HIV-1进入抑制剂的研究近况

分类综述靶向病毒进入宿主细胞过程各环节的HIV-1进入抑制剂，包括HIV-1附着抑制剂、HIV-1辅助受体抑制剂、HIV-1融合抑制剂以及氧化还原酶蛋白二硫化物异构酶抑制剂的作用机制和疗效研究及其开发。     

Small-molecule HIV-1 entry inhibitors targeting gp120 and gp41: a patent review (2010-2015)

Introduction: It is essential to discover and develop small-molecule HIV-1 entry inhibitors with suitable pharmaceutical properties.

Areas covered: We review the development of small-molecule HIV-1 entry inhibitors as evidenced in patents, patent applications, and related research articles published between 2010 and 2015.

Expert opinion: HIV-1 Env gp120 and gp41 are important targets for development of HIV-1 entry inhibitors. The Phe43 pocket in gp120 and the highly conserved hydrophobic pocket on gp41 NHR-trimer are important targets for identification of HIV-1 attachment and fusion inhibitors, respectively. Compounds that bind to Phe43 pocket can block viral gp120 binding to CD4 on T cells, thus inhibiting HIV-1 attachment. However, most compounds targeting Phe43 pocket identified so far are HIV-1 entry agonists with the ability to enhance infectivity of HIV-1 in CD4-negative cells. Therefore, it is essential to identify HIV-1 entry antagonist-based HIV-1 attachment/entry inhibitors. Compounds binding to the gp41 hydrophobic pocket may inhibit CHR binding to the gp41 NHR trimer, thus blocking six-helix bundle formation and gp41-mediated virus-cell fusion. However, most lead compounds targeting this pocket have low potency, possibly because the pocket is too big or too deep. Therefore, it is necessary to identify other pockets in gp41 for developing HIV-1 fusion/entry inhibitors.     

Discovery of Small Molecule Entry Inhibitors Targeting the Fusion Peptide of SARS-CoV-2 Spike Protein

SARS-CoV-2 entry into host cells relies on the spike (S) protein binding to the human ACE2 receptor. In this study, we investigated the structural dynamics of the viral S protein at the fusion peptide (FP) domain and small molecule binding for therapeutics development. Following comparative modeling analysis and docking studies of our previously identified fusion inhibitor chlorcyclizine, we performed a pharmacophore-based virtual screen and identified two novel chemotypes of entry inhibitors targeting the FP. The compounds were evaluated in the pseudoparticle viral entry assay and SARS-CoV-2 cytopathic effect assay and showed single-digital micromole inhibition against SARS-CoV-2 as well as SARS-CoV-1 and MERS. The characterization of the FP binding site of SARS-CoV-2 S protein provides a promising target for the structure-based development of small molecule entry inhibitors as drug candidates for the treatment of COVID-19.     

HIV-1融合抑制剂研究现状及发展趋势

HIV-1融合抑制剂是继逆转录酶和蛋白酶抑制剂后的新一类抗HIV感染药物, 通过阻断病毒与靶细胞膜的融合从而抑制病毒进入靶细胞, 在感染的初始环节切断HIV-1的传播, 其中多肽类融合抑制剂T-20已于2003年上市。HIV-1融合抑制剂以HIV-1跨膜糖蛋白gp41为作用靶标, 它们是一些天然或合成的多肽以及小分子化合物, 通过与gp41功能区结合从而抑制其促融合功能的发挥。近年来, 随着对膜融合过程分子机制以及gp41功能研究的不断深入, 新的以gp41不同功能区为靶点的融合抑制剂分子不断被发现, 成为倍受关注的研究热点之一。本文着重对近年来HIV-1融合抑制剂的研究现状及发展趋势进行综述。     

Small-molecule HIV-1 gp120 inhibitors to prevent HIV-1 entry: an emerging opportunity for drug development

