O ritonavir (RTV) é um anti-retroviral, inibidor da protease do VIH, produzido nas formas farmacêuticas cápsula e solução oral sob o nome comercial Norvir® (Abbott). Levando-se em consideração que o RTV está sendo sintetizado no Brasil e que não existem métodos oficiais para o seu doseamento na forma farmacêutica cápsula, faz-se necessário o desenvolvimento e validação de métodos para assegurar a qualidade do produto acabado. Deste modo, o objetivo deste trabalho foi a validação de métodos analíticos para o controle qualitativo e quantitativo do RTV matéria-prima e cápsulas, assim como a realização de estudo preliminar para avaliar a estabilidade da matéria-prima. A identificação e caracterização do fármaco e seus polimorfos (forma I e II) foi realizada através da análise do ponto de fusão, calorimetria exploratória diferencial (DSC), rotação específica, métodos espectrofotométricos na região do infravermelho (IV) e do ultravioleta (UV), cromatografia em camada delgada (CCD) e cromatografia líquida de alta eficiência (CLAE), microscopia óptica (MO) e eletrônica de varredura (MEV), além da difração de raios-X. Para a determinação quantitativa foram validados, segundo normas da International Conference on Harmonization (ICH), os métodos de espectrofotometria na região do UV, ordem-zero e segunda derivada (UV-D2), e CLAE. A análise estatística demonstrou equivalência entre os métodos CLAE / UV para a determinação do teor da matéria-prima e entre os métodos CLAE / UV-D2 para a determinação do RTV nas cápsulas. No estudo preliminar de estabilidade térmica e fotoestabilidade, a matéria-prima foi submetida à temperatura de 60 °C por 30 dias e permaneceu sob luz branca por até 15 dias respectivamente. A CLAE foi o método empregado na análise do teor e pureza das amostras submetidas às degradações, sendo que os resultados demonstraram a estabilidade da matéria-prima nas condições testadas, não havendo redução significativa do teor do fármaco nem aparecimento de potenciais produtos de degradação. / Ritonavir (RTV) is a HIV-protease inhibitor, available as capsule and oral solution (Norvir®). Considering that the drug has been produced in Brazil and there are no official methods to quantify RTV capsules, it became necessary the development and validation of methods for ensuring the quality of pharmaceutical formulations. The objective of this work was the validation of these analytical methods for the qualitative and quantitative analysis of RTV bulk substance and capsules. A preliminary studie of stability was also performed. RTV identification and polymorphs I and II characterization were performed by using several techniques such as: melting point, differential scanning calorimetry (DSC), optical rotation, infrared (IR) and ultraviolet (UV) spectrophotometry, thin-layer chromatography, high performance liquid chromatography (HPLC), optical and scanning electron microscopy, and powder X-ray diffraction. The HPLC, zero-order UV spectrophotometric and second-derivative UV spectrophotometric (UV-D2) methods were validated according to the International Conference on Harmonization (ICH) guidelines for the quantitative determination of RTV bulk substance and capsules. The statistics analysis showed that HPLC / UV methods were equivalent to assay bulk substance and HPLC / UV-D2 methods were equivalent to assay capsules. The preliminary studies of thermal and photostability were conducted by exposing RTV samples at 60 °C during 30 days and under fluorescent lamp during 15 days. The developed HPLC method was used to assay the drug and detect its potential degradation products. The results showed that the RTV bulk substance was stable and there was no evidence of its degradation, under the established conditions.

