Background: The hepatitis B and D virus (HBV/HDV) hepatocyte entry inhibitor bulevirtide (BLV) has been available in Europe since July 2020, after the registrational trial MYR202. Real-life data on the efficacy and safety of BLV are sparse. Methods: We have analysed the course of treatment with BLV (2 mg/day) plus tenofovir disoproxil fumarate (TDF) (245 mg/day) in patients with chronic hepatitis delta (CHD). Virologic (≥2 log reduction in HDV RNA or suppression of HDV RNA below the lower limit of detection) and biochemical (normalisation of serum ALT) treatment responses after 24 weeks were defined according to the MYR202 trial. Results: Seven patients were recruited (four with liver cirrhosis Child–Pugh A). After 24 weeks, a virologic response was observed in five of seven and a biochemical response was seen in three of six patients with elevated serum ALT at baseline. Extended treatment data > 48 weeks were available in three cases: two presented with continuous virologic and biochemical responses and in one individual an HDV-RNA breakthrough was observed. Adverse effects were not recorded. Conclusions: The first real-life data of the approved dosage of 2 mg of BLV in combination with TDF confirm the safety, tolerability, and efficacy of the registrational trial MYR202 for a treatment period of 24 weeks and beyond.

No description available.

No description available.

La protéine kinase activée par AMP (AMPK) est un senseur et régulateur central de l'état énergétique cellulaire, mais ces voies de signalisation ne sont pour le moment que partiellement comprises. Deux criblages non-biaisés pour la recherche de partenaires d'interaction et de substrats d'AMPK ont précédemment été réalisés dans le laboratoire. Ces derniers ont permis l'identification de plusieurs candidats (protéines), mais leur rôle fonctionnel et physiologique n'était pas encore établi. Ici nous avons caractérisé la fonction de la relation entre AMPK et quatre partenaires d'interaction : gluthation S-transferases (GSTP1 and GSTM1), fumarate hydratase (FH), l'E3 ubiquitine-ligase (NRDP1), et les protéines associées à la membrane (VAMP2 and VAMP3). Chacune de ces interactions parait avoir un rôle différent dans la signalisation AMPK, agissant en amont ou en aval de la protéine AMPK. GSTP1 et GSTM1 contribueraient à l'activation d'AMPK en facilitant la S-glutathionylation d'AMPK en conditions oxydatives moyennes. Cette régulation non-canonique suggère que l'AMPK peut être un senseur de l'état redox cellulaire. FH mitochondrial est l'unique substrat AMPK clairement identifié. Etonnamment le site de phosphorylation se trouve dans le peptide signal mitochondrial, ce qui pourrait affecter l'import mitochondrial. NRDP1, protéine pour laquelle nous avons pour la première fois développé un protocole de production de la protéine soluble, est faiblement phosphorylée par l'AMPK. L'interaction ne sert pas à l'ubiquitination d'AMPK, mais affecte le renouvellement de NRDP1. Finalement, l'interaction de VAMP2/3 avec AMPK n'implique pas d'évènement de phosphorylation ou d'activation d'un des partenaires. Nous proposons un mécanisme de recrutement d'AMPK par VAMP2/3 (" scaffold ") au niveau des vésicules en exocytose. Ce recrutement favoriserait la phosphorylation de substrats de l'AMPK à la surface des vésicules en exocytoses. Une fois mis en commun, nos résultats enrichissent les connaissances sur les voies de signalisation AMPK, et suggèrent une grande complexité de ces dernières. Plus que les kinases en amont et des substrats en aval, la régulation de la signalisation d'AMPK se fait via des modifications secondaires autres que la phosphorylation, via des effets sur le renouvellement de protéines, et probablement via un recrutement spécifique de l'AMPK dans certains compartiments cellulaires. / AMP-activated protein kinase (AMPK) is a central energy sensor and regulator of cellular energy state, but the AMPK signaling network is still incompletely understood. Two earlier non-biased screens for AMPK interaction partners and substrates performed in the laboratory identified several candidate proteins, but functional and physiological roles remained unclear. Here we characterized the functional relationship of AMPK with four different protein interaction partners: gluthatione S-transferases (GSTP1 and GSTM1), fumarate hydratase (FH), an E3 ubiquitin-ligase (NRDP1), and vesicle-associated membrane proteins (VAMP2 and VAMP3). Each of these interaction partners seems to have a different function in AMPK signaling, either acting up- or down-stream of AMPK. GSTP1 and GSTM1 can contribute to AMPK activation by facilitating S-glutathionylation of AMPK under mildly oxidative conditions. This non-canonical regulation suggests AMPK as a sensor of cellular redox state. Mitochondrial FH was identified as the only clear AMPK downstream substrate, but surprisingly the phosphorylation site is present in the mitochondrial targeting prepeptide, possibly affecting mitochondrial import. NRDP1, whose expression as a full-length soluble protein was achieved here for the first time, is phosphorylated by AMPK only at low levels. The interaction does neither serve for AMPK ubiquitinylation, but rather affects NRDP1 turnover. Finally, interaction of VAMP2/3 with AMPK does not involve phosphorylation or activation events of one of the partners. Instead, we propose VAMP2/3 as scaffolding proteins that recruit AMPK to exocytotic vesicles which could favor phosphorylation of vesicular AMPK substrates for exocytosis. Collectively, our results add some new elements to the AMPK signaling network, suggesting that it is much more complex than anticipated. In addition to upstream kinases and downstream substrates, regulation of AMPK signaling occurs by second

