PHARMACEUTICAL PRODUCT FOR THE TREATMENT OF VIRAL INFECTIONS, IN PARTICULAR OF THE HUMAN IMMUNODEFICIENCY VIRUS (HIV)

Abstract: The invention describes a pharmaceutical product for the treatment of viral infections, in particular of the human immunodeficiency virus (HIV). According to the invention, the pharmaceutical product comprises a compound that as active component contains an iron chelator. Suitable iron chelators are selected from the group of hydroxamates (such as deferoxamine), the family of the hydroxypyridinons (such as deferiprone), and the nucleic acid-binding chemotherapeutical products (such as bleomycine). A synergistic effect is obtained in vitro when in addition to the component containing the iron chelator, a product is used that contains another virus-inhibiting compound. As the antiviral agent a protease-inhibitor, preferably ritonavir, is considered. Another suitable antiviral agent is a reverse transcriptase inhibitor, preferably a dideoxyinosine.

Description: Pharmaceutical product for the treatment of viral infections, in particular of the human immunodeficiency virus (HIV) The present invention relates to a pharmaceutical product for the treatment of viral infections, in particular of the human immunodeficiency virus (HIV) . Viral infections, in particular infections by the human immunodeficiency virus (HIV) are the serious threat to public health. World-wide much effort goes into the development of a pharmaceutical product to combat this usually incurable disease. It is known that iron is involved in the replication of human immunodeficiency virus. In the first place, the HIV-1 long terminal repeat (LTR) portion contains nuclear factor (NF) -kB response elements that regulate proviral transcription. NF-kB activation may be influenced with iron via the production of reactive oxygen species. A second route by which iron chelation can influence HIV replication is by inhibition of the DNA synthesis by inactivation of iron-dependent ribonucleotide reductase. Another strategy which can be employed in targeting iron chelators against HIV-1 is a direct viral DNA/RNA attack. It is the object of the present invention to provide a pharmaceutical product for the efficient treatment of viral infection, in particular of the human immunodeficiency virus, to which end the pharmaceutical product is characterized in that the pharmaceutical product comprises a compound that as active component contains an iron chelator. Suitable iron chelators according to the invention may be selected from the group of hydroxamates (such as deferoxamine) , the family of the hydroxypyridinons (such as deferiprone) , and the nucleic acid-binding chemotherapeutical products (such as bleomycin) . Very surprisingly it has been shown that in vitro particularly favourable results were obtained when in addition to the component containing as the active compound an iron chelator, a preparation containing another virus-inhibiting compound was used; which was due to a synergistic effect. A protease inhibitor, in particular ritonavir, proved to be especially suitable as the antiviral agent. Another antiviral agent producing a favourable synergistic effect with iron chelators is reverse transcriptase inhibitor, in particular dideoxyinosine . In this connection applicant has examined the effect of deferoxamine (DF) , deferiprone (LI) and bleomycin (BLM) on HIV-1 replication in primary blood cells. For this purpose human peripheral blood lymphocytes (PBL) and monocyte-derived macrophages (MDM) , the main target cells for HIV, were used. It was shown, that the considerable production of HIV-1 replication by DF was accompanied by a proliferation inhibition. The same was observed with LI. Surprisingly, BLM inhibited the viral replication in PBL and MDM without affecting lymphocyte proliferation. The use of iron chelators in combination with established antiviral agents for antiviral combination therapy was examined. When DF was used in combination with the nucleoside analog dideoxyinosine (ddl) , a surprising synergistic inhibition of p24 in HIV- infected PBL seemed to occur. Materials and methods used in the study are the following. Cell isolation. Peripheral Blood Mononuclear Cell (PBMC) fractions were isolated from heparinized blood from HIV-1- , HIV-2- and hepatitis B-seronegative donors (Bloodbank, Utrecht, The Netherlands) by Ficoll-Isopaque gradient separation. Cells were washed twice and were then either subjected to counter-current centrifugal elutriation, or monocytes in the PBMC fraction were allowed to adhere to fibronectin-coated