Antiretroviral drugs have revolutionized HIV care and enabled better management of the infection thus allowing patients survive for many years. One proposed approach to increase access to such drugs in sub-Saharan Africa is to use of a reduced-dose alternative of the drug efavirenz, with 400 mg rather than regular 600 mg dose. This effectively would provide medication for 50 percent more persons with the same amount of active ingredient. However, antiretroviral drugs require high patient adherence to achieve intended therapeutic effect, and it is unclear if a reduced-dose therapy would have sufficient efficacy, and if it would lead to an increased risk of viral resistance. The time profile of drug plasma concentration and corresponding long-term viral load was estimated using integrated population PK/PD simulations, with model parameters based on selected research studies. The results suggest a reduced dose 400 mg, rather than 600 mg regular dose, efavirenz in HIV therapy would place strict demands on patients to maintain very high adherence levels, at least 80-90 percent, to maintain sufficient drug concentration in blood plasma, and to minimize risk of viral failure. However, it is relatively rare for HIV therapy programs in sub-Saharan Africa to consistently achieve such high adherence levels. In addition, if patients are co-administered rifampin, a drug widely used in TB care, this increases hepatic metabolism and plasma clearance rate, resulting in further reduced average drug plasma concentration. These findings suggest a reduced dose efavirenz treatment alternative may be most (only) relevant for patient categories expected to maintain high adherence; and in particular among persons who have been confirmed to have CYP2B6 genotype consistent with inherently lower drug metabolism. At usual adherence levels it is estimated a reduced dose alternative may increase the share of patients at risk of viral failure by 5 to 15 percent vs. regular dose of 600 mg.

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2014-09-30T15:22:16Z No. of bitstreams: 2 Melo, Ariane Carla Campos de-2013-dissertação.pdf: 4034937 bytes, checksum: 463f8b0f4d2e9a65e273d336d96f0691 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2014-09-30T15:24:53Z (GMT) No. of bitstreams: 2 Melo, Ariane Carla Campos de-2013-dissertação.pdf: 4034937 bytes, checksum: 463f8b0f4d2e9a65e273d336d96f0691 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2014-09-30T15:24:53Z (GMT). No. of bitstreams: 2 Melo, Ariane Carla Campos de-2013-dissertação.pdf: 4034937 bytes, checksum: 463f8b0f4d2e9a65e273d336d96f0691 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2013-08-02 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / Lamivudine and Efavirenz are anti-HIV drug largely used as, respectively a non-nucleoside and a nucleoside reverse transcriptase inhibitor as part of antiretroviral therapies. During the tests to obtain co-crystals of efavirenz with lamivudine it was obtained a novel crystalline phase, the polymorph of the hydrochloride salt of lamivudine. The structural and conformational analysis of this crystal modification showed that this keeps similarities, in intramolecular and intermolecular level, respectively with lamivudine hydrochloride and lamivudine hydrochloride monohydrate. Based on the intermolecular analysis and packing efficiency is expected that the polymorph of the hydrochloride salt of lamivudine is more soluble than the anhydrous phase. There are few reports on efavirenz solid state structures and behaviors. Crystal engineering strategies have not been well-exploited for this drug. In this sense, we delineate our synthesis strategy from the structural comparison and possibility of formation of intermolecular interactions patterns similar to those observed in the cocrystal of efavirenz and 4,4’-bipyridine. Two 4,4’-bipyridine-like compounds whose heterocycles are spaced by either an ethylene and an ethane moiety were cocrystallized together with efavirenz into solid state forms isostructural with respect to that of the drug cocrystal with 4,4’-bipyridine. The formation of a three-molecule entity based mainly on the hydrogen bonding donation