Thèse de doctorat : Virologie : Paris 12 : 2007. / Version électronique uniquement consultable au sein de l'Université Paris 12 (Intranet). Titre provenant de l'écran-titre. Bibliogr. : 260 réf.

Lamivudin war der erste Inhibitor der Hepatitis-B-Virus(HBV)-Polymerase, der für die Therapie der chronischen HBV-Infektion in Deutschland zugelassen wurde und seitdem zu einer signifikanten Senkung der HBV-assoziierten Letalität beigetragen hat. Aufgrund des hohen Resistenzrisikos unter Lamivudin wird der Einsatz der Substanz jedoch in den aktuellen HBV-Leitlinien nicht mehr empfohlen. Stattdessen sollen hochpotente Nukleos(t)id-Analoga wie Entecavir oder Tenofovir angewendet werden, die jedoch gerade in den ärmeren Endemiegebieten nur selten verfügbar sind. Zudem gibt es auch in den westlichen Industrieländern Patienten, die seit Jahren resistenzfrei mit Lamivudin behandelt wurden. Ob diese von einer prophylaktischen Therapieumstellung profitieren, ist bislang unklar. Ziel dieser Studie war es, die Langzeiteffektivität der Lamivudin-Therapie sowie die Häufigkeit und die prädiktiven Faktoren der Lamivudin-Resistenz zu ermitteln. In einer retrospektiven Untersuchung wurden hierzu die Verläufe von 147 HBeAg-positiven und 80 HBeAg-negativen Patienten aus 3 hepatologischen Zentren in Deutschland analysiert. Zur Sicherung der Lamivudin-Resistenz erfolgte eine genetische Resistenztestung. Zusätzlich wurde der klinische Nutzen einer hoch-sensitiven Real-Time-PCR zur Bestimmung der HBV-DNA evaluiert. Im Langzeitverlauf zeigte sich bei einer bestimmten Subgruppe von Patienten ein gutes virologisches, serologisches und biochemisches Ansprechen. Die vorliegende Studie bestätigte jedoch auch das hohe Resistenzrisiko unter einer Langzeittherapie mit Lamivudin, welches nach 7 Jahren 55% erreichte. Maßgeblicher prädiktiver Faktor für eine spätere Resistenzentwicklung war das virologische Ansprechen im Therapieverlauf. Entgegen den Ergebnissen früherer Studien stellte die Höhe der HBV-DNA zum Zeitpunkt des Therapiebeginns keinen prädiktiven Faktor der Resistenzentwicklung dar, sondern beeinflusste die Wahrscheinlichkeit des virologischen Ansprechens. Der Einsatz hoch-sensitiver Verfahren zur Bestimmung der HBV-DNA zur Therapiekontrolle oder Prädiktion der Lamivudin-Resistenz ist unseren Beobachtungen nach nicht erforderlich. Bei HBeAg-positiven Patienten hatte zudem ein HBeAg-Verlust einen günstigen Einfluss auf die Resistenzwahrscheinlichkeit. Auffällig war außerdem, dass HBeAg-positive Patienten nach einem virologischen Ansprechen nur noch ein sehr geringes Resistenzrisiko aufwiesen, während bei HBeAg-negativen Patienten trotz eines virologischen Ansprechens im gesamten Therapiezeitraum neue Fälle von Lamivudin-Resistenz beobachtet wurden. Auch durch die Kombination verschiedener Merkmale, die die Resistenzwahrscheinlichkeit nachweislich beeinflussten, konnte letztlich keine Subgruppe identifiziert werden, die im Verlauf resistenzfrei blieb oder nur ein sehr geringes Resistenzrisiko aufwies. Zusätzlich wurden diverse weitere Wirts-, virale und therapieassoziierte Charakteristika untersucht, die jedoch keinen prädiktiven Wert in Hinblick auf eine Resistenzentwicklung aufwiesen. Insbesondere natürlich vorkommende HBV-Mutationen, die mit einer Lamivudin-Resistenz assoziiert sind, wurden bei 9% der unvorbehandelten Patienten nachgewiesen, ohne dass dieser Befund einen signifikanten Einfluss auf das virologische Ansprechen oder die Resistenzwahrscheinlichkeit zeigte. Zusammenfassend ist festzustellen, dass wir in unserer Studie Parameter definieren konnten, die mit einem Langzeitansprechen assoziiert sind und damit die Grundlage einer individualisierten Therapie darstellen könnten. Die Ergebnisse sind vor allem für Länder mit eingeschränkten Therapiemöglichkeiten von Relevanz. Sofern höher potentere Nukleos(t)idanaloga zur Verfügung stehen, sollte in Anbetracht des hohen Resistenzrisikos allerdings von einer Therapie mit Lamivudin abgesehen werden. Liegt bereits eine langjährige Lamivudin-Therapie ohne Zeichen einer Resistenzentwicklung vor, so erscheint die Fortsetzung jedoch gerechtfertigt. Dennoch sind regelmäßige Kontrollen erforderlich, da Lamivudin-Resistenzen auch nach mehr als 10 Jahren auftreten können.

