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1.
Mar Drugs ; 22(6)2024 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-38921553

RESUMO

Subjecting the Australian marine-derived fungus Aspergillus noonimiae CMB-M0339 to cultivation profiling using an innovative miniaturized 24-well plate format (MATRIX) enabled access to new examples of the rare class of 2,6-diketopiperazines, noonazines A-C (1-3), along with the known analogue coelomycin (4), as well as a new azaphilone, noonaphilone A (5). Structures were assigned to 1-5 on the basis of a detailed spectroscopic analysis, and in the case of 1-2, an X-ray crystallographic analysis. Plausible biosynthetic pathways are proposed for 1-4, involving oxidative Schiff base coupling/dimerization of a putative Phe precursor. Of note, 2 incorporates a rare meta-Tyr motif, typically only reported in a limited array of Streptomyces metabolites. Similarly, a plausible biosynthetic pathway is proposed for 5, highlighting a single point for stereo-divergence that allows for the biosynthesis of alternate antipodes, for example, the 7R noonaphilone A (5) versus the 7S deflectin 1a (6).


Assuntos
Aspergillus , Aspergillus/metabolismo , Aspergillus/química , Austrália , Dicetopiperazinas/química , Dicetopiperazinas/isolamento & purificação , Organismos Aquáticos , Vias Biossintéticas , Cristalografia por Raios X , Estrutura Molecular , Benzopiranos , Pigmentos Biológicos
2.
Arch Sex Behav ; 53(7): 2795-2806, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38849704

RESUMO

Cabotegravir (CAB-LA), the first long-acting injectable pre-exposure prophylaxis (PrEP), has been approved for use in the USA and is not currently on the market in China. However, willingness to use CAB-LA and associated factors among men who have sex with men (MSM) have not yet been evaluated in China. A cross-sectional study was conducted in Guangxi, China, in 2022 recruiting 1,006 MSM. Their mean age was 30.2 years, 74.2% had college or above education, and 48.6% had a monthly income between 3,000 and 5,999 Chinese yuan (CNY). Most (73.4%) had previously heard of PrEP while few (8.3%) had ever used this type of preventative medication. Willingness to use CAB-LA was 79.8% and was positively associated with eight variables: younger age, being married to a woman, having a low monthly income, having six or more male partners in the past six months, having only regular male partners in the past month, having a high perceived risk of HIV infection, and history of using PrEP. Ten other variables were not significantly associated with willingness to use CAB-LA. Among 894 participants who were willing to use or did not definitely reject using CAB-LA, the main concerns about CAB-LA were its side effects (90.2%), efficacy (63.6%), and high cost (58.2%). Only 14.7% were willing to pay more than 1,200 CNY (~US$180) every two months to use CAB-LA. The preferred injection places were centers for disease control facilities, hospitals, and social organizations. Many (89.0%) said that they would recommend CAB-LA to their male sexual partners. We conclude that willingness to use CAB-LA was high among MSM in Guangxi. However, implementation of CAB-LA faces tough challenges due to its high cost and the low use of PrEP. Peer education may play a large role in the implementation of CAB-LA in China.


Assuntos
Infecções por HIV , Homossexualidade Masculina , Profilaxia Pré-Exposição , Piridonas , Humanos , Masculino , China , Adulto , Estudos Transversais , Homossexualidade Masculina/estatística & dados numéricos , Homossexualidade Masculina/psicologia , Infecções por HIV/prevenção & controle , Profilaxia Pré-Exposição/estatística & dados numéricos , Piridonas/administração & dosagem , Piridonas/uso terapêutico , Fármacos Anti-HIV/uso terapêutico , Fármacos Anti-HIV/administração & dosagem , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Parceiros Sexuais/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Adulto Jovem , Pessoa de Meia-Idade , Dicetopiperazinas
3.
Front Public Health ; 12: 1404255, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38873299