flasks before the PBL fraction was harvested. Monocytes were of >95% purity by criteria of cell morphology on May-Grϋnwald-Giemsa- stained cytosmears and by non-specific esterase staining using (α-naphthylacetate (Sigma Chemical Co., St. Louis, MO) and PBL >85% purity by May-Grύnwald-Giemsa-staining. Viability of both cell types was >95% at the point of experiment initiation as determined by trypan-blue exclusion. Isolated monocytes were cultured in suspension at a concentration of 2 x 10 6 cells/ml in teflon flasks minimizing adherence (Nalgene, Rochester, NY) and allowed to differentiate for 7 days. MDM medium consisted of Dulbecco's modified Eagle's medium supplemented with 10% heat-inactivated human AB serum, negative for anti-HIV antibodies (Bloodbank Utrecht, NL) , 10 μg/ml gentamycin (Life Technologies Ltd, Paisley, Scotland) , 5 μg/ml ciprofloxacin (Beyer, Leverkusen, Germany), 0.6 mg/ml L- glutamine (Sigma) and 3.4 g/L bicarbonate (Merck, Darmstadt, Germany) . Isolated PBL was stimulated to proliferate for 3 days with 4 μg/ml phytohemagglutinin (PHA; Sigma) in RPMI-1640 (Life Technologies Ltd.) medium supplemented with 10% heat inactivated fetal calf serum (Life Technologies Ltd.) and 10 μg/ml gentamycin. After PHA stimulation the PBL were cultured in medium containing 10 U/ml human recombinant IL-2 (Boehringer, Mannheim, Germany) . All incubations were carried out in flat- bottomed 96-well plates at 37 °C, 5% C0 2 and 95% air. HIV infection and p24 measurements . Cells were infected for 2 hours with HIV-I B ,. ! .. Macrophages were infected with a multiplicity of infection (MOD of 0.005 and lymphocytes with an MOI of 0.001. The cells were then washed twice to remove excess virus and subsequently incubated with either DF (Novartis Pharma, Arnhem, The Netherlands), Ll (from Duchefa Farma B.V., Haarlem, The Netherlands) or BLM (H. Lundbeck A/S, Copenhagen, Denmark) for a period of 5 days. Virus in culture supernatant was inactivated in a final concentration of 0.05% empigen (Calbiochem-Novabiochem Co., La Jolla, CA) . The presence of HIV-1 in the inactivated supernatant was monitored by checking for the p24-core antigen by enzyme-linked immunosorbent assay (ELISA) . Lymphocyte proliferation measurements . Since iron chelators may influence cellular proliferation the effect of the three iron chelators on PBL proliferation was also determined. This was performed by monitoring overnight 3 H-thymidine ( 3 H-TdR) incorporation into DNA. 25 μl 3 H-TdR (0.5 μCi, Amersham International pic, UK) was added in the presence of DF, Ll, BLM or DF/ddl combination, in a total volume of 200 μl cell suspension after 4 days incubation with the different compound concentrations. Cell incubations were in 96-well plastic plates (Costrar, Cambridge, MA, US) . After overnight incubation with 3 H-TdR, the cells were harvested onto a filter using an automatic cell microharvester (Titertek ® cell harvester 530) . The filter was subsequently dried and immersed in a scintillation cocktail (Wallac UK) . Radioactivity was counted in a Mark II liquid Scintillation system (Model x, Tricton analytics, Inc.). Cy to toxi ci ty . Possible cytotoxicity of DF, Ll or BLM was monitored by the MTT [3- (4, 5 dimethylthiazol-2-yl) -2 , 5- diphenyltetrazolium bromide] (Sigma) assay. Studies of DF-ddl combination . Three separate experiments were performed substantially as described in the section HIV infection and p24 measurements . Multiply-diluted fixed-ratio combinations of the drugs, or single drugs were added to £ P> on g H- H H O H (V o. cr ^ i o- re o H (D P» 01 fD H- a TJ N O M H- Hi ID H P> ft M- O a ^ --, Hi H- KQ C H π> H o . Thus, non-cytotoxic DF concentrations were capable of reducing HIV replication and this reduction was accompanied by cellular proliferation inhibition. Effect of Ll on HIV-1 replication, cellular proliferation and cytoloxicity in PBL. HIV-1 replication in lymphocytes was reduced to minimal levels by 100 μM Ll (figure 2A) . This concentration was not cytotoxic in PBL (figure 2B) . There seemed to be a threshold point in Ll concentration where the inhibition slope became very steep and this phenomenon was also mirrored by a decrease in proliferation (figure 2C) . Thus, the HIV-inhibition observed with Ll could also be attributed to cellular proliferation inhbition. At lower compound concentrations a subtle increase in p24 antigen production was observed (figure 2A) . Effect of BLM on HIV-1 replication, cellular proliferation and cytotoxicity in PBL. BLM dose-dependently decreased HIV-1 replication in lymphocytes (figure 