics were compared at baseline, 3, 6, and 12 month between patients that continued and discontinued TDF. Factors associated with renal function recovery were assessed by multivariable logistic regression. RESULTS Eighty patients were identified with TDFN; 84% male, 74% African American (AA) with a median age of 55 years, and median length of TDF use for 122 weeks. Renal recovery at 12 months differed in those who stopped versus (vs.) continued TDF (83% vs. 57% p=0.03). In a crude analysis, baseline chronic kidney disease was negatively associated with renal recovery (p=0.01). An adjusted analysis showed that those who stopped TDF had 3.76 higher odds of renal recovery compared to those who did not stop TDF (95% CI: 1.26-11.27, p=0.02). There were no significant differences in virologic response after switching TDF to an alternative agent. CONCLUSION In this mostly AA male population with suspected TDFN, discontinuation of TDF was strongly associated with renal function recovery without affecting viral suppression.
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Affiliation(s)
| | - Mariam Aziz
- Rush University Medical Center, Chicago, IL, USA ; Cook County Health and Hospitals System, Chicago, IL, USA
| | - Britt Livak
- Cook County Health and Hospitals System, Chicago, IL, USA
| | | | - Ben Colton
- Resurrection Health Care, Chicago, IL, USA
| | - Timothy P Flanigan
- The Miriam Hospital, Providence, RI, USA ; Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Blake Max
- Ruth M. Rothstein CORE Center, Chicago, IL, USA
| | - Harold Kessler
- Rush University Medical Center, Chicago, IL, USA ; Cook County Health and Hospitals System, Chicago, IL, USA
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BMS-986001, an HIV nucleoside reverse transcriptase inhibitor, does not degrade mitochondrial DNA in long-term primary cultures of cells isolated from human kidney, muscle, and adipose tissue. Antimicrob Agents Chemother 2013; 57:6205-12. [PMID: 24080659 DOI: 10.1128/aac.01206-13] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) remain the cornerstone of HIV treatment; however, they are associated with toxicities attributed in part to inhibition of mitochondrial DNA (mtDNA) polymerase γ. In this study, we compared the in vitro toxicity profiles of structurally similar NRTIs (BMS-986001 to stavudine and tenofovir to adefovir) that differ by the presence of an acetylene or methyl group, respectively. Primary cultures of human renal proximal tubule epithelium, skeletal muscle myotubes, and differentiated adipocytes were exposed to the NRTIs at the maximum concentration (Cmax) reported for the clinically approved dose (investigational dose for BMS-986001, 600 mg) and a high equimolar concentration (200 μM) for 19 days. After 19 days, BMS-986001 did not significantly decrease mtDNA or cell protein at either concentration in any cell line. In contrast, stavudine significantly decreased mtDNA in all cultures (1.5- to 2.5-fold) (except at Cmax in renal cells) and cell protein in renal cells (1.4- to 2.4-fold). By day 19, at 200 μM, tenofovir significantly reduced mtDNA in adipocytes (1.9-fold) and adefovir significantly decreased mtDNA in all cultures (3.7- to 10.2-fold); however, no significant reduction in mtDNA was observed at Cmax in any cell line. Adefovir also significantly reduced cell protein at both concentrations in renal cells (2.2- to 2.8-fold) and at 200 μM in muscle cells (2.0-fold). In conclusion, BMS-986001 and tenofovir were considerably less cytotoxic than their respective structural analogs, demonstrating that small structural differences can contribute to significant differences in toxicity.
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Tenofovir, emtricitabine intracellular and plasma, and efavirenz plasma concentration decay following drug intake cessation: implications for HIV treatment and prevention. J Acquir Immune Defic Syndr 2013; 62:275-81. [PMID: 23274933 DOI: 10.1097/qai.0b013e3182829bd0] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND In vivo data on tenofovir (TFV), emtricitabine (FTC), and efavirenz (EFV) concentration decay after intake cessation are limited; determinations of "true" elimination half-lives (t½) have often been based on suboptimal sampling windows. Understanding these parameters is important in managing missed doses and planning HIV pre-exposure prophylaxis (PrEP). This study investigated the pharmacokinetics (PK) of plasma TFV/FTC, their intracellular (IC) anabolites, TFV-diphosphate (DP) and FTC-triphosphate (TP), and plasma EFV over 10 days after intake cessation in HIV-negative volunteers. METHODS Volunteers received an Atripla (TFV/FTV/EFV) tablet daily for 14 days. PK sampling occurred before final dose and up to 228 hours after stopping. Peripheral blood mononuclear cells for [IC](drug) and [plasma](drug) were isolated, with analysis by tandem mass spectrometry. RESULTS Sixteen participants completed the study. Geometric mean plasma (t½)(228h) of TFV and FTC were 31 and 37 hours. These were longer than the previous reports (TFV 12-18 hours, FTC 10 hours).Geometric mean (t½)(228h) of IC TFV-DP and FTC-TP were 164 and 39 hours, whereas for EFV in plasma was 92 hours. [EFV](plasma) in 5/16 participants were below the suggested MEC of 1000 ng/mL within 48 hours postdose; however, 50% of the participants maintained concentrations above this level after 84 hours. CONCLUSIONS These data fully characterize the PK of TFV and TFV-DP, FTC and FTC-TP, and EFV after stopping the drug combination. Although decay in concentrations can be related to a target for EFV, this is more difficult for the IC phosphates. Consensus on 'target' triphosphate/diphosphate concentrations will further our understanding of missed/delayed doses in treatment and prevention strategies.