Les femmes enceintes sont exposées à de nombreux médicaments et les essais cliniques sont difficilement réalisables dans cette population, c'est pourquoi avoir une méthode qui permet d'estimer l'ampleur des modifications de pharmacocinétique chez la femme enceinte et le passage transplacentaire est essentiel. En effet les modifications physiologiques prennent place durant cette période clé. Nous avons développé des modèles pharmacocinétiques basé sur la physiologie (PBPK) et intégré les modifications physiologiques connues survenant durant la grossesse. Ils décrivent bien la pharmacocinétique de 3 antirétroviraux éliminés par le rein, le ténofovir (TFV), l'emtricitabine (FTC) et la lamivudine (3TC) et d'une molécule métabolisée par le CYP3A4, 2D6 et 2B6, la névirapine (NVP) et ceci pour différentes voies d'administration et pour des populations enceintes et non enceintes. De plus les clairances individuelles disponibles pour le TFV, le FTC et le 3TC tout au long de la grossesse ont permis d'explorer l'évolution de la sécrétion rénale. Celle-ci évoluerait proportionnellement au débit plasmatique rénal. L'intégration dans les modèles PBPK, des paramètres estimés à partir de l'expérience ex-vivo de cotylédon humain perfusé, a permis la prédiction de la cinétique foetale en fin de grossesse du TFV, FTC et NVP. Les prédictions ont été validées en les comparants aux concentrations mesurées au sang de cordon à l'accouchement. De plus, pour la névirapine nous avons exploré le métabolisme foetal et en avons conclu que même si celui-ci existe et est proche voir un peu supérieur à celui du nouveau-né, il n'influence pas la cinétique foetale. / Pregnant women are exposed to numerous drugs and for obvious ethical reasons studies in this sensitive population arelimited. Information about the maternal pharmacokinetic (PK) changes and transplacental transfer of drugs prior to theiradministration to pregnant women would be highly useful. Indeed is it known that physiological changes during pregnancycan affect drug disposition. Time-varying pregnancy-related physiological parameters changes were implemented in fullPBPK models. They successfully predicted the disposition of 3 renally excreted drugs tenofovir (TFV), emtricitabine (FTC)and lamivudine (3TC) and one metabolized drug, nevirapine (NVP) for non-pregnant and pregnant populations. We foundthat both renal secretion and filtration changed during pregnancy. Changes in renal clearance secretion were related tochanges in renal plasma flow. Transplacental parameters estimated from ex vivo human placenta perfusion experiments implemented in PBPK models allowed good prediction of foetal TFV, FTC and NVP PK. Predictions were compared to observed cord blood concentrations to validate these models. Moreover, we have explored nevirapine foetal metabolism and concluded that even if the foetal metabolism is the same than the newborn one or a little more important, it is notlikely to impact foetal PK.

