Improving anti-hepatitis C virus therapy

Discovery and mechanism of action of Novel Baicalein modified derivatives as potent antihepatitis agent

Anti-hepatitis B virus (HBV) activity was evaluated in HepG2 2.2.15 cells by novel Baicalein derivatives. The result showed that compounds 4k and 4h was found to be effective anti-HBV agent. Further, the effect of compounds 4k and 4h showed dose-dependent inhibition of HBV-DNA as compared to control together with significant inhibition of HbeAG and HbsAG expression in the tested dose. Both compounds showed considerable affinity against the HepG2.2.15 cells. Moreover, the docking study of compound 4k was carried out with HLA molecule showing excellent intermolecular interactions with the receptor via creation of numerous bonds with Ser5, Thr27, Asp29 and Phe8. The compound 4k showed significant effect on the HO-1 expression in HepG2.2.15 cells together with excellent anti-HBV activity in transgenic mouse confirmed by biochemical and histopathological parameters. Compound 4k also showed excellent pharmacokinetic profile in experimental animal and thus, provide a novel class of potent anti-HBV agents.

High potency improvements to weak aryl uracil HCV polymerase inhibitor leads

Described herein is the development of a potent non-nucleoside, small molecule inhibitor of genotype 1 HCV NS5B Polymerase. A 23 μM inhibitor that was active against HCV polymerase was further elaborated into a potent single-digit nanomolar inhibitor of HCV NS5B polymerase by additional manipulation of the R and R1 substituents. Subsequent modifications to improve physical properties were made in an attempt to achieve an acceptable pharmacokinetic profile.

10-year trends in the diagnosis and treatment of hepatitis C and concomitant mental health disorders: 1995 to 2005

OBJECTIVE

To evaluate trends in the rate and timing of treatment for hepatitis C in those with and without mental health comorbidities.

METHOD

Data from the population-based Olmsted County Hepatitis C Registry in Minnesota were linked to patients' medical records to identify the dates and duration of any hepatitis C-specific therapy as well as all diagnoses of mental health comorbid conditions prior to initiation of therapy. The most common mental health conditions, major depressive disorder, alcohol dependence, and intravenous drug use, were assessed separately. The registry includes all Olmsted County residents with a physician diagnosis of hepatitis C or non-A/non-B hepatitis (ICD-9 criteria) from January 1, 1990, through December 31, 2005.

RESULTS

The age-adjusted prevalence of diagnosed hepatitis C increased markedly between 1995 and 2000 (15.5/10,000 persons to 27.0/10,000 persons) but changed little between 2000 and 2005 (27.0 to 27.9/10,000 persons). The number of people with comorbid hepatitis C and depressive disorder (including minor depression) increased significantly between 1995 and 2005 from 18% to over 35% of all people with diagnosed hepatitis C. Treatment rates more than doubled between 1995 and 2005, while the time from diagnosis to treatment decreased during that same period. By 2005, major depressive disorders were associated with a high rate of reasonably prompt treatment. There were no gender differences in treatment rates or time to treatment when other comorbidities and age were included in the analyses.

CONCLUSIONS

From 1995 to 2005, rates of treatment for hepatitis C among people with and without comorbid mental health problems increased. Rates of increase were higher among those with depression and hepatitis C than among those with hepatitis C and drug abuse or other mental health diagnoses. Even with this progress in treating those with multiple diagnoses, over 75% of people with hepatitis C remain untreated.

Discovery of (7R)-14-cyclohexyl-7-{[2-(dimethylamino)ethyl](methyl) amino}-7,8-dihydro-6H-indolo[1,2-e][1,5]benzoxazocine-11-carboxylic acid (MK-3281), a potent and orally bioavailable finger-loop inhibitor of the hepatitis C virus NS5B polymerase

Infections caused by hepatitis C virus (HCV) are a significant world health problem for which novel therapies are in urgent demand. The polymerase of HCV is responsible for the replication of viral genome and has been a prime target for drug discovery efforts. Here, we report on the further development of tetracyclic indole inhibitors, binding to an allosteric site on the thumb domain. Structure-activity relationship (SAR) studies around an indolo-benzoxazocine scaffold led to the identification of compound 33 (MK-3281), an inhibitor with good potency in the HCV subgenomic replication assay and attractive molecular properties suitable for a clinical candidate. The compound caused a consistent decrease in viremia in vivo using the chimeric mouse model of HCV infection.

Composition of inflammatory infiltrate and its correlation with HBV/HCV antigen expression

AIM: To study the composition of liver inflammatory infiltrate in biopsy material from patients chronically infected with hepatotropic viruses and to evaluate the correlation of inflammatory infiltrate with hepatitis B virus (HBV) and hepatitis C virus (HCV) viral antigen expression in chronic B and C hepatitis.

