Plusieurs aminoglycosides font partie d’une famille d’antibiotiques à large spectre d’action. Les aminoglycosides ayant une activité antibiotique viennent interférer dans la synthèse protéique effectuée par les bactéries. Les protéines mal codées entraineront la mort cellulaire. Au fil des années, de nombreux cas de résistance ont émergé après une utilisation soutenue des aminoglycosides. De nombreux aminoglycosides semi-synthétiques ont été synthétisés avec comme objectif de restaurer leur activité antimicrobienne. Parmi les modifications ayant connu du succès, notons la didésoxygénation d’un diol et l’introduction de la chaine latérale HABA. Des études précédentes ont montré l’efficacité de ces modifications sur les aminoglycosides. Les présents travaux portent sur l’installation de la chaine latérale HABA et la didésoxygénation d’un diol sur la paromomycine et la néomycine. La didésoxygénation sélective des diols a été effectuée en utilisant la méthodologie développée par Garegg et Samuelsson, une variation de la réaction de Tipson-Cohen. Cette méthode a permis l’obtention du motif didésoxygéné sur les cycles A et D dans des rendements jamais égalés pour ce motif synthétique. La chaîne latérale a été introduite en tirant profit de la réactivité et de la sélectivité d’un carbamate cyclique. Ces méthodes combinées ont permis la synthèse efficace de nombreux analogues semi-synthétiques nouveaux. La 3',4'-didéhydro-N-1-HABA-néomycine et la 3',4',3''',4'''-tétradésoxy-N-1-HABA-néomycine montrent une activité impressionnante contre des souches de bactéries résistantes aux aminoglycosides. Des tests de toxicité effectués en collaboration avec Achaogen Inc. ont démontré que ces composés sont relativement toxiques sur les cellules rénales de type H2K, ce qui réduit de façon importante leur index thérapeutique. Afin d’abaisser la toxicité des composés, la relation entre toxicité et basicité a été explorée. Des substitutions de l’amine en 6''' ont été effectuées afin d’abaisser la basicité de l’amine. Les résultats de toxicité et d’activité antimicrobienne démontrent une corrélation importante entre la basicité des amines et la toxicité/activité des aminoglycosides antibiotiques. L’effet d’une modulation du pKa a aussi été exploré en installant des chaines fluorées sur l’amine en 6''' de la paromomycine et de la néomycine. Une séquence synthtétique pour isoler l’amine en 6''' de la néomycine a aussi été développée. / Some aminoglycosides are part of a broad-spectrum family of antibiotics used in the clinic. They interfere in protein synthesis in bacterium cell by interfering with the transcription of proteins leading to cellular death. After an intense usage of aminoglycosides in the clinic, numerous cases of resistance have been encountered which render aminoglycosides less effective. Semi-synthetic aminoglycosides have been synthesized with the objective of restoring their original antimicrobial activity. Deoxygenation of the diol on ring A and introduction of the lateral chain HABA at N-1 had a significant impact on their antimicrobial activity against resistant strains. The present work will focus on deoxygenation of the diol at 3', 4' and on the introduction of the lateral HABA chain on aminoglycoside, more specificaly on paromomycin and neomycin. The selective dideoxygenation of the A ring diol was done using a methodology developed by Garegg and Samuelsson, which is a modification of the original Tipson-Cohen reaction. This method allows the dideoxygenation on ring A and D with unprecedented yields. The lateral HABA chain was introduced via the ring opening of a cyclic carbamate. These methods were combined to produce very potent analogs such as 3',4'-didehydro-N-1-HABA-neomycin and 3',4',3''',4'''-tetradeoxy-N-1-HABA-neomycin. Toxicity tests done in collaboration with Achaogen Inc. showed that these analogs were toxic to H2K renal cells, which reduced significantly their therapeutic index. In order to lower the toxicity of those compounds, the relation between toxicity and basicity was explored. Substitution of the amine at 6''' was done in order to lower the basicity of this amine. The results showed a strong correlation beetween the basicity of this amine and toxicity/activity. The pKa of this amine was modulated by installing fluorinated alkyl chain on the amine at 6''' in order to see the effect of the pKa on the activity/toxicity on paromomycin and neomycin. A synthetic sequence was also developed to allow the 6''' amine on neomycin to be modified selectively.

