Andrew P. Halestrap, Philippe Gallay, Brigitte Rosenwirth, Kamel Besseghir, Marie-Pierre de Béthune, Dirk Jochmans, Roland Wenger, Michael Bobardt, Jean-Maurice Dumont, Luke A. Pallansch, Roger G. Ptak, Erik De Clercq, Urs T. Ruegg, Pietro Scalfaro, and Johan Neyts
The introduction of highly active antiretroviral therapy has led to significant changes in disease progression and mortality of human immunodeficiency virus (HIV) type 1 (HIV-1) infection and its sequela, AIDS. HIV-1 infection has been turned into a chronic condition that can be treated and that may be manageable over many years (90). However, a significant proportion of patients still fail to have a complete response to treatment over a prolonged time and are at risk of virological rebound, which may lead to the emergence of drug-resistant virus variants (20). The 21 anti-HIV-1 drugs used at present target only three steps in the viral replication cycle, namely, virus fusion, reverse transcription, and the proteolytic processing of viral proteins (22). An inhibitor directed against a fourth step, envelope glycoprotein binding to the CCR5 coreceptor (24, 99), and an inhibitor of a fifth step, integration of viral DNA in the cellular genome (34), were recently approved by FDA. Further inhibitors of the last two steps are in clinical evaluation (23, 86). Thus, the four virus-coded proteins, the envelope glycoprotein, reverse transcriptase (RT), protease, and integrase, are the molecular targets of anti-HIV-1 chemotherapy in the clinic at present. This limits the number of possible combinations that may be used, because cross-resistance of virus strains against drugs targeted to the same viral molecule is common (61). Therefore, novel anti-HIV drugs directed against other steps in the viral replication cycle are highly needed. Cyclophilin A (CypA) was established more than a decade ago to be a valid target in anti-HIV-1 chemotherapy (69, 70). The cellular protein CypA fulfills an essential function early in the HIV-1 replication cycle. It was found to bind specifically to the HIV-1 Gag polyprotein (48). A defined amino acid sequence around G89 and P90 of capsid protein p24 (CA) was identified as the binding site for CypA (17, 31). The affinity of CypA for CA promotes the incorporation of CypA into the virion particles during assembly (10, 30, 87). Experimental evidence indicates that the CypA-CA interaction is essential for HIV-1 replication; inhibition of this interaction impairs HIV-1 replication in human cells (10, 37, 81, 82). The step in the viral replication cycle where CypA is involved was demonstrated to be an event after penetration of the virus particle and before integration of the double-stranded viral DNA into the cellular genome (13, 51, 82). CypA is a member of the immunophilin class of proteins. These ubiquitous cellular proteins possess cis-trans prolyl isomerase (PPIase) activities (27) and are assumed to be involved in protein folding and to function as chaperones in intracellular transport (78). Cyclophilins are also known to be the intracellular receptor molecules for cyclosporines (35), a class of cyclic undecapeptides produced by Trichoderma polysporum (25, 71). Binding of cyclosporines to cyclophilins leads to the blockade of the isomerase activity. The most prominent representative of this class of compounds is cyclosporine (Cs), a potent inhibitor of T-cell activation widely used in the clinic as an immunosuppressant in organ transplantation (11). When Cs is bound to CypA it forms a ternary complex with calcineurin. This binding inhibits the phosphatase activity of calcineurin, which is crucial for signal transduction in the activation cascade of T cells. Inhibition of calcineurin function is thus the molecular basis of the immunosuppressive action of Cs (8). The structure of Cs bound to its ligands has been elucidated: two separate domains in the undecapeptide Cs that are involved in binding to CypA and calcineurin, respectively, can be distinguished (40, 43, 66, 94, 98). The immunosuppressive capacity of Cs can therefore be separated from its affinity to CypA by chemical modification. The anti-HIV-1 activity of Cs was first reported in 1988 (91). Evaluation of this drug and many derivatives for inhibition of HIV-1 replication revealed that nonimmunosuppressive Cs analogs had anti-HIV-1 activities equal to or even superior to those of immunosuppressive analogs (7, 10). A clear correlation was evident, however, between their antiviral activities and the ability of cyclosporines to bind to their cellular receptor protein, CypA. Modification of amino acids in the calcineurin binding domain of Cs, in particular, substitution of the undecapeptide at position 4, was shown to abolish the formation of the ternary complex with calcineurin and, thus, led to the loss of its immunosuppressive capacity (62, 96, 105). Binding to CypA and anti-HIV-1 activity were not impaired by such modifications. (Methyl Ile4)cyclosporine (NIM811), a nonimmunosuppressive cyclosporine with a high affinity for binding to CypA and also potent and selective anti-HIV-1 activity, was characterized in more detail (68). Mode-of-action studies revealed that NIM811 inhibited the CypA-CA interaction in a dose-dependent manner (10, 87) and that an early step in the replication cycle of HIV-1 was impaired in the presence of the compound (10, 51, 82). NIM811 was produced by fermentation of the fungus Tolypocladium niveum, followed by extraction and purification (89). Chemical derivatization procedures for the production of a large variety of Cs derivatives are well established. A large amount of knowledge exists about the structure-activity relationships regarding immunosuppressive capacity, CypA binding, and anti-HIV-1 activity (7, 10, 41, 96, 105). We set out to synthesize a series of novel cyclosporines using Cs as a starting material. The goal was to produce by chemical derivatization nonimmunosuppressive cyclosporines with increased affinities for cyclophilin, which was expected to yield derivatives with improved anti-HIV-1 activities. The most promising compound in this series of derivatives turned out to be (d-MeAla3-EtVal4)cyclosporine (Debio-025; where Me and Et are methyl and ethyl, respectively) (97). The in vitro pharmacological profile of this novel CypA-blocking compound and, in particular, its anti-HIV-1 potential are described in this report.