Hepatitis C Virus (HCV) is a small RNA virus that progresses to chronicity in 50-80% of infected individuals. Direct-acting antivirals (DAAs) are revolutionary treatments for HCV with 90-98% cure rates. However, over time, chronic HCV infections can result in advanced liver disease, including cirrhosis. Patients with advanced fibrosis experience a poor response to vaccination, recurrent infections and increased risk for hepatocellular carcinoma (HCC). These outcomes are, in part, a consequence of immune dysfunction. Increased inhibitory receptor and Galectin-9 (GAL-9) expression is a possible mechanism promoting lymphocyte dysfunction. In this study, blood samples were collected from chronic HCV patients with different degrees of liver fibrosis. I conducted a 13-parameter flow stain on the peripheral blood mononuclear cells (PBMC) of these patients. Next, I measured the expression of inhibitory receptors (PD-1, CTLA-4, LAG-3, TIGIT and TIM-3) and GAL-9 on bulk T cell and NK cells of 15 chronic HCV patients with no to moderate fibrosis (F0-F2) and 15 with advanced fibrosis (F3-F4). To analyze receptor co-expression, I employed t-distributed stochastic neighbor embedding (t-SNE) analysis to dimensionally reduce the multi-parametric data. Notably, I found that F3-F4 patients had higher frequencies of >3 inhibitory receptor co-expression on NK cells. Moreover, t-SNE analysis of bulk T cells revealed that F3-F4 patients manifest a higher frequency of cells in the clusters with CD25+TIGITmed-hi CD4+ T cells and PD-1medLAG-3med-hiGAL-9med-hi CD4+ T cells. t-SNE analysis of NK cells also showed that F3-F4 patients manifest a higher frequency of cells in the cluster with CD25+TIGITmed-hiTIM-3med-hi CD56Dim NK cells and CCR7+ PD-1medLAG-3med-hiGAL-9med-hi CD56Dim NK cells. Lastly, the frequency of cells in these clusters was found to positively correlate with patient’s extent of liver damage. In conclusion, I identified phenotypes of immune dysregulation that could explain the increased susceptibility to infection and HCC in chronic HCV patients with advanced fibrosis. These phenotypes could identify targets for combinatorial checkpoint blockade therapy to potentially improve immune function in these patients.

Actuellement, les nucléosides représentent une classe majeure de composés dans les différentes thérapies anti-virales. Leur développement au cours des 50 dernières années a contribué à la mise sur le marché d'une quarantaine de composés, notamment dans la lutte des hépatites, des herpès et du VIH. Les infections virales représentent cependant toujours un large problème de santé publique, de par l'apparition de résistances aux médicaments existants ainsi que de nouvelles espèces virales. Il est donc nécessaire de développer de nouveaux antiviraux plus actifs et plus sûrs. Dans ce manuscrit, il est décrit la synthèse métallo-catalysée d'acyclonucléosides phosphonate innovants, modifiés sur la partie phosphonate, nucléobase et sur la chaîne acyclique. Pour ce faire, nous nous sommes appuyés sur des réactions de métathèses croisées et la synthèse convergente d'un large panel de nucléobases et phosphonates modifiés. Une importance toute particulière a été donnée à l'utilisation de nouvelles techniques d'activation comme le micro-onde ou les ultrasons. Ces divers procédés de synthèse ont permis la synthèse de trois séries d'alkényl phosphononucléosides, qui se sont révélés d'une activité antivirale remarquable sur certains virus à herpès, comme le VZV ou le CMV. / Nucleosides represents a major class of compounds in different antiviral chemotherapies. Their development from now 50 years has led to the emergence of nearly 40 compounds, to contain many epidemics and in the fight against viral infections as HIV, hepatitis or herpes. Viral infections still represent a tremendous problem in public health with the emergence of resistance to known drugs and the appearance of new viruses. In this context, it's essential to develop new antivirals with higher activity and safer. This manuscript describes organo-metallic syntheses of new modified acyclonucleoside phosphonates, on the nucleobase, the phosphonate or the acyclic spacer. Thus, the use of cross-metathesis and convergent syntheses of a broad panel of nucleic bases and modified phosphonates represents a cornerstone of our work. A particular importance was given to the use of new activations way, as ultrasound or microwave irradiation. Those processes allowed us to synthetize three new families of acyclic phosphononucleosides, which revealed a remarkable antiviral activity against some herpes viruses, as VZV or CMV.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第20989号 / 医博第4335号 / 新制||医||1027(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 朝長 啓造, 教授 松田 文彦, 教授 小柳 義夫 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