RESUMO

Background: In Europe, the combination of cabotegravir (CAB) with rilpivirine (RPV) has been approved as a dual injection long-acting (LA) therapy for the treatment of human immunodeficiency virus type 1 (HIV-1) infections in adults since December 2020. Studies have shown that between 36 and 61% of people living with HIV (PLWHIV) prefer LA therapy. However, there are no real-world data on the number of people receiving LA therapy, in Germany or internationally. The aim of this study was to assess the current situation and trends in usage of LA therapy for the treatment of HIV-1 in Germany. Methods: Based on pharmacy prescription data derived from Insight Health, the monthly number of prescriptions for oral CAB, CAB-LA, and RPV-LA over the entire period of availability in Germany was analyzed and evaluated (May 2021 to December 2023). The number of 1st and 2nd initiation injections and subsequent maintenance injections was calculated on the basis of the prescriptions for oral CAB initiation. Results: The bimonthly schedule resulted in two growing cohorts from September 2021 with an estimated 14,523 CAB-LA prescriptions over the entire period. Accordingly, in December 2023, there were approximately 1,364 PLWHIV receiving LA therapy, of whom 1,318 were receiving maintenance therapy. Only treatments with bimonthly regimens were carried out. Accounting for people not covered by statutory health insurance (~13%), a total of ~1,600 PLWHIV were receiving LA therapy in Germany in December 2023. The average rounded annual cost of therapy in 2023 was €11,940 (maintenance therapy with initiation) and €10,950 (maintenance therapy without initiation). Conclusion: To our knowledge, this is the first study of real-world use and number of people receiving LA therapy. A strength of our study is the nearly complete coverage of people with statutory health insurance in Germany. The predicted demand for LA therapy does not match the actual number of people receiving LA therapy. Although the number of PLWHIV receiving LA therapy increased steadily, they accounted for just under 2% of the estimated total number of people receiving HIV therapy in Germany in 2023, almost 2 years after the market launch. No significant increase in prescriptions is expected; on the contrary, the trend is leveling off and is unlikely to change drastically in the near future. Hence, the need for this mode of therapy in Germany appears to be limited. Follow-up studies at regular intervals on the further course would be useful and are recommended, as well as investigations into the possible reasons for the slow uptake to inform public health experts and possibly broaden treatment options.


Assuntos
Fármacos Anti-HIV , Infecções por HIV , HIV-1 , Humanos , Alemanha , Infecções por HIV/tratamento farmacológico , Fármacos Anti-HIV/uso terapêutico , Fármacos Anti-HIV/economia , Rilpivirina/uso terapêutico , Prescrições de Medicamentos/estatística & dados numéricos , Masculino , Adulto , Feminino , Piridonas , Dicetopiperazinas
4.
Methods Enzymol ; 698: 169-194, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38886031

RESUMO

Peptide ligation chemistries have revolutionized the synthesis of proteins with site-specific modifications or proteomimetics through assembly of multiple peptide segments. In order to prepare polypeptide chains consisting of 100-150 amino acid residues or larger generally assembled from three or more peptide segments, iterative purification process that decreases the product yield is usually demanded. Accordingly, methodologies for one-pot peptide ligation that omit the purification steps of intermediate peptide segments have been vigorously developed so far to improve the efficiency of chemical protein synthesis. In this chapter, we first outline the concept and recent advances of one-pot peptide ligation strategies. Then, the practical guideline for the preparation of peptide segments for one-pot peptide ligation is described with an emphasis on diketopiperazine thioester synthesis. Finally, we disclose the explicit protocols for one-pot four segment ligation via repetitive deprotection of N-terminal thiazolidine by a 2-aminobenzamide type aldehyde scavenger.


Assuntos
Peptídeos , Tiazolidinas , Tiazolidinas/química , Peptídeos/química , Dicetopiperazinas/química
5.
Rev Med Virol ; 34(4): e2563, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38886179

RESUMO

HIV infection has been a severe global health burden, with millions living with the virus and continuing new infections each year. Antiretroviral therapy can effectively suppress HIV replication but requires strict lifelong adherence to daily oral medication regimens, which presents a significant challenge. Long-acting formulations of antiretroviral drugs administered infrequently have emerged as a promising strategy to improve treatment outcomes and adherence to HIV therapy and prevention. Long-acting injectable (LAI) formulations are designed to gradually release drugs over extended periods of weeks or months following a single injection. Critical advantages of LAIs over conventional oral dosage forms include less frequent dosing requirements, enhanced patient privacy, reduced stigma associated with daily pill regimens, and optimised pharmacokinetic/pharmacodynamic profiles. Several LAI antiretroviral products have recently gained regulatory approval, such as the integrase strand transfer inhibitor cabotegravir for HIV preexposure prophylaxis and the Cabotegravir/Rilpivirine combination for HIV treatment. A leading approach for developing long-acting antiretroviral depots involves encapsulating drug compounds in polymeric microspheres composed of biocompatible, biodegradable materials like poly (lactic-co-glycolic acid). These injectable depot formulations enable high drug loading with customisable extended-release kinetics controlled by the polymeric matrix. Compared to daily oral therapies, LAI antiretroviral formulations leveraging biodegradable polymeric microspheres offer notable benefits, including prolonged therapeutic effects, reduced dosing frequency for improved adherence, and the potential to kerb the initial HIV transmission event. The present manuscript aims to review the pathogenesis of the virus and its progression and propose therapeutic targets and long-acting drug delivery strategies that hold substantial promise for enhancing outcomes in HIV treatment and prevention.