from two efavirenz molecules to both pyridyl nitrogens of each coformer unit was kept in the three efavirenz cocrystals. The introduction of spacer groups in the coformers has altered the pattern of weak non-classical hydrogen bonds of the type C— H· · ·O. This intriduction was also related to the formation of a π-π stacking interaction between pyridyl rings of the ethane-spaced conformer. Furthermore, a polymorphic form of efavirenz with only one molecule in the asymmetric unit is reported for the first time here. This polymorph crystallizes in the monoclinic system and space group C2, strictly similar to form / Lamivudina e Efavirenz são fármacos anti-VIH utilizados respectivamente como um inibidor não nucleosídeo da transcriptase reversa e inibidor nucleosídeo da transcriptase reversa como parte de terapias anti-retrovirais. Durante os ensaios destinados a obtenção dos co-cristais de efavirenz com lamivudina obteve-se uma fase cristalina inédita, o polimorfo do cloridrato de lamivudina. As análises conformacionais e estruturais desta modificação cristalina revelaram que a mesma guarda semelhanças em nível intramolecular e intermolecular, respectivamente com o cloridrato de lamivudina e com o cloridrato monohidratado de lamivudina. Baseada na análise intermolecular e na eficiência do empacotamento espera-se que o polimorfo do cloridrato de lamivudina seja mais solúvel que a fase anidra. Existem poucos registros de comportamento e estruturas da fase sólida do efavirenz. Estratégias de engenharia de cristais não têm sido bem exploradas com esse fármaco. Nesse sentindo, delineamos nossa estratégia de síntese a partir da comparação estrutural e possibilidade de formação de padrões de interações intermoleculares similares àquelas observadas no cocristal de efavirenz com 4,4’ - bipiridina. Dois compostos semelhantes a 4,4’- bipiridina, BPE e BPA, cujos heterociclos são respectivamente separados por um grupo etileno respectivamente e um grupo etano cristalizaram com o efavirenz em formas sólidas isoestruturais aquela obtida com a 4,4’- bipiridina. A formação de uma entidade tri-molecular baseada principalmente em doações de ligações de hidrogênio de duas moléculas de efavirenz para ambos os nitrogênios piridinícos de cada unidade do co-cristalizante foi mantida nos três cocristais de efavirenz. A introdução de grupos espaçadores nos co-cristais alterou o padrão das ligações de hidrogênio do tipo C—H· · ·O. A introdução destes grupos também está relacionada com a formação de interações do tipo π-π entre os anéis de piridil do cocristalizante espaçado com etano. Além disso, uma forma polimórfica do fármaco efavirenz com apenas uma molécula na unidade assimétrica é relatada pela primeira vez aqui. Este polimorfo, forma V, cristaliza no sistema monoclínico e grupo espacial C2, e estritamente similar à forma V.

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Medicina, 2008. / Submitted by Jaqueline Oliveira (jaqueoliveiram@gmail.com) on 2008-11-19T19:26:40Z No. of bitstreams: 1 DISSERTACAO_2008_EricaAlessandraRAlves.pdf: 1225470 bytes, checksum: 1bdf066ff4cc5dac11f9085df9118f7d (MD5) / Approved for entry into archive by Georgia Fernandes(georgia@bce.unb.br) on 2009-03-05T14:09:36Z (GMT) No. of bitstreams: 1 DISSERTACAO_2008_EricaAlessandraRAlves.pdf: 1225470 bytes, checksum: 1bdf066ff4cc5dac11f9085df9118f7d (MD5) / Made available in DSpace on 2009-03-05T14:09:36Z (GMT). No. of bitstreams: 1 DISSERTACAO_2008_EricaAlessandraRAlves.pdf: 1225470 bytes, checksum: 1bdf066ff4cc5dac11f9085df9118f7d (MD5) / A introdução da terapia antiretroviral de alta eficácia em 1996 determinou uma queda substancial da morbidade e mortalidade associadas ao Vírus da Imunodeficiência Humana (VIH). Embora a infecção seja controlada pelos antiretrovirais, observam-se efeitos colaterais indesejados, fato que demonstra a capacidade de interação destes fármacos com as células dos indivíduos que os recebem. Recentemente, estes medicamentos têm sido relacionados à modulação do sistema imunitário inato e adaptativo, entretanto pouco se sabe acerca da influência dos protocolos rotineiramente utilizados pelos indivíduos infectados por este vírus, já que a maior