Senescence as a main mechanism of Ritonavir and Ritonavir‐NO action against melanoma

The main focus of this study is exploring the effect and mechanism of two HIV‐protease inhibitors: Ritonavir and Ritonavir‐nitric oxide (Ritonavir‐NO) on in vitro growth of melanoma cell lines. NO modification significantly improved the antitumor potential of Ritonavir, as the IC₅₀ values of Ritonavir‐NO were approximately two times lower than IC₅₀ values of the parental compound. Our results showed for the first time, that both compounds induced senescence in primary and metastatic melanoma cell lines. This transformation was manifested as a change in cell morphology, enlargement of nuclei, increased cellular granulation, upregulation of β‐galactosidase activity, lipofuscin granules appearance, higher production of reactive oxygen species and persistent inhibition of proliferation. The expression of p53, as one of the key regulators of senescence, was upregulated after 48 hours of Ritonavir‐NO treatment only in metastatic B16F10 cells, ranking it as a late‐response event. The development of senescent phenotype was consistent with the alteration of the cytoskeleton—as we observed diminished expression of vinculin, α‐actin, and β‐tubulin. Permanent inhibition of S6 protein by Ritonavir‐NO, but not Ritonavir, could be responsible for a stronger antiproliferative potential of the NO‐modified compound. Taken together, induction of senescent phenotype may provide an excellent platform for developing therapeutic approaches based on selective killing of senescent cells.     

基于美国FDA不良事件报告系统数据库的洛匹那韦/利托那韦风险信号挖掘研究

目的挖掘洛匹那韦/利托那韦(LPV/r)不良事件(AE)的风险信号,探讨LPV/r的临床安全性,为该药在新型冠状病毒肺炎(COVID-19)治疗中的安全应用提供参考。方法采用报告比值比法(ROR)对美国食品药品管理局不良事件报告系统(FAERS)2010年第1季度至2019年第3季度AE报告数据中LPV/r相关的风险信号进行挖掘,检测阈值为报告数大于3且ROR的95%置信区间(CI)下限大于1的AE,并对AE采用国际医学用语词典(MedDRA)的首选系统器官分类(SOC)和首选术语(PT)进行统计和分类,选取AE报告数和信号强度排名前50位的PT进行分析。结果2010年第1季度至2019年第3季度FAERS数据库共收到LPV/r为首要可疑药物的AE报告13335例,检测出报告数>3且ROR的95%CI下限>1的AE风险信号455个,涉及AE报告7718例。涉及AE报告数占比居前2位的系统器官依次为"各类损伤、中毒及手术并发症"[13.6%(1051/7718)]和"妊娠期、产褥期及围产期状况"[11.7%(899/7718)],但在"各类损伤、中毒及手术并发症"所涉及的1051例AE报告中与妊娠期药物暴露有关者为998例,占95.0%;信号数占比居首位的系统器官为"各种先天性家族遗传性疾病"[16.3%(74/455)]。另外,药物相互作用所致AE共144例,在AE报告数中排第7位。结论检测出LPV/r妊娠期用药相关胎儿、新生儿和婴儿异常等风险信号,提示应关注孕妇和婴幼儿使用LPV/r的风险。LPV/r与其他药物联用时的相互作用也值得关注。     

利托那韦过饱和溶液中相分离研究

目的探索利托那韦过饱和溶液相分离的浓度,考察相分离后药物的结晶过程。方法通过溶剂转移法制备利托那韦过饱和溶液,采用偏光显微镜,紫外消光,动态光散射表征过饱和溶液发生相分离的浓度以及相分离形成的第二分散相的存在状态,进一步用荧光光谱(芘探针)和动态光散射表征第二分散相的结晶过程和粒径变化。结果过饱和溶液第二分散相以纳米液滴形式存在,它在药物溶度>37μg·mL^-1时形成,初始形成的是可溶解的无定型富药纳米液滴,在没有辅料存在的情况下,随即开始发生结晶。结论全面表征了药物过饱和溶液发生相分离到结晶的行为,为后续研究辅料和工艺对过饱和体系中第二分散相的影响提供了理论基础。     

Related factors to atazanavir plasma levels in a cohort of HIV positive individuals with undetectable viral load

ObjectiveTo evaluate the factors associated with plasma concentrations of atazanavir (ATV) in a cohort of well-controlled HIV infected subjects (undetectable viremia).DesignCross-sectional study where 69 subjects were consecutively enrolled between April and November, 2011.MethodsPatients had to be on atazanavir for at least six months, undetectable viral load for a period equal to or longer than 12 months, T CD4+ lymphocyte count higher than 200 cells/mm³, and aged between 18 years and 70 years old. Exclusion criteria were pregnancy, any neurologic disease, active opportunistic disease, hepatitis or cancer. Atazanavir plasma levels were measured by ultra-performance liquid chromatography.Results and discussionOverall, 54 patients (mean age of 47 years and 50% women) were included in the analysis. Those without ritonavir (unboosted atazanavir) had statistically lower plasma concentrations than those with ritonavir boosted atazanavir (p = 0.001) and total and indirect bilirubin were statistically associated with plasma concentration of atazanavir (r = 0.32 and r = 0.33 respectively; p < 0.05 in both cases). No statistical association was found among gender, ethnicity, age, weight, body mass index (BMI), lipid profile, and the plasma concentration of atazanavir.ConclusionIn summary, as expected, concomitant ritonavir use was the only factor associated with atazanavir plasma levels. Prospective studies with a larger sample size might help to observe an association of atazanavir concentrations to other characteristics such as body weight, since the p-value showed to be close to significance (p = 0.068).     

Efficacy and safety of “unboosting” atazanavir in a randomized controlled trial among HIV-infected patients receiving tenofovir DF

Objectives: To assess safety and efficacy of a switch to unboosted atazanavir (ATV) among HIV-infected adults receiving ATV/ritonavir (r) and tenofovir disoproxil fumarate (TDF).

Methods: HIV-infected adults with viral load (VL) <40 copies/mL at screening and <150 copies/mL consistently for ≥3 months while receiving a regimen including ATV/r and TDF were randomized to continue ATV/r 300/100 mg daily (control) or change to ATV 400 mg daily (switch), while maintaining their TDF backbone. The primary outcome was proportion of subjects without treatment failure (regimen switch or VL > 200 copies/mL twice consecutively) at 48 weeks.

Results: Fifty participants (46 male, median age 47 years) were randomized, 25 to each arm. At week 48, treatment success occurred in 76% in the control arm and 92% in the switch arm (ITT, p = 0.25). ATV trough levels at week 9 were higher in controls (median 438 ng/mL) than in the switch arm (median 124 ng/mL) (p = 0.003), as was total bilirubin at week 48 (median 38 μmol/L and 28 μmol/L, respectively; p = 0.02). Estimated glomerular filtration rate (eGFR) decreased in the control arm (p = 0.007), but did not change in the switch arm. At week 48, eGFR was higher in the switch arm (median 96 mL/min) than in the control arm (median 85 mL/min) (p = 0.035), but the arms were similar with respect to fasting glucose, C-reactive protein, and lipid parameters.

Conclusions: Switching from ATV/r to unboosted ATV appears to be safe and effective in selected virologically suppressed patients receiving TDF-containing regimens, and may have favorable effects on bilirubin and renal function.