De grandes variations physiologiques s’opèrent tout au long du développement de l’enfant et touchent toutes les étapes du devenir du médicament dans l’organisme. Ces changements physiologiques vont être à l’origine de l’importante variabilité interindividuelle des paramètres pharmacocinétiques chez l’enfant. Il est donc essentiel de connaître la pharmacocinétique des différentes molécules administrées ainsi que la variation des paramètres associés. Dans ce but, la pharmacocinétique de population semble être la méthode de choix. L’approche de population contrairement aux études pharmacocinétiques classiques peut se réaliser à partir de très peu de prélèvements sanguins par patient obtenus à des délais variables, ce qui représente un grand intérêt du point de vue éthique. La pharmacologie des antirétroviraux reste très peu connue chez l’enfant et très peu d’information est disponible sur l’efficacité des doses pédiatriques actuellement recommandées. Nous avons modélisé la pharmacocinétique de population de la lamivudine chez l’enfant et montré que les enfants les pluslégers donc les plus jeunes étaient potentiellement sous-exposés avec la dose recommandée et nous avons proposé une posologie plus adaptée. Nous avons également pu, pour la première fois, proposer des doses chez le nouveau-né car jusqu’alors les doses n’étaient basées que sur des hypothèses de maturation physiologique par rapport à l’adulte. Des doses pédiatriques pour le ténofovir ont pu être déterminées pour la première fois à partir de la modélisation de sa pharmacocinétique. La dernière étape de ma thèse a été consacrée à l’utilisation de l’approche de population dans un cadre pharmacocinétique et pharmacodynamique : un modèle reliant les concentrations de la lamivudine, de la didanosine et de l’efavirenz à l’efficacité virologique de cette trithérapie chez l’enfant nous a permis d’élaborer un score prédictif de l’échec de la thérapie très puissant et prometteur quant à son utilité dans la prise en charge thérapeutique des enfants infectés par le VIH. / Large physiological variations are observed throughout the development of children, these variations are involved in all steps of the fate of the drug. These physiological changes induce a high interindividual variability of pharmacokinetic parameters in children. Thus, it is important to study the pharmacokinetics of various compounds administered in children as well as the variation of associated parameters. For this purpose, population pharmacokinetics seems to be well adapted. The population approach unlike conventional pharmacokinetic studies can be performed with very few blood samples per patient obtained at different times, which presents a great interest in terms of ethics in children. The pharmacology of many antiretroviral drugs remains unknown in children and very few information is available on the effectiveness of currently recommended pediatric doses. A population pharmacokinetic model of lamivudine in children has been performed and we found that the youngest children were potentially underexposed with the recommended dose and an appropriate dosage has been proposed. For the first time, doses for newborns have been proposed as well; indeed the current lamivudine doses are based on physiological maturity assumptions derived from adults. Pediatric doses for tenofovir were proposed also for the first time thanks’ to population modeling. In the last part of this thesis we use the population approach to perform a pharmacokinetic and pharmacodynamic model linking the concentrations of lamivudine, didanosine and efavirenz to virologic efficacy in children. A composite score has been derived from the model and provided a high predictive performance to treatment failure. This score seems to be very useful in the therapeutic management of HIV-1 infected children.