parte das pesquisas investiga a influência de drogas isoladas sobre o sistema imunitário. Portanto, o objetivo deste trabalho foi investigar a influência, in vitro, da zidovudina (AZT), da lamivudina (3TC), do efavirenz (EFV) e do lopinavir/ritonavir (LPV/RTV) isoladamente ou das associações AZT/3TC/EFV e AZT/3TC/LPV/RTV sobre a capacidade fagocitária e produção de ânions superóxido por neutrófilos e monócitos de indivíduos saudáveis. Foram retirados 20 ml do sangue periférico de 20 voluntários, após consentimento informado, para realização dos ensaios e avaliadas tanto a capacidade fagocitária dos neutrófilos e monócitos pelos receptores para padrões moleculares de patógenos (rPMP) quanto pelos receptores para opsoninas. Os fármacos foram utilizados nas concentrações plasmáticas máximas observadas após ingestão, sendo para o AZT 1,64 µg/ml, para o 3TC 1,5µg/ml, para o EFV 3,7 µg/ml, para o LPV 11,45 µg/ml e para o RTV 2,86 µg/ml. O índice fagocitário foi determinado pela multiplicação da média de Saccharomyces cerevisiae aderidas/ingeridas por fagócito pelo percentual de fagócitos envolvidos na fagocitose. A avaliação da capacidade oxidativa dos fagócitos foi feita pelo teste do nitroblue tetrazolium. O EFV isoladamente aumentou o percentual de neutrófilos envolvidos na fagocitose pelos rPMP (p=0,004) e para opsoninas (p=0,020) enquanto que a préincubação com LPV/RTV (p=0,024) e com a associação AZT/3TC/LPV/RTV (p=0,008) por 60 minutos diminuiu o índice fagocitário dos neutrófilos quando avaliada a capacidade fagocitária destas células pelos rPMP. A pré-incubação dos fagócitos por 30 minutos com LPV/RTV aumentou a capacidade fagocitária dos monócitos pelos rPMP (p=0,003) tanto pelo aumento da média de leveduras aderidas/ingeridas por monócito quanto pelo percentual de monócitos envolvidos na fagocitose, resultado semelhante ao da pré-incubação dos monócitos com a associação AZT/3TC/LPV/RTV por 30 minutos e tendeu a aumentar o percentual de neutrófilos envolvidos na fagocitose (p=0,077) quando avaliada a fagocitose por meio dos receptores para opsoninas. Entretanto, quando avaliada a influência do pré-tratamento dos monócitos com LPV/RTV por 60 minutos, a capacidade fagocitária destas células pelos rPMP diminuiu (p=0,013) devido ao decréscimo do percentual de monócitos envolvidos na fagocitose. Estes fármacos isoladamente também diminuíram a capacidade fagocitária dos monócitos (p=0,020) mediada por receptores para opsoninas pela diminuição da média de leveduras aderidas/ingeridas por monócito, enquanto que o AZT tendeu a aumentar a capacidade fagocitária destas células pelos receptores para padrões moleculares de patógenos (p=0,097), pois tendeu a aumentar o percentual de monócitos envolvidos na fagocitose. A produção de radicais de oxigênio foi mais abrangentemente influenciada pelos antiretrovirais estudados. O AZT (p=0,027) e o 3TC (p=0,004) isoladamente e as associações LPV/RTV (p=0,0001) e AZT/3TC/LPV/RTV (p=0,0001) diminuíram a produção estimulada do ânion superóxido pelos fagócitos. O percentual de redução do NBT basal também foi deprimido pela associação LPV/RTV (p=0,0007) e AZT/3TC/LPV/RTV (p<0,0001) e tendeu a ser reduzido pelo 3TC isoladamente (p=0,071). Os demais tratamentos não influenciaram a capacidade fagocitária ou a produção de ânions superóxido pelos fagócitos. Os resultados sugerem que o protocolo AZT/3TC/EFV, por não interferir com a capacidade fagocitária, seja mais adequado para o tratamento inicial dos indivíduos infectados pelo VIH enquanto que o protocolo contendo AZT/3TC/LPV/RTV, por sua propriedade imunomoduladora, deveria ser reservado para aqueles pacientes que apresentem intolerância ou resistência ao EFV. É possível também que pacientes com resistência a múltiplos esquemas antiretrovirais se beneficiem de protocolos que contenham LPV/RTV, pois como evidenciado diminuem a produção de radicais de oxigênio, podendo contribuir para taxas mais baixas de replicação do viral, de apoptose de linfócitos e da neurodegeneração relacionada ao VIH. __________________________________________________________________________________ ABSTRACT / The introduction of highly active antiretroviral therapy (HAART) in 1996 