Assuntos
Fármacos Anti-HIV , Preparações de Ação Retardada , Infecções por HIV , Humanos , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , Fármacos Anti-HIV/administração & dosagem , Fármacos Anti-HIV/uso terapêutico , Fármacos Anti-HIV/farmacocinética , Injeções , Adesão à Medicação , Composição de Medicamentos , Piridonas , Dicetopiperazinas
6.
Sex Health ; 212024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38833542

RESUMO

Long-acting injectable PrEP, particularly cabotegravir (CAB-LA), has the potential to enhance HIV prevention in Asia, and was the topic of a roundtable held in Singapore in June 2023. Despite proven efficacy, CAB-LA's impact in Asia is hindered by regulatory, manufacturing, and cost barriers. There is an urgent need to address these challenges to expedite CAB-LA's introduction and scale-up, including collaborative research, streamlined regulatory processes, and increased manufacturing capacity. We call for better preparedness in long-acting PrEP in research and implementation science, product licensing and accessibility, and capacity readiness for scale-up, to meet the significant demand among key populations in Asia.


Assuntos
Fármacos Anti-HIV , Infecções por HIV , Profilaxia Pré-Exposição , Humanos , Infecções por HIV/prevenção & controle , Profilaxia Pré-Exposição/métodos , Ásia , Fármacos Anti-HIV/administração & dosagem , Fármacos Anti-HIV/uso terapêutico , Piridonas/administração & dosagem , Dicetopiperazinas
7.
Artigo em Inglês | MEDLINE | ID: mdl-38823149

RESUMO

Although antiretroviral therapy (ART) is highly effective for the treatment of HIV-1 infection to suppress virus in the blood, HIV persists in tissues. HIV persistence in the tissues is due to numerous factors, and one of those factors are antiretroviral (ARV) concentrations. ARV concentrations in tissues must be adequate to suppress HIV at the sites of action. While therapeutic drug monitoring in the plasma is well-known, drug monitoring in the tissues provides local assessments of adequate ARV exposure to prevent localized HIV resistance formation. Towards these efforts, we validated an ultra-high performance liquid chromatography-mass spectrometry (UHPLC-MS/MS) method in human tissues (cervical, rectal, and vaginal tissues) for the simultaneous quantification of five ARVs: bictegravir, cabotegravir, dolutegravir, doravirine, and raltegravir. For this assay, protein precipitation with acetonitrile with stable, isotopically-labeled internal standards followed by supernatant pre-concentration was performed. Analyte separation was accomplished using a multistep UPLC gradient mixture of 0.1 % formic acid in water (A) and acetonitrile (B) with a Waters Cortecs T3 (2.1x100 mm) column. The assay was extensively validated as per the United States Food and Drug Administration Bioanalytical Method Validation Guidance over a clinically observed range (0.05-50 ng/mL) with superb linearity (R2 > 0.99 across all ARVs). The assay run time was 8.5 min. This analytical method achieves appropriate performance of trueness (85.5-107.4 %), repeatability, and precision (CV < 15 %). Our method will be employed for the therapeutic monitoring of guideline-recommended ARVs in human tissues for monitoring therapeutic efficacy in HIV treatment and prevention research efforts.