The world is grappling with an escalating risk of viral outbreaks of pandemic proportion, with zoonotic RNA viruses such as chikungunya virus (CHIKV) and SARS-CoV-2 posing significant threats to global health. Several environmental and evolutionary factors have fueled the emergence and spread of infection, creating a constant arms race against emerging pathogens. Current prevention and mitigation strategies are inadequate, necessitating tools to prevent and control viral infections; innovative strategies are needed in the pipeline to address significant challenges. CHIKV is a mosquito-borne virus that has caused millions of disease cases worldwide and is a reemerging threat with increasing potential to become endemic in the US. Currently, there are no licensed treatments available to protect against CHIK disease, making the development of a vaccine crucial. Live-attenuated vaccines (LAVs) have traditionally been a promising strategy due to their high immunogenicity and cost-effectiveness. However, concerns regarding adverse side effects and the potential for viral replication leading to pathogenic reversions or transmission into mosquitoes have limited their use. To that end, we have developed a new generation of safer vaccines by modifying the standard LAV platform through innovative attenuating strategies. Our dual-attenuated platform utilizes a previously developed chimera of CHIKV and the closely related Semliki Forest virus (SFV) as a vaccine backbone which expresses antiviral mouse cytokines IFN-γ or IL-21, as an additional mechanism to control infection. In several mouse models, both cytokine-expressing candidates showed reduced footpad swelling and minimal to no systemic replication or dissemination capacity compared to the parental vaccine post-vaccination. Importantly, these candidates conferred full protection from wildtype CHIK disease. Our IFNγ-expressing vaccine showed the most significant attenuation of viral replication. To understand the underlying mechanism, we identified three IFNγ-regulated antiviral genes (Gbp1/2 and Ido1) that were highly upregulated in 3T3 mouse fibroblasts post-infection with the IFN-γ-expressing candidate but not the parental backbone. To further investigate the role of these genes in restricting viral replication and enhance the clinical relevance of our vaccine platform, we redesigned our vaccine to express human IFNγ (hIFNγ) and performed viral growth kinetics in MRC5 human lung fibroblasts. Our vaccine showed reduced viral replication compared to controls and high expression of human GBP1/2/3 was observed post-infection. Overexpression of these genes demonstrated a direct impact on viral replication against wildtype CHIKV. These findings shed light on the mechanism of action of our vaccine and highlight the potential of targeting IFNγ-regulated antiviral genes for developing effective vaccines against CHIKV. Our results provided a foundation for investigating the broad-use application of IFN-γ against other alphaviruses for vaccine or therapeutic design. We evaluated the effects of increasing levels of exogenous hIFNγ on Mayaro virus (MAYV), Ross River virus (RRV), and Venezuelan Equine Encephalitis virus (VEEV). We observed a positive dose-dependent relationship between hIFNγ and decreasing viral titers for all three viruses. Interestingly, we also observed similar patterns of GBP upregulation with MAYV and RRV, both Old World alphaviruses, but not with VEEV, a New World alphavirus. This finding may indicate an alternative IFNγ-stimulated pathway responsible for controlling different alphaviruses. Overall, these studies establish a fundamental role of IFNγ in controlling viral infection and highlight its potential use in both vaccine and therapeutic intervention. While LAVs are a gold standard for developing immunity against a virus, the urgency of responding to an active and deadly pandemic has promoted the use of faster strategies such as mRNA vaccines. Once the viral sequence was known, these vaccines were comparatively quick to produce for SARS-CoV-2 and prevented millions of disease cases at the height of their introduction. However, the emergence of variants of concerns bypassing previous immunization efforts has demonstrated the need for complementary treatments such as antivirals to control disease. To that end, we evaluated several rhodium organometallic complexes as potential antivirals against SARS-CoV-2. We show that two pentamethylcyclopentadienyl (Cp*) rhodium piano stool complexes, Cp*Rh(ICy)Cl2 and Cp*Rh(dpvm)Cl are non-toxic in Vero E6 and Calu3 cells and reduce SARS-CoV-2 plaque formation up to 99%. These complexes have previously demonstrated high antimicrobial activity against multiple antibiotic-resistance bacteria and with our results, support their potential application as pharmaceuticals, warranting further investigation into their activity. / Doctor of Philosophy / The global response to the COVID-19 pandemic, and its far-reaching