has decreased the morbidity and the mortality rates associated with the HIV infection. Though the infection can be controlled by antiretrovirals, these medicines may cause undesirable side effects due to their capacity to interact with cells of patients. It has been reported that these drugs may modulate the innate and adaptative immnune system. However, few is known about the influences on immune functions by protocols routinely used in the treatment of HIV infected patients, constituted by reverse transcriptase and protease inhibitors, because most of researches have just investigated the influence restricted to isolated drugs. So, this work aimed to evaluate the influence of the isolate treatment with zidovudine (AZT), lamivudine (3TC), efavirenz (EFV), lopinavir/ritonavir (LPV/RTV) and of the associations AZT/3TC/EFV or AZT/3TC/LPV/RTV on phagocytic capacity and superoxide production by neutrophils and monocytes of healthy individuals, in vitro. It was collected 20 ml of peripheral blood from 20 healthy volunteers and the phagocytic capacity was assessed through pathogen-associated molecular patterns receptors (PAMPr) and through opsonin receptors. The drugs were used on maximum plasma levels considering pharmacokinetic studies after ingestion and the concentration applied for each one was 1,64 µg/ml for AZT, 1,5µg/ml for 3TC, 3,7 µg/ml for EFV and 11,45 µg/ml and 2,86 µg/ml for LPV and RTV, respectively. The phagocytic index was calculated as the average number of ingested Saccharomyces cerevisiae per phagocyte multiplied by the percentage of these cells engaged in phagocytosis. The oxidative capacity was assessed by the nitroblue tetrazolium (NBT) test. The isolated treatment with EFV increased the percentual of neutrophils engaged in phagocytosis through PAMPr (p=0,004) and through opsonin receptors (p=0,020), while the preincubation with LPV/RTV (p=0,024) and AZT/3TC/LPV/RTV (p=0,008) for 60 minutes decreased neutrophil phagocytic index when phagocytosis through PAMPr was investigated. The pretreatment of phagocytes for 30 minutes with LPV/RTV increased the monocyte phagocytic capacity through PAMPr (p=0,003) due to both the increase of the ingested yeasts average and the percentual of monocytes involved in phagocytosis, similar to the result observed to the pretreatment of these cells with AZT/3TC/LPV/RTV for 30 minutes and tended to increase (p=0,077) the percentual of neutrophils engaged in phagocytosis through opsonin receptors. However, when LPV/RTV was incubated with monocytes for 60 minutes, the monocyte phagocytic index through PAMPr decreased (p=0,013) due to the diminished percentual of monocytes engaged in phagocytosis. The LPV/RTV isolately decreased the monocyte phagocytic capacity (p=0,020) due to the reduction of the number of ingested yeasts by these cells. The AZT tended to increase the monocyte phagocytic capacity when phagocytosis through PAMPr was analyzed (p=0,097), because it tended to increase the percentual of monocytes engaged in phagocytosis. The production of reactive oxygen species (ROS) were more intensely influenced by the studied antiretrovirals. The AZT (p=0,027) and the 3TC (p=0,004) isolately and the associations LPV/RTV (p=0,0001) and AZT/3TC/LPV/RTV (p=0,0001) decreased the stimulated production of ROS by phagocytes. The percentual of baseline NBT reduction was also depressed by the associations LPV/RTV (p=0,0007) e AZT/3TC/LPV/RTV (p<0,0001) and tended to be reduced by the treatment with 3TC alone (p=0,071). These results suggest that the protocol AZT/3TC/EFV can be more adequate to the initial treatment of those individuals infected by HIV because it has not changed the phagocytic capacity or ROS production by neutrophils and monocytes, while the association AZT/3TC/LPV/RTV could be more interesting to patients with intolerance or viral resistance to EFV. It is also possible that patients with multiple resistances to antiretrovirals can be benefited by protocols containing LPV/RTV, because the reduction of ROS determined by these drugs, as demonstrated in this research, can contribute for the lowest rates of viral replication, lymphocyte apoptosis and HIV-related neurodegeneration.

