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标题: Medical researchers identify potential new treatments for hepatitis B and tuberc [打印本页]

作者: StephenW 时间: 2010-12-8 18:39 标题: Medical researchers identify potential new treatments for hepatitis B and tuberc

本帖最后由风雨不动于 2012-4-14 14:46 编辑

http://www.expressnews.ualberta.ca/en/NewsArticles/2010/12/MedicalresearchersidentifypotentialnewtreatmentsforhepatitisBandtuberculosis.aspx
Medical researchers identify potential new treatments for hepatitis B and tuberculosis
By Raquel Maurier December 7, 2010
(From left)Babita Agrawal, Rakesh Kumar and Dennis Kunimoto, a research team with the University of Alberta’s Faculty of Medicine & Dentistry, have identified a new class of drugs for the treatment of Hepatitis B and Tuberculosis.

(Edmonton) A researcher and his team with the Faculty of Medicine & Dentistry at the University of Alberta have discovered a new class of drugs that could one day be used to treat people with hepatitis B. They have also made a similar discovery for the treatment of tuberculosis.

Working with cultures in his lab, Rakesh Kumar and his colleagues have discovered a new class of drugs for hepatitis B that does three important things: it is effective against the normal strain of the hepatitis B virus; it is effective against the drug-resistant strain and it isn’t toxic to healthy cells. He says no one else in the world has identified this class of drugs. These new drugs could be used in combination with other hepatitis B drugs on the market—at the same time, by themselves or one after the other.

Right now, four drugs are used to treat hepatitis B. Some of these treatments trigger drug-resistant strains of the virus. When the treatment is halted for any reason, it can result in more severe hepatitis B infection. Some of these current treatments are also toxic to patients.

“We want to inhibit the virus without killing healthy cells and that’s what this new class of drugs can do,” says Kumar, an associate professor in the Department of Laboratory Medicine and Pathology. “And we want to inhibit the DNA of the virus with maximum impact in hopes of eradicating the hepatitis B virus altogether.”

Kumar’s findings were recently published in three papers in two prestigious journals: the Journal of Medicinal Chemistry and Bioorganic & Medicinal Chemistry. He collaborated with two other researchers in the faculty, Lorne Tyrrell and Babita Agrawal, on these papers.

His next steps are to test this new class of drugs on non-human models and people. He thinks human clinical trials could start within three to five years.

Worldwide, there are about 400 million chronic carriers of hepatitis B, a very contagious virus that causes inflammation of the liver. The virus may eventually lead to liver cancer and liver cirrhosis. About 1.2 million people worldwide die each year from the virus. In North America, there are about 300,000 new cases of hepatitis B infection each year, resulting in 43,000 chronic infections and 3,000 deaths, although Kumar says new infections can be prevented with a vaccine.

Kumar has been researching hepatitis B for 15 years. His primary funders are the Canadian Institutes of Health Research and Alberta Innovates – Health Solutions.

Earlier this year, Kumar, Agrawal and Dennis Kunimoto, another researcher in the faculty, discovered a new class of drugs for treating tuberculosis. Kumar says it is important to find another drug to treat this condition because one third of the world’s population has been exposed to TB and the rates of infection are continually increasing, presenting a major global health challenge. Tuberculosis is the most common infection among people living with HIV or AIDS, resulting in death for one third of HIV patients who contract TB.

Current medications used to treat TB are toxic and have led to multiple and an extremely drug-resistant strain of the disease, making TB almost incurable, says Kumar. The new class of drugs Kumar and his colleagues identified is effective in fighting drug-resistant strains of TB, as demonstrated by tests at the cellular level in his lab. The research findings were published earlier this year in the Journal of Medicinal Chemistry.