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Evaluation of the effect of cobicistat on the in vitro renal transport and cytotoxicity potential of tenofovir. Antimicrob Agents Chemother 2013; 57:4982-9. [PMID: 23896476 DOI: 10.1128/aac.00712-13] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
A once-daily single-tablet antiretroviral regimen containing tenofovir (TFV) disoproxil fumarate, emtricitabine (FTC), elvitegravir (EVG), and cobicistat (COBI) is an approved combination for the treatment of patients infected with HIV. COBI and TFV have been reported to interact with distinct transporters in renal proximal tubules; while TFV is renally eliminated by a combination of glomerular filtration and tubular secretion via anion transporters OAT1, OAT3, and MRP4, COBI inhibits renal cation transporters, particularly MATE1, resulting in a measurable decrease in the tubular secretion of creatinine. To investigate the potential for a renal drug-drug interaction between TFV and COBI in vitro, the uptake of TFV in the presence and absence of COBI was determined in fresh human renal cortex tissue and in cells expressing the relevant renal transporters. At concentrations exceeding clinical protein-unbound plasma levels, COBI did not significantly inhibit the transport of TFV by the anion transporters OAT1, OAT3, and MRP4 (50% inhibitory concentrations [IC50s] of >15, 6.6, and 8.5 μM, respectively). Conversely, TFV had little or no effect on the cation transporters OCT2 and MATE1 (IC50 > 100 μM). Consistent with studies using individual transporters, no increase in the accumulation of TFV in freshly isolated human renal cortex tissue or renal proximal tubule cells (RPTECs) was observed in the presence of COBI. Finally, COBI alone or in combination with FTC and EVG did not affect the sensitivity to TFV of cultured primary RPTECs or cells coexpressing OAT1 and MRP4. These results illustrate that COBI and TFV interact primarily with distinct renal transporters and indicate a low potential for pharmacokinetic renal drug-drug interaction.
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Update on tenofovir toxicity in the kidney. Pediatr Nephrol 2013; 28:1011-23. [PMID: 22878694 DOI: 10.1007/s00467-012-2269-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 07/02/2012] [Accepted: 07/03/2012] [Indexed: 01/09/2023]
Abstract
Tenofovir (TFV) is a widely used and effective treatment for HIV infection. Numerous studies have shown that TFV exposure is associated with small but significant declines in estimated glomerular filtration rate (eGFR). However, TFV toxicity is targeted mainly at the proximal tubule (PT), and in severe cases can cause the renal Fanconi syndrome or acute kidney injury. Severe toxicity occurs in a minority of patients, but milder PT dysfunction is more common; the long-term significance of this on kidney and bone health is uncertain. Recent work suggests that changes in eGFR on TFV therapy might be explained by inhibition of PT creatinine secretion rather than actual alterations in glomerular function. Risk factors for nephrotoxicity include pre-existing kidney disease, increased age, and low body mass. Mitochondria in the PT are the targets of TFV toxicity, but the exact mechanisms remain unclear. Substantial improvement of renal function occurs in many patients with TFV toxicity upon stopping therapy, but function does not always return to baseline. In recent years, TFV usage has been extended to new clinical spheres, including pediatrics, resource-poor settings and treatment of hepatitis B infection; theoretical reasons exist as to why some of these patients might be at higher or lower risk of TFV toxicity. Finally, strategies have been proposed to prevent TFV toxicity or enhance recovery.
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26
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Hukezalie KR, Thumati NR, Côté HCF, Wong JMY. In vitro and ex vivo inhibition of human telomerase by anti-HIV nucleoside reverse transcriptase inhibitors (NRTIs) but not by non-NRTIs. PLoS One 2012; 7:e47505. [PMID: 23166583 PMCID: PMC3499584 DOI: 10.1371/journal.pone.0047505] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2012] [Accepted: 09/14/2012] [Indexed: 02/03/2023] Open
Abstract
Telomerase is a specialized reverse transcriptase responsible for the de novo synthesis of telomeric DNA repeats. In addition to its established reverse transcriptase and terminal transferase activities, recent reports have revealed unexpected cellular activities of telomerase, including RNA-dependent RNA polymerization. This telomerase characteristic, distinct from other reverse transcriptases, indicates that clinically relevant reverse transcriptase inhibitors might have unexpected telomerase inhibition profiles. This is particularly important for the newer generation of RT inhibitors designed for anti-HIV therapy, which have reported higher safety margins than older agents. Using an in vitro primer extension assay, we tested the effects of clinically relevant HIV reverse transcriptase inhibitors on cellular telomerase activity. We observed that all commonly used nucleoside reverse transcriptase inhibitors (NRTIs), including zidovudine, stavudine, tenofovir, didanosine and abacavir, inhibit telomerase effectively in vitro. Truncated telomere synthesis was consistent with the expected mode of inhibition by all tested NRTIs. Through dose-response experiments, we established relative inhibitory potencies of NRTIs on in vitro telomerase activity as compared to the inhibitory potencies of the corresponding dideoxynucleotide triphosphates. In contrast to NRTIs, the non-nucleoside reverse transcriptase inhibitors (NNRTIs) nevirapine and efavirenz did not inhibit the primer extension activity of telomerase, even at millimolar concentrations. Long-term, continuous treatment of human HT29 cells with select NRTIs resulted in an accelerated loss of telomere repeats. All tested NRTIs exhibited the same rank order of inhibitory potencies on telomerase and HIV RT, which, according to published data, were orders-of-magnitude more sensitive than other DNA polymerases, including the susceptible mitochondria-specific DNA polymerase gamma. We concluded that telomerase activity could be inhibited by common NRTIs, including currently recommended RTI agents tenofovir and abacavir, which warrants large-scale clinical and epidemiological investigation of the off-target effects of long-term highly active antiretroviral therapy (HAART) with these agents.