Kaletra® (lopinavir e ritonavir) é uma combinação fixa de dois inibidores da protease do vírus da imunodeficiência humana (VIH) indicada para o tratamento da infecção pelo VIH em associação com outros anti-retrovirais. Esta classe de fármacos inibe a protease do VIH evitando a clivagem da poliproteina gag-pol, levando à produção de vírus imaturos, incapazes de infectar outras células. Este trabalho teve como objetivo estabelecer o perfil de dissolução in vitro baseado nos dados in vivo, avaliar a estabilidade térmica do lopinavir e do ritonavir cápsulas, determinar a cinética de reação, isolar e identificar os principais produtos de degradação do ritonavir. Método por CLAE indicativo de estabilidade foi desenvolvido e validado para a quantificação do lopinavir e do ritonavir cápsulas. Método alternativo por espectrometria derivada também foi desenvolvido. Os resultados demonstraram uma correlação nível A entre o perfil de dissolução in vitro e a absorção in vivo nas condições propostas. O método por CLAE para a quantificação desta associação demonstrou ser específico, linear exato, preciso e robusto. O teste t demonstrou que houve diferença significativa entre o método CLAE e UV derivada. Os estudos de estabilidade térmica demonstraram que o lopinavir foi estável nas condições testadas enquanto que o ritonavir foi sensível ao calor, seguindo uma cinética de degradação de primeira ordem. De acordo com os resultados da RMN os principais produtos de degradação do ritonavir são os compostos de fórmula molecular C33H45N5O5S e C25H33N3O6. / Kaletra® (lopinavir and ritonavir) is a combination of two human immunodeficiency virus (HIV) protease inhibitors indicated as part of a multi drug therapy along with other antiretroviral agents. This class of drugs inhibits the HIV protease preventing cleavage of the gag-pol polyprotein, reducing the probability of viral particles reaching a mature, infectious state. The objective of this work was: to establish the in vitro dissolution profile based on in vivo data; to determine their thermal stability in the dosage form; to determine their kinetics of degradation and to isolate and identify their major products of degradation. A stability indicating method was developed and validated for simultaneous quantitation of both drugs in Kaletra®, using liquid chromatography. An alternative method using UV-derivative spectrometry was also proposed. The result showed a level A correlation between the in vitro dissolution profile and in vivo absorption under the proposed conditions. The LC method was fully validated and have shown to be stability indicating. The UV-derivative method showed not to be equivalent (t-test) to the LC method. Thermal stability studies have shown that lopinavir was very stable under the conditions tested while ritonavir was sensitive to heat, following a first order degradation kinetic. According to NMR results ritonavir the main degradation products have the molecular formula C33H45N5O5S and C25H33N3O6.

O ritonavir (RTV) é um anti-retroviral, inibidor da protease do VIH, produzido nas formas farmacêuticas cápsula e solução oral sob o nome comercial Norvir® (Abbott). Levando-se em consideração que o RTV está sendo sintetizado no Brasil e que não existem métodos oficiais para o seu doseamento na forma farmacêutica cápsula, faz-se necessário o desenvolvimento e validação de métodos para assegurar a qualidade do produto acabado. Deste modo, o objetivo deste trabalho foi a validação de métodos analíticos para o controle qualitativo e quantitativo do RTV matéria-prima e cápsulas, assim como a realização de estudo preliminar para avaliar a estabilidade da matéria-prima. A identificação e caracterização do fármaco e seus polimorfos (forma I e II) foi realizada através da análise do ponto de fusão, calorimetria exploratória diferencial (DSC), rotação específica, métodos espectrofotométricos na região do infravermelho (IV) e do ultravioleta (UV), cromatografia em camada delgada (CCD) e cromatografia líquida de alta eficiência (CLAE), microscopia óptica (MO) e eletrônica de varredura (MEV), além da difração de raios-X. Para a determinação quantitativa foram validados, segundo normas da International Conference on Harmonization (ICH), os métodos de espectrofotometria na região do UV, ordem-zero e segunda derivada (UV-D2), e CLAE. A análise estatística demonstrou equivalência entre os métodos CLAE / UV para a determinação do teor da matéria-prima e entre os métodos CLAE / UV-D2 para a determinação do RTV nas cápsulas. No estudo preliminar de estabilidade térmica e fotoestabilidade, a matéria-prima foi submetida à temperatura de 60 °C por 30 dias e permaneceu sob luz branca por até 15 dias respectivamente. A CLAE foi o método empregado na análise do teor e pureza das amostras submetidas às degradações, sendo que os resultados demonstraram a estabilidade da matéria-prima nas condições testadas, não havendo redução significativa do teor do fármaco nem aparecimento de potenciais produtos de degradação. / Ritonavir (RTV) is a HIV-protease inhibitor, available as capsule and oral solution (Norvir®). Considering that the drug has been produced in Brazil and there are no official methods to quantify RTV capsules, it became necessary the development and validation of methods for ensuring the quality of pharmaceutical formulations. The objective of this work was the validation of these analytical methods for the qualitative and quantitative analysis of RTV bulk substance and capsules. A preliminary studie of stability was also performed. RTV identification and polymorphs I and II characterization were performed by using several techniques such as: melting point, differential scanning calorimetry (DSC), optical rotation, infrared (IR) and ultraviolet (UV) spectrophotometry, thin-layer chromatography, high performance liquid chromatography (HPLC), optical and scanning electron microscopy, and powder X-ray diffraction. The HPLC, zero-order UV spectrophotometric and second-derivative UV spectrophotometric (UV-D2) methods were validated according to the International Conference on Harmonization (ICH) guidelines for the quantitative determination of RTV bulk substance and capsules. The statistics analysis showed that HPLC / UV methods were equivalent to assay bulk substance and HPLC / UV-D2 methods were equivalent to assay capsules. The preliminary studies of thermal and photostability were conducted by exposing RTV samples at 60 °C during 30 days and under fluorescent lamp during 15 days. The developed HPLC method was used to assay the drug and detect its potential degradation products. The results showed that the RTV bulk substance was stable and there was no evidence of its degradation, under the established conditions.