京都大学 / 0048 / 新制・論文博士 / 博士(工学) / 乙第13241号 / 論工博第4179号 / 新制||工||1720(附属図書館) / 京都大学大学院工学研究科高分子化学専攻 / (主査)教授 吉崎 武尚, 教授 中村 洋, 教授 古賀 毅 / 学位規則第4条第2項該当 / Doctor of Philosophy (Engineering) / Kyoto University / DFAM

Magister Pharmaceuticae - MPharm / Background: Tenofovir disoproxil fumarate (TDF) and Zidovudine (AZT) are both nucleotide and nucleoside analogue reverse transcriptase inhibitors (NtRTIs and NRTIs), respectively. They are used for the management and prevention of the Human Immunodeficiency Virus (HIV) infection. These drugs are faced with oral delivery challenges such as low intestinal permeability and extensive first pass liver metabolism for TDF and AZT, respectively. Their use may also be limited by dose-dependent adverse effects, which may result in treatment failure when patients become non-compliant and non-adherent to their prescribed antiretroviral (ARV) regimen. Non-compliance and non-adherence to ARV regimen may lead to drug resistance and a need for change in regimen, which can be very expensive, not only financially but in terms of morbidity and mortality. To solve such issues, a new drug can be formulated, or an existing drug can be modified. The development and formulation of a new drug is time consuming and expensive, especially with no available data and a high probability of failure. Modifying existing drugs is a cheaper, less time-consuming option with lower probability of failure. Such modification can be achieved via non-covalent interactions using various methods such as preparation of nano-particulates with polymeric micelles (a non-covalent interaction). Polymeric micelles offer a variety of polymers to choose from for drug modification purposes. Purpose: The aim of this study was to formulate polymeric nanoparticles of TDF and AZT using different ratios of poly-lactic-co-glycolic acid (PLGA), characterize the formulated nanoparticles (using the following analyses: particle size, zeta potential, encapsulation efficiency, hot stage microscopy, thermogravimetric analysis, differential scanning calorimetry, Fourier transform infrared spectroscopy and scanning electron microscopy), analyze for stability during storage (2-8˚C) and determine the release rate of the active pharmaceutical ingredients in the formulated nanoparticles. Methods: Nanoparticles were prepared using a modified version of the double emulsion (water-in-oil-in-water) solvent evaporation and diffusion method. Two ratios of PLGA (50:50 and 85:15) were used to prepare four formulations (two each of TDF and AZT). Thereafter, the physicochemical and pharmaceutical properties of the formulations were assessed by characterizing the nanoparticles for particle size, zeta potential, polydispersity index, percentage yield, release profile and particle morphology, using the suggested analytical techniques. Results: For TDF-PLGA 85:15, TDF-PLGA 50:50, AZT-PLGA 85:15 and AZT-PLGA 50:50, nanoparticles of 160.4±1.7 nm,154.3±3.1 nm,127.0±2.32 nm and 153.2±4.3 nm, respectively, were recovered after washing. The polydispersity index (PDI) values were ≤0.418±0.004 after washing, indicating that the formulations were monodispersed. The zeta potential of the particles was -5.72±1 mV, -19.1 mV, -12.2±0.6 mV and -15.3±0.5 mV for TDF-PLGA 85:15, TDF-PLGA 50:50, AZT-PLGA 85:15 and AZT-PLGA 50:50 respectively after washing. The highest percentage yield was calculated to be 79.14% and the highest encapsulation efficiency obtained was 73.82% for AZT-PLGA 50:50, while the particle morphology showed spherical nanoparticles with signs of coalescence and aggregation for all formulated nanoparticles. The release profiles were biphasic; that is, an initial burst which indicated the presence of surface API followed by sustained release. Comparing the release profiles of AZT and TDF at pH 1.2 and 7.4, it was indicative that more AZT was released at pH 1.2 while more TDF was released at pH 7.4. On computing the release data further into various mathematical models, the Weibull model was found to be the best fit. The loaded nanoparticles showed an increase in stability after washing; however, they showed signs of gradual decrease in stability after 10 days of storage at 2-8°C. Conclusions: Relatively small, spherical and smooth nanoparticles were formulated. The nanoparticle release profile was indicative of sustained release; however, there was no conclusive indication that 48 hours duration was sufficient to release all encapsulated drug. Further studies with an increased API or polymer ratio in the formulation needs to be performed to determine if the encapsulation efficiency can be improved and in-vivo studies are required for a better understanding of the API release from formulations as well as its absorption in the body.