HIV/AIDS is the most threatening and challenging infectious diseases of our time, with the highest increase of newly infected cases reported. This infectious disease was discovered in the early eighties under homosexual men and was later to be discovered in heterosexuals. HIV is a systemic immunosuppressive disorder which causes a depletion of CD4+ T cells and develops into the acquired immunodeficiency syndrome - AIDS. Africa is the continent most affected by HIV/AIDS with the southern parts of Africa having the highest prevalence rates compared to the rest of Africa. Statistics indicate that AIDS is responsible for 3% of deaths in children worldwide - one in seven people dying of an HIV-related illness is a child under the age of 15 years. It was stated by the WHO that countries should develop improved antiretrovirals regimes for the prevention of mother-to-child transmission. Difficulties in administering antiretrovirals (ARVs) to patients (especially children) are the strict dosage regimes and the severe adverse reactions. These factors complicate patient adherence. The list of problems in treating patients is endless and includes the distribution, stability as well as the low efficacy of these drugs. Most of the above mentioned problems and obstacles related to ARVs and ARV treatment could be minimized or eliminated by the use of a stable and effective drug delivery system. Enhancing ARV treatment may be accomplished by the use of the Pheroid™ drug delivery system. Pheroids™ consists mainly of fatty acids and sterile nitrous oxide gassed water. Pharmacological active substances are entrapped into submicron and micron sized structures called Pheroids™. Research showed promising results and advantages in delivering drugs through oral and transdermal routes using Pheroid™ technology. The focus of this study was to test the possible enhancement of the efficacy of antiretrovirals using Pheroid™ technology. The assays used to study this possible enhancement were a modified neutral red and a modified 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium (MTT) assay. These assays confirmed and illustrated the toxic and protective properties of the tested ARVs (stavudine, lamivudine and nevirapine). An MT-2 cell line was used and infected with an HIV-1 strain, SW7-TCL. Applying Pheroid™ technology in these assays resulted in massive cell death, due to increased ARV toxic levels within the cells. Viability tests proved that Pheroids™ had no effect on the viability of cells at the concentration typically used. This confirmed the enhancing properties of Pheroids™ in the delivery of drugs into the cells. The MTT assay was further adapted from a seven day incubation period to a three day incubation period. By using a low concentration series and a three day incubation period the loss of cells through toxicity was partially overcome. One of the problems that arose form this study was the non-reproducibility of the results. Absorbance levels fluctuated at specific concentrations of the same ARV, which cause difficulties in comparing results. This result was repeatedly confirmed in this syncytium forming infection model. In conclusion, Pheroid™ technology enhanced the delivery of ARVs into the cells although it resulted in cell death. Both the neutral red and MTT assays were found to be inaccurate but further development, research and assay optimization could result in improved in vitro studies. The article format was used for this thesis, as described in the general academic rules in section A.13.7.3 of the North West University. Chapter 1 deals with HIV/AIDS related problems, statistics and treatment obstacles. Chapter 2 is a summary of the cell viability assays used in this study. Pheroid™ technology and its application to ARV treatment are dealt with in chapter 3. The proposed article for submission in the journal Cell Death and Differentiation has been included in chapter 4. Some of the results from the study are reported in the article and annexures, whilst other results are shown and discussed in Chapter 5. Chapter 6 gives a conclusion and final summary of this study. All other experimental methods and results are enclosed in the annexures, as is the "Guide for authors" for the article. / Thesis (M.Sc. (Pharmaceutics))--North-West University, Potchefstroom Campus, 2008.

Este trabalho teve como objetivo propor novo método para estudar a permeabilidade de fármacos, utilizando epitélio intestinal de rã-touro (Rana catesbeiana) em método ex vivo, empregando células de Franz. Por utilizar epitélio intestinal, um material de descarte proveniente de um animal utilizado como alimento humano, pode ser considerado um método alternativo, pois não implica no sacrifício de animais. A quantidade de fármaco permeada foi determinada por método de eletroforese capilar com detecção ultravioleta e validado para os antivirais lamivudina, zidovudina e aciclovir, na presença de metoprolol e floridizina. O fármaco escolhido como modelo nos ensaios de permeabilidade foi a lamivudina. Para estabelecimento do protocolo experimental dos estudos de permeabilidade, foi proposta uma análise de variância three-way para verificar a influência na permeabilidade dos fármacos, das seguintes variáveis: secção intestinal, pH da solução de Ringer e temperatura. Foram determinados a quantidade total de fármaco permeado (Qt), o coeficiente de permeabilidade aparente (Papp) e a constante de absorção de primeira ordem (ka). A partir da análise do planejamento experimental, os efeitos das variáveis não foram significativos, exceto para a secção intestinal. Os resultados de coeficiente de permeabilidade aparente (Papp) obtidos foram de 0,09 x 10-4 cm/s para lamivudina e de 0,22 x 10-4 cm/s para o metoprolol. O valor de Papp obtido de para o metoprolol é próximo dos valores encontrados na literatura para outras técnicas. Para a lamivudina, entretanto, a diferença encontrada em comparação às células Caco-2 pode ser devida às diferentes técnicas empregadas. / This work aimed to propose a new method for studying drug permeability using frog intestinal epithelium (Rana catesbeiana) in ex vivo method, using Franz cells. By using intestinal epithelium, a disposal material from an animal used as human food, can be considered an alternative method, because it doesn\'t involve the sacrifice of animals. The amount of permeated drug was determined by capillary electrophoresis method with UV detection and validated for antiviral drugs lamivudine, zidovudine and acyclovir in the presence of metoprolol and floridizina. The drug chosen as a model in permeability studies was lamivudine. To establish the experimental protocol for the permeability studies, a three-way analysis of variance was proposed to check the influence of intestinal section, pH of Ringer\'s solution and the temperature on the permeability. Total amount of drug permeated (Qt), apparent permeability coefficient (Papp) and first-order constant absorption (ka) were determined. By the analysis of experimental design, the effects of the variables were not significant, except for intestinal section. The results of apparent permeability coefficient (Papp) obtained were 0.09 x 10-4 cm/s for lamivudine and 0.22 x 10-4 cm/s for metoprolol. The value of Papp obtained for metoprolol is quite close to the values found in literature for other methods. For lamivudine, however, the difference found in comparison to Caco-2 cells may be due to different techniques.