The HIV-1 gp120 envelope protein is an essential component in the multi-tiered viral entry process. Despite the overall genetic heterogeneity of the gp120 glycoprotein, the conserved CD4 binding site provides an attractive antiviral target. Recently, increased efforts aimed at the development of inhibitors of gp120 have been reported. This review focuses primarily on small-molecule gp120 inhibitors and discusses key characteristics of compounds that appear to fall within this class. The preclinical profiles of compounds that prevent gp120 from assuming a conformation favorable for CD4 binding are described in this review. In addition, inhibitors possessing some common structural features, including at least one compound that exhibits sub-nanomolar potency in a cell fusion assay are discussed. A series of compounds that were designed to enhance immune responses to virus via alteration of the gp120 conformation after targeting the CD4 binding pocket are also described. The efficacy of gp120 inhibitors as a microbicide to prevent sexual HIV transmission in the rhesus macaque model is discussed. Results suggest that this class of compounds may have value if included in a microbicide cocktail with inhibitors of alternate mechanisms. Importantly, preliminary results from clinical studies of orally administered BMS-488043 demonstrate that antiviral efficacy can be achieved in humans with a CD4-attachment inhibitor that targets gp120.     

Access denied? The status of co-receptor inhibition to counter HIV entry

As resistance and long-term metabolic abnormalities hamper the efficacy of previous drugs against HIV-1, targeting of HIV co-receptors represents an exciting new frontier for antiretroviral therapeutics. CCR5 inhibitors are most likely to be the new available drugs within the class of entry inhibitors. This paper reviews the most recent clinical data available on the small-molecule compounds vicriviroc and maraviroc and on the antibodies PRO 140 and CCR5mAb004, as well as some novel genetic approaches. A thorough overview of the many challenges, past, present and future, that CCR5 inhibitors encounter during their development pathway is then presented. Possible immunologic consequences are also discussed. It could be foreseen that the benefit for HIV-infected individuals derived by the use of these potential novel drugs will outweigh the costs/risks intrinsically present in every new therapeutic approach.     

Access denied? The status of co-receptor inhibition to counter HIV entry

As resistance and long-term metabolic abnormalities hamper the efficacy of previous drugs against HIV-1, targeting of HIV co-receptors represents an exciting new frontier for antiretroviral therapeutics. CCR5 inhibitors are most likely to be the new available drugs within the class of entry inhibitors. This paper reviews the most recent clinical data available on the small-molecule compounds vicriviroc and maraviroc and on the antibodies PRO 140 and CCR5mAb004, as well as some novel genetic approaches. A thorough overview of the many challenges, past, present and future, that CCR5 inhibitors encounter during their development pathway is then presented. Possible immunologic consequences are also discussed. It could be foreseen that the benefit for HIV-infected individuals derived by the use of these potential novel drugs will outweigh the costs/risks intrinsically present in every new therapeutic approach.     

Multi-targeting the entrance door to block HIV-1

The multistep nature of HIV-1 entry provides multisite targeting at the entrance door of HIV-1 to cells. Blocking HIV-1 entry to its host cells has clear advantages over blocking subsequent stages in the life cycle of the virus. Indeed, potent cooperative and synergistic inhibition of HIV-1 proliferation has been observed in in vitro studies with several entry inhibitor combinations, interacting with different steps of the HIV-1-cell entry cascade. Targeting a compound to several steps of the viral-cell entry and also to subsequent steps in the viral life cycle promises an even more effective therapeutic, by reducing the probability of HIV-1 to develop resistance. Using one drug that can target multiple sites and/or steps in the viral life cycle will have obvious advantages in clinical use. In this article we review the multistep process of HIV-1 cell entry and the current repertoire of inhibitors of this critical stage in the viral life cycle, and introduce an example of multisite HIV-1 targeting of the cell entry and subsequent critical steps in the viral life cycle.     