impact, revealed significant shortcomings in public health preparedness for emerging viruses. Despite efforts to develop vaccines and antivirals to prevent and treat disease, current mitigation strategies have proven insufficient to eradicate the pathogen. The emergence of viral outbreaks caused by viruses such as chikungunya (CHIKV) and SARS-CoV-2 underscores the ongoing threat posed by emerging infectious diseases. Improved countermeasures are urgently needed to address gaps in vaccine and antiviral development. CHIKV is a mosquito-borne virus that has caused millions of infections across hundreds of countries with the emergent potential to become endemic in the US. Currently, there are no vaccines available to the public; therefore, it is important to generate and administer an effective vaccine before further spread of the virus. To this end, we developed innovative live-attenuated vaccines (LAVs) against CHIKV using a weakened chimeric backbone of CHIKV and its close relative, Semliki Forest virus (SFV), along with vaccine-driven expression of antiviral cytokines to control viral replication. Vaccination of highly susceptible mice with these cytokine-expressing vaccines produced significantly decreased side-effects compared to the parental virus not expressing the cytokines. Additionally, these viruses had significantly restricted viral replication capabilities while robustly protecting mice from a semi-lethal CHIKV infection. Our interferon-gamma (IFNγ) expressing vaccine had the greatest impact on viral replication, and we investigated the mechanism leading to this attenuation. To assess the clinical relevance of our vaccine platform, we redesigned the virus to express human IFNγ and identified a specific pattern of IFNγ-stimulated genes that are potentially responsible for limiting CHIKV replication. Furthermore, we demonstrated the broad therapeutic use of IFNγ against other medically relevant alphaviruses. Overall, these studies establish an improved mechanism to create safer vaccines without compromising efficacy and highlight the therapeutic potential of IFNγ against alphaviruses. Lastly, in a collaborative effort to respond to the COVID-19 pandemic, we also explored and characterized the use of a new class of antiviral drugs. With the advent of increasing drug resistance, it is essential to develop novel and resilient therapeutics. We demonstrated the first antiviral potential of rhodium organometallics, which was previously shown to be effective against multiple antibiotic-resistant bacteria. Two complexes demonstrated high virucidal activity against SARS-CoV-2 and low toxicity in mammalian cell lines. Moreover, these complexes can be further derivatized to improve efficacy, making them a promising new antiviral strategy.

Cette étude a pour objectif d’évaluer la stratégie d’utilisation de critères de base, d’un point de vue éthique, dans l’allocation d’une quantité limitée d’antiviraux pour une utilisation préventive, lors d’une pandémie. Il est entendu qu’une réserve publique pour la prévention n’est pas présentement en vue. Ainsi un des objectifs de cette recherche est de servir de guide aux personnes ressources en positions décisionnelles, à savoir si l’acquisition d’une telle réserve est justifiée, et dans l’affirmatif, à qui elle serait destinée. La perspective spécifique de deux groupes de professionnels de la santé œuvrant en première ligne est considérée. Le premier groupe est constitué de professionnels provenant des hôpitaux de la région de Toronto qui ont vécu l’expérience du SRAS en 2003. Le second groupe est composé de travailleurs en santé de la région de Montréal qui n’auront pas vécu cette crise sanitaire. Les deux groupes sont analysés ensemble sur leur discours verbal et sur leurs réponses à un questionnaire bâti afin d’évaluer quel poids les participants donnent aux critères proposés. / The goal of this study is to assess the use of criteria as a means of deciding who might be priority recipients of an antiviral stockpile, aimed specifically at prevention, during an influenza pandemic. It is understood that a public antiviral stockpile for prevention is not available at this time. Thus one of the objectives of this research is to provide guidance to decision-makers in terms of feedback from healthcare workers on the issue of whether it is necessary to acquire such a stockpile and, if so, for whom. The specific perspectives of two groups of front-line healthcare workers are considered. One group consists of healthcare workers from Toronto hospitals who have experienced the 2003 SARS outbreak. The other group consists of healthcare workers from hospitals in Montreal who did not experience the SARS outbreak. The two groups analyses are based on verbal comments and their responses to a questionnaire designed to evaluate how participants with different background experiences will view and rank the proposed criteria.