A zidovudina, conhecida como AZT, é um inibidor da transcriptase reversa, enquanto que a lamivudina é um fármaco antirretroviral que atua na inibição da síntese de ácidos nucléicos. Estes são dois dos 21 fármacos componentes dos medicamentos distribuídas pelo Ministério da Saúde Brasileiro em programas de combate a Síndrome da imunodeficiência Adquirida (Acquired Immunodeficiency Syndrome - AIDS), configurando-se assim uma grande demanda de produção de medicamentos com estes fármacos. Programas de Tecnologia Analítica em Processo (Process Analytical techology - PAT), embasadas por avanços nos guias internacionais da Conferência Internacional sobre a Harmonização dos Requerimentos Técnicos para o Registro de Produtos Farmacêuticos para o uso Humano (International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use - ICH) e pela agência norte-americana para a Administração de Alimentos e Medicamentos (Food and Drugs Administration - FDA), estão ganhando força como alternativas para aumentar a eficiência e a segurança na produção de medicamentos, tanto para aqueles já em processo produtivo como também para medicamentos em fase de desenvolvimento. Estes últimos são denominados desenvolvimento em programas de Qualidade por Design (QbD). Métodos de quantificação por espectroscopia (NIR, MID, RAMAM, entre outras) são reconhecidos como ferramentas para a PAT. Neste contexto propôs-se comparar objetivamente o método tradicional de quantificação destes dois fármacos frente a um método de quantificação desenvolvido utilizando-se a espectroscopia no infravermelho médio (MID). Prepararam-se assim 41 amostras de calibração e 23 amostras de validação, compostas por misturas de zidovudina, lamivudina e placebo (qs) em escala laboratorial, na faixa de 80 a 120% da concentração nominal de uma associação comercial dos dois fármacos. As concentrações de referência de todas as preparações foram determinadas empregando-se o método de referência por Cromatografia Líquida de Alta Eficiência (CLAE) da Farmacopeia Americana (United States Pharmacopeia - USP). Subsequentemente, obtiveram-se cinco espectros no infravermelho de cada uma das preparações, na faixa de 450 a 4000 cm-1. Os espectros foram então pré-processados e utilizados para a construção de um modelo de calibração multivariado por PLS (mínimo quadrados parciais), de acordo com a ASTM E1655-05. Adicionalmente, o método de CLAE foi transferido para um método de UPLC de acordo com o Capitulo Geral descrito no volume 37(3) do Fórum da USP (United States Pharmacopeia). O desempenho do método MID foi então comparado com o método tradicional, bem como com o novo método de quantificação por UPLC. Foram definidaLs assim regiões de confiança para embasar a utilização dos métodos desenvolvidos. O método de quantificação por MID apresentou uma grande variabilidade enquanto que o método por UPLC foi totalmente comparável com o método tradicional, reduzindo o tempo de corrida de 60 minutos para 12.55 minutos. / Zidovudine, also known as AZT is a reverse transcriptase inhibitor, whereas lamivudine is an antiretroviral drug that acts on the inhibition of nucleic acid synthesis. These are two of the 21 active ingredients components of medicines distributed by Brazilian Health Ministry in programs against the Acquired Immunodeficiency Syndrome (AIDS), becoming thus a great demand for production of these two drugs. Process Analytical Technology (PAT) programs, supported by advances in international guides from the International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH) and by