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Affiliation(s)
- Kyle R. Hukezalie
- Genetics Graduate Program, The University of British Columbia, Vancouver, British Columbia, Canada
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Naresh R. Thumati
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Hélène C. F. Côté
- Genetics Graduate Program, The University of British Columbia, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine (HCFC), The University of British Columbia, Vancouver, British Columbia, Canada
| | - Judy M. Y. Wong
- Genetics Graduate Program, The University of British Columbia, Vancouver, British Columbia, Canada
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
- * E-mail:
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Buti M, Homs M. Tenofovir disoproxil fumarate in the treatment of chronic hepatitis B. Expert Rev Gastroenterol Hepatol 2012; 6:413-21. [PMID: 22928893 DOI: 10.1586/egh.12.19] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The specific drugs available for chronic hepatitis B infection include standard and pegylated IFN-α, and nucleoside/nucleotide analogs that directly inhibit the reverse transcriptase. The main goal of current hepatitis B virus therapy is to achieve sustained suppression of viral replication to prevent the development of chronic liver disease, but favorable long-term tolerability and resistance profiles are also desirable. This article reviews the chemistry and the mechanisms of action of tenofovir disoproxil fumarate, but it also focuses on the related clinical trails designed to date, in which clinical efficacy has been analyzed attending to HBe antigen status. In addition, studies including patients that have been previously treated with lamivudine or adefovir are discussed.
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Affiliation(s)
- Maria Buti
- CIBERehd, Instituto Carlos III, Madrid, Spain.
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Le Douce V, Janossy A, Hallay H, Ali S, Riclet R, Rohr O, Schwartz C. Achieving a cure for HIV infection: do we have reasons to be optimistic? J Antimicrob Chemother 2012; 67:1063-74. [PMID: 22294645 PMCID: PMC3324423 DOI: 10.1093/jac/dkr599] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The introduction of highly active antiretroviral therapy (HAART) in 1996 has transformed a lethal disease to a chronic pathology with a dramatic decrease in mortality and morbidity of AIDS-related symptoms in infected patients. However, HAART has not allowed the cure of HIV infection, the main obstacle to HIV eradication being the existence of quiescent reservoirs. Several other problems have been encountered with HAART (such as side effects, adherence to medication, emergence of resistance and cost of treatment), and these motivate the search for new ways to treat these patients. Recent advances hold promise for the ultimate cure of HIV infection, which is the topic of this review. Besides these new strategies aiming to eliminate the virus, efforts must be made to improve current HAART. We believe that the cure of HIV infection will not be attained in the short term and that a strategy based on purging the reservoirs has to be associated with an aggressive HAART strategy.
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Affiliation(s)
- Valentin Le Douce
- University of Strasbourg, EA4438, Institute of Parasitology, Strasbourg, France
| | - Andrea Janossy
- University of Strasbourg, EA4438, Institute of Parasitology, Strasbourg, France
| | - Houda Hallay
- University of Strasbourg, EA4438, Institute of Parasitology, Strasbourg, France
| | - Sultan Ali
- University of Strasbourg, EA4438, Institute of Parasitology, Strasbourg, France
| | - Raphael Riclet
- University of Strasbourg, EA4438, Institute of Parasitology, Strasbourg, France
| | - Olivier Rohr
- University of Strasbourg, EA4438, Institute of Parasitology, Strasbourg, France
- IUT de Schiltigheim, 1 Allée d'Athènes, 67300 Schiltigheim, France
- Institut Universitaire de France, 103 Bd Saint Michel, Paris, France
| | - Christian Schwartz
- University of Strasbourg, EA4438, Institute of Parasitology, Strasbourg, France
- IUT de Schiltigheim, 1 Allée d'Athènes, 67300 Schiltigheim, France
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Ryom L, Mocroft A, Lundgren J. HIV Therapies and the Kidney: Some Good, Some Not So Good? Curr HIV/AIDS Rep 2012; 9:111-20. [DOI: 10.1007/s11904-012-0110-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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30
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Affiliation(s)
- Wei Shen
- a TSRL Inc. , Ann Arbor , Michigan , USA
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31
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Cherrier T, Elias M, Jeudy A, Gotthard G, Le Douce V, Hallay H, Masson P, Janossy A, Candolfi E, Rohr O, Chabrière E, Schwartz C. Human-Phosphate-Binding-Protein inhibits HIV-1 gene transcription and replication. Virol J 2011; 8:352. [PMID: 21762475 PMCID: PMC3157455 DOI: 10.1186/1743-422x-8-352] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 07/15/2011] [Indexed: 01/04/2023] Open
Abstract
The Human Phosphate-Binding protein (HPBP) is a serendipitously discovered lipoprotein that binds phosphate with high affinity. HPBP belongs to the DING protein family, involved in various biological processes like cell cycle regulation. We report that HPBP inhibits HIV-1 gene transcription and replication in T cell line, primary peripherical blood lymphocytes and primary macrophages. We show that HPBP is efficient in naïve and HIV-1 AZT-resistant strains. Our results revealed HPBP as a new and potent anti HIV molecule that inhibits transcription of the virus, which has not yet been targeted by HAART and therefore opens new strategies in the treatment of HIV infection.
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Affiliation(s)
- Thomas Cherrier
- Institut de Parasitologie et Pathologie Tropicale, EA 4438, Université de Strasbourg, 3 rue Koeberlé, 67000 Strasbourg, France
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Rodriguez-Nóvoa S, Alvarez E, Labarga P, Soriano V. Renal toxicity associated with tenofovir use. Expert Opin Drug Saf 2010; 9:545-59. [PMID: 20384533 DOI: 10.1517/14740331003627458] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
IMPORTANCE OF THE FIELD Tenofovir (TFV) is a nucleotide analogue widely used for the treatment of HIV infection. Despite its proven efficacy and safety, cases of kidney tubular dysfunction have increasingly been reported and concern exists about the risk of nephrotoxicity associated with the long-term use of TFV. AREAS COVERED IN THIS REVIEW Evidences about the renal toxicity associated with TFV use as well as predictors are examined. The most relevant publications assessing TFV safety and those which have reported cases of tubular dysfunction were identified and carefully revised. WHAT THE READER WILL GAIN Renal damage of clinical significance caused by TFV is uncommon in the short-mid-term. It occurs more frequently in subjects with underlying kidney conditions. TFV primarily results in kidney tubular dysfunction and less frequently in glomerular abnormalities. Kidney damage may progress over time under long-term TFV exposure but is reversible in most cases on drug discontinuation. TAKE HOME MESSAGE Severe renal damage associated with TFV use is uncommon and of multifactorial origin. However, mild tubular dysfunction is recognized in a substantial proportion of TFV-treated individuals and tends to increase with cumulative exposure.