Trypanosoma cruzi é um protozoário flagelado que ao infectar seres humanos causa a doença de Chagas, uma doença tropical negligenciada que afeta milhões de pessoas no mundo todo. As fumarato hidratases (FH), ou fumarases, são enzimas que catalisam a reação estéreo-específica reversível de hidratação do fumarato em S-malato, e foram recentemente consideradas essenciais para a viabilidade do parasito Trypanosoma brucei, sugerindo seu potencial como alvo macromolecular para o desenvolvimento de novos fármacos tripanocidas. O presente trabalho visou à caracterização funcional, bioquímica, biofísica e estrutural das fumarases de T. cruzi (TcFHs) e humana (HsFH) de forma a avaliar o papel das TcFHs para o parasito Trypanosoma cruzi, mapear o mecanismo de ação e identificar as diferenças entre TcFHs e a enzima humana de forma a serem exploradas no planejamento de inibidores seletivos às fumarases do parasito. Análise das sequências mostrou que TcFHs pertencem à classe I das fumarases (enzimas diméricas dependentes de ferro) e não são homólogas à HsFH que pertence a classe II (tetraméricas independentes de ferro). Estudos de localização celular confirmaram a existência de duas fumarases em T. cruzi, uma citosólica (TcFHc) e uma mitocondrial (TcFHm), e experimentos de nocaute gênico sugeriram que essas enzimas são essências para o parasito. A caracterização cinética das enzimas TcFHc, TcFHm e HsFH mostrou que as fumarases de T. cruzi são sensíveis ao oxigênio enquanto a enzima humana se mantém ativa em condições aeróbicas. Estudos de ressonância eletrônica paramagnética mostraram a presença de um cluster de ferro-enxofre, sensível a oxidação por oxigênio, envolvido no mecanismo enzimático das enzimas TcFHs. Modelos estruturais das TcFHs, construídos por homologia à estrutura cristalográfica da fumarase de Leishmania major, foram comparados à estrutura cristalográfica obtida para a fumarase humana e as diferenças entre as duas estruturas foram utilizadas no planejamento de ligantes seletivos às fumarases do parasito. O ligante planejado inibiu a fumarase citosólica de T. cruzi na faixa de 1 ?M e não apresentou efeito na atividade da enzima humana. Testes in vivo demonstraram o efeito tripanocida do inibidor provavelmente por interferir na produção de ATP pela mitocôndria do T. cruzi. Os resultados obtidos com o desenvolvimento desse projeto apresentam uma proposta inovadora no desenvolvimento de novas terapias contra a doença de Chagas, o uso da enzima fumarase como alvo macromolecular, assim como apresenta um inibidor potente e seletivo para a enzima do parasito a ser utilizado como protótipo no desenvolvimento de fármacos contra Trypanosoma cruzi. A síntese de moléculas análogas ao inibidor de forma a melhorar suas propriedades farmacológicas encontra-se em andamento / Trypanosoma cruzi is a flagellate protozoan parasite that infects humans and causes Chagas disease, a tropical neglected disease that affects millions of people worldwide. Fumarate hydratases (FH), or fumarases, are enzymes responsible for the reversible stereo-specific hydration of fumarate into S-malate, and were recently considered to be essential to Trypanosoma brucei viability, suggesting, therefore, a potential role for FHs as macromolecular targets to the drug development against trypanosomatids. The present work focused on the functional, biochemical, biophysical and structural characterization of T. cruzi fumarases (TcFHs) and human fumarase (HsFH) to evaluate TcFHs role for T. cruzi, map the reaction mechanism and identify and exploit differences between the parasite and host enzymes in order to design selective inhibitors to the parasite enzyme. Sequence analysis revealed that TcFHs belong to class I fumarases (dimeric and iron-sulfur containing enzymes) and are not homologous to HsFH which belongs to class II fumarases (tetrameric iron independent enzymes). Cellular sub-localization studies confirmed the presence of a cytosolic and a mitochondrial fumarases in T. cruzi and gene knockout experiments suggested TcFHs are essential to the parasite. The kinetic characterization showed that TcFHs activity is highly sensitive to oxygen whereas HsFH activity remained stable in aerobic conditions. Electron paramagnetic experiments further revealed the presence of an iron-sulfur cluster highly sensitive to oxidation and involved in the catalytic mechanism in both TcFHm and TcFHc. TcFHs structural models, built by homology modeling using the Leishmania major fumarase crystal structure as template, were compared to the HsFH crystal structure and the differences were used to design a selective ligand to the parasite fumarases. The designed ligand showed to inhibit TcFHc with an IC50 of 1 ?M and showed no effect on the human fumarase activity. In vivo assays using T. cruzi epimastigotes demonstrated the trypanocidal effect of the designed inhibitor probably caused by stalling ATP production. The results obtained with the development of this project represent an innovative proposal on the development of new therapies against Chagas disease, the use of fumarase enzyme as a macromolecular target, as well as present a potent and selective inhibitor to the parasite enzyme to be further used as a prototype in the development of drugs against Chagas disease. The synthesis of inhibitor analogues with optimized pharmacological properties are currently in progress.