Kaletra® (lopinavir e ritonavir) é uma combinação fixa de dois inibidores da protease do vírus da imunodeficiência humana (VIH) indicada para o tratamento da infecção pelo VIH em associação com outros anti-retrovirais. Esta classe de fármacos inibe a protease do VIH evitando a clivagem da poliproteina gag-pol, levando à produção de vírus imaturos, incapazes de infectar outras células. Este trabalho teve como objetivo estabelecer o perfil de dissolução in vitro baseado nos dados in vivo, avaliar a estabilidade térmica do lopinavir e do ritonavir cápsulas, determinar a cinética de reação, isolar e identificar os principais produtos de degradação do ritonavir. Método por CLAE indicativo de estabilidade foi desenvolvido e validado para a quantificação do lopinavir e do ritonavir cápsulas. Método alternativo por espectrometria derivada também foi desenvolvido. Os resultados demonstraram uma correlação nível A entre o perfil de dissolução in vitro e a absorção in vivo nas condições propostas. O método por CLAE para a quantificação desta associação demonstrou ser específico, linear exato, preciso e robusto. O teste t demonstrou que houve diferença significativa entre o método CLAE e UV derivada. Os estudos de estabilidade térmica demonstraram que o lopinavir foi estável nas condições testadas enquanto que o ritonavir foi sensível ao calor, seguindo uma cinética de degradação de primeira ordem. De acordo com os resultados da RMN os principais produtos de degradação do ritonavir são os compostos de fórmula molecular C33H45N5O5S e C25H33N3O6. / Kaletra® (lopinavir and ritonavir) is a combination of two human immunodeficiency virus (HIV) protease inhibitors indicated as part of a multi drug therapy along with other antiretroviral agents. This class of drugs inhibits the HIV protease preventing cleavage of the gag-pol polyprotein, reducing the probability of viral particles reaching a mature, infectious state. The objective of this work was: to establish the in vitro dissolution profile based on in vivo data; to determine their thermal stability in the dosage form; to determine their kinetics of degradation and to isolate and identify their major products of degradation. A stability indicating method was developed and validated for simultaneous quantitation of both drugs in Kaletra®, using liquid chromatography. An alternative method using UV-derivative spectrometry was also proposed. The result showed a level A correlation between the in vitro dissolution profile and in vivo absorption under the proposed conditions. The LC method was fully validated and have shown to be stability indicating. The UV-derivative method showed not to be equivalent (t-test) to the LC method. Thermal stability studies have shown that lopinavir was very stable under the conditions tested while ritonavir was sensitive to heat, following a first order degradation kinetic. According to NMR results ritonavir the main degradation products have the molecular formula C33H45N5O5S and C25H33N3O6.