METHODS: The phenotype of inflammatory cells was evaluated by the EnVision system, using a panel of monoclonal antibodies. HBV and HCV antigens were detected with the use of monoclonal anti-HBs, polyclonal anti-HBc and anti-HCV antibodies, respectively.

RESULTS: The cellular composition of liver inflammatory infiltrate was similar in the patients with B and C hepatitis: ~50%-60% of cells were T helper lymphocytes. Approximately 25% were T cytotoxic lymphocytes; B lymphocytes comprised 15% of inflammatory infiltrate; other cells, including NK, totalled 10%. Expression of HLA antigens paralleled inflammatory activity. Portal lymphadenoplasia was found more often in hepatitis C (54.5%) than in hepatitis B (30.6%). Expression of HBcAg was found more often in chronic B hepatitis of moderate or severe activity. Overall inflammatory activity in HBV-infected cases did not correlate with the intensity of HBsAg expression in hepatocytes. Inflammatory infiltrates accompanied the focal expression of HCV antigens. A direct correlation between antigen expression and inflammatory reaction in situ was noted more often in hepatitis C than B.

CONCLUSION: Irrespective of the etiology and activity of hepatitis, components of the inflammatory infiltrate in liver were similar. Overall inflammatory activity did not correlate with the expression of HBsAg and HCVAg; HBcAg expression, however, accompanied chronic hepatitis B of moderate and severe activity.

Des-A-ring benzothiadiazines: inhibitors of HCV genotype 1 NS5B RNA-dependent RNA polymerase

In our program to discover non-nucleoside, small molecule inhibitors of genotype 1 HCV polymerase, we investigated a series of promising analogs based on a benzothiadiazine screening hit that contains an ABCD ring system. After demonstrating that a methylsulfonylamino D-ring substituent increased the enzyme potency into the low nanomolar range, we explored a minimum core required for activity by truncating to a three-ring system. Described herein are the syntheses and structure-activity relationship of a set of inhibitors lacking the A-ring of an ABCD ring system. We observed that small aromatic rings and alkenyl groups appended to the 5-position of the B-ring were optimal, resulting in inhibitors with low nanomolar potencies.

Barriers to care of chronic hepatitis patients in Latin America

Delay in diagnosis of chronic hepatitis due to HCV or HBV is mainly caused by lack of information about these prevalent and life-threatening disorders. Diagnostic tests are either not easily available or not requested by primary care physicians. When cases positive for hepatitis-B markers or anti-HCV are found, misleading guidance may be given to patients. Absence of symptoms associated with lack of information is another barrier to the care of chronic hepatitis patients. Management of these diseases is not simple, and treatment options and schedules are in rapid and continuous evolution. Surveillance of patients with chronic hepatitis before, during and after antiviral therapy is mandatory. For patients with no indication for therapy, identification of optimal follow-up frequency constitutes a problem, as does determination of the correct amount and type of diagnostic tests to be used. Another important barrier to care of patients with chronic hepatitis is the absence of an ideal drug, namely, one that is inexpensive, does not have collateral effects, and has very high percentages of cure or resolution. Access to therapy is uncertain, and the side effects of interferon frighten some patients and physicians. Lack of adherence to the medication, early interruption, and the need for other supportive therapies are frequent barriers to successful treatment.

Controversies in and challenges to our understanding of hepatitis C

Discovered in 1989, the hepatitis C virus (HCV) continues to cause significant morbidity and mortality world-wide despite a huge research commitment to defining and understanding the virus and the disease it causes. This paper discusses a number of areas where progress in the management of the HCV have not kept pace with the scientific understanding of the HCV. It is suggested that in the fields of HCV prevention and providing access to treatment, practice falls short of what could be achieved. The role of alcohol in the pathogenesis of HCV liver injury is discussed. Discrimination against those with HCV infection and particularly those in prison settings fails to match good clinical practice. The complicated processes of sharing information between specialty groups is also discussed in an attempt to optimise knowledge dissemination in this field.

Chemical and biological effects of substitution of the 2-position of ring-expanded ('fat') nucleosides containing the imidazo[4,5-e][1,3]diazepine-4,8-dione ring system: the role of electronic and steric factors on glycosidic bond stability and anti-HCV activity