3A) . This compound was not cytotoxic in PBL (figure 3B) . At concentrations in the range of 3-300 ng BLM/ml a 20-50% reduction was noted, reflecting a decrease from 19 to 15 (20%) or 9.5 (50%) ng p24/ml (n=3) (figure 3A) . Cellular proliferation remained intact (figure 3C) . Thus, HIV-1 inhibition by BLM, in contrast to DF and Ll, seems to proceed via a pathway other than cellular proliferation inhibition. Effect of DF, Ll, and BLM on HIV-1 replication and cytotoxicity in MDM. In MDM, DF concentrations around 100 μM reduced viral replication by up to 50% (1.2 vs 0.6 ng p24/ml) in a dose-dependent manner (figure 4AI) . However this p24 decrease was associated with the onset of cytotoxicity (figure 4AII) . Ll in the concentrations studied, strikingly up-regulated p24 antigen production by up to two fold at 30 μM (figure 4BI) . These concentrations were not cytotoxic (figure 4BII) . In MDM a dose-dependent decrease in p24 levels was also observed with a 50% reduction at 300 ng BLM/ml from 1.2 to 0.6 ng p24/ml (figure 4CI) . BLM concentrations, similarly to PBL, were found not to affect cell viability in MDM (figure 4CII) . Combined antiviral effects of DF-ddl. Moderate to strong synergism was detected when DF was used in combination with ddl. Figure 5 shows a representative graph of the combination index (CI) with respect to fraction affected (f for the inhibition of HIV by a mixture of DF and ddl (molar ratio 4:1) . IC 50 of DF was 8.5 μM and that of ddl 3.7 μM. Figure 5 clearly shows that there is a marked synergism at all f a values obtained with the different combinations, with the synergism getting stronger as f a increases. At around the IC S0 concentrations of both DF and ddl (combination points on figure 5: 10 μM DF: 2.5 μM ddl), the highest f a value was obtained and the combination was strongly synergistic. Cellular proliferation was also monitored with these combinations and with each drug alone. It was found that ddl in combination with DF did not have an additional inhibitory effect on cellular proliferation when compared to DF alone (results not shown) . The invention is explained in more detail with reference to the Figures 1-6. Fig. l. Effect of DF on HIV-I replication (A), cytotoxicity (B) and cellular proliferation (C) in PBL after 5 days incubation with DF. For the HIV-l replication measurements cells were infected for 2 hours with HIV-l Ba-I , at an MOI of 0.001; the cells were subsequently washed 2 times and incubated with different DF concentrations. After 5 days, supenatant was harvested for p24 ELISA. Virus replication was expressed as % p24 reduction after DF incubations, compared to p24 measured from control HIV-infected cells incubated in the absence of DF (set at 100% p24) . Cytotoxicity was measured by the MTT test and is represented as % viable cells after 5 days DF incubations, compared to viable cells from control HIV-infected cells incubated in the absence of DF (set at 100% viable cells) . PBL proliferation was measured by overnight 3 H-thymidine incorporation after DF was incubated for 4 days with cells,- it is represented as counts per minute (cpm) after DF incubations, compared to cpm from control cells, incubated in the absence of DF. Results are the average of 3 experiments in duplicate (statistical analysis using repeated ANOVA and student Newman-Keuls test, *p<0.05). 100% p24 production represents 19 ng p24/ml Fig. 2. Effect of Ll on HIV-1 replication (A), cytotoxicity (B) and cellular proliferation (C) in PBL after 5 days incubation with Ll . For the HIV-I replication measurements cells were infected for 2 hours with HIV-l Ba-L at an MOI of 0.001; the cells were subsequently washed 2 times and incubated with different Ll concentrations. After 5 days, supernatant was harvested for p24 ELISA. Virus replication was expressed as % p24 reduction after Ll incubation, compared to p24 measured from control HIV-infected cells incubated in the absence of Ll (set at 100% p24) . Cytotoxicity was measured by the MTT test and is represented as % viable cells after 5 days Ll incubations, compared to viable cells from control HIV-infected cells incubated in the absence of Ll (set at 100% viable cells) . PBL proliferation was measured by overnight 3 H-thymidine incorporation after Ll was incubated for 4 days with cells; it is represented as counts per minute (cpm) after Ll incubations, compared to cpm from control cells, incubated in the absence of Ll. Results are the average of 3 experiments in duplicate (statistical analysis using repeated ANOVA and student Newman-Keuls test, *p<0.05). 