O ritonavir (RTV) é um anti-retroviral, inibidor da protease do VIH, produzido nas formas farmacêuticas cápsula e solução oral sob o nome comercial Norvir® (Abbott). Levando-se em consideração que o RTV está sendo sintetizado no Brasil e que não existem métodos oficiais para o seu doseamento na forma farmacêutica cápsula, faz-se necessário o desenvolvimento e validação de métodos para assegurar a qualidade do produto acabado. Deste modo, o objetivo deste trabalho foi a validação de métodos analíticos para o controle qualitativo e quantitativo do RTV matéria-prima e cápsulas, assim como a realização de estudo preliminar para avaliar a estabilidade da matéria-prima. A identificação e caracterização do fármaco e seus polimorfos (forma I e II) foi realizada através da análise do ponto de fusão, calorimetria exploratória diferencial (DSC), rotação específica, métodos espectrofotométricos na região do infravermelho (IV) e do ultravioleta (UV), cromatografia em camada delgada (CCD) e cromatografia líquida de alta eficiência (CLAE), microscopia óptica (MO) e eletrônica de varredura (MEV), além da difração de raios-X. Para a determinação quantitativa foram validados, segundo normas da International Conference on Harmonization (ICH), os métodos de espectrofotometria na região do UV, ordem-zero e segunda derivada (UV-D2), e CLAE. A análise estatística demonstrou equivalência entre os métodos CLAE / UV para a determinação do teor da matéria-prima e entre os métodos CLAE / UV-D2 para a determinação do RTV nas cápsulas. No estudo preliminar de estabilidade térmica e fotoestabilidade, a matéria-prima foi submetida à temperatura de 60 °C por 30 dias e permaneceu sob luz branca por até 15 dias respectivamente. A CLAE foi o método empregado na análise do teor e pureza das amostras submetidas às degradações, sendo que os resultados demonstraram a estabilidade da matéria-prima nas condições testadas, não havendo redução significativa do teor do fármaco nem aparecimento de potenciais produtos de degradação. / Ritonavir (RTV) is a HIV-protease inhibitor, available as capsule and oral solution (Norvir®). Considering that the drug has been produced in Brazil and there are no official methods to quantify RTV capsules, it became necessary the development and validation of methods for ensuring the quality of pharmaceutical formulations. The objective of this work was the validation of these analytical methods for the qualitative and quantitative analysis of RTV bulk substance and capsules. A preliminary studie of stability was also performed. RTV identification and polymorphs I and II characterization were performed by using several techniques such as: melting point, differential scanning calorimetry (DSC), optical rotation, infrared (IR) and ultraviolet (UV) spectrophotometry, thin-layer chromatography, high performance liquid chromatography (HPLC), optical and scanning electron microscopy, and powder X-ray diffraction. The HPLC, zero-order UV spectrophotometric and second-derivative UV spectrophotometric (UV-D2) methods were validated according to the International Conference on Harmonization (ICH) guidelines for the quantitative determination of RTV bulk substance and capsules. The statistics analysis showed that HPLC / UV methods were equivalent to assay bulk substance and HPLC / UV-D2 methods were equivalent to assay capsules. The preliminary studies of thermal and photostability were conducted by exposing RTV samples at 60 °C during 30 days and under fluorescent lamp during 15 days. The developed HPLC method was used to assay the drug and detect its potential degradation products. The results showed that the RTV bulk substance was stable and there was no evidence of its degradation, under the established conditions.

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.

The novel coronavirus disease 2019 (COVID-19), appeared in the United States over 1 year ago. This virus has a wide range of presentations, from being asymptomatic to causing severe acute respiratory syndrome, which can lead to death. It has led to a worldwide effort to find effective treatments, from repurposed medications to new discoveries, as well as the push to develop effective vaccines. As the race to fight this pandemic unfolds, this column provides what is currently available to combat this virus, how it has been utilized in the pregnant population, and what data have been made available about how these treatments affect fetal development and the neonate.

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Referat: Background: Human African Trypanosomiasis (HAT) also called sleeping sickness is an infectious disease of humans caused by an extracellular protozoan parasite. The disease, if left untreated, results in 100% mortality. However, the available drugs are full of severe drawbacks and fail to escape the fast development of trypanosoma resistance. Due to the probable similarities in cell metabolism among tumor and trypanosoma cells, some of the current registered drugs against HAT were derived from cancer chemotherapeutic research. Here too, for the first time, we have demonstrated that the simple ester, ethyl pyruvate, comprises such properties. On the other hand initial studies have confirmed the efficacy of protease inhibitors in treatment of Trypanosoma cruzi, Plasmodium falciparum and Leishmania major. However, studies on efficacy and specific proteases inhibition using HIV-1 protease inhibitors on T. brucei cells remain untouched. Methodology/Principal findings: The current study covers efficacy and corresponding target evaluation of ethyl pyruvate and HIV-1 protease inhibitors (ritonavir and saquinavir) on T. brucei cell lines using a combination of biochemical techniques including cell proliferation assays, enzyme kinetics, zymography, phase contrast microscopic video imaging and ex vivo drug toxicity tests. We have shown that ethyl pyruvate effectively kills trypanosomes most probably by net ATP depletion through inhibition of pyruvate kinase (Ki=3.0±0.29 mM). The potential of this compound as an anti-trypanosomal drug is also strengthened by its fast acting property, killing cells within three hours post exposure. This was demonstrated using video imaging of live cells as well as concentration and time dependency experiments. Most importantly, this drug produced minimal side effects in human erythrocytes and is known to easily cross the blood-brain-barrier (BBB) which makes it a promising candidate for effective treatment of the two clinical stages of sleeping sickness. Trypanosome drug resistance tests indicate irreversible killing of cells and a low chance of drug resistance development under applied experimental conditions. In addition to ethyl pyruvate our experimental study on HIV-1 protease inhibitors showed that both ritonavir (RTV) (IC50=12.23 µM) and saquinavir (SQV) (IC50=11.49 µM) effectively inhibited T. brucei cells proliferation. The major proteases identified in these cells were the cysteine- (~29kDa Mr) and metallo- (~66kDa Mr) proteases. Their proteolytic activity was, however, not hampered by either of these two protease inhibitors. Conclusion/Significance: Our results present ethyl pyruvate as a safe and fast acting drug. Hence, because of its predefined property to easily cross the BBB, it can probably be a new candidate agent to treat the heamolymphatic as well as neurological stages of sleeping sickness. Similarly, HIV-1 protease inhibitors, SQV and RTV, exhibited their antitrypanosomal potential but require further anlysis to identify their specific targets.