Assuntos
Monitoramento de Medicamentos , Compostos Heterocíclicos com 3 Anéis , Piperazinas , Piridonas , Espectrometria de Massas em Tandem , Humanos , Espectrometria de Massas em Tandem/métodos , Cromatografia Líquida de Alta Pressão/métodos , Monitoramento de Medicamentos/métodos , Compostos Heterocíclicos com 3 Anéis/análise , Compostos Heterocíclicos com 3 Anéis/farmacocinética , Compostos Heterocíclicos com 3 Anéis/uso terapêutico , Compostos Heterocíclicos com 3 Anéis/sangue , Reprodutibilidade dos Testes , Piridonas/análise , Piridonas/sangue , Piperazinas/análise , Piperazinas/sangue , Limite de Detecção , Modelos Lineares , Feminino , Oxazinas/química , Raltegravir Potássico/análise , Raltegravir Potássico/uso terapêutico , Triazóis/análise , Triazóis/sangue , Compostos Heterocíclicos de 4 ou mais Anéis/análise , Compostos Heterocíclicos de 4 ou mais Anéis/farmacocinética , Compostos Heterocíclicos de 4 ou mais Anéis/sangue , Piridazinas/análise , Piridazinas/farmacocinética , Antirretrovirais/análise , Antirretrovirais/farmacocinética , Antirretrovirais/sangue , Antirretrovirais/uso terapêutico , Piridinas/análise , Piridinas/sangue , Piridinas/farmacocinética , Piridinas/uso terapêutico , Colo do Útero/química , Infecções por HIV/tratamento farmacológico , Amidas , Dicetopiperazinas
8.
AIDS ; 38(8): 1267-1269, 2024 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-38814715

RESUMO

In a cohort of 72 consecutive virologically-suppressed patients with HIV-1 switching to long-acting cabotegravir and rilpivirine, we observed low cabotegravir trough concentrations 1 and 3 months after the first injection, with a significant association with no oral lead-in at 1 month [odds ratio (OR) = 6.3 [95% confidence interval (CI) 1.7-29.5], P = 0.01] and three months (OR = 5.6 [95% CI 1.3-29.7], P = 0.03), and with high BMI at 1 month (OR = 1.3 [95% CI 1.1-1.6], P = 0.007).


Assuntos
Fármacos Anti-HIV , Infecções por HIV , HIV-1 , Piridonas , Rilpivirina , Humanos , Piridonas/administração & dosagem , Rilpivirina/administração & dosagem , Rilpivirina/uso terapêutico , Rilpivirina/farmacocinética , Infecções por HIV/tratamento farmacológico , Masculino , Feminino , Fármacos Anti-HIV/administração & dosagem , Fármacos Anti-HIV/farmacocinética , Fármacos Anti-HIV/uso terapêutico , HIV-1/isolamento & purificação , Pessoa de Meia-Idade , Adulto , Substituição de Medicamentos , Administração Oral , Plasma/química , Dicetopiperazinas
9.
Lancet HIV ; 11(6): e419-e426, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38697180

RESUMO

Two-drug regimens for the treatment of HIV are increasingly available. The oral regimen of dolutegravir plus lamivudine is recommended as a preferred option in multiple national guidelines but is not currently included in WHO HIV treatment guidelines nor widely used in Africa. Long-acting injectable cabotegravir and rilpivirine is being rolled out in the USA, Europe, and Australia but its use in sub-Saharan Africa is currently restricted to clinical trials. Given the increasing life expectancy, rising prevalence of non-communicable diseases, and resulting polypharmacy among people living with HIV, there are potential advantages to the use of two-drug regimens, particularly in African women, adolescents, and older adults. This Viewpoint reviews existing evidence and highlights the risks, benefits, and key knowledge gaps for the use of two-drug regimens in settings using the public health approach in Africa. We suggest that a two-drug regimen of dolutegravir and lamivudine can be safely used as a switch option for virologically suppressed individuals in settings using the public health approach once chronic hepatitis B has been excluded. Individuals with HIV who are switched to two-drug regimens should receive a full course of hepatitis B vaccinations. More efficacy data is needed to support dolutegravir plus lamivudine combination in the test and treat approach, and long-acting cabotegravir and rilpivirine in the public health system in sub-Saharan Africa.