the FDA (Food and Drugs Administration), are gaining momentum as alternatives to increase efficiency and safety in the production of medicines, both for those medicines already in the production process as well as to those medicines under development. The latter are called Quality by Design (QbD) programs. Spectroscopy quantification methodologies methodologies (NIR, MID, Ramam, among others) are recognized as PAT tools. In this context it was proposed to compare objectively the traditional method for quantification of these two drugs against a quantification method developed using the MID (middle infrared spectroscopy). Thus 41 calibration and 23 validation samples, comprising of laboratorial scale mixtures of lamivudine, zidovudine and placebo (qs), were prepared in the range equivalent to 80 to 120% of the nominal concentration of the commercial tablets product. The concentrations of all calibration and validation samples were determined using the HPLC reference method of USP (United States Pharmacopeia). Subsequently, there were obtained five infrared spectra of each of the preparations in the range 450-4000 cm-1. The spectra were then pre-processed and used to build a multivariate calibration model for PLS (Partial Least Squares) according to ASTM E1655-05. Additionally, the HPLC method was transferred to a UPLC method according to General Chapter described in volume 37 (3) Forum USP (United States Pharmacopeia). The performance of the method MID was then compared with the traditional method and with the new method of quantification by UPLC. Confidence regions were built to support the use of the methods developed. The MID quantification method presented considerable variability, while the method the UPLC method was fully comparable to the traditional method. Another advantage of the UPLC method was the reduction of running time from 60 minutes to 12:55 minutes.

Es gibt wenige Erkenntnisse über den Zusammenhang zwischen Lamivudin induzierten Resistenzmutationen und Hepatitis B Genotypen. Die vorliegende Studie untersucht das Verhältnis zwischen diesen Mutationen und den Hepatitis B Genotypen A-D. Die Datenbank der US-amerikanischen Kongressbibliothek (Pubmed) wurde nach den Begriffen „HBV OR hepatitis B”, „YMDD”, „genotype”, und „lamivudine” durchsucht. Alle in dieser Suche gefundenen Arbeiten, die bis Juni 2009 veröffentlicht worden waren, wurden in die Studie eingeschlossen. Die Ergebnisse der Literaturanalyse wurden mit den Hepatitis B-Genomdaten zweier Referenzlabore in Tübingen und Melbourne verglichen. Insgesamt konnten 29 Arbeiten aus der Datenbankrecherche in die Literaturanalyse eingeschlossen werden. Diese Studien enthielten Daten zu insgesamt 827 Patienten, deren Hepatitis B Genotyp bekannt war und die eine Lamivudinresistenzmutation aufwiesen. In statistischen Untersuchungen konnte nachgewiesen werden, dass die rtM204V-Mutation die dominierende Mutation bei Infektionen mit Genotyp A ist. Dieses Ergebnis konnte durch die Analyse der Genomdaten der Referenzlabore bestätigt werden. Ferner konnte gezeigt werden, dass bei den Genotypen A, B, und D die rtL180M-Mutation hochsignifikant mit der rtM204V-Mutation verknüpft ist. Die Dissertationsschrift enthält neben dem Artikel „Mutation pattern of lamivudine resistance in relation to hepatitis B genotypes: hepatitis B genotypes differ in their lamivudine resistance associated mutation pattern“ (Damerow, H, Yuen L et al.; J Med Virol. 2010 Nov; 82(11):1850-8) eine Einführung in die Rationale der Studie, eine Zusammenfassung der Ergebnisse sowie ein Fazit.