L’identification de molécules organiques capables de moduler des interactions protéine-protéine (PPIs) est longtemps restée un domaine peu exploité par la recherche pharmaceutique privée comme académique. Cependant, le développement de méthodologies innovantes pour l’étude des PPIs et la validation récente de ce type d’inhibiteurs dans des essais précliniques, démontrent que les PPIs constituent une nouvelle source de cibles importantes. Les composés capables de moduler ces interactions représentent une nouvelle classe d’outils prometteurs, tant en recherche fondamentale qu’en thérapeutique. Elles peuvent aider à différencier les multiples fonctions portées par une même protéine, à replacer la protéine dans une cascade de réactions, ainsi qu’à disséquer et reconstituer des réseaux de signalisations protéiques. Ces molécules permettront également de faire émerger de nouvelles familles d’agents pharmacologiques actifs dans diverses pathologies.Mon travail de thèse s'est projeté dans l'avenir de la recherche biomédicale, en ciblant les interactions protéine-protéine. J’ai pu durant mon doctorat mettre en œuvre plusieurs méthodologies pour étudier et caractériser des interactions protéiques afin de développer des inhibiteurs de ces interactions. J’ai ainsi pu travailler sur l’optimisation d’un composé inhibiteur de l’interaction de la protéine virale Nef VIH-1 avec les domaines SH3 des Src kinases, le composé DLC27. J’ai également pu mettre en évidence la pertinence biologique de ce composé, qui cible un mode d’interaction unique, ou très rare, au niveau cellulaire en étudiant l’interaction avec les domaines SH3 de deux protéines, ALIX (ALG2-Interacting Protein X) et la sous-unité p85 de la PI3K (phosphatidylinositol 3-kinase).J’ai également pu caractériser la surface et le mode d’interaction de protéines virales impliquées dans le complexe de réplication du virus du SRAS (Syndrome Respiratoire Aigu Sévère). Cette étude tend à montrer que la protéine virale nsp10 agit comme une plateforme de reconnaissance pour ses partenaires, les protéines virales nsp14 et nsp16. Ces interactions permettent l’activation ou l’augmentation des activités respectives de nsp16 et nsp14 et jouent un rôle au niveau de la réplication virale. Suite à l’identification d’un ‘point chaud’ d’interaction, le résidu Tyr96 à la surface de nsp10, nous avons mis en évidence la première famille de molécules inhibitrices du complexe nsp10-nsp14 en couplant des méthodes informatiques (in silico) à des criblages expérimentaux. Ces molécules pourraient être utilisées comme antiviraux ou servir d’outils pour la recherche, en permettant par exemple de mieux comprendre et d’élucider les mécanismes moléculaires impliqués dans la réplication du virus du SRAS et des coronavirus en général. / Protein-protein interactions (PPIs) participate in and regulate almost all essential cellular functions. As a consequence, they are frequently involved in various pathologies (going from cancer development to viral replication and host cell infection) but their study remains a challenge.Thus understanding those interactions as well as finding small drug candidates able to modulate them, a field of research not currently fully developed, appear as the future of the healthcare industry.In this context, I chose to learn different techniques to study PPIs that are usually employed in academic (IMR laboratory, CNRS, France) or corporate environments (Genentech, USA). Moreover, I also worked on the development of small organic inhibitors of PPIs coupling in silico methodologies (chemo-informatics, Drug Design) to biological and structural validations.During my PhD, I could manage and work on different projects involving the study of PPIs involved in cancer signaling pathways as well as the development of potent antiviral drugs targeting the HIV and SARS viruses.My organizational, personal and scientific skills as well as the practical experience I developed on various techniques (from cell biology to biophysics, structural biochemistry and Drug Design), make me feel confident on the management of PPIs drug discovery projects.I am thus able to efficiently work on, and manage, the study of protein-protein interactions in various pathologies as well as the development of potent PPIs inhibitors, that will be a major breakthrough for Biotech/Pharma companies in the coming years.