Assuntos
Fármacos Anti-HIV , Infecções por HIV , Compostos Heterocíclicos com 3 Anéis , Lamivudina , Oxazinas , Piperazinas , Piridonas , Humanos , Infecções por HIV/tratamento farmacológico , Piridonas/administração & dosagem , Piridonas/uso terapêutico , Oxazinas/uso terapêutico , Oxazinas/administração & dosagem , Compostos Heterocíclicos com 3 Anéis/uso terapêutico , Compostos Heterocíclicos com 3 Anéis/administração & dosagem , Fármacos Anti-HIV/uso terapêutico , Fármacos Anti-HIV/administração & dosagem , Lamivudina/uso terapêutico , Lamivudina/administração & dosagem , Piperazinas/administração & dosagem , Piperazinas/uso terapêutico , África/epidemiologia , Feminino , Rilpivirina/uso terapêutico , Rilpivirina/administração & dosagem , Quimioterapia Combinada , Masculino , Adolescente , Adulto , Dicetopiperazinas
10.
HIV Res Clin Pract ; 25(1): 2351258, 2024 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38726811

RESUMO

BACKGROUND: Recently, injectable cabotegravir/rilpivirine (ICAB/RPV) became available for HIV treatment. However, there are no real-life data on the impact of switching to ICAB/RPV on sleep disturbances (SD). Therefore, we aimed at assessing and investigating this aspect in our cohort. METHODS: A SD multidimensional assessment (Epworth Sleepiness scale, Insomnia severity Index, Berlin Questionnaire, and Pittsburg Sleep Quality Index, PSQI) was performed to all people who consented before starting ICAB/RPV and 12 wk after the switch. Demographics, life-style habits, laboratory, and clinical data were collected from medical health records. RESULTS: To June 2023, 46 people were included, 76.1% males, with a median age of 48.5 (IQR: 41-57), 50% had multimorbidity, 13% was on polypharmacy. Median age with HIV and CD4 + T cell count nadir were 10 (5-19.5) years and 360 (205-500) cell/mm3, respectively. The reason to start a long-acting strategy was person's choice in all cases. Baseline antiretroviral regimens were mostly: tenofovir alafenamide/emtricitabine/rilpivirine (39.1%) and dolutegravir/lamivudine (32.6%). No significant changes were observed in any of the scores for each questionnaire, but for a worsening PSQI. 37% people reported a subjectively improved sleep quality, even if statistically significant changes were not observed in almost all the sleep parameters. CONCLUSIONS: To the best of our knowledge, this is the first study exploring impact of switching to ICAB/RPV on SD. Despite integrase inhibitor have been associated with SD, we did not observed a negative impact on sleep quality after the switch to ICAB/RPV. More studies and with larger number of people are necessary to confirm our results.


Assuntos
Fármacos Anti-HIV , Infecções por HIV , Piridonas , Rilpivirina , Transtornos do Sono-Vigília , Humanos , Rilpivirina/uso terapêutico , Rilpivirina/administração & dosagem , Masculino , Feminino , Adulto , Infecções por HIV/tratamento farmacológico , Infecções por HIV/complicações , Pessoa de Meia-Idade , Piridonas/uso terapêutico , Piridonas/administração & dosagem , Fármacos Anti-HIV/uso terapêutico , Fármacos Anti-HIV/administração & dosagem , Transtornos do Sono-Vigília/tratamento farmacológico , Estudos de Coortes , Substituição de Medicamentos/estatística & dados numéricos , Tenofovir/uso terapêutico , Tenofovir/administração & dosagem , Dicetopiperazinas
11.
Pan Afr Med J ; 47: 102, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38766564

RESUMO

Adolescent girls and young women in Africa are at high risk of HIV and should be considered a key population for HIV prevention initiatives. Oral Tenofovir/Emtricitabine as pre-exposure prophylaxis (PrEP) has been shown to be effective on an individual and population level among key populations in Europe, Australia, and the US. However, studies in sub-Saharan Africa in a generalised epidemic have been less promising with adherence to daily tablets identified as a major problem. Long-acting PrEP drugs are being developed as a response to this problem. The first of these long-acting agents, injectable Cabotegravir given every two months has shown superiority to oral PreP and has been approved by the US Food and Drug Administration (FDA). Another long-acting PrEP drug in development is Lenacapavir which is an investigational, first-in-class long-acting HIV-1 capsid inhibitor that can be given as a six-monthly injection. These long-acting drugs could be a highly effective public health HIV prevention intervention. If made readily available to a vulnerable population of adolescent young women who are at high risk of HIV they could play an important role in protecting this key population against HIV and potentially reduce the population level risk of HIV.