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Affiliation(s)
- Sonia Rodriguez-Nóvoa
- Hospital Carlos III, Pharmacokinetic & Pharmacogenetic Unit, Department of Infectious Diseases, Calle Sinesio Delgado 10, Madrid 28029, Spain
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Abstract
Highly active antiretroviral therapy (HAART) has had a profound impact on improving the long-term prognosis for individuals infected with human immunodeficiency virus (HIV). HAART has been available for close to two decades, and now a significant number of patients with access to HAART are over the age of 50 years. Many clinical studies have indicated that HIV infection, as well as components of HAART, can increase the risk in these individuals to a variety of noninfectious complications, including a risk to bone health. There is a significant need for detailed mechanistic analysis of the aging, HIV-infected population regarding the risk of HIV infection and therapy in order to maintain bone health. Insights from basic mechanistic studies will help to shed light on the role of HIV infection and the components of HAART that impact bone health, and will help in identifying preventative countermeasures, particularly for individuals 50 years of age and older.
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Affiliation(s)
- Kim C Mansky
- Division of Orthodontics, Department of Developmental and Surgical Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN 55455, USA.
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Zidan AS, Spinks C, Fortunak J, Habib M, Khan MA. Near-infrared investigations of novel anti-HIV tenofovir liposomes. AAPS JOURNAL 2010; 12:202-14. [PMID: 20195931 DOI: 10.1208/s12248-010-9177-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2009] [Accepted: 01/28/2010] [Indexed: 11/30/2022]
Abstract
Near-infrared (NIR) approaches is considered one of the most well-studied process analyzers evolving from the process analytical technology initiatives. The objective of this study was to evaluate NIR spectroscopy and imaging to assess individual components within a novel tenofovir liposomal formulation. By varying stearylamine, as a positive charge imparting agent, five batches were prepared by the thin film method. Each formulation was characterized in terms of drug entrapment efficiency, release characteristics, particle sizing, and zeta potential. Drug excipients compatibility was tested using Fourier transform infrared spectroscopy, differential scanning calorimetry, and X-ray diffraction. The obtained results showed an increase in drug entrapment and a slower drug release by increasing the incorporated percentage of stearylamine. The compatibility testing revealed a significant interaction between the drug and some of the investigated excipients. The developed NIR calibration model was able to assess drug, phospholipid, and stearylamine levels along the batches. The calibration and prediction plots were linear with correlation coefficients of more than 0.9. The root square standard errors of calibration and prediction did not attain 5% of the measured values confirming the accuracy of the model. In contrast, NIR spectral imaging was capable of clearly distinguishing the different batches, both qualitatively and quantitatively. A linear relationship was obtained correlating the actual drug entrapped and the predicted values obtained from the partial least squares images.
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Affiliation(s)
- Ahmed S Zidan
- Division of Product Quality Research, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
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Grigsby IF, Pham L, Mansky LM, Gopalakrishnan R, Carlson AE, Mansky KC. Tenofovir treatment of primary osteoblasts alters gene expression profiles: implications for bone mineral density loss. Biochem Biophys Res Commun 2010; 394:48-53. [PMID: 20171173 DOI: 10.1016/j.bbrc.2010.02.080] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Accepted: 02/12/2010] [Indexed: 11/20/2022]
Abstract
There is strong clinical evidence that implicates tenofovir in the loss of bone mineral density during treatment of human immunodeficiency virus infection. In this study, we sought to test the hypothesis that tenofovir treatment of osteoblasts causes changes in the gene expression profile that would impact osteoblast function during bone formation. Primary osteoblasts were isolated and then treated with the tenofovir prodrug, tenofovir disoproxil fumarate (TDF). Total RNA from TDF-treated and untreated osteoblasts were extracted and used for microarray analysis to assess TDF-associated changes in the gene expression profile. Strikingly, the changes in gene expression profiles involved in cell signaling, cell cycle and amino acid metabolism, which would likely impact osteoblast function in bone formation. Our findings demonstrate for the first time that tenofovir treatment of primary osteoblasts results in gene expression changes that implicate loss of osteoblast function in tenofovir-associated bone mineral density loss.
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Affiliation(s)
- Iwen F Grigsby
- Division of Orthodontics, School of Dentistry, University of Minnesota, Minneapolis, MN 55455, USA
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Mehellou Y, Balzarini J, McGuigan C. Aryloxy phosphoramidate triesters: a technology for delivering monophosphorylated nucleosides and sugars into cells. ChemMedChem 2010; 4:1779-91. [PMID: 19760699 DOI: 10.1002/cmdc.200900289] [Citation(s) in RCA: 168] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Prodrug technologies aimed at delivering nucleoside monophosphates into cells (protides) have proved to be effective in improving the therapeutic potential of antiviral and anticancer nucleosides. In these cases, the nucleoside monophosphates are delivered into the cell, where they may then be further converted (phosphorylated) to their active species. Herein, we describe one of these technologies developed in our laboratories, known as the phosphoramidate protide method. In this approach, the charges of the phosphate group are fully masked to provide efficient passive cell-membrane penetration. Upon entering the cell, the masking groups are enzymatically cleaved to release the phosphorylated biomolecule. The application of this technology to various therapeutic nucleosides has resulted in improved antiviral and anticancer activities, and in some cases it has transformed inactive nucleosides to active ones. Additionally, the phosphoramidate technology has also been applied to numerous antiviral nucleoside phosphonates, and has resulted in at least three phosphoramidate-based nucleotides progressing to clinical investigations. Furthermore, the phosphoramidate technology has been recently applied to sugars (mainly glucosamine) in order to improve their therapeutic potential. The development of the phosphoramidate technology, mechanism of action and the application of the technology to various monophosphorylated nucleosides and sugars will be reviewed.