HIV-1 has evolved with a great deal of functional complexity contained within a very small genome by encoding small, but critical viral proteins within larger viral genes and dividing the replication cycle into early and late phases to differentially produce all proteins leading to efficient replication and virion release. Early replication is restricted by the host spliceosome that processes HIV-1 vRNA transcripts so only the small intragenomic proteins are produced, one of which is Rev (Regulator of Virion Expression). Rev in turn governs the transition from early to late replication by interacting with a highly structured region of vRNA termed the Rev Response Element (RRE). The binding of Rev to the RRE is believed to cause a change in the vRNA tertiary structure and inhibition of splicing of the vRNA. Once, a Rev:RRE complex is formed, a nuclear export signal within Rev facilitates the export of partially spliced and unspliced vRNA to the cytoplasm. During late replication the partially spliced and unspliced vRNA is translated to polyproteins and is packaged into a budding virion where the viral aspartyl protease (HIV-1 PR) autocatalytically excises itself from the larger polyprotein and processes the remaining polyproteins to release all viral structural and functional proteins to form a mature and infectious virion. Since the vRNA salvaged by Rev is translated to the polyproteins containing HIV-1 PR, the inhibition of Rev function will reduce the amount of HIV-1 PR available and thereby reduce the amount of HIV-1 PR therapeutics required to elicit a clinical effect. Therfore a combination approach to HIV-1 treatment using suitably developed therapeutics that inhibit Rev and HIV-1 PR function represents an attractive synergistic approach to treating HIV-1 infection in vivo. The work of this thesis was divided into two parts, the first part was concerned with HIV-1 PR structural biology and addressing problems encountered with inhibitor design. A bicyclic peptide (based on inhibitors of analogous structure) was co-crystallised with active HIV-1 PR to develop an enzyme-product (E-P) complex and with a catalytically inactive mutant HIV-1 PR to provide an analogy to the enzyme-substrate (E-S) complex. Both structures of the E-P and E-S complexes were solved to 1.6Å resolution and were compared to a hydroxyethylamine isostere enzyme-inhibitor complex (E-I), highlighting the similarity of binding mode for all ligands. The inhibitor in the E-I complex was translated towards the S1 - S3 pockets of the substrate binding cleft relative to the substrate in the E-S complex due to the increased length of the hydroxylethylamine isostere compared to the peptide backbone, although the inhibitor "puckered" the isostere linkage and maintains a binding mode similar to the substrate with very little overall differences in the position of the ligands and surrounding protein. The similarity of the E-S, E-I and E-P complexes was attributed to the macrocyclic ligands ordering the surrounding protein environment, especially the protein -strand "flap" structures that form a roof over the ligands in the active site but were not found to close more tightly in any of the trapped catalytic states. The new structures allowed refinement of details of the mechanism of peptide hydrolysis. The mechanism relies on the optimal nucleophilic attack of a water molecule on the scissile amide bond with concerted acid-base catalysis of the active site aspartyl residues intitiated by D125. The alignment and intrinsic position of the N-terminus of the bicyclic substrate was interpreted as being critical to facilitate efficient electron transfer with the bicyclic substrate. An N-terminal cyclic inhibitor, similar to the N-terminal portion of the bicyclic substrate, was used to address a major problem in HIV-1 PR drug design termed "cooperativity," where the sequential optimisation of an inhibitor (or substrate) to individual pockets of the substrate binding cleft, can negatively impact on adjacent and downfield subsites and thereby alter the binding mode of the "optimised" inhibitor. The technique referred to here as "templating" uses the N-terminal cycle to lock the binding mode into a known conformation, probing the S1' and S2' pockets. The structure activity relationship suggested that by viewing the S1' - S3' pockets as a single trough, bulky aromatic groups attached to an N-alkyl sulfonamide could be directed along the line of the trough without adverse interactions with the tops of the S1' and S3' pockets, providing very potent inhibitors. It was also found that specificity and potency of an inhibitor can be maintained with smaller functionalities that carry their bulk low and close to the inhibitor backbone