Assuntos
Fármacos Anti-HIV , Infecções por HIV , Profilaxia Pré-Exposição , Humanos , Profilaxia Pré-Exposição/métodos , Feminino , Infecções por HIV/prevenção & controle , Adolescente , Fármacos Anti-HIV/administração & dosagem , Piridonas/administração & dosagem , Adesão à Medicação , África Subsaariana , Preparações de Ação Retardada , Dicetopiperazinas
12.
Phytochemistry ; 223: 114119, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38705266

RESUMO

Six previously undescribed prenylated indole diketopiperazine alkaloids, talaromyines A-F (1-6), were isolated from the marine-derived fungus Talaromyces purpureogenus SCSIO 41517. Their structures including absolute configurations were elucidated on the basis of comprehensive spectroscopic data including NMR, HR-ESI-MS, and electronic circular dichroism calculations, together with chemical analysis of hydrolysates. Compounds 1-5 represent the first example of spirocyclic indole diketopiperazines biosynthesized from the condensation of L-tryptophan and L-alanine. Compounds 2 and 4-5 showed selective inhibitory activities against phosphatases TCPTP and MEG2 with IC50 value of 17.9-29.7 µM, respectively. Compounds 4-5 exhibited mild cytotoxic activities against two human cancer cell lines H1975 and HepG-2.


Assuntos
Dicetopiperazinas , Talaromyces , Talaromyces/química , Dicetopiperazinas/química , Dicetopiperazinas/farmacologia , Dicetopiperazinas/isolamento & purificação , Humanos , Estrutura Molecular , Prenilação , Ensaios de Seleção de Medicamentos Antitumorais , Relação Estrutura-Atividade , Antineoplásicos/farmacologia , Antineoplásicos/química , Antineoplásicos/isolamento & purificação , Alcaloides Indólicos/isolamento & purificação , Alcaloides Indólicos/química , Alcaloides Indólicos/farmacologia , Alcaloides/química , Alcaloides/farmacologia , Alcaloides/isolamento & purificação , Relação Dose-Resposta a Droga , Inibidores Enzimáticos/farmacologia , Inibidores Enzimáticos/química , Inibidores Enzimáticos/isolamento & purificação , Células Hep G2 , Proliferação de Células/efeitos dos fármacos , Monoéster Fosfórico Hidrolases/antagonistas & inibidores , Monoéster Fosfórico Hidrolases/metabolismo , Linhagem Celular Tumoral
13.
J Int AIDS Soc ; 27(5): e26252, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38783534

RESUMO

INTRODUCTION: HPTN 083 demonstrated the superiority of long-acting cabotegravir (CAB-LA) versus daily oral emtricitabine/tenofovir disoproxil fumarate (TDF/FTC) as pre-exposure prophylaxis (PrEP) among cisgender men and transgender women who have sex with men (MSM/TGW). HPTN 083 provided the first opportunity to understand experiences with injectable PrEP in a clinical trial. METHODS: Participants from two US sites (Chicago, IL and Atlanta, GA) and one international site (Rio de Janeiro, Brazil) were purposively sampled for individual qualitative interviews (N = 40), between November 2019 and March 2020, to explore trial experiences, barriers to adherence and other factors that may have impacted study implementation or outcomes. The blinded phase ended early due to efficacy; this analysis includes interviews conducted prior to unblinding with three groups defined by adherence (i.e. injection visit attendance): adherent (n = 27), non-adherent (n = 12) and early discontinuers (n = 1). Data were organized using NVivo software and analysed using content analysis. RESULTS: Participants (mean age: 27) were primarily cisgender MSM (90%) and Black/African American (60%). Reasons for trial enrolment and PrEP use included a preference for using HIV prevention medication versus treatment in the event of HIV acquisition; the ability to enhance health via study-related education and services; access to a novel, convenient HIV prevention product at no cost; and contributing to MSM/TGW communities through research. Participants contrasted positive experiences with study staff with their routine clinical care, and emphasized increased scheduling flexibility, thorough communication, non-judgemental counselling and open, affirming environments (e.g. compassion, less stigma) as adherence facilitators. Injection experiences were positive overall; some described early injection-related anxiety, which abated with time and when given some measure of control (e.g. pre-injection countdown), and minimal injection site discomfort. Some concerns and misperceptions about injectable PrEP were reported. Barriers to adherence, across all adherence categories, included structural factors (e.g. financial constraints, travel) and competing demands (e.g. work schedules). CONCLUSIONS: Respondents viewed injectable PrEP trial participation as a positive experience and a means of enhancing wellbeing. Study site flexibility and affirming clinic environments, inclusive of non-judgemental counselling, were key facilitators of adherence. To support injection persistence, interventions that address structural barriers and promote flexible means of injection delivery may be most effective.