（埃德蒙顿）研究员和他与医学与牙科在艾伯塔大学的师资队伍已经发现了，可能有一天被用来治疗B型肝炎，他们也作出了类似的发现为治疗药物的新阶层人士肺结核。

在他的实验室培养工作，拉克什Kumar和他的同事们发现了一种新的乙肝药物类，它三个重要问题：它是针对B型肝炎病毒株的正常有效，它是针对耐药株有效它是不是有毒的健康细胞。他说，没有人在世界上已发现这类药物的。这些新的药物可用于其他乙肝药物组合对市场的同时，由本人或者一个接一个。

现在，四种药物被用于治疗B型肝炎，这些疗法一些触发病毒耐药株。在治疗因任何原因而停止，它会导致更严重的B型肝炎感染。这些目前的治疗也有些是有毒的病人。

“我们希望抑制而不杀死健康细胞的病毒，而这正是这种新型药物可以做，”Kumar说，一个在检验医学与病理学系副教授。 “我们希望能够抑制与在消除乙肝病毒完全希望最大影响病毒的DNA。”

Kumar的研究结果发表在最近两三年在著名的期刊论文：在药物化学和生物有机与药物化学杂志。他与两位老师，洛恩泰瑞尔和Babita阿格拉瓦尔对这些文件的其他研究人员。

他的下一个步骤是测试这种药物对非人体模型和人民的新类。他认为，人体临床试验也开始在三至五年。
在世界范围内，大约有400万B型肝炎，传染性病毒十分导致肝脏慢性炎症载体。该病毒可能最终导致肝癌和肝硬化。全世界约有120万人死于这种病毒每一年。在北美，大约有30万乙肝感染的新病例，每年在43,000慢性感染，3000人死亡，虽然库马尔说，新的感染可以用疫苗预防。

库马尔已经研究了15年乙型肝炎。他的主要资助者是健康的研究与加拿大艾伯塔创新的机构 - 卫生解决方案。
今年早些时候，库马尔，Agrawal和丹尼斯国本，另外该学院研究员，发现了治疗结核病的药物新类。库马尔说，重要的是找到另一种药物来治疗这种情况，因为占世界人口的三分之一已经暴露在结核病和感染的比率不断增加，呈现出重大的全球性公共卫生挑战。结核病是在感染艾滋病毒或艾滋病患者最常见的感染，导致死亡的艾滋病患者为一合同谁结核病的三分之一。

目前用于治疗结核病的药物是有毒的，并导致多种疾病和极度的耐药株，使结核病几乎无法医治，Kumar说。库马尔的药物和他的同事发现一类新的打击毒品耐药菌株的结核病，经测试证明，在他的实验室在细胞水平有效。研究结果发表在今年早些时候的药物化学杂志。

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第一投注.现金网:招代理年薪10万以上:6668.cc

作者: MP4 时间: 2010-12-8 23:35

噢，李氏力场再发力。

www.hbvhbv.com/forum/thread-972180-1-4.html

作者: StephenW 时间: 2011-10-4 20:25

[studyforhope] kindly provided the abstract regarding these treatments.
[studyforhope]
提供关于这些治疗的摘要。

Here is the abstract:

Antiviral activity of various 1-(2'-deoxy-β-D-lyxofuranosyl), 1-(2'-fluoro-β-D-xylofuranosyl), 1-(3'-fluoro-β-D-arabinofuranosyl), and 2'-fluoro-2',3'-didehydro-2',3'-dideoxyribose pyrimidine nucleoside analogues against duck hepatitis B virus (DHBV) and human hepatitis B virus (HBV) replication.
Srivastav NC, Shakya N, Mak M, Agrawal B, Tyrrell DL, Kumar R.
SourceDepartment of Laboratory Medicine and Pathology, 1-71 Medical Sciences Building, Dentistry, University of Alberta, Edmonton, Alberta, Canada T6G 2H7.

