Studies on Probenecid Prodrugs that Protect against Mitochondrial Toxicity of Tenofovir

摘要：全世界约有3800万人感染了人类免疫缺陷病毒（HIV） 获得性免疫缺陷病（艾滋病）的病原体，其中120万是美国人。没有 由于没有疫苗，而且没有治愈方法，艾滋病毒/艾滋病患者必须终生服用抗艾滋病毒药物。因此，在本发明中， 长期使用高效抗逆转录病毒疗法（HAART）药物，彻底改变了艾滋病毒/艾滋病 艾滋病患者也可以和非感染者一样长寿， 伴随着严重的线粒体毒性，致命的后果，导致许多停药， 早期有效的核苷逆转录酶（RT）抑制剂（NRTI）骨架成分，如ddC和d4 T。的 核苷酸逆转录酶抑制剂（NtRTIs）特别是替诺福韦（TFV）的开发在HIV逆转录酶中具有创新性 抑制剂领域，在某种程度上，它已经获得了广泛的使用，并纳入几乎所有的一线 艾滋病毒/艾滋病治疗组合方案，以及用于暴露前预防药物（PrEP）。TFV是 作为两种前药富马酸替诺福韦二吡呋酯（TDF）和替诺福韦艾拉酚胺（TAF）销售。但长期 TDF前药的使用引起源自活性母体TFV的肾毒性。TTV相关肾毒性 据说是由一个 转介专科肾病服务 当TFD第一次被引入时。此外，即使在治疗后，约30%的患者的肾功能下降也是不可逆的。 停止TFV治疗。虽然，TAF，这是最近推出的更有效，毒性较低， TDF，案例研究表明，它具有肾脏毒性潜力，长期使用可能会表现出来。此外，它还导致 令人不安的体重增加，可能会加剧代谢综合征。这些问题意味着TAF不能总是 替换TDF。TFV毒性的机制尚不清楚，但对肾近端小管的损害是其毒性的主要原因。 线粒体有很大的关联本研究的目的是为了更好地了解和发展 解决TFV肾毒性的有效方法。具体目标是：1）确认人类 线粒体膜表达功能性有机阴离子转运蛋白1和3（hOAT 1和hOAT 3），并显示 它们将TFV导入线粒体的能力，以及，2）开发和研究TFV的保护能力。 针对TFV毒性的脑靶向hOAT 1和3抑制剂前药。我们已经展示了 TFV转运蛋白hOAT 1和hOAT 3在人肾近端线粒体膜中的表达 肾小管上皮细胞，支持我们的假设，即TFV通过hOAT 1和3进入线粒体， 线粒体毒性对于目标2，我们已经合成了初始的hOAT 1和3抑制剂前药，并表明它是 保护免于TFV线粒体毒性。一个全面的多学科方法，涉及医学 将应用化学、生物化学、功能基因组学和药理学，使用人肾近端 肾小管细胞我们最初合成的靶向前药逆转了TFV诱导的线粒体毒性。的成功 该项目将为TFV诱导的毒性提供新的见解，并提供生物探针和/或潜在的药物线索。

ABSTRACT: Almost 38 million individuals worldwide are infected with the human immunodeficiency virus (HIV) causative agent of acquired immunodeficiency disease (AIDS), 1.2 million of them being Americans. With no vaccine and no cure available, HIV/AIDS patients must take anti-HIV drugs throughout the rest of their lives. Thus, the long-term use of highly active antiretroviral therapy (HAART)drugs that revolutionized HIV/AIDS AIDS patients can also live as long as non-infected people, has been accompanied by serious mitochondrial toxicities, with fatal consequences that led to discontinuation of many of the early effective nucleoside reverse transcriptase (RT) inhibitor (NRTIs) backbone components, like ddC and d4T. The development of the nucleotide RT inhibitors (NtRTIs) particularly tenofovir (TFV), has been innovative in the HIV RT inhibitors field, to the extent that it has gained widespread use worldwide and is incorporated into almost all first-line HIV/AIDS therapeutic combination regimens, as well as used for pre-exposure prophylactics (PrEP). TFV is marketed as two prodrugs tenofovir disoproxil fumarate (TDF) and tenofovir alafenamide (TAF). However, long-term use of the TDF prodrug causes kidney toxicity stemming from the active parent TFV. TFV-associated kidney toxicity is said to have constituted the single referrals for specialist renal services when TFD was first introduced. Moreover, this renal decline was irreversible in about 30 % of patients even after cessation of TFV therapy. Although, TAF, which was introduced more recently is more potent and less toxic than TDF, case studies show it has kidney toxicity potential which may manifest upon long-term use. Moreover, it causes troubling weight gain that could exacerbate metabolic syndrome. These problems mean that TAF cannot always replace TDF. The mechanisms of TFV toxicity are not well understood, but damage to renal proximal tubular mitochondrial has been strongly implicated. The goal of this research is to gain better understanding and develop effective approaches to addressing TFV kidney toxicity. The specific aims are: 1) to confirm that human mitochondrial membranes express functional organic anion transporters 1 and 3 (hOAT1 and hOAT3), and show their ability to import TFV into mitochondria, and, 2) to develop and investigate the protective ability of mitochondrially targeted hOAT1 and 3 inhibitor prodrugs against TFV toxicity. We have demonstrated the expression of the TFV transporters hOAT1 and hOAT3 in the mitochondrial membranes of human renal proximal tubule epithelial cells, supporting our hypothesis that TFV enters mitochondria through hOAT1 and 3 to cause mitochondrial toxicity. For aim 2, we have synthesized an initial hOAT1, and 3 inhibitor prodrug and shown that it is protective against TFV mitochondrial toxicity. A comprehensive multidisciplinary approach involving medicinal chemistry, biochemistry, functional genomics, and pharmacology will be applied, using human kidney proximal tubule cells. Our initially synthesized targeted prodrug reverses TFV-induced mitochondrial toxicity. The success of this project will give new insights into TFV-induced toxicity and provide biological probes and/or potential drug leads.