HIV/AIDS is the most threatening and challenging infectious diseases of our time, with the highest increase of newly infected cases reported. This infectious disease was discovered in the early eighties under homosexual men and was later to be discovered in heterosexuals. HIV is a systemic immunosuppressive disorder which causes a depletion of CD4+ T cells and develops into the acquired immunodeficiency syndrome - AIDS. Africa is the continent most affected by HIV/AIDS with the southern parts of Africa having the highest prevalence rates compared to the rest of Africa. Statistics indicate that AIDS is responsible for 3% of deaths in children worldwide - one in seven people dying of an HIV-related illness is a child under the age of 15 years. It was stated by the WHO that countries should develop improved antiretrovirals regimes for the prevention of mother-to-child transmission. Difficulties in administering antiretrovirals (ARVs) to patients (especially children) are the strict dosage regimes and the severe adverse reactions. These factors complicate patient adherence. The list of problems in treating patients is endless and includes the distribution, stability as well as the low efficacy of these drugs. Most of the above mentioned problems and obstacles related to ARVs and ARV treatment could be minimized or eliminated by the use of a stable and effective drug delivery system. Enhancing ARV treatment may be accomplished by the use of the Pheroid™ drug delivery system. Pheroids™ consists mainly of fatty acids and sterile nitrous oxide gassed water. Pharmacological active substances are entrapped into submicron and micron sized structures called Pheroids™. Research showed promising results and advantages in delivering drugs through oral and transdermal routes using Pheroid™ technology. The focus of this study was to test the possible enhancement of the efficacy of antiretrovirals using Pheroid™ technology. The assays used to study this possible enhancement were a modified neutral red and a modified 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium (MTT) assay. These assays confirmed and illustrated the toxic and protective properties of the tested ARVs (stavudine, lamivudine and nevirapine). An MT-2 cell line was used and infected with an HIV-1 strain, SW7-TCL. Applying Pheroid™ technology in these assays resulted in massive cell death, due to increased ARV toxic levels within the cells. Viability tests proved that Pheroids™ had no effect on the viability of cells at the concentration typically used. This confirmed the enhancing properties of Pheroids™ in the delivery of drugs into the cells. The MTT assay was further adapted from a seven day incubation period to a three day incubation period. By using a low concentration series and a three day incubation period the loss of cells through toxicity was partially overcome. One of the problems that arose form this study was the non-reproducibility of the results. Absorbance levels fluctuated at specific concentrations of the same ARV, which cause difficulties in comparing results. This result was repeatedly confirmed in this syncytium forming infection model. In conclusion, Pheroid™ technology enhanced the delivery of ARVs into the cells although it resulted in cell death. Both the neutral red and MTT assays were found to be inaccurate but further development, research and assay optimization could result in improved in vitro studies. The article format was used for this thesis, as described in the general academic rules in section A.13.7.3 of the North West University. Chapter 1 deals with HIV/AIDS related problems, statistics and treatment obstacles. Chapter 2 is a summary of the cell viability assays used in this study. Pheroid™ technology and its application to ARV treatment are dealt with in chapter 3. The proposed article for submission in the journal Cell Death and Differentiation has been included in chapter 4. Some of the results from the study are reported in the article and annexures, whilst other results are shown and discussed in Chapter 5. Chapter 6 gives a conclusion and final summary of this study. All other experimental methods and results are enclosed in the annexures, as is the "Guide for authors" for the article. / Thesis (M.Sc. (Pharmaceutics))--North-West University, Potchefstroom Campus, 2008.