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Grigsby IF, Pham L, Gopalakrishnan R, Mansky LM, Mansky KC. Downregulation of Gnas, Got2 and Snord32a following tenofovir exposure of primary osteoclasts. Biochem Biophys Res Commun 2009; 391:1324-9. [PMID: 20026012 DOI: 10.1016/j.bbrc.2009.12.039] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Accepted: 12/09/2009] [Indexed: 11/30/2022]
Abstract
Clinical observations have implicated the antiretroviral drug tenofovir with bone density loss during the management of HIV infection. The goal of this study was to investigate the in vitro effects of tenofovir exposure of primary osteoclasts in order to gain insights into the potential mechanisms for the drug-induced bone density loss. We hypothesized that tenofovir may alter the expression of key genes involved in osteoclast function. To test this, primary osteoclasts were exposed to physiologically relevant concentrations of the prodrug tenofovir disoproxil fumarate (TDF), then intensive microarray analysis was done to compare tenofovir-treated versus untreated cells. Specific downregulation of Gnas, Got2 and Snord32a were observed in the TDF-treated cells. The functions of these genes help to explain the basis for tenofovir-associated bone density loss. Our studies represent the first analysis of the effects of tenofovir on osteoclast gene expression and help to explain the basis of tenofovir-associated bone density loss in HIV-infected individuals.
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Affiliation(s)
- Iwen F Grigsby
- Division of Orthodontics, School of Dentistry, University of Minnesota, Minneapolis, MN 55455, USA
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Rodriguez-Novoa S, Labarga P, Soriano V. Pharmacogenetics of tenofovir treatment. Pharmacogenomics 2009; 10:1675-85. [DOI: 10.2217/pgs.09.115] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Tenofovir disoproxil fumarate (TDF) is a nucleotide analog used as part of HIV therapy. Its favorable profile in terms of high efficacy, low toxicity and once-daily dosing makes TDF one of the most attractive antiretroviral agents, and therefore, it is widely used. However, cases of kidney tubular dysfunction have been reported and concern exists regarding the long term use of TDF. Owing to the high interindividual variability in the presentation of kidney function abnormalities, research has recently focused on host genetic factors predisposing to TDF-associated renal dysfunction. Transporter proteins involved in the renal elimination of TDF, such as organic anion transporter 1 or multidrug resistant protein 2 or 4, seem to be involved importantly and several genetic polymorphisms in these proteins have been associated with an increased risk of kidney tubulopathy in patients treated with TDF. In this review, all relevant pharmacogenetic factors that may play a role in the risk of renal toxicity associated with the use of tenofovir are summarized.
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Affiliation(s)
- Sonia Rodriguez-Novoa
- Pharmacokinetic & Pharmacogenetic Unit, Department of Infectious Diseases, Hospital Carlos III, C/ Sinesio Delgado № 10, CP: 28029, Madrid, Spain
| | - Pablo Labarga
- Pharmacokinetic & Pharmacogenetic Unit, Department of Infectious Diseases, Hospital Carlos III, C/ Sinesio Delgado № 10, CP: 28029, Madrid, Spain
| | - Vincent Soriano
- Pharmacokinetic & Pharmacogenetic Unit, Department of Infectious Diseases, Hospital Carlos III, C/ Sinesio Delgado № 10, CP: 28029, Madrid, Spain
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Bagnis CI, Karie S, Deray G, Essig M. Hypophosphataemia: An Easy Strategy for Diagnosis and Treatment in HIV Patients. Antivir Ther 2009. [DOI: 10.1177/135965350901400404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Because HIV infection has become a chronic disease, it is crucial that metabolic complications secondary to HIV infection or prolonged therapy be diagnosed and managed appropriately over time. Therefore the optimal follow-up becomes complex and time consuming. Our review aimed to provide physicians in charge of HIV-infected patients with key data helping them to diagnose and understand hypophosphataemia in HIV patients. Hypophosphataemia is frequent and sometimes secondary to renal phosphate wasting. It is very rarely a component of a complex proximal tubular disorder, such as Fanconi syndrome. When isolated, hypophosphataemia is easy to rule out and treat. In rare cases, prolonged hypophosphataemia, when related to renal phosphate wasting and tubular dysfunction, might have potential consequences on bone outcome, however, more studies are needed. HIV infection by itself might be a risk factor for bone metabolism abnormalities; antiretroviral drugs might also be involved. Therefore, it seems valuable for patients that the minimal screening should be performed routinely, in order to prevent long-term disabilities.
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Affiliation(s)
| | - Svetlana Karie
- Nephrology Department, Pitie Salpetriere Hospital, Paris, France
| | - Gilbert Deray
- Nephrology Department, Pitie Salpetriere Hospital, Paris, France
| | - Marie Essig
- Nephrology Department, Dupuytren Hospital, Limoges, France
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Reynaud L, Carleo MA, Talamo M, Borgia G. Tenofovir and its potential in the treatment of hepatitis B virus. Ther Clin Risk Manag 2009; 5:177-85. [PMID: 19436619 PMCID: PMC2697525 DOI: 10.2147/tcrm.s3335] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Recent literature is reviewed about treatment of chronic hepatitis B virus (CHB), focusing on tenofovir disoproxil fumarate (TDF; Viread®), among the nucleotide and nucleoside analogs. TDF pharmacokinetics and pharmacodynamics, activity in respect of hepatitis B virus (HBV) multi-drug-resistant mutations, efficacy in treatment-naïve and treatment-experienced patients, and side effects are described. The most predictive response factors to TDF therapy are discussed and all available combination therapies to optimize clinical outcome in the various patient profiles are analyzed, such as compensated and/or decompensated cirrhotic patients. The use of TDF in pregnancy, and prophylaxis after exposure to HBV and post-liver transplantation are also evaluated.