Introdução: Indivíduos com infecção pelo vírus de Hepatite C (HCV) frequentemente apresentam uso de álcool, contudo, pacientes com consumo moderado ainda são pouco estudados, especialmente, sobre qual o impacto desse uso de álcool nos sintomas depressivos e ansiosos. Objetivos: Caracterização dos pacientes portadores de HCV e investigação do impacto do uso moderado de álcool na presença e intensidade dos sintomas de depressão e ansiedade nessa população. Métodos: Foram selecionados 109 indivíduos, portadores de HCV, provenientes dos ambulatórios de Hepatologia e Moléstias Infecciosas do Hospital das Clínicas da FMUSP, que aguardavam o início do tratamento para HCV. Os pacientes foram submetidos à entrevista psiquiátrica, análise dos dados clínicolaboratoriais e elastografia hepática transitória não invasiva com FibroScan®; os sintomas depressivos e ansiosos foram avaliados por meio das escalas de BDI e BAI. Os participantes foram divididos em dois grupos, de acordo com o consumo de álcool, baseado em pontuação positiva na segunda questão do ASSIST (teste de triagem para o uso de álcool, tabaco e outras substâncias). O grupo com ASSIST positivo para uso de álcool foi comparado ao grupo com ASSIST negativo para uso de álcool, referente aos dados sociodemográficos, clínicos, sintomas depressivos e ansiosos. Resultados: Nessa amostra, 44% dos participantes encontravam-se na faixa etária a partir dos 60 anos, 59% eram do gênero masculino, 59% casados e 53% completaram o ensino fundamental I. Em relação às características relacionadas ao HCV: 82% apresentavam o genótipo tipo 1 e 61% apresentavam avaliação da fibrose hepática pelo FibroScan®, entre F3 e F4. Ao comparar os grupos com ASSIST positivo e negativo para uso de álcool, não foram observadas diferenças significativas nos dados sociodemográficos, clínicolaboratoriais, sintomas depressivos e ansiosos. Ao associar o uso moderado de álcool, bem como sintomas depressivos (BDI) e ansiosos (BAI), não foi encontrada diferença estatisticamente significante entre os grupos. Conclusão: Nessa amostra, o uso moderado de álcool, em indivíduos portadores de HCV não submetidos ao tratamento com antivirais de ação direta, não foi associado à maior intensidade de sintomas depressivos e ansiosos / Background: Individuals with hepatitis C virus infection (HCV) frequently present alcohol use; however, patients with moderate alcohol consumption are still poorly studied, especially regarding the impact of this alcohol use on depressive and anxiety symptoms in patients with HCV. Aims: Characterization of patients with HCV and investigation of the impact of moderate alcohol use on the presence and intensity of symptoms of depression and anxiety in this population. Methods: We selected 109 individuals with HCV from the Hepatology and Infectious Diseases clinics of the Hospital das Clinicas of FMUSP, who were waiting to start HCV treatment. Those patients were submitted to a psychiatric interview, analysis of clinical and laboratory data and non-invasive transient hepatic elastography with FibroScan®; depressive and anxiety symptoms were evaluated using the BDI and BAI scales. Participants were divided into two groups according to alcohol consumption based on a positive score on the second point of the ASSIST (screening test for alcohol, tobacco and other substances). The positive ASSIST group for alcohol use was compared to the negative ASSIST group for alcohol use, referring to socio-demographic, clinical data, and depression and anxiety symptoms. Results: In this sample, 44% of the participants were above 60 years old, 59% were males, 59% were married, and 53% completed elementary education I. In relation to HCV-related characteristics, 82% were type 1 genotype and 61% presented FibroScan® assessment of hepatic fibrosis between F3 and F4. When comparing the groups with positive and negative ASSIST for alcohol use, no significant differences were observed in sociodemographic, clinical and laboratory data or depression and anxiety symptoms. By associating moderate use of alcohol and depression (BDI) and anxiety (BAI) symptoms, no statistically significant difference was found between the groups. Conclusion: In this sample, the moderate use of alcohol in HCV patients not submitted to treatment with direct-acting antivirals was not associated with a greater intensity of depression and anxiety symptoms