Opportunities and challenges in targeting HIV entry

Characterization of the mechanisms by which HIV-1 enters cells has allowed for an increased understanding of not only tropism and pathogenesis, but also the identification of new targets for rational drug design. Several classes of HIV-1 entry inhibitors have been developed. Antagonists targeting the interaction of the viral envelope protein and receptors on the cell surface, as well as peptides that target an intermediate in the fusion process, have shown promise in vitro and are currently being evaluated in clinical trials. The addition of entry inhibitors to current drug regimens has the potential to significantly improve the therapeutic options for infected individuals, which is crucial for those resistant to or failing currently available therapies.     

Inhibitors of HIV infection via the cellular CD4 receptor

Recent advances in our understanding of cellular and molecular mechanisms of viral penetration of the target cell have provided the basis for novel chemotherapy and prophylaxis of HIV-1 infections. This knowledge has been successfully applied to the development of inhibitors that target discrete steps of the entry process. Interesting approaches for prevention of HIV-1 entry include the use of small-molecule inhibitors, natural ligands and/or monoclonal antibodies that interfere with gp120/CD4 interaction. Other compounds acting by novel mechanisms have recently been identified as anti-HIV agents and seem worthy of further preclinical development. Of particular interest in this regard are cyclotriazadisulfonamide (CADA) compounds, which down-modulate the cellular receptor, CD4. A series of analogues of 9-benzyl-3-methylene-1,5-di-p-toluenesulfonyl-1,5,9-triazacyclododecane (CADA) has been synthesized and tested for CD4 down-modulation and anti-HIV activity. Some derivatives proved to be highly effective in decreasing cellular CD4 and in acting as HIV entry inhibitors. Three-dimensional quantitative structure-activity relationship (3D-QSAR) studies correlating molecular features with potency have been used to produce a computational model. This model can be used to design more potent CD4 down-modulating drugs for HIV therapy and prophylaxis. This review summarizes the results of recent studies relating to inhibitors of HIV infection via CD4 and discusses the therapeutic potential of targeting this cellular receptor. Special attention is given to our own work on small-molecule HIV entry inhibitors endowed with CD4 down-modulating properties.     

CD4 down-modulating compounds with potent anti-HIV activity

The use of HAART with double or triple drug combinations has significantly improved the survival of AIDS patients. However, the emergence of virus-drug resistance and both short- and long-term drug-related side effects are among the main reasons for continuing the development of new classes of effective anti-HIV drugs that target the replicative cycle at different sites. In recent years, tremendous progress has been made in understanding HIV-1 entry, a multistep process that comprises viral attachment, coreceptor interactions and fusion. The mechanistic insight gained from these studies has enabled the design of specific agents that can inhibit each step in the HIV entry process. The successful results from clinical trials with enfuvirtide (T-20), the first approved entry inhibitor, indicate that targeting of HIV entry will soon be an important component of antiretroviral therapy and further encourage the development of effective entry inhibitors. In this article the recent developments of therapeutic agents endowed with inhibitory properties against the binding of the HIV envelope glycoprotein gp120 to the CD4 receptor (e.g., PRO 542, BMS-378806, TNX-355, PRO 2000 and CV-N) are briefly outlined. Major focus is placed on the anti-HIV activity of cyclotriazadisulfonamides (CADA), a novel class of compounds with a unique mode of action by down-modulating the CD4 receptor in lymphocytic and monocytic cells.     

HIV-1 entry inhibitors: closing the front door

Highly active antiretroviral therapy (HAART) has led to major declines in morbidity and mortality of HIV-1-infected individuals, but the increasing prevalence of drug-resistant viral isolates, combined with the toxicity and other limitations of current treatments, make the development of new therapies a high priority. As knowledge of viral entry has expanded, this step of the viral life cycle has become a target for novel therapeutic strategies. An emerging group of antiretrovirals, known collectively as entry inhibitors, targets several distinct steps in viral entry including CD4 binding, chemokine receptor engagement and the structural changes in the viral envelope required for fusion between viral and cellular membranes. Many entry inhibitors are in various stages of clinical development, with one already licensed for use. This review will provide an overview of the mechanisms involved in the entry process, highlight promising entry blockers under development and discuss several considerations related to treatment that are unique to this class of antiretroviral drugs.     