A zidovudina, conhecida como AZT, é um inibidor da transcriptase reversa, enquanto que a lamivudina é um fármaco antirretroviral que atua na inibição da síntese de ácidos nucléicos. Estes são dois dos 21 fármacos componentes dos medicamentos distribuídas pelo Ministério da Saúde Brasileiro em programas de combate a Síndrome da imunodeficiência Adquirida (Acquired Immunodeficiency Syndrome - AIDS), configurando-se assim uma grande demanda de produção de medicamentos com estes fármacos. Programas de Tecnologia Analítica em Processo (Process Analytical techology - PAT), embasadas por avanços nos guias internacionais da Conferência Internacional sobre a Harmonização dos Requerimentos Técnicos para o Registro de Produtos Farmacêuticos para o uso Humano (International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use - ICH) e pela agência norte-americana para a Administração de Alimentos e Medicamentos (Food and Drugs Administration - FDA), estão ganhando força como alternativas para aumentar a eficiência e a segurança na produção de medicamentos, tanto para aqueles já em processo produtivo como também para medicamentos em fase de desenvolvimento. Estes últimos são denominados desenvolvimento em programas de Qualidade por Design (QbD). Métodos de quantificação por espectroscopia (NIR, MID, RAMAM, entre outras) são reconhecidos como ferramentas para a PAT. Neste contexto propôs-se comparar objetivamente o método tradicional de quantificação destes dois fármacos frente a um método de quantificação desenvolvido utilizando-se a espectroscopia no infravermelho médio (MID). Prepararam-se assim 41 amostras de calibração e 23 amostras de validação, compostas por misturas de zidovudina, lamivudina e placebo (qs) em escala laboratorial, na faixa de 80 a 120% da concentração nominal de uma associação comercial dos dois fármacos. As concentrações de referência de todas as preparações foram determinadas empregando-se o método de referência por Cromatografia Líquida de Alta Eficiência (CLAE) da Farmacopeia Americana (United States Pharmacopeia - USP). Subsequentemente, obtiveram-se cinco espectros no infravermelho de cada uma das preparações, na faixa de 450 a 4000 cm-1. Os espectros foram então pré-processados e utilizados para a construção de um modelo de calibração multivariado por PLS (mínimo quadrados parciais), de acordo com a ASTM E1655-05. Adicionalmente, o método de CLAE foi transferido para um método de UPLC de acordo com o Capitulo Geral descrito no volume 37(3) do Fórum da USP (United States Pharmacopeia). O desempenho do método MID foi então comparado com o método tradicional, bem como com o novo método de quantificação por UPLC. Foram definidaLs assim regiões de confiança para embasar a utilização dos métodos desenvolvidos. O método de quantificação por MID apresentou uma grande variabilidade enquanto que o método por UPLC foi totalmente comparável com o método tradicional, reduzindo o tempo de corrida de 60 minutos para 12.55 minutos. / Zidovudine, also known as AZT is a reverse transcriptase inhibitor, whereas lamivudine is an antiretroviral drug that acts on the inhibition of nucleic acid synthesis. These are two of the 21 active ingredients components of medicines distributed by Brazilian Health Ministry in programs against the Acquired Immunodeficiency Syndrome (AIDS), becoming thus a great demand for production of these two drugs. Process Analytical Technology (PAT) programs, supported by advances in international guides from the International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH) and by the FDA (Food and Drugs Administration), are gaining momentum as alternatives to increase efficiency and safety in the production of medicines, both for those medicines already in the production process as well as to those medicines under development. The latter are called Quality by Design (QbD) programs. Spectroscopy quantification methodologies methodologies (NIR, MID, Ramam, among others) are recognized as PAT tools. In this context it was proposed to compare objectively the traditional method for quantification of these two drugs against a quantification method developed using the MID (middle infrared spectroscopy). Thus 41 calibration and 23 validation samples, comprising of laboratorial scale mixtures of lamivudine, zidovudine and placebo (qs), were prepared in the range equivalent to 80 to 120% of the nominal concentration of the commercial tablets product. The concentrations of all calibration and validation samples were determined using the HPLC reference method of USP (United States Pharmacopeia). Subsequently, there were obtained five infrared spectra of each of the preparations in the range 450-4000 cm-1. The spectra were then pre-processed and used to build a multivariate calibration model for PLS (Partial Least Squares) according to ASTM E1655-05. Additionally, the HPLC method was transferred to a UPLC method according to General Chapter described in volume 37 (3) Forum USP (United States Pharmacopeia). The performance of the method MID was then compared with the traditional method and with the new method of quantification by UPLC. Confidence regions were built to support the use of the methods developed. The MID quantification method presented considerable variability, while the method the UPLC method was fully comparable to the traditional method. Another advantage of the UPLC method was the reduction of running time from 60 minutes to 12:55 minutes.