O objetivo principal deste estudo foi avaliar a frequência de cepas do HBV com mutações de resistência aos análogos nucleos(t)ídeos (AN) utilizados no tratamento da hepatite B entre indivíduos cronicamente infectados, não submetidos a tratamento, procedentes de diferentes regiões do Brasil. Além disso, foram avaliadas a presença de mutações que alteram a antigenicidade do HBsAg promovendo escape dos anticorpos anti-HBs; mutações nos genes pré-core/core e a associação dos diferentes subgenótipos com as mutações encontradas e características demográficas e laboratoriais dos pacientes. Foram incluídas 779 amostras de soro de pacientes com infecção crônica pelo HBV e virgens de tratamento com AN ou interferon, as quais foram coletadas no período de 2006 a 2011. Os pacientes eram procedentes dos seguintes estados brasileiros: Pará, Maranhão, Bahia, Minas Gerais, São Paulo, Paraná e Rio Grande do Sul. O DNA do HBV foi extraído das amostras de soro utilizando o Kit QIAamp DNA Blood Mini Kit (Qiagen) e posteriormente foi realizada a amplificação das regiões S/polimerase (S/P) e pré-core/core (PCC) do genoma viral por nested PCR. O fragmento amplificado foi submetido a sequenciamento direto em sequenciador automático de DNA (ABI 3500) e as sequências obtidas foram analisadas para identificação dos genótipos e subgenótipos do HBV, pesquisa de mutações na polimerase, no HBsAg e nos genes pré-core/core. A região S/Pol foi amplificada e sequenciada com sucesso em 702 amostras, as quais foram incluídas para atender aos objetivos deste estudo. Entre as 702 amostras analisadas sete genótipos e 12 subgenótipos do HBV foram identificados. O subgenótipo A1 foi o mais frequente (63,7%, 447/702), seguido pelo HBV/D3 (14,5%, 102/702). Os demais genótipos e subgenótipos encontrados e suas frequências foram as seguintes: A2 (3,3%, 23/702), A3 (0,1%, 1/702), B1 (0,1%, 1/702), B2 (0,1%, 1/702), C2 (0,9%, 6/702), D1 (0,9%, 6/702), D2 (4,6%, 32/702), D4 (5,1%, 36/702), D com subgenótipo não identificado (0,7%, 5/702), E (0,6%, 4/702), F2a (4,6%, 32/702), F4 (0,4%, 3/702), e G (0,4%, 3/702). Cepas do HBV com mutações de resistência (rtS202G, rtM204V/I, rtA194T, rtM250I, rtA181T/S, rtT184S) associadas ou não a mutações compensatórias (rtL80I, rtV173L, rtL180M, rtV207I) foram identificadas em 1,6% (11/702) das amostras analisadas. Cepas com mutações potencialmente associadas com resistência ao adefovir (rtS85A, rtL217R, rtI233V, rtN238T, rtN238D, rtN248H, rtV214A,e rtQ215S) ou ao entecavir (rtS219A) foram identificadas em 7,7% (54/702) e 2,6% (16/702) dos pacientes, respectivamente. Cinquenta e sete (8,5%) amostras apresentaram cepas do HBV com mutações na principal região hidrofílica do HBsAg previamente relacionadas com escape dos anticorpos anti-HBs ou com prejuízo na secreção do HBsAg. Foram feitas análises estatísticas para avaliar a correlação entre os subgenótipos do HBV mais frequentes na casuística (A1, A2, D1, D2, D3, D4 e F2a) e a presença de mutações nos genes PCC. Dentre as mutações nos genes PCC associadas com redução ou falha na expressão do HBeAg, as mutações A1762T/T1764A estiveram associadas aos subgenótipos A1 e F2a; G1862T e mutações nas posições 1809-1812 ao subgenótipo A1; G1896A e/ou G1899A aos subgenótipos D2, D3 e D4. Mutações associadas com evolução da doença foram detectadas e entre essas as mutações C1766T e T1768A estiveram associadas aos subgenótipos A1 e F2a, e a mutação G1888A foi associada ao subgenótipo A1. As cepas do HBV que circulam nas diferentes regiões brasileiras estudadas apresentam grande variabilidade genética e a distribuição dos genótipos e subgenótipos reflete a formação histórica de cada região e do fluxo migratório mais recente. A frequência de cepas do HBV com mutações de resistência aos AN circulando entre pacientes virgens de tratamento com esses medicamentos nas diferentes regiões do Brasil estudadas é baixa, sendo que o perfil de mutações que confere resistência total à lamivudina e parcial ao entecavir parece ser o mais disseminado. Embora tenham sido detectados casos de infecção com cepas do HBV portando mutações com grande impacto na antigenicidade dessa proteína todas as amostras apresentaram HBsAg detectável. Pacientes com HBeAg negativo foram mais frequentes na casuística estudada, independente do subgenótipo. As mutações encontradas nos genes PCC sugerem que há perfis de mutações diferentes envolvidos na negatividade do HBeAg para cada subgenótipo / The main aim of this study was to evaluate the frequency of HBV strains harboring mutations that confer resistance to nucleos(t)ide