Leishmania é um protozoário parasito flagelado responsável pelas Leishmanioses, classificadas como doenças negligenciadas, que causam um risco a 350 milhões de pessoas em todo o mundo. As fumarato hidratases (FHs) são enzimas que catalisam a hidratação reversível da molécula de fumarato em S-malato e estudos recentes em tripanosomatídeos, utilizando Trypanosoma brucei como modelo, apontam essas enzimas como potenciais alvos para o planejamento de compostos com ação tripanossomicida e leishmanicida. O presente trabalho visou à caracterização funcional e estrutural das enzimas fumarato hidratase de Leishmania major através da determinação da estrutura por técnicas de difração de raios-X em monocristais, aliadas a técnicas espectroscópicas, de mutagênese sítio dirigida e simulação de dinâmica molecular. A susceptibilidade dessa classe de enzimas ao oxigênio devido a presença de um complexo do tipo [4Fe-4S] exigiu a utilização de técnicas modernas para a realização dos experimentos em condição de anaerobiose. A estrutura da isoforma citosólica da FH em L. major (LmFH-2) foi determinada por técnicas de difração de raios-X em monocristais e consiste na primeira estrutura de uma proteína da classe I das FHs a ser determinada. O enovelamento de LmFH-2 foi descrito como novo e consiste em uma proteína dimérica na qual cada monômero apresenta dois domínios denominados domínios N- e C- terminais, que possuem grande mobilidade entre si. A análise das estruturas cristalográficas de LmFH-2 em complexo com o substrato malato e os inibidores malonato e succinato, associada aos estudos de dinâmica molecular, nos permitiu propor que a mobilidade entre os domínios está associada à entrada do substrato no sítio ativo. Os dados estruturais corroborados pelos dados espectroscópicos e bioquímicos foram utilizados para mapear o sítio ativo e construirmos um modelo para descrever o mecanismo de ação enzimática adotado por essa classe de enzimas. Na tentativa de dar ínicio à validação do nosso modelo, o resíduo conservado Thr467, pertencente ao sítio ativo da LmFH-2 e identificado como importante na interação com o substrato, teve seu papel catalítico avaliado através da combinação de técnicas de mutação sítio-dirigida associada a estudos cinéticos e estruturais. A perda significativa na atividade da proteína mutante LmFH-2-T467A fortaleceu nossas hipóteses de que a Thr467 poderia atuar como ácido ou base no mecanismo RESUMO | II de ação das FHs da classe I. Os resultados obtidos nesse trabalho nos fornecerão as bases estruturais para o mapeamento acerca do mecanismo catalítico adotado pelas enzimas fumarato hidratase da classe I, assim como, para o planejamento de ligantes específicos como uma importante ferramenta na avaliação do potencial desta classe de enzimas como alvo para o desenvolvimento de novas terapias contra a Leishmaniose. / Leishmania parasites are the casual agent of leishamaniasis, classified as neglected tropical diseases, with 350 million people at risk of infection. Fumarate hydratases (FH) are enzymes that catalyze the stereospecific reversible hydratation of fumarate to S-malate and recent studies in trypanosomatids, using Trypanosoma brucei as a model suggest that the fumarate hydratase enzymes are essential for the parasite survival and should be exploited as potential targets for the development of new therapies against trypanosomatid related diseases. The present work focused the functional and structural characterization of both fumarate hydratase enzymes from Leishmania major by a combination of crystallographic, spectroscopic, site-direct mutagenesis and molecular dynamics techniques. The susceptibility to oxygen observed for this class of proteins due to the presence of a [4Fe-4S] cluster required the use of state-of-art infrastructure to perform the experiments under anaerobic environment. The structure of LmFH-2 has been determined by X-ray diffraction techniques and consists of the first class I FH structure to be reported. LmFH-2 folding has been found to be unique and consists of a dimer with each monomer composed of two major domains named N- and C-terminal domains. The analysis of the crystallographic structure of LmFH-2 in complex with the substrate malate and with both inhibitors malonate and succinate has allowed us to propose that the movement observed between both N- and C-domains is associated to the entrance of the substrate into the active site. The structural data corroborated with biochemical and spectroscopic studies have been used to map the active site and to build a model to describe the mechanism of action adopted by this class of enzymes. As our first attempt to validate our model, the residue Thr467 that belongs to the active site and has been identified as important in the interaction with the substrate, had its catalytic role evaluated by site-direct mutagenesis in combination with kinetic and structural studies. The significant loss in activity observed for the mutant LmFH-2-T467A supports our hypothesis that Thr467 can act as either acid or base during catalysis. Our results have provided the structural basis for the complete mapping of the catalytic mechanism adopted by fumarate hydratase enzymes, as well as for the design of specific ligands as an important tool for evaluating FHs as drug targets in development of new therapies against Leishmaniasis.