in the S2' pocket, making the P2 functionalities more substrate-like. The second part of the thesis was concerned with establishing suitable surface plasmon resonance assays for testing potential inhibitors of Rev function. Recombinant Rev and its minimal RNA aptamer target (stem loop II of the RRE termed RBE3), were expressed, purified, and used to develop BIAcore-based assays and test potential inhibitors of their interaction. The system was applied to screening of aminoglycoside antibiotics and other small molecules in a competitive assay, and also to quantitative assay of Neomycin and moderate sized analytes: Rev and three peptidic analogues of the high-affinity binding site of Rev - the native peptide, succinylated form of the peptide and a form incorporating a novel helix-inducing cap. The peptide and protein assay was undertaken to test the proposition that helix induction of the high-affinity binding site of Rev can increase affinity for the biologically important RNA target and thereby form the basis of a new class of inhibitors. The screen of small molecule antagonists found that Neomycin was the best inhibitor of the Rev:RBE3 interaction and that efficacy of other aminoglycosides was due to the neamine-base structure presenting charge to bind to the RNA and blocking interaction with Rev. The quantitative assay was optimised to reduce non-specific interactions of Rev protein to allow reliable studies of the analytes with RBE3 by the sytematic testing of buffers and modifiers. It was found that mutliple analytes bound to the RBE3 aptamer and a comparison of the KD values found that the native and capped peptides had similar affinity for RBE3 RNA (native slightly greater at 21 ± 7nM cf capped 41 ± 10nM) that was greater than the Rev protein (101 ± 19nM), however the succinylated peptide exhibited stronger binding with a KD ≤8nM and Neomycin had the lowest affinity (KD 13 ± 3M). The similarity of the native and capped peptides may be due to the high concentration of salt in the assay buffers and was necessary for the stability of the Rev protein, but is sufficient to influence secondary structure of the peptides. Therefore, it could not be stated that the helix-inducing cap increased the affinity of the native peptide for the biologically important therapeutic target. The work conducted in this thesis firmly establishes foundations for the continued development of inhibitors against both Rev and HIV-1 PR that play key roles in the HIV-1 replication strategy. It is envisaged this work could lead to a novel synergistic therapeutic approach to treating HIV-1 infection.

The purpose of the study was to develop best practice guidelines to prevent permanent hearing loss associated with the management of multi-drug resistant tuberculosis (MDR-TB) through raised awareness and monitoring. The Human Immunodeficiency Virus (HIV) and MDR-TB are global public health problems requiring urgent scale-up of treatment services. Irreversible sensorineural hearing loss (SNHL) is one of the adverse drug reactions of the current World Health Organization (WHO) recommended MDR-TB chemotherapy fuelling another public health problem, that disabling hearing loss, which is the second highest contributor of Years Lived with Disability (YLD) according to the World Health Report (2003). Expansion of MDR-TB treatment threatens to increase incidence of SNHL unless there is urgent implementation of intervention towards preservation of hearing for patients on treatment. This empirical study determined and documented the incidence of SNHL in HIV positive and HIV negative patients on MDR-TB treatment, the risk factors for SNHL, from the time treatment initiation to SNHL. Based on the findings, developed and improved the understanding of best practice guidelines for monitoring and prevention of MDR-TB treatment-related SNHL. The empirical study recruited a cohort of 173 patients with normal hearing status, after diagnosis with MDR-TB and enrolled on MDR-TB therapy over thirteen month period. Patients in the cohort received monthly hearing sensitivity testing during the intensive MDR-TB therapy when injectable aminoglycoside antibiotics are part of the treatment regimen. The three study endpoints included completion of the eight-month intensive treatment phase without developing hearing loss, development incident hearing loss or loss to follow up. Data was analysed using STATA statistical software and summarised using frequencies, means, proportions, and rates. The study documented incidence of SNHL, time to hearing loss and risk factors for hearing loss. Recommendations to prevent and monitor hearing loss are made based on the the study findings. / Health Studies / D. Litt. et Phil. (Health Studies)