Abstract
Despite the existence of successful vaccine and antiviral therapies, infection with hepatitis B virus (HBV) continues to be a major global cause of acute and chronic liver disease and high mortality. We synthesized and evaluated several lyxofuranosyl, 2'-fluoroxylofuranosyl, 3'-fluoroarabinofuranosyl, and 2'-fluoro-2',3'-didehydro-2',3'-dideoxyribose pyrimidine nucleoside analogues for antiviral activities against hepatitis B virus. Among the compounds examined, 1-(2-deoxy-β-d-lyxofuranosyl)thymine (23), 1-(2-deoxy-β-d-lyxofuranosyl)-5-trifluoromethyluracil (25), 1-(2-deoxy-2-fluoro-β-d-xylofuranosyl)uracil (38), 1-(2-deoxy-2-fluoro-β-d-xylofuranosyl)thymine (39), 2',3'-dideoxy-2',3'-didehydro-2'-fluorothymidine (48), and 2',3'-dideoxy-2',3'-didehydro-2'-fluoro-5-ethyluridine (49) were found to possess significant anti-HBV activity against DHBV in primary duck hepatocytes with EC(50) values of 4.1, 3.3, 40.6, 3.8, 0.2, and 39.0 μM, respectively. Compounds 23, 25, 39, 48, and 49 (EC(50) = 41.3, 33.7, 19.2, 2.0-4.1, and 39.0 μM, respectively) exhibited significant activity against wild-type human HBV in 2.2.15 cells. Intriguingly, 25, 39, 48, and 49 retained sensitivity against lamivudine-resistant HBV containing a single mutation (M204I) and 48 emerged as an effective inhibitor of drug-resistant HBV with an EC(50) of 4.1 μM. In contrast, 50% inhibition could not be achieved by lamivudine at 44 μM concentration in the drug-resistant strain. The compounds investigated did not show cytotoxicity to host cells up to the highest concentrations tested.

尽管存在着成功的疫苗和抗病毒药物的治疗，与乙肝病毒感染（HBV）的仍然是一个主要的全球引起急性和慢性的肝脏疾病，死亡率高。我们几个lyxofuranosyl，fluoroxylofuranosyl2' -3' - fluoroarabinofuranosyl，2' -氟-2'，3'-双脱氢-2'，3' - dideoxyribose对B型肝炎病毒的抗病毒活性的嘧啶核苷类似物的合成和评估。其中化合物的研究，1 - （2 - 脱氧-β- D - lyxofuranosyl）胸腺嘧啶（23），1 - （2 - 脱氧-β- D - lyxofuranosyl）- 5 - trifluoromethyluracil（25），1 - （2 - 脱氧2 - 氟-β- D - xylofuranosyl）尿嘧啶（38），1 - （2 - 脱氧- 2 -氟-β- D - xylofuranosyl）胸腺嘧啶（39），2'，3' -脱氧- 2“，3发现有显著的抗HBV活性对' - 双脱氢-2' - fluorothymidine（48），和2'，3' -脱氧- 2'，3'-脱氢-2' - 氟- 5 - ethyluridine（49） DHBV在EC（50）值的4.1，3.3，40.6，3.8，0.2和39.0μM，分别为小学鸭肝。化合物23，25，39，48和49（EC（50）=41.3，33.7，19.2，2.0-4.1和39.0微米，分别）表现出对野生型人类乙肝病毒在2.2.15细胞活性显著。有趣的是，25，39，48和49保留包含一个单一的突变（M204I）和48个出现4.1μMEC（50）作为抗乙肝病毒药物有效抑制对拉米夫定耐药的HBV敏感性。相比之下，无法实现50％的抑制拉米夫定耐药株在44μM浓度。化合物调查并未显示细胞毒性对宿主细胞的最高浓度测试。

作者: StephenW 时间: 2011-10-4 20:31

本帖最后由 StephenW 于 2011-10-4 20:33 编辑

[studyforhope]回答我的问题"

Thank you for the abstract. In layman terms, how do these compounds work against HBV?
感谢您的论文摘要。在一般用语中，这些化合物如何对HBV工作？

[studyforhope]回答:

These compounds are other nuceloside analogs, variants, as so many exist, that act principally like Tenofovir or Entecavir. The chance for any one of those to achieve practical standing at this time of historical development is extremely small.

The only drug currently in advanced development with a very realistic chance to join the established very selected antiviral HBV drug family is the following.
LB80380
(it possesses similar powers to Entecavir, has very little toxicity and is effective against LAM resistant strains).

it might be effective against ADF or ETV resistant strains also, but this needs to be shown clearly. Here are its latest data for the AASLD 2011:

