Human cytomegalovirus: challenges, opportunities and new drug development

In the age of highly active antiretroviral therapy, the incidence of human cytomegalovirus (HCMV) retinitis in AIDS patients has decreased substantially. However, this change does not indicate that HCMV disease in AIDS patients and other immunocompromised patients has abated and is no longer a concern. On the contrary, HCMV disease in graft recipients, newborns, and even in AIDS patients still accounts for considerable morbidity, and drug resistance to the anti-HCMV compounds is a major problem. Furthermore, HCMV may have a role in metabolic diseases, such as atherosclerosis. Fortunately there are novel and potentially very effective new compounds undergoing pre-clinical and clinical evaluation. These developments point the way toward new therapies and also to a clearer understanding of the biology of HCMV replication, infection and disease.

In vitro inhibition of hepadnavirus polymerases by the triphosphates of BMS-200475 and lobucavir

The guanosine analogs BMS-200475 and lobucavir have previously been shown to effectively suppress propagation of the human hepatitis B virus (HBV) and woodchuck hepatitis virus (WHV) in 2.2.15 liver cells and in the woodchuck animal model system, respectively. This repression was presumed to occur via inhibition of the viral polymerase (Pol) by the triphosphate (TP) forms of BMS-200475 and lobucavir which are both produced in mammalian cells. To determine the exact mode of action, BMS-200475-TP and lobucavir-TP, along with several other guanosine analog-TPs and lamivudine-TP were tested against the HBV, WHV, and duck hepatitis B virus (DHBV) polymerases in vitro. Estimates of the 50% inhibitory concentrations revealed that BMS-200475-TP and lobucavir-TP inhibited HBV, WHV, and DHBV Pol comparably and were superior to the other nucleoside-TPs tested. More importantly, both analogs blocked the three distinct phases of hepadnaviral replication: priming, reverse transcription, and DNA-dependent DNA synthesis. These data suggest that the modest potency of lobucavir in 2.2.15 cells may be the result of poor phosphorylation in vivo. Kinetic studies revealed that BMS-200475-TP and lobucavir-TP competitively inhibit HBV Pol and WHV Pol with respect to the natural dGTP substrate and that both drugs appear to bind to Pol with very high affinities. Endogenous sequencing reactions conducted in replicative HBV nucleocapsids suggested that BMS-200475-TP and lobucavir-TP are nonobligate chain terminators that stall Pol at sites that are distinct yet characteristically two to three residues downstream from dG incorporation sites.

The structure and function of the HSV DNA replication proteins: defining novel antiviral targets

The absolute dependence of herpes simplex virus (HSV) replication on HSV DNA polymerase and six other viral-encoded replication proteins implies that specific inhibitors of these proteins' functions would be potent antiviral agents. The only currently licensed anti-herpes simplex drug, acyclovir, is an inhibitor of HSV DNA polymerase and is widely held to block viral replication primarily by specifically inhibiting viral DNA replication. In spite of the substantial advance in HSV therapy in recent years through the introduction of acyclovir, this anti-HSV compound and most of the other compounds under pharmaceutical development are substrate analogs. Since antiviral drug resistance has become an issue of increasing clinical importance, the need for structurally unrelated agents which incorporate novel mechanisms of viral inhibition is apparent. Understanding the structure and function of herpesvirus DNA polymerase and its interaction with the other six essential replication proteins at the replication origin should assist us in designing the next generation of therapeutic agents. The sequences of these proteins have been deduced and the proteins themselves have been expressed and purified in a variety of systems. The current challenge, therefore, is to use the available information about these proteins to identify and develop new, exquisitely specific antiviral therapeutics. In this review, we have summarized the current approaches and the results of structure/function studies of the herpes virus proteins essential for DNA replication, with the goal of more precisely defining novel antiviral targets.

Antiviral agents: characteristic activity spectrum depending on the molecular target with which they interact

The target protein (enzyme) with which antiviral agents interact determines their antiviral activity spectrum. Based on their activity spectrum, antiviral compounds could be divided into the following classes: (1) sulfated polysaccharides (i.e., dextran sulfate), which interact with the viral envelope glycoproteins and are inhibitory to a broad variety of enveloped viruses (i.e., retro-, herpes-, rhabdo-, and arenaviruses): (2) SAH hydrolase inhibitors (i.e., neplanocin A derivatives), which are particularly effective against poxvirus, (-)RNA viruses (paramyxovirus, rhabdovirus), and (+/-)RNA virus (reovirus); (3) OMP decarboxylase inhibitors (i.e., pyrazofurin) and CTP synthetase inhibitors (i.e., cyclopentenylcytosine), which are active against a broad range of DNA, (+)RNA, (-)RNA, and (+/-)RNA viruses; (4) IMP dehydrogenase inhibitors (i.e., ribavirin), which are also active against various (+)RNA and (-)RNA viruses and, in particular, ortho- and paramyxoviruses; (5) acyclic guanosine analogs (i.e., ganciclovir) and carbocyclic guanosine analogs (i.e., cyclobut-G), which are particularly active against herpesviruses (i.e., HSV-1, HSV-2, VZV, CMV); (6) thymidine analogs (i.e., BVDU, BVaraU), which are specifically active against HSV-1 and VZV because of their preferential phosphorylation by the virus-encoded thymidine kinase; (7) acyclic nucleoside phosphonates (i.e., HPMPA, HPMPC, PMEA, FPMPA), which, depending on the structure of the acyclic side chain, span an activity spectrum from DNA viruses (papova-, adeno-, herpes-, hepadna-, and poxvirus) to retroviruses (HIV); (8) dideoxynucleoside analogs (i.e., AZT, DDC), which act as chain terminators in the reverse transcriptase reaction and thus block the replication of retroviruses as well as hepadnaviruses; and (9) the TIBO, HEPT, and other TIBO-like compounds, which interact specifically with the reverse transcriptase of HIV-1 and thus block the replication of HIV-1, but not of HIV-2 or any other retrovirus.