analogues (NA) used to hepatitis B treatment among treatment-naïve patients with chronic hepatitis B from different Brazilian region. Furthermore, we evaluated the presence of mutations that alter the antigenicity of HBsAg causing anti-HBs escape; mutations in genes pre-core/core and the association of different subgenotypes with the mutations detected and demographic and laboratory characteristics of the patients. Serum samples from 779 treatment-naïve patients with chronic HBV infection were included in this study. The samples were collected between 2006 to 2011 and the patients were from the following states: Pará, Maranhão, Bahia, Minas Gerais, São Paulo, Paraná and Rio Grande do Sul. HBV DNA was extracted from serum samples using the QIAamp DNA Blood Mini Kit (Qiagen) and amplification of S/polymerase (S/Pol) and pre-core/core (PCC) regions were performed by nested PCR. The amplified PCR products were submitted to sequencing in an automatic DNA sequencer (ABI 3500). The sequences obtained were analyzed to classify HBV genotypes/subgenotypes and to analyze the presence of mutations. S/Pol region was amplified and sequenced successfully from 702 samples, which were included in this study. Among these 702 samples, seven genotypes and 12 subgenotypes have been identified. HBV subgenotype A1 was the most frequent (63.7%, 447/702), followed by HBV/D3 (14.5%; 102/ 702). The remaining genotypes and subgenotypes identified and their frequencies were as follows: A2 (3.3%, 23/702), A3 (0.1%, 1/702), B1 (0.1%, 1/702), B2 (0.1%, 1/702), C2 (0.9%, 6/702), D1 (0.9%, 6/702), D2 (4.6%, 32/702), D4 (5.1%, 36/702), D unclassified subgenotype (0.7%, 5/702), E (0.6%, 4/702), F2a (4.6%, 32/702), F4 (0.4%, 3/702), and G (0.4%, 3/702). HBV strains harboring mutations conferring NA resistance alone (rtS202G, rtM204V/I, rtA194T, rtM250I, rtA181T/S, rtT184S) or combined with compensatory mutations (rtL80I, rtV173L, rtL180M, rtV207I) were identified in 1.6% (11/702) of the patients. Isolates harboring mutations potentially associated with adefovir resistance (rtS85A, rtL217R, rtI233V, rtN238T, rtN238D, rtN248H, rtV214A, and rtQ215S) or entecavir resistance (rtS219A) were identified in 7.7% (54/702) and 2.6% (16/702) of the patients, respectively. HBV with HBsAg mutations previous related with anti-HBs escape or impaired secretion were detected in 8.5% (57/702) of the samples. Statistical analyzes were performed to assess the correlation between the more frequent HBV subgenotypes found in this study (A1, A2, D1, D2, D3, D4 and F2a ) and mutations in PCC genes. Among the mutations found in these genes that were associated with reduction or failure in HBeAg synthesis, A1762T/T1764A mutations were associated to subgenotypes A1 and F2a; G1862T and mutations at positions 1809-1812 to subgenotype A1; G1896A and/or G1899A to subgenotypes D2, D3 and D4. Other mutations associated with disease progression were found: C1766T and T1768A mutations were associated with subgenotypes A1 and F2a, and the G1888A mutation was associated with subgenotype A1. HBV strains circulating in different Brazilian regions studied showed high genetic variability and distribution of genotypes and subgenotypes reflects the population formation history of each region and the occurrence of recent events of migration. The frequency of HBV strains with NA resistance mutations circulating among treatment-naive patients in different regions of Brazil studied is low and the profile of mutations that confer total resistance to lamivudine and partial resistance to entecavir is more widespread. Although some cases of infection have been detected with HBV strains carrying mutations associated with major impact on the antigenicity of this protein, all samples had detectable HBsAg. HBeAg negative cases were more frequent in the studied population, regardless of subgenotype. Different pattern of mutations were found in PCC genes, suggesting that different mechanisms are involved in HBeAg negativity for each subgenotype