WEEK 48 ANALYSIS OF A PHASE IIb STUDY OF THE EFFICACY AND SAFETY OF LB80380 vs. ENTECAVIR IN TREATMENT-NAÏVE PATIENTS WITH CHRONIC HEPATITIS B
C. Lai1; S. Ahn2; K. Lee2; S. Um3; M. Cho4; S. Yoon5; J. Lee6; N. Park7; Y. Kweon8; J. Sohn9; J. Lee10; J. Kim10; K. Han2; M. Yuen1
1. University of Hong Kong, Hong Kong, Hong Kong.
2. Yonsei University, Seoul, Korea, Republic of.
3. Korea University, Seoul, Korea, Republic of.
4. Pusan National University, Pusan, Korea, Republic of.
5. The Catholic University of Korea, Seoul, Korea, Republic of.
6. Inha University, Incheon, Korea, Republic of.
7. Ulsan University, Ulsan, Korea, Republic of.
8. Kyungpook National University, Daegu, Korea, Republic of.
9. Hanyang University, Seoul, Korea, Republic of.
10. LG Life Sciences, Ltd., Seoul, Korea, Republic of.

Background: LB80380, a novel nucleotide analogue, is effective and safe in chronic hepatitis B(CHB) patients with lamivudine-resistant mutations, with doses above 90 mg daily.

Aim: To compare the efficacy and safety of LB80380 with entecavir in treatment-naïve CHB patients up to week 48 of therapy.

Methods: 115 CHB patients fulfilling the following criteria were recruited from Hong Kong and Korea: (1) HBsAg positive for >6 months, (2) HBeAg-positive with HBV DNA ≥105 copies/mL or HBeAg-negative with HBV DNA ≥104 copies/mL, (3) elevated ALT levels (1.2-10 X ULN), (4) treatment-naïve and (5) compensated liver disease. They were randomized in the ratio of 1:1:1 to receive either LB80380 90 mg, 150 mg or entecavir 0.5 mg daily orally for 48 weeks. 102 patients who adhered to the protocol were analysed as per-protocol analysis set. The efficacy endpoint was the change in HBV DNA at week 48 from baseline. There is an extension study up to week 96 which is ongoing.

Results: The data up to week 48 of treatment are tabulated below.

All two doses of LB80380 showed comparable anti-viral activity with entecavir 0.5 mg daily after 48-week treatment.
Carnitine supplement 660 mg was given to the patients who developed low serum L-carnitine levels throughout the treatment period. The levels became normal in all patients after the carnitine supplements. No drug-related serious or significant adverse events were observed.
Full sequencing of the HBV polymerase region was performed at baseline, at week 48 and whenever there was virologic breakthrough for samples with HBV DNA > 103 copies/mL. No resistant mutations were found in any of the 3 groups of patients by week 48.

Conclusions: (1) At week 48, LB80380, 90 or 150 mg daily had comparable antiviral activity with entecavir 0.5 mg daily, and no resistant mutation was detected. (2) Low serum L-carnitine levels, though occurring in a significant proportion of patients, were normalized in all patients with carnitine supplement. (3) Other than lowering of serum L-carnitine levels, no LB80380-related serious or significant adverse events were not reported.

      LB80380
90mg
(n=34)       LB80380
150mg
(n=33)       Entecavir
0.5mg
(n=35)       p
M : F       20 : 14       28 : 5       28 : 7       0.035
Age (yrs) ± SD       42.4 ± 10.3       40.4 ± 10.7       41.4 ± 11.8       NS
HBeAg+ : HBeAg-       19 : 15       18 : 15       21 : 14       NS
Baseline HBV DNA (log10 c/mL) ± SD       7.65 ± 1.18       7.64 ± 1.43       7.92 ± 1.28       NS
Week 48 HBV DNA (log10 c/mL) ± SD       2.40 ± 0.53       2.41 ± 0.78       2.34 ± 0.59       NS
Log10 HBV DNA decrease at week 48 ± SD       -5.26 ± 1.00       -5.23 ± 1.23       -5.59 ± 1.16       NS
HBV DNA < 300 copies/mL at week 48 (%)       67.7       81.8       80.0       NS
ALT normalized at week 48 (%)       88.2       78.8       91.4       NS
HBeAg loss for HBeAg+ pts       4/19       3/18       3/21       NS
Serum L-carnitine lower
than normal (%)       72.2       97.4       -       0.0025

这些化合物是其他nuceloside类似物，变种，因为存在这么多，主要喜欢替诺福韦或恩替卡韦的行为。，任何一个实现在这个历史发展的时间的实际站在的机会非常小。

在目前先进的开发，具有非常现实的的机会参加非常选定的抗病毒乙肝药物家庭唯一的药物是以下。
LB80380
（它拥有类似的权力恩替卡韦，已经很少的毒性和对林耐药菌株有效）。