>Magister Scientiae - MSc / Efavirenz is a non-nucleoside reverse transcriptase inhibitor used as an anti-retroviral for the treatment of human immunodeficiency virus (HIV) type I. It is classified as a class IΙ drug under the Biopharmaceutical Classification System (BCS) and exhibits a low solubility (aqueous solubility of 9.0 μg/ml) and high permeability (variable oral bioavailability). This study aims to choose a pre-formulation protocol with the best efavirenz derivative in literature between co-crystals and CD inclusion complexes. Upon selection of the efavirenz derivative, the complications of both small scale and large scale laboratory pre-formulation production is highlighted for formulation of a tablet dosage form. Numerous variables were selected for the pre-formulation protocol. Physical, chemical, pharmacological, pharmaceutical and economical variables were investigated. Citric acid monohydrate (CTRC) was chosen as the best co-former for a co-crystal while hydroxypropyl-beta-cyclodextrin (HP-β-CD) was selected as a host for an inclusion complex. Pharmaceutically, the angle of repose, Carr’s index, Hausner’s ratio, moisture content, disintegration time, hardness/resistance to crush, manufacturing process problems and particle size of the CTRC and HP-β-CD were all evaluated. The CTRC was ultimately selected for formulation of a tablet. The preparation of small laboratory scale of EFA/CTRC co-crystal was successfully achieved after several attempts. The large laboratory scale of EFA/CTRC was prepared under various environmental seasons which were indicated as batches 1-6 for purposes of this study. Characterization of the large laboratory scale EFA/CTRC co-crystals was performed by scanning electron microscopy (SEM), hot-stage microscopy (HSM), differential scanning calorimetry (DSC), thermogravimetric analysis (TGA) and by physical inspection (i.e. season, texture, colour, shape and particle size) of the EFA/CTRC product. Batch 1 and 2 were prepared during the summer season. The SEM analysis showed that the particles were needle-like shaped. The thermal analysis values of batch 1 by HSM, DSC and TGA results were 123 °C, 119 °C and 1.68 % of mass loss, respectively. In batch 2, morphology results by SEM revealed spikes of irregular and agglomerated particles. Batch 2 melted at 123 °C and a small unmelted quantity was observed at 143 °C. The DSC and TGA (mass loss) analysis were 118 °C and 0.75 % respectively. The hardness test of EFA/CTRC tablet prepared in batch 2 was extremely hard hence failed the disintegration test. The EFA/CTRC prepared in batches 3, 4 and 5 was during the winter season which is associated with high humidity and wet weather conditions. The SEM, DSC, TGA results were significantly different from the previous batches. The SEM morphology was highly irregular particles for batch 3, clustered and randomly size particle for batch 4 and irregular, needle-like, spikes and spherical shaped particles for batch 5, respectively. The thermal results HSM, DSC and TGA confirmed the presence of moisture in the prepared EFA/CTRC products. The HSM melting point results of batches 3, 4 and 5 were 123 °C, 115 °C and 121 °C, respectively. The DSC results of 110 °C, 105 °C and 118 °C were observed for batches 3, 4 and 5 respectively. The mass loss i.e. TGA results for batches 3, 4 and 5 were 1.178%, 1.5 % and 2.235 % respectively. In batch 6, EFA/CTRC was prepared using a different commercial batch of EFA and CTRC. The SEM results indicated the formation of needle-like and clustered particles. The values obtained from HSM, DSC and TGA results were 124 °C, 114 °C and 0.54 % in mass loss. The physical appearance of EFA/CTRC prepared from batch 1 and 2 were white in colour while batch 3, 4, 5 and 6 of the prepared EFA/CTRC was pink in colour. The physical appearance of the individual batches differed but the identity of the sample remained intact implying the same pharmacological effects with differing pharmaceutical properties impacting the dosage form preparation.