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Affiliation(s)
- Laura Reynaud
- Department of Public Medicine and Social Security - Section of Infectious Disease University of Naples "Federico II", Italy
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Marfo K, Garala M, Kvetan V, Gasperino J. Use of Tris-hydroxymethyl aminomethane in severe lactic acidosis due to highly active antiretroviral therapy: a case report. J Clin Pharm Ther 2009; 34:119-23. [PMID: 19125910 DOI: 10.1111/j.1365-2710.2008.00977.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Lactic acidosis is a rare, yet life-threatening adverse drug effect of highly active antiretroviral therapy (HAART), specifically stavudine and lamivudine. These nucleoside analogue reverse transcriptase inhibitors (NRTIs) are commonly used to treat patients infected with the human immunodeficiency virus (HIV). CASE We report the use of Tris-hydroxymethyl aminomethane (THAM) to treat severe lactic acidosis due to HAART in a 50-year-old African-American woman. NRTIs can cause hyperlactinaemia by interfering with mitochondrial oxidative phosphorylation function, which normally removes H(+) generated by the hydrolysis of adenosine triphosphate. This side-effect is associated with a high mortality in patients infected with HIV. One explanation for this high mortality is that lactic acidosis is typically refractory to treatment with commonly used buffering agents. CONCLUSION THAM generates serum bicarbonate, and reduces the level of carbon dioxide in arterial blood. Both of these qualities appear to make THAM an ideal agent for treating lactic acidosis caused by HAART.
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Affiliation(s)
- K Marfo
- Department of Pharmacy Montefiore Medical Center, Bronx, NY, USA
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42
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Miralles Alvarez C. [Are all analogue combinations equal?]. Enferm Infecc Microbiol Clin 2009; 26 Suppl 8:38-44. [PMID: 19195437 DOI: 10.1157/13126271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The huge improvement in the therapeutic arsenal for HIV infection has led to HIV becoming a chronic disease. Like us, our patients are aging and their life expectancy is close to that of the general population. Consequently, we need safe, easily administered drugs with interactions that can be controlled and the least possible impact on highly prevalent comorbidities such as atherosclerosis or coinfection with hepatotropic viruses. Drugs should fit the patient's lifestyle without affecting quality of life and, above all, be free of effects leading to stigma, such as lipoatrophy, a major concern for most recently diagnosed patients. The choice of the two nucleoside analogue reverse transcriptase inhibitors used at the start of antiretroviral therapy should be based on careful evaluation of the abundant data accumulated on all these determining factors which are heralding a new era in the control of HIV infection. Thus, in this scenario, thymidine analogues have been relegated to alternative use. Fixeddose combinations of tenofovir and emtricitabine (TDF/FTC) or abacavir and lamivudine (ABC/3TC) are the backbone of choice when initiating antiretroviral therapy. Direct comparative data are still scarce but suggest similar virological efficacy, with highly preliminary data suggesting some disadvantages associated with the use of ABC/3TC. After excluding patients at risk of hypersensitivity to ABC, both combinations are well tolerated, but TDF/FTC is associated with a better lipid profile. Recent data from the Data Collection on Adverse Events of Anti-HIV drugs (DAD) study show an unexpected association of ABC with increased cardiovascular risk and thus more detailed studies are required.
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Affiliation(s)
- Celia Miralles Alvarez
- Consulta de VIH. Unidad de Enfermedades Infecciosas. CHU. Xeral-Cíes. Complejo Hospitalario Universitario de Vigo. Vigo. Pontevedra. España.
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Abstract
With the introduction of combination antiretroviral therapy, there have been substantial declines in both morbidity and mortality associated with human immunodeficiency virus (HIV)-1 infection. However, data increasingly indicate that HIV-1-infected individuals are faced with accelerated rates of chronic diseases that afflict the general population such as diabetes mellitus, hypertension, and dyslipidemia, as well as cardiovascular, liver, and kidney diseases. Furthermore, this population is exposed to a variety of adverse effects from long-term use of antiretroviral medications, which may cause clinically important renal toxicities. However, it often is challenging to distinguish antiretroviral-related renal toxicity from either direct effects of HIV-1 on the kidney or from a multitude of non-HIV-related kidney diseases. A timely and coordinated effort by the HIV primary provider and a nephrologist is likely to facilitate the evaluation of HIV-1-infected patients with new kidney problems.