100% p24 production represents 19 ng p24/ml. Fig. 3. Effect of BLM on HIV-1 replication (A), cytotoxicity (B) and cellular proliferation (C) in PBL after 5 days incubation with BLM. For the HIV-1 replication measurements cells were infected for 2 hours with HIV-l Ba . L at an MOI of 0.001; the cells were subsequently washed 2 times and incubated with different BLM concentrations. After 5 days, supernatant was harvested for p24 ELISA. Virus replication was expressed as % p24 reduction after BLM incubations, compared to p24 measured from control HIV-infected cells incubated in the absence of BLM (set at 100% p24) . Cytotoxicity was measured by the MTT test and is represented as % viable cells after 5 days BLM incubations, compared to viable cells from control HIV- infected cells incubated in the absence of BLM (set at 100% viable cells) . PBL proliferation was measured by overnight 3 H-thymidine incorporation after BLM was incubated for 4 days with cells; it is represented as counts per minute (cpm) after BLM incubations, compared to cpm from control cells, incubated in the absence of BLM. Results are the average of 3 experiments in duplicate (statistical analysis using repeated ANOVA and student Newman-Keuls test, *p<0.05). 100% p24 production represents 19 ng p24/ml Fig. 4. Effect of DF (AI-II) , Ll (BI-II) and BLM (CI-II) on HIV-l replication (A-CI) and cytotoxicity (A- CII) in MDM after 5 days incubation. For the HIV-1 replication measurements cells were infected for 2 hours with HIV-l Ba-L at an MOI of 0.001; the cells were subsequently washed 2 times and incubated with different compound concentrations. After 5 days supernatant was harvested for p24 ELISA; Virus replication was expressed as % p24 reduction after compound incubations, compared to p24 measured from control HIV- infected cells incubated in the absence of compounds (set at 100% p24) . Cytotoxicity was measured by the MTT test and is represented as % viable cells after 5 days compound incubations, compared to viable cells from control HIV- TJ o TJ φ Pi £ 01 Φ H Hi i Hi a μ- a g O H Hi P. rt TJ TJ IP n P> Φ tr Φ μ- H tr g Ω V H iQ P» o Φ rt H Φ a φ g a rt 01 a i a g Φ μ- N rt Φ Pl H a pi PJ • a 01 H P. a a P. Φ μ- Φ rt P. P 01 Ω 1 a H H TJ P ) ≤ rr Pi φ Φ rt μ- ) 4 rt Ω φ a 01 Φ tr i O rt ?r μ- cr μ- 01 Φ 3 TJ 01 Pi rt <J ϊ Pi Φ H ^ P> Φ i Φ Φ - μ- φ μ- 01 01 TJ a *<: H g a Φ Pi φ - IP g H a Φ a P. μ- a Φ Ω H P. p ) 01 a i φ μ- a Ω rt o g rt 01 Ω μ- 01 cr o tr μ- O Ω o ^ Hi a φ a H H rt lΩ P. tr P. w n μ- i Φ Φ H rt PI rt a Pi a rt < tr l- J tr IQ P. rt φ 1 Φ Ω φ μ- H H a rt rt pi g H ω 3 O μ- 01 μ- μ- n • s φ <! 01 a a o p. O φ J μ- Ω μ- tr ► <: a rt o J o P> iQ tr Hi Ω a a a ^ - ^ . Φ O Pi M rt ω g Φ i F tr μ- t→ TJ Hi a P ) H Φ a 3 a Hi P. a 01 P» rt Φ rt TJ Ω s: Φ Ω H Pi t rr ) H rt PJ IP • it* μ- 01 o < 01 Φ i a o Pi P> μ> O Λ H 1 μ- H a rt Hi a P> 01 Λ rt φ o rt P> *< rt H μ- Pi rt μ- - ιp T= P» μ- Ω φ ( P H O H II a Φ a a- g Φ H and of ritonavir 0.04 μM. This graph is representative of two independent experiments.

Claims: NEW CLAIMS 1. A pharmaceutical product for the treatment of viral infections, in particular of the human immunodeficiency virus (HIV) , characterized in that the pharmaceutical product comprises a compound that as active component contains an iron chelator and a component comprising another virus- inhibiting compound. 2. A pharmaceutical product according to claim 1, characterized in that the iron chelator is selected from the group of hydroxamates (such as deferoxamine) , the family of the hydroxypyridinons (such as deferiprone) , and the nucleic acid-binding chemotherapeutical products (such as bleomycine) . 3. A pharmaceutical product according to claim 2, characterized in that the virus-inhibiting compound is a protease-inhibitor . 4. A pharmaceutical product according to claim 3, characterized in that the protease-inhibitor is ritonavir. 5. A pharmaceutical product according to claim 1, characterized in that the virus-inhibiting compound is a reverse transcriptase inhibitor. 6. A pharmaceutical product according to claim 5, characterized in that the reverse transcriptase inhibitor is a dideoxyinosine.

Inventors: MARX JOHANNES JOSEPHUS MARIA, VAN ASBECK BERNT SWEDER, MARX, JOHANNES, JOSEPHUS, MARIA, VAN ASBECK, BERNT, SWEDER
Applicants: ASBECK BERNT SWEDER VAN, FACULTEIT GENEESKUNDE UNIVERSI, MARX JOHANNES JOSEPHUS MARIA, FACULTEIT GENEESKUNDE UNIVERSITEIT UTRECHT, MARX, JOHANNES, JOSEPHUS, MARIA, VAN ASBECK, BERNT, SWEDER
Application year: 2000
Main classification: A61K31
IPC codes: A61K31, A61K38, A61K45, A61P35, A61P39