The prevalence of milder forms of HIV-associated neurocognitive disorders (HAND) is rising despite combination antiretroviral therapy (cART). Efavirenz (EFV) is among the most commonly used antiretroviral drugs globally, but causes neurological symptoms that may interfere with adherence and reduce tolerability, and may have central nervous system (CNS) effects that contribute in part to HAND in patients on cART. Thus we evaluated a commonly used EFV containing regimen: EFV/zidovudine (AZT)/lamivudine (3TC) in murine N2a cells transfected with the human “Swedish” mutant form of amyloid precursor protein (SweAPP N2a cells) to assess for promotion of amyloid-beta (Aβ) production (Chapter 3). Treatment with EFV or the EFV containing regimen generated significantly increased soluble Aβ, and promoted increased β-secretase-1 (BACE-1) expression while 3TC, AZT, or, vehicle control did not significantly alter these endpoints. Further, EFV or the EFV containing regimen promoted significantly more mitochondrial stress in SweAPP N2a cells as compared to 3TC, AZT, or vehicle control. We next tested the EFV containing regimen in Aβ - producing Tg2576 mice combined or singly using clinically relevant doses. EFV or the EFV containing regimen promoted significantly more BACE-1 expression and soluble Aβ generation while 3TC, AZT, or vehicle control did not. Finally, microglial Aβ phagocytosis was significantly reduced by EFV or the EFV containing regimen but not by AZT, 3TC, or vehicle control alone. These data suggest the majority of Aβ promoting effects of this cART regimen are dependent upon EFV as it promotes both increased production, and decreased clearance of Aβ peptide. Further (Chapter 4), there is evidence that neural stem cells (NSCs) can migrate to sites of brain injury such as those caused by inflammation and oxidative stress, which are pathological features of HAND. Thus, reductions in NSCs may contribute to HAND pathogenesis. Since the HIV non-nucleoside reverse transcriptase inhibitor EFV has previously been associated with cognitive deficits and promotion of oxidative stress pathways, we examined its effect on NSCs in vitro as well as in C57BL/6J mice. Here we report that EFV induced a decrease in NSC proliferation in vitro as indicated by MTT assay, as well as BrdU and nestin immunocytochemistry. In addition, EFV decreased intracellular NSC adenosine triphosphate (ATP) stores and NSC mitochondrial membrane potential (MMP). Further, we found that EFV promoted increased lactate dehydrogenase (LDH) release, activation of p38 mitogen-activated protein kinase (MAPK), and increased Bax expression in cultured NSCs. Moreover, EFV reduced the quantity of proliferating NSCs in the subventricular zone (SVZ) of C57BL/6 mice as suggested by BrdU, and increased apoptosis as measured by active caspase-3 immunohistochemistry. If these in vitro and in vivo models translate to the clinical syndrome, then a pharmacological or cell-based therapy aimed at opposing EFV-mediated reductions in NSC proliferation may be beneficial to prevent or treat HAND in patients receiving EFV. 1 Portions of this abstract have been previously published (Brown LAM, et al., 2014; Jin, J, et al, 2016) and are utilized with permission of the publisher.1

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La principale difficulté lors de l'administration orale d'un ingrédient pharmaceutique actif (API) est de garantir que la dose clinique de l’API sera dissoute dans le volume disponible de liquides gastro-intestinaux. Toutefois, environ 40% des API sur le marché et près de 90% des molécules en cours de développement sont peu solubles dans l’eau et présentent une faible absorption par voie orale, ce qui entraîne une faible biodisponibilité. Les dispersions solides amorphes (ASD) sont considérées comme l’une des stratégies plus efficaces pour résoudre des problèmes de solubilité des principes actifs peu solubles dans l’eau et, ainsi, améliorer leur biodisponibilité orale. En dépit de leur introduction il y a plus de 50 ans comme stratégie pour améliorer l’administration orale des API, la formation et la stabilité physique des ASD font toujours l'objet de recherches approfondies. En effet, plusieurs facteurs peuvent influer sur la stabilité physique des ASD pendant le stockage, parmi lesquels la température de transition vitreuse du mélange binaire API-polymère, la solubilité apparente de l'API dans le polymère, les interactions entre l'API et le polymère et le procédé de fabrication. Cette thèse consistait en deux parties qui avaient pour objectif le développement de nouvelles formulations sous forme d’ASD d'un antirétroviral, l'Efavirenz (EFV), dispersé dans un polymère amphiphile, le Soluplus, en utilisant deux procédés différents, le séchage par atomisation (SD) et l'extrusion à chaud (HME). EFV est l’API BCS de classe II de notre choix car c’est un API qui représente un défi pour les nouvelles formulations. En effet, il a besoin d’ASD plus fortement concentrées, pour lesquelles la stabilité chimique et