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Affiliation(s)
- Mohamed G Atta
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Wendelsdorf KV, Song Z, Cao Y, Samuels DC. An analysis of enzyme kinetics data for mitochondrial DNA strand termination by nucleoside reverse transcription inhibitors. PLoS Comput Biol 2009; 5:e1000261. [PMID: 19132079 PMCID: PMC2603287 DOI: 10.1371/journal.pcbi.1000261] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2008] [Accepted: 11/26/2008] [Indexed: 01/06/2023] Open
Abstract
Nucleoside analogs used in antiretroviral treatment have been associated with mitochondrial toxicity. The polymerase-γ hypothesis states that this toxicity stems from the analogs' inhibition of the mitochondrial DNA polymerase (polymerase-γ) leading to mitochondrial DNA (mtDNA) depletion. We have constructed a computational model of the interaction of polymerase-γ with activated nucleoside and nucleotide analog drugs, based on experimentally measured reaction rates and base excision rates, together with the mtDNA genome size, the human mtDNA sequence, and mitochondrial dNTP concentrations. The model predicts an approximately 1000-fold difference in the activated drug concentration required for a 50% probability of mtDNA strand termination between the activated di-deoxy analogs d4T, ddC, and ddI (activated to ddA) and the activated forms of the analogs 3TC, TDF, AZT, FTC, and ABC. These predictions are supported by experimental and clinical data showing significantly greater mtDNA depletion in cell culture and patient samples caused by the di-deoxy analog drugs. For zidovudine (AZT) we calculated a very low mtDNA replication termination probability, in contrast to its reported mitochondrial toxicity in vitro and clinically. Therefore AZT mitochondrial toxicity is likely due to a mechanism that does not involve strand termination of mtDNA replication. While HIV/AIDS therapy is very successful at controlling HIV infection, the therapy must continue for the remainder of the patient's life. Approximately one-fourth of these patients suffer from serious drug toxicity problems. It is generally believed that the toxicity of these drugs is caused by damage to mitochondria, the “power plants” of every cell. But we do not know exactly how this damage occurs. The most common explanation is that these drugs damage mitochondria in the same way that they control the virus, by interfering with DNA replication. We tested that idea by analyzing data for the interaction of several AIDS drugs with the mitochondrial DNA polymerase, the protein responsible for copying mitochondrial DNA. By using a detailed simulation of the mitochondrial DNA polymerase, we show that some of these drugs do interact well enough with the mitochondrial DNA polymerase to lead to toxic effects. However, many of these drugs, including the commonly used drug AZT, had very little toxic effect in this simulation although AZT often causes toxicity in patients. This indicates that the toxicity of AZT occurs through some other process and not through the direct interruption of mitochondrial DNA replication.
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Affiliation(s)
- Katherine V. Wendelsdorf
- Virginia Bioinformatics Institute, Virginia Polytechnic Institute and State University, Virginia, United States of America
| | - Zhuo Song
- Virginia Bioinformatics Institute, Virginia Polytechnic Institute and State University, Virginia, United States of America
| | - Yang Cao
- Department of Computer Science, Virginia Polytechnic Institute and State University, Virginia, United States of America
| | - David C. Samuels
- Virginia Bioinformatics Institute, Virginia Polytechnic Institute and State University, Virginia, United States of America
- The Center for Human Genetics Research, Department of Molecular Physiology and Biophysics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- * E-mail:
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45
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Harris M. Nephrotoxicity associated with antiretroviral therapy in HIV-infected patients. Expert Opin Drug Saf 2008; 7:389-400. [PMID: 18613803 DOI: 10.1517/14740338.7.4.389] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND With the success of modern antiretroviral therapies in increasing longevity of patients with HIV infection, chronic conditions including renal disease have assumed a greater importance in patient management. Some antiretroviral therapies have themselves been identified to have clinically significant nephrotoxicity. OBJECTIVE To review the risk factors and mechanisms for renal toxicity of antiretroviral drugs, and their impact on the clinical management of patients with HIV. METHODS Current literature and HIV treatment guidelines are reviewed. RESULTS/CONCLUSIONS Background rates of renal disease and associated risk factors are significant in the HIV clinic population, and renal function should be assessed in all HIV-infected patients. Modern HIV treatment regimens have a relatively low but clinically significant nephrotoxic potential; therefore, renal function should be evaluated on an ongoing basis in patients receiving antiretroviral therapy.
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Fine DM, Perazella MA, Lucas GM, Atta MG. Renal disease in patients with HIV infection: epidemiology, pathogenesis and management. Drugs 2008; 68:963-80. [PMID: 18457462 DOI: 10.2165/00003495-200868070-00006] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
With the introduction of highly active antiretroviral therapy, we have witnessed prolonged survival with the potential for normal life expectancy in HIV-infected individuals. With improved survival and increasing age, HIV-infected patients are increasingly likely to experience co-morbidities that affect the general population, including kidney disease. Although HIV-associated nephropathy, the most ominous kidney disease related to the direct effects of HIV, may be prevented and treated with antiretrovirals, kidney disease remains an important issue in this population. In addition to the common risk factors for kidney disease of diabetes mellitus and hypertension, HIV-infected individuals have a high prevalence of other risk factors, including hepatitis C, cigarette smoking and injection drug use. Furthermore, they have exposures unique to this population, including antiretrovirals and other medications. Therefore, the differential diagnosis is vast. Early identification (through efficient screening) and definitive diagnosis (by kidney biopsy when indicated) of kidney disease in HIV-infected individuals are critical to optimal management. Earlier interventions with disease-specific therapy, often with the help of a nephrologist, are likely to lead to better outcomes. In those with chronic kidney disease, interventions, such as aggressive blood pressure control with the use of ACE inhibitors or angiotensin receptor antagonists where tolerated, tight blood glucose control in those with diabetes, and avoidance of potentially nephrotoxic medications, can slow progression and prevent end-stage renal disease. Only with greater awareness of kidney-disease manifestations and their implications in this particularly vulnerable population will we be able to achieve success in confronting this growing problem.
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Affiliation(s)
- Derek M Fine
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Abstract
Nucleoside analogues revolutionized the treatment of chronic HBV infection and have become the most important therapeutic option within the last decade. Currently, the nucleoside analogues lamivudine, telbivudine and entecavir, and the nucleotide analogue adefovir dipivoxil, are licensed. Tenofovir disoproxil fumarate (TDF) is another acyclic nucleotide analogue that has been successfully used in the treatment of HIV-infected patients, but has demonstrated significant antiviral activity in wild-type and lamivudine-resistant HBV infections. The use of TDF 300 mg/day leads to marked suppression of HBV replication below the detection limit in different patients groups with HBV mono- or HIV/HBV co-infection in most instances, and a remarkably high rate of hepatitis B e antigen loss and even hepatitis B surface antigen loss was found in small, uncontrolled studies. Belonging to the substance class of acyclic nucleotide analogues, TDF is not cross-resistant to nucleoside analogue resistance-associated mutations. In equal dosages, TDF has comparable antiviral potency as compared with its congender adefovir dipivoxil, but in clinical studies exhibits higher antiviral efficacy and generates a higher genetic barrier against the development of genotypic HBV resistance due to its approximately 24-fold higher dosage. Owing to the numerous newly developed compounds and as a consequence of the emerging problem of drug resistance, treatment concepts for chronic hepatitis B will certainly be modified in the future. Because of its quite favorable antiviral and safety properties, TDF will likely be highly regarded in the management of HBV infections in the future.