它可能是对ADF或教育电视耐药菌株也有效，但需要清楚显示。这里有最新数据为2011年的肝病学会：

48周治疗慢性乙肝初治患者的LB80380与恩替卡韦的疗效和安全性的IIb期研究分析
C.来1; S.安2; K.李2，S.庵3 M.赵4 S.尹5 J.李6 N.公园7，Y。Kweon 8 J.孙某9，李笃10; J.金10; K。 Han2; M.元朗1
1。香港大学，香港，香港。
2。延世大学，首尔，大韩民国。
3。韩国高丽大学，首尔，大韩民国。
4。釜山国立大学，釜山，韩国，共和国。
5。韩国天主教大学，首尔，大韩民国。
6。仁荷大学，韩国仁川，共和国。
7。蔚山大学，蔚山，大韩民国。
8。大邱，庆北国立大学，韩国，共和国。
9。汉阳大学，首尔，大韩民国。
10。 LG生命科学有限公司，首尔，大韩民国。

背景：LB80380，一种新的核苷类似物，是有效和安全的慢性乙型肝炎（CHB）患者拉米夫定耐药性突变的，每天超过90毫克的剂量。

目的：比较恩替卡韦在治疗初治的慢性乙型肝炎患者的疗效和安全LB80380治疗48周。

方法：115例慢性乙型肝炎患者，符合以下条件的，来自香港和韩国招募：（1）乙肝表面抗原阳性> 6个月，（2），e抗原阳性乙肝病毒DNA≥105拷贝/ mL或HBeAg阴性与HBV DNA≥104拷贝/ ml，（3）ALT水平升高（1.2-10 x ULN的），（4）治疗初治和（5）代偿期肝病。他们在1:1:1的比例随机接受要么LB80380 90毫克，150毫克或恩替卡韦0.5毫克每日口服48周。谁坚持到协议的102例患者进行分析每个协议的分析设置。疗效终点是从基线48周时的HBV DNA的变化。有96周正在进行的扩展研究。

结果：治疗48周的数据表列如下。

LB80380所有两种剂量均治疗48周后的可比用恩替卡韦0.5毫克，每日的抗病毒活性。
肉碱补充660毫克的病人在整个治疗期间低血清的L -肉碱水平。水平正常后，所有患者肉碱补充剂。有没有药物相关的严重或显著的不良反应观察。
HBV聚合酶地区的全部测序是在基线，48周时，每当有与HBV - DNA> 103拷贝/毫升样本的病毒学突破。没有发现任何病人的3组48周的耐药性突变。

结论：（1）在本周的48，LB80380，90或150毫克，每日有比较恩替卡韦0.5毫克的抗病毒活性，无耐药性突变检测。（2）低血清的L -肉碱水平，虽然发生在一个显著的患者比例，分别归在所有患者肉碱补充。（3）比的降低血清中的L -肉碱水平的其他，没有LB80380相关严重或重大不良事件没有报告。

LB80380
90mg
（N = 34）LB80380
150毫克
（N = 33），恩替卡韦
0.5mg的
（N = 35）P
男：F 20：14月28日：5月28日：7 0.035
年龄（岁）± SD 42.4 ± 10.3 40.4 ± 10.7 41.4 ± 11.8 NS
大三阳：大三阳- 19：15 18：15 21：14的NS
基线HBV DNA（LOG10 C /毫升）± SD 7.65 ± 1.18 7.64 ± 1.43 7.92 ± 1.28 NS
第48周HBV - DNA（LOG10 C /毫升）± SD 2.40 ± 0.53 2.41 ± 0.78 2.34 ± 0.59 NS
LOG10 48周时HBV DNA下降± SD -5.26 ± 1.00 -5.23 ± 1.23 -5.59 ± 1.16 NS
HBV DNA <300拷贝/ mL的48周（％）67.7 81.8 80.0 NS
ALT正常化48周（％）88.2 78.8 91.4 NS
HBeAg转阴为大三阳+分4 / 19 3 / 18 3 / 21 NS
血清L -肉碱
比正常（％）72.2 97.4 - 0.0025

Many thanks to [studyforhope]

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