physique pendant le stockage et la dissolution seront essentielles. Dans le but de développer de manière rationnelle les ASDs EFV- Soluplus à forte concentration, la première partie s'est concentrée sur la construction d'un diagramme de phases EFV-Soluplus en fonction de la composition et de la température. Le diagramme de phases a été construit à partir d'une étude thermique de recristallisation d'un ASD sursaturé (85 %m EFV), générée par séchage par atomisation. À notre connaissance, il s'agit de la première étude à présenter un diagramme de phase pour ce système binaire. Ce diagramme de phases est très utile et démontre que la solubilité de l'EFV dans les solutions varie de 20 %m (25 °C) à 30 %m (40 °C). Les ASD de EFV dans le Soluplus contenant plus de 30 %m d'EFV doivent être surveillées pendant le stockage dans des conditions typiques de température. Ce diagramme de phases peut être considéré comme un outil de pré-formulation pour les chercheurs qui étudient de nouvelles ASD d'EFV dans le Soluplus afin de prédire la stabilité (thermodynamique et cinétique). Les ASD préparées par différentes techniques peuvent afficher des différences dans leurs propriétés physicochimiques. La deuxième partie de cette thèse portait sur la fabrication d’ASD par des procédés HME et SD. Cette étude montre clairement que la formation d’ASD est une stratégie de formulation utile pour améliorer la solubilité dans l'eau et la vitesse de dissolution de l'EFV à partir de mélanges binaires EFV-Soluplus. Les procédés de fabrication (HME et SD) se sont révélés efficaces pour générer des ASD dans une large gamme de compositions en EFV. L'optimisation du ratio EFV-Soluplus peut être utilisée pour adapter la libération cinétique des ASD. Le choix d’une charge EFV élevée dépassant la solubilité thermodynamique de l’EFV dans le Soluplus est possible, mais il convient de prendre en compte sa stabilité cinétique dans le temps. / The main difficulty when an Active Pharmaceutical Ingredient (API) is orally administered is to guarantee that the clinical dose of the API will be dissolved in the available volume of gastrointestinal fluids. However, about 40% of APIs with market approval and nearly 90% of molecules in the discovery pipeline are poorly water-soluble and exhibits a poor oral absorption, which leads to a weak bioavailability. Amorphous solid dispersions (ASD) are considered as one of the most effective strategies to solve solubility limitations of poorly-water soluble compounds and hence, enhance their oral bioavailability. Despite their introduction as technical strategy to enhance oral APIs bioavailability more than 50 years ago, ASD formation and physical stability remains a subject of intense research. Indeed, several factors can influence the physical storage stability of ASD, among them, the glass transition temperature of the API-carrier binary mixture, the apparent solubility of the API in the carrier, interactions between API and carrier, and the manufacturing process. This thesis consisted of two parts that aim on developing new formulations of ASD of an antiretroviral API, Efavirenz (EFV), dispersed in an amphiphilic polymer, Soluplus, by using two different processes, Spray-drying (SD) and Hot-melt extrusion (HME). EFV is the class II BCS API of our choice because it is a challenging API for new formulations. It needs higher-dosed ASDs, for which chemical and physical stability during storage and dissolution will be critical. Aiming a rational development of high-loaded EFV-Soluplus ASDs, the first part focused on the construction of a temperature- composition EFV-Soluplus phase diagram. The phase-diagram was constructed from a thermal study of recrystallization of a supersaturated ASD (85 wt% in EFV), generated by spray drying. To our knowledge, this is the first study reporting a phase-diagram for this binary system. This phase-diagram is very useful and demonstrated that the EFV solubility in Soluplus ranges from 20 wt% (25 °C) to 30 wt% (40 °C). ASD of EFV in Soluplus containing more than 30 wt% of EFV should be monitored over storage under typical temperature conditions. This phase-diagram might be considered as a preformulation tool for researchers studying novel ASD of EFV in Soluplus, to predict (thermodynamic and kinetic) stability. ASD prepared by different techniques can display differences in their physicochemical properties. The second part of this thesis focused on the manufacturing of ASD by HME or SD processes. This study clearly shows that ASD is a useful formulation strategy to improve the aqueous solubility and the dissolution rate of EFV from EFV-Soluplus binary mixtures. HME and SD manufacturing processes demonstrated to be efficient to generate ASDs in a large range of compositions and loads of EFV. The optimization of EFV to Soluplus ratio can be used to tailor the release kinetics from ASD. The choice of a high EFV load exceeding the thermodynamic solid solubility in Soluplus is possible but it needs the consideration of its kinetic stability over time.