Referat: Background: Human African Trypanosomiasis (HAT) also called sleeping sickness is an infectious disease of humans caused by an extracellular protozoan parasite. The disease, if left untreated, results in 100% mortality. However, the available drugs are full of severe drawbacks and fail to escape the fast development of trypanosoma resistance. Due to the probable similarities in cell metabolism among tumor and trypanosoma cells, some of the current registered drugs against HAT were derived from cancer chemotherapeutic research. Here too, for the first time, we have demonstrated that the simple ester, ethyl pyruvate, comprises such properties. On the other hand initial studies have confirmed the efficacy of protease inhibitors in treatment of Trypanosoma cruzi, Plasmodium falciparum and Leishmania major. However, studies on efficacy and specific proteases inhibition using HIV-1 protease inhibitors on T. brucei cells remain untouched. Methodology/Principal findings: The current study covers efficacy and corresponding target evaluation of ethyl pyruvate and HIV-1 protease inhibitors (ritonavir and saquinavir) on T. brucei cell lines using a combination of biochemical techniques including cell proliferation assays, enzyme kinetics, zymography, phase contrast microscopic video imaging and ex vivo drug toxicity tests. We have shown that ethyl pyruvate effectively kills trypanosomes most probably by net ATP depletion through inhibition of pyruvate kinase (Ki=3.0±0.29 mM). The potential of this compound as an anti-trypanosomal drug is also strengthened by its fast acting property, killing cells within three hours post exposure. This was demonstrated using video imaging of live cells as well as concentration and time dependency experiments. Most importantly, this drug produced minimal side effects in human erythrocytes and is known to easily cross the blood-brain-barrier (BBB) which makes it a promising candidate for effective treatment of the two clinical stages of sleeping sickness. Trypanosome drug resistance tests indicate irreversible killing of cells and a low chance of drug resistance development under applied experimental conditions. In addition to ethyl pyruvate our experimental study on HIV-1 protease inhibitors showed that both ritonavir (RTV) (IC50=12.23 µM) and saquinavir (SQV) (IC50=11.49 µM) effectively inhibited T. brucei cells proliferation. The major proteases identified in these cells were the cysteine- (~29kDa Mr) and metallo- (~66kDa Mr) proteases. Their proteolytic activity was, however, not hampered by either of these two protease inhibitors. Conclusion/Significance: Our results present ethyl pyruvate as a safe and fast acting drug. Hence, because of its predefined property to easily cross the BBB, it can probably be a new candidate agent to treat the heamolymphatic as well as neurological stages of sleeping sickness. Similarly, HIV-1 protease inhibitors, SQV and RTV, exhibited their antitrypanosomal potential but require further anlysis to identify their specific targets.:Bibliographic description ii Acronyms iii 1. Introduction 1 1.1. Disease background 1 1.2. Epidemiological distribution and disease transmission dynamics 1 1.3. Biology and life cycle of the trypanosomatidea 3 1.4. Public health significance 4 1.5. Clinical stages and disease progression 5 1.6. Current challenges of disease control 6 1.7. Current drugs and their clinical applications 9 1.8. Targets for drug discovery 12 1.8.1. Energy metabolism 12 1.8.2. Proteolysis 17 1.9. Ethyl pyruvate 18 1.10. HIV-1 Protease Inhibitors 21 2. Aim of the study 22 3. Materials and Methods 24 4. Results 31 5. Discussion 45 6. Conclusion 53 7. Supporting information 54 8. Summary 56 9. References 62 Erklärung über die eigenständige Abfassung der Arbeit 77 Curriculum vitae 78 Publications and Presentations 81 Acknowledgement 83