The attempted removal of the aralkyl group of 2-bromo-1-p-methoxybenzyl-6-octylimidazo[4,5-e][1,3]diazepine (ZP-33) with trifluoroacetic acid resulted in replacement of the bromo group with a carbonyl at position-2 in addition to the desired deprotection at the 1-position. 2'-Deoxynucleosides of 2-bromo-substituted-imidazole-4,5-diesters (ZP-35 and ZP-103) were synthesized by direct glycosylation of the corresponding heterocycles. The attempted ring-closure of the above nucleosides resulted in deglycosylation to form the starting heterocycles. The 2-phenyl derivatives of the above nucleosides (ZP-45 and ZP-73) were successfully prepared by Suzuki coupling with the appropriate phenylboronic acids, but the attempted ring-closure with guanidines to form the desired 5,7-fused ring-expanded nucleosides (RENs) resulted once again in the formation of the corresponding heterocyclic aglycons (ZP-64 and ZP-75). The first successful 2-substituted REN (ZP-110) was synthesized by replacing the 2-deoxyribose sugar moiety with a ribosyl group and replacing the bromo group with a p-methoxyphenyl substituent at the 2-position. A number of imidazole riboside diester precursors containing a substituted phenyl group at the 2-position were synthesized in order to prepare analogues of ZP-110. The substituents on the phenyl ring included a variety of electron-donating or electron-withdrawing groups operating through inductive and/or resonance effects. However, the final ring-closure of the diesters with guanidines in order to prepare RENs was successful only in a limited number of cases, including the ones containing a p-fluorophenyl (ZP-121), a m-methoxyphenyl (ZP-122), or an unsubstituted phenyl (NZ-53) at the 2-position. Deglycosylation and incomplete ring-closure of the intermediates were the major problems encountered with most other cases. The stability of glycosidic bonds was found to be dependent on several factors including, but not limited to, the electron-donating inductive effect of the 2-phenyl substituents and the temperature of the reaction medium. The three target RENs ZP-110, ZP-121, and ZP-122 were screened for in vitro anti-HCV activity, employing an HCV RNA replicon assay. While ZP-121 was inactive, the other two compounds showed only weak anti-HCV activity.

An analogue of AICAR with dual inhibitory activity against WNV and HCV NTPase/helicase: synthesis and in vitro screening of 4-carbamoyl-5-(4,6-diamino-2,5-dihydro-1,3,5-triazin-2-yl)imidazole-1-beta-D-ribofuranoside

The title compound (4) was synthesized by the reaction of ethyl 1-(2,3,5-tri-O-benzoyl-beta-d-ribofuranosyl)-5-formylimidazole-4-carboxylate with excess guanidine in ethanol at reflux. Compound 4 was evaluated in vitro against NTPases/helicases of four different viruses of the Flaviviridae family, including the West Nile virus (WNV), hepatitis C virus (HCV), dengue virus (DENV), and the Japanese encephalitis virus (JEV), employing both an RNA and a DNA substrate. The compound showed activity against NTPase/helicase of WNV and HCV with an IC(50) of 23 and 37 microM, respectively, when a DNA substrate was employed, while no activity was observed when an RNA substrate was used. There was no activity against the NTPase/helicase of either DENV or JEV irrespective of whether an RNA or a DNA substrate was employed. Considering that Flaviviridae are RNA viruses, the observed absence of activity against an RNA substrate, but the presence of activity against a DNA substrate is intriguing and somewhat surprising. The preliminary studies show that compound 4 does not form a tight complex with either an RNA or a DNA substrate, suggesting that its mechanism of action may involve direct interaction with the enzyme.

Structure-activity relationship studies on anti-HCV activity of ring-expanded ('fat') nucleobase analogues containing the imidazo[4,5-e][1,3]diazepine-4,8-dione ring system

In continuation of our structure-activity relationship studies on anti-HCV activity of the title imidazo[4,5-e][1,3]diazepine ring system, we report here the synthesis and effect on biological activity of introducing hydrophobic substituents at the 2-position of the heterocycle. Our results suggest that there is no particular advantage to that end as the observed antiviral activity of the test compounds was lower than that of the unmodified 2-bromo derivative used for comparison. The activity/toxicity profile of all target compounds, however, was still better than that of the reference compound ribavirin used in the antiviral assay, but not as good as that of interferon-alpha, the other reference compound used in the assay.

Discontinued drugs in 2005: anti-infectives

This perspective is the fifth in a series discussing drugs dropped from development in 2005, of which 11 were being developed for infectious diseases. Of these, eight were antivirals and were dropped in Phase II or III: Medivir's alovudine, Ono Pharmaceuticals' aplaviroc hydrochloride and Excite's immunotherapeutic Xcellerate for HIV; Boehringer Ingelheim's ciluprevir, ViroPharma's HCV-086, Isis Pharmaceuticals' antisense oligonucleotide ISIS-14803, Japan Tobacco's JTK-003 and Rigel's R803 for hepatitis C virus. The remaining discontinued anti-infective drugs were an antibacterial vaccine (Vical's anthrax vaccine), an antiseptic (YM Bioscience's Dermofural) and an antifungal formulation (MacroChem's topical econazole). The drugs are grouped by compound class and reasons for their failure are discussed in this article.