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Affiliation(s)
- Florian van Bömmel
- Medizinische Klinik m. S. Hepatologie und Gastroenterologie Charité, Campus Virchow-Klinikum Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Thomas Berg
- Medizinische Klinik mit Schwerpunkt Hepatologie und Gastroenterologie, Charité - Campus Virchow-Klinikum, Universitätsmedizin Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany
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Entecavir for treatment of hepatitis B virus displays no in vitro mitochondrial toxicity or DNA polymerase gamma inhibition. Antimicrob Agents Chemother 2007; 52:598-605. [PMID: 18056280 DOI: 10.1128/aac.01122-07] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Therapy with nucleoside reverse transcriptase inhibitors (NRTIs) can be associated with mitochondrial toxicity. In vitro studies have been used to predict the predisposition for and characterize the mechanisms causing mitochondrial toxicity. Entecavir (ETV) is an approved deoxyguanosine nucleoside for the treatment of chronic hepatitis B virus (HBV) infection that exhibits potent activity against viral reverse transcriptase. We assessed the potential for mitochondrial toxicity of ETV in long-term cultures of HepG2 hepatoma cells by measuring mitochondrial function (through lactate secretion), levels of mitochondrial DNA (mtDNA), and levels of mitochondrial proteins COX II and COX IV. Furthermore, we tested the activity of ETV-triphosphate (ETV-TP) against mitochondrial DNA polymerase gamma (Pol gamma) in vitro. ETV concentrations as high as 100 times the maximal clinical exposure (C(max)) did not affect cell proliferation, levels of lactate, mitochondrial DNA, or mitochondrial proteins throughout the 15-day culture. The lack of mitochondrial toxicity was consistent with the finding that ETV-TP was not recognized by mitochondrial DNA Pol gamma and failed to be incorporated into DNA or inhibit the polymerase assay at the highest levels tested, 300 microM. Combinations of ETV with each of the other HBV NRTI antivirals, adefovir, tenofovir, and lamivudine at 10 times their respective C(max) levels also failed to result in cellular or mitochondrial toxicity. In summary, cell culture and enzymatic studies yielded no evidence that would predict mitochondrial toxicity of ETV at exposure levels in excess of those expected to be achieved clinically.
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49
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de Silva TI, Post FA, Griffin MD, Dockrell DH. HIV-1 infection and the kidney: an evolving challenge in HIV medicine. Mayo Clin Proc 2007; 82:1103-16. [PMID: 17803878 DOI: 10.4065/82.9.1103] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
With the advent of highly active antiretroviral therapy (HAART), the incidence of opportunistic infections has declined substantially, and cardiovascular, liver, and renal diseases have emerged as major causes of morbidity and mortality in individuals with human immunodeficiency virus (HIV). Acute renal failure is common in HIV-infected patients and is associated with acute infection and medication-related nephrotoxicity. HIV-associated nephropathy is the most common cause of chronic kidney disease in HIV-positive African American populations and may respond to HAART. Other important HIV-associated renal diseases include HIV immune complex kidney diseases and thrombotic microangiopathy. The increasing importance of non-HIV-associated diseases, such as diabetes mellitus, hypertension, and vascular disease, to the burden of chronic kidney disease has been recognized, focusing attention on prevention and control of these diseases in HIV-positive individuals. HIV-positive individuals who experience progression to end-stage renal disease and who have undetectable HIV-1 viral loads while receiving HAART should be evaluated for renal transplant. Emerging evidence suggests that HIV-positive individuals may have graft and patient survival comparable to HIV-negative individuals. Several studies suggest that HIV-1 can potentially infect renal cells, and HIV transgenic mice have clarified the roles of a number of HIV proteins in the pathogenesis of HIV-associated renal disease. Host factors may modify disease expression at the level of cytokine networks and the renal microvasculature and contribute to the pathogenic effects of HIV-1 infection on the kidney.
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Affiliation(s)
- Thushan I de Silva
- Section of Infection, Inflammation and Immunity, University of Sheffield School of Medicine and Biomedical Sciences, L Floor, Royal Hallamshire Hospital, Glossop Road, Sheffield, UK
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50
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Florescu D, Kotler DP. Insulin resistance, glucose intolerance and diabetes mellitus in HIV-infected patients. Antivir Ther 2007; 12:149-62. [PMID: 17503657 DOI: 10.1177/135965350701200214] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
An increased prevalence of insulin resistance, glucose intolerance and diabetes has been reported in HIV infection in the highly active antiretroviral therapy (HAART) era. This development might be clinically significant because of its association with cardiovascular morbidity and mortality as well as the therapeutic challenges of managing polypharmacy. The development of insulin resistance, glucose intolerance and diabetes could be related to the underlying HIV infection, the contribution of different antiretroviral agents, treatment-associated weight gain, immune restoration, as well as the non-HIV related factors. Dissecting these factors in clinical practice might be difficult. Clinical studies include short-term treatments in healthy, non-HIV-infected individuals; randomized, controlled trials; comparative studies of different HAART regimens; and randomized studies of switching regimens in patients with viral suppression and stable immune function. This article reviews the latest knowledge regarding the epidemiology, pathogenesis, prevention and treatment of insulin resistance, glucose intolerance and diabetes mellitus in HIV-infected individuals.
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Affiliation(s)
- Diana Florescu
- Immunocompromised Host Infectious Diseases Program, Department of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
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