Haemophilus influenzae (Hi) é uma bactéria Gram negativa dependente dos fatores de crescimento NAD e hemina. O sorotipo b (Hib) é causador de doenças invasivas de importância clínica. É uma bactéria anaeróbia facultativa, e se adapta em devido à versatilidade do seu arsenal metabólico e assim, sendo capaz de causar infecção em nichos com e sem oxigênio no hospedeiro. O objetivo deste trabalho foi estudar o comportamento cinético de Hib em anaerobiose, aerobiose e a interface entre as duas condições, utilizando diferentes aceptores de elétrons (fumarato, DMSO, nitrato e oxigênio). Nitrato possui o maior potencial de redução padrão, porém o nitrito gerado de sua oxidação inviabilizou o crescimento de Hib. DMSO apresentou o melhor crescimento celular em frascos agitados, frente a fumarato de sódio. Ensaios em biorreator demonstraram que em anaerobiose, com fumarato de sódio como aceptor, succinato é o metabólito principal formado. Acetato foi produzido com todos os aceptores testados, seja em anaerobiose ou aerobiose, majoritário na última condição. Lactato de sódio e glicerol foram totalmente consumidas em aerobiose e lentamente em anaerobiose, sem esgotar nenhuma das fontes de carbono. / Haemophilus influenzae (Hi) is a Gram-negative bacterium and require growth factors for its development (hemin and NAD). Serotype b (Hib) is an important human pathogen for public health. It is a facultative anaerobic bacterium, which is allowed to adapt in several host niches due to its metabolic versatility with oxygen or its absence. The aim of this work is to study the growth kinetic of Hibs in anaerobiosis and aerobiosis, in the presence of different final electron acceptors (fumarate, DMSO, nitrate and oxygen). Nitrate has the major reduction potential among the electron acceptors tested, however Hib did not growth. In the presence of DMSO, Hib has the better growth. Anaerobic essay carried out in bioreactor showed that in the presence of fumarate as electron acceptor, succinate was the major metabolite produced. Acetate was produced in the presence of all electron acceptors tested, in both conditions (anaerobiosis and aerobiosis. Lactate and glycerol were entirely consumed in aerobiosis as carbon source and in anaerobiosis, the consumption of both carbon sources were not expressive.

Thesis (Ph.D. (Nutrition))--North-West University, Potchefstroom Campus, 2007.