A 700bp portion of the promoter of CYP2D25, the porcine microsomal vitamin D 25-hydroxylase was isolated and sequenced. The computer analysis of the sequence revealed the existence of a putative VDRE at 220 bp upstream of the transcription start site. A CYP2D25 promoter-luciferase reporter plasmid was constructed in order to study the transcriptional regulation of the gene. Treatment with the vitamin D metabolites calcidiol and calcitriol suppressed the promoter, provided that the nuclear receptors VDR and RXR were overexpressed. Phenobarbital was also capable of suppressing the promoter if the nuclear receptors PXR or CAR were overexpressed. The 25-hydroxylases are not expressed solely in liver but in a wide array of other organs as well. It is therefore possible at least in theory to study the vitamin D 25-hydroxylation in human subjects using cells from extrahepatic organs, from which biopsy retrieval is easier than from the liver. Dermal fibroblasts are frequently used to study different pathological conditions in human subjects and they are easy to come by. Dermal fibroblasts were shown to express two vitamin D 25-hydroxylases: CYP27A1 and CYP2R1. The expression pattern of CYP2R1 displayed considerable interindividual variation. The fibroblasts were also capable of measurable vitamin D 25-hydroxylation, which makes dermal fibroblasts a possible tool in studying vitamin D 25-hydroxylation in human subjects. Little is known about the regulation of expression and activity of the human vitamin D 25-hydroxylases. Therefore dermal fibroblasts – expressing CYP2R1 and CYP27A1 – and human prostate cancer LNCaP cells, that express CYP2R1 and CYP2J2, were treated with calcitriol and phenobarbital and efavirenz, two drugs that give rise to vitamin D deficiency. Treatment decreased the mRNA levels of CYP2R1 and CYP2J2 provided that the treated cells also expressed the necessary nuclear receptors. CYP27A1 did not respond to any of the treatments. The treatments also managed to decrease the 25-hydroxylating activity of the cells. The results show that vitamin D 25-hydroxylases can be regulated by both endogenous and xenobiotic compounds.

Magister Scientiae - MSc (Pharmaceutical Chemistry) / The rapid increase in access to new antiretrovirals (ARVs) worldwide and, especially in sub-Saharan Africa, coupled with the well-documented problem of poor quality ARVs in developing countries has underscored the need for quality assessment of these medicines. South Africa has the worst human immunodeficiency virus (HIV) epidemic profile in the world; consequently, it has rolled out the world's largest antiretroviral ARV programme. With increasing market penetration of generic medicine in South Africa and especially ARVs, there is a call for stringent quality control mechanisms following the marketing approval (post-market quality control) of these medications. Unfortunately, evidence suggests that the World Health Organisation (WHO) recommendations for this aspect of quality assurance is not met by most Medicine Regulatory Authorities. In South Africa and many other countries this is attributed to a lack of physical and financial resources to enforce effective post-marketing surveillance (PMS) of all pharmaceuticals available in the country.