Assuntos
Fármacos Anti-HIV , Infecções por HIV , Adesão à Medicação , Profilaxia Pré-Exposição , Humanos , Masculino , Profilaxia Pré-Exposição/métodos , Adesão à Medicação/estatística & dados numéricos , Infecções por HIV/prevenção & controle , Infecções por HIV/tratamento farmacológico , Feminino , Fármacos Anti-HIV/administração & dosagem , Fármacos Anti-HIV/uso terapêutico , Adulto , Pessoas Transgênero/psicologia , Homossexualidade Masculina , Adulto Jovem , Piridonas/administração & dosagem , Piridonas/uso terapêutico , Brasil , Injeções , Piridinas/administração & dosagem , Piridinas/uso terapêutico , Entrevistas como Assunto , Tenofovir/administração & dosagem , Tenofovir/uso terapêutico , Combinação Emtricitabina e Fumarato de Tenofovir Desoproxila/administração & dosagem , Combinação Emtricitabina e Fumarato de Tenofovir Desoproxila/uso terapêutico , Pessoa de Meia-Idade , Dicetopiperazinas
14.
Biomaterials ; 309: 122586, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-38718615

RESUMO

It is imperative to optimize chemotherapy for heightened anti-tumor therapeutic efficacy. Unrestrained tumor cell proliferation and sustained angiogenesis are pivotal for cancer progression. Plinabulin, a vascular disrupting agent, selectively destroys tumor blood vessels. Tirapazamine (TPZ), a hypoxia-activated prodrug, intensifies cytotoxicity in diminishing oxygen levels within tumor cells. Despite completing Phase III clinical trials, both agents exhibited modest treatment efficiency due to dose-limiting toxicity. In this study, we employed methoxy poly(ethylene glycol)-b-poly(D,L-lactide) (mPEG-b-PDLLA) to co-deliver Plinabulin and TPZ to the tumor site, concurrently disrupting blood vessels and eliminating tumor cells, addressing both symptoms and the root cause of tumor progression. Plinabulin was converted into a prodrug with esterase response (PSM), and TPZ was synthesized into a hexyl chain-containing derivative (TPZHex) for effective co-delivery. PSM and TPZHex were co-encapsulated with mPEG-b-PDLLA, forming nanodrugs (PT-NPs). At the tumor site, PT-NPs responded to esterase overexpression, releasing Plinabulin, disrupting blood vessels, and causing nutritional and oxygen deficiency. TPZHex was activated in response to increased hypoxia, killing tumor cells. In treating 4T1 tumors, PT-NPs demonstrated enhanced therapeutic efficacy, achieving a 92.9 % tumor suppression rate and a 20 % cure rate. This research presented an innovative strategy to enhance synergistic efficacy and reduce toxicity in combination chemotherapy.


Assuntos
Polietilenoglicóis , Tirapazamina , Tirapazamina/farmacologia , Animais , Linhagem Celular Tumoral , Humanos , Polietilenoglicóis/química , Antineoplásicos/farmacologia , Antineoplásicos/uso terapêutico , Feminino , Camundongos , Camundongos Endogâmicos BALB C , Neovascularização Patológica/tratamento farmacológico , Triazinas/farmacologia , Triazinas/química , Triazinas/uso terapêutico , Dicetopiperazinas
15.
AIDS Patient Care STDS ; 38(5): 221-229, 2024 05.
Artigo em Inglês | MEDLINE | ID: mdl-38656905

RESUMO

Long-acting injectable (LAI) antiretroviral therapy (ART) has the potential to change the lives of people living with HIV (PLWH). To ensure equitable access to new treatment modalities, we examined the feasibility and acceptability of administering Cabotegravir Rilpivirine Long Acting (CAB/RPV LA) to individuals who experience challenging social determinants of health (SDoH) and struggle with adherence to traditional oral ART. Quantitative and qualitative data were used to assess feasibility of utilizing ART at alternative clinic. Data were collected on individuals eligible to receive CAB/RPV LA at an alternative street-based