Anti-HIV agents targeting the interaction of gp120 with the cellular CD4 receptor

Perhaps one of the most effective approaches to prevent and inhibit viral infections is to block host cell receptors that are used by viruses to gain cell entry. Major advances have been made over the past decade in the understanding of the molecular mechanism of HIV entry into target cells. A crucial step in this entry process is the interaction of the external HIV envelope glycoprotein, gp120, with the cellular CD4 receptor molecule. This binding step represents a potential target for new antiviral agents, and current efforts to develop safe and effective HIV entry inhibitors are focused on natural ligands and/or monoclonal antibodies that interfere with gp120/CD4 interaction. Also, small synthetic compounds obtained either by high-throughput screening of large compound libraries or by structure-guided rational design have recently entered the antiretroviral arena. In this review, the anti-HIV activity of novel entry inhibitors targeting gp120/CD4 interaction is outlined, and special attention is given to the cyclotriazadisulfonamide compounds, which are the most specific CD4-targeted antiviral drugs described so far.     

HIV-1 entry inhibitors: closing the front door

Highly active antiretroviral therapy (HAART) has led to major declines in morbidity and mortality of HIV-1-infected individuals, but the increasing prevalence of drug-resistant viral isolates, combined with the toxicity and other limitations of current treatments, make the development of new therapies a high priority. As knowledge of viral entry has expanded, this step of the viral life cycle has become a target for novel therapeutic strategies. An emerging group of antiretrovirals, known collectively as entry inhibitors, targets several distinct steps in viral entry including CD4 binding, chemokine receptor engagement and the structural changes in the viral envelope required for fusion between viral and cellular membranes. Many entry inhibitors are in various stages of clinical development, with one already licensed for use. This review will provide an overview of the mechanisms involved in the entry process, highlight promising entry blockers under development and discuss several considerations related to treatment that are unique to this class of antiretroviral drugs.     

人类免疫缺陷病毒进入抑制剂的临床开发与应用

耐药性是目前用抗病毒药物治疗获得性免疫缺陷综合征(艾滋病,AIDS)的主要问题。HIV进入抑制剂可以阻断HIV病毒进入人体细胞,具有新的作用机制,对其开发是目前解决耐药性问题的主要方向之一。目前国内已有多家单位在进行HIV进入抑制剂研究,有些即将进入临床试验阶段。本文结合我们自身的研究工作,着重综述了HIV进入抑制剂在预防与治疗艾滋病中的应用研究情况,特别讨论了其临床试验的目的、设计方案,以及进入抑制剂与目前药物联合使用的思路。     

Anti-HIV agents targeting the interaction of gp120 with the cellular CD4 receptor

Perhaps one of the most effective approaches to prevent and inhibit viral infections is to block host cell receptors that are used by viruses to gain cell entry. Major advances have been made over the past decade in the understanding of the molecular mechanism of HIV entry into target cells. A crucial step in this entry process is the interaction of the external HIV envelope glycoprotein, gp120, with the cellular CD4 receptor molecule. This binding step represents a potential target for new antiviral agents, and current efforts to develop safe and effective HIV entry inhibitors are focused on natural ligands and/or monoclonal antibodies that interfere with gp120/CD4 interaction. Also, small synthetic compounds obtained either by high-throughput screening of large compound libraries or by structure-guided rational design have recently entered the antiretroviral arena. In this review, the anti-HIV activity of novel entry inhibitors targeting gp120/CD4 interaction is outlined, and special attention is given to the cyclotriazadisulfonamide compounds, which are the most specific CD4-targeted antiviral drugs described so far.