Résumé Le virus de l’immunodéficience humaine (VIH) est l’agent pathogène responsable du Syndrome del’Immunodéficience Acquise (SIDA). A l’heure actuelle, le traitement des patients infectés par le VIH estbasé sur l’emploi de substances chimiques destinées à perturber les différentes étapes du cycle deréplication du virus (chimiothérapie). Même si elles permettent d’améliorer l’état de santé des patientset d’augmenter leur espérance de vie, ces thérapies restent coûteuses, contraignantes et imparfaites.La recherche de nouveaux composés plus efficaces reste donc d’actualité. Ce travail de thèse est dédié à la conception rationnelle et à l’étude d’inhibiteurs non nucléosidiques dela transcriptase inverse du VIH-1 (INNTI) une enzyme essentielle au cycle de réplication de ce virus.Les molécules étudiées dérivent du cycle 2-pyridinone dont sont déjà issues plusieurs familles d’INNTIdécrites dans la littérature. La conception rationnelle de molécules d’intérêt pharmaceutique nécessite une bonne compréhensiondes interactions mises en jeu entre la macromolécule cible et ses ligands. Etant donné qu’aucunestructure cristallographique d’un complexe TI-pyridinone n’est disponible dans la littérature, la premièrepartie de ce travail est consacrée à la proposition d’un mode d’interaction TI-pyridnone et à larationalisation des relations structure-activité liées à cette famille de molécules. Les informationsrecueillies lors de cette étude théorique sont ensuite exploitées dans le but d’aider au développementd’une nouvelle série d’inhibiteurs. Abstract Human Immunodeficiency Virus (HIV) is the causative agent of Acquired Immune DeficiencySyndrome (AIDS). Treatment of HIV-infected patients is currently based on the use of chemicalcompounds that interfere with various steps of the viral replication cycle (chemotherapy).Although these therapies allow for a significant improvement of a patient’s health, theynonetheless remain imperfect and expensive. Research for new and improved anti-HIVcompounds is therefore necessary. This Ph. D. thesis is dedicated to the rational design and analysis of new non nucleosideinhibirors of HIV-1 reverse transcriptase (NNRTI), a key enzyme in HIV lifecycle. Most of thestudied compounds are derived from the 2-pyridinone ring, that is part of several NNRTIfamilies. Rational drug design usually requires a good understanding of the main interactions betweenthe macromolecular target (RT) and its ligands. However, no crystal structure of a RT-pyridinone complex has been reported yet. Our first objective was therefore to build atheoretical model describing RT-pyridinone interactions and providing a better understanding ofstructure-activity relationships among pyridinones. The information obtained in this theoreticalmodel was then used in order to develop new and potent inhibitors.

Cette étude a pour objectif d’évaluer la stratégie d’utilisation de critères de base, d’un point de vue éthique, dans l’allocation d’une quantité limitée d’antiviraux pour une utilisation préventive, lors d’une pandémie. Il est entendu qu’une réserve publique pour la prévention n’est pas présentement en vue. Ainsi un des objectifs de cette recherche est de servir de guide aux personnes ressources en positions décisionnelles, à savoir si l’acquisition d’une telle réserve est justifiée, et dans l’affirmatif, à qui elle serait destinée. La perspective spécifique de deux groupes de professionnels de la santé œuvrant en première ligne est considérée. Le premier groupe est constitué de professionnels provenant des hôpitaux de la région de Toronto qui ont vécu l’expérience du SRAS en 2003. Le second groupe est composé de travailleurs en santé de la région de Montréal qui n’auront pas vécu cette crise sanitaire. Les deux groupes sont analysés ensemble sur leur discours verbal et sur leurs réponses à un questionnaire bâti afin d’évaluer quel poids les participants donnent aux critères proposés. / The goal of this study is to assess the use of criteria as a means of deciding who might be priority recipients of an antiviral stockpile, aimed specifically at prevention, during an influenza pandemic. It is understood that a public antiviral stockpile for prevention is not available at this time. Thus one of the objectives of this research is to provide guidance to decision-makers in terms of feedback from healthcare workers on the issue of whether it is necessary to acquire such a stockpile and, if so, for whom. The specific perspectives of two groups of front-line healthcare workers are considered. One group consists of healthcare workers from Toronto hospitals who have experienced the 2003 SARS outbreak. The other group consists of healthcare workers from hospitals in Montreal who did not experience the SARS outbreak. The two groups analyses are based on verbal comments and their responses to a questionnaire designed to evaluate how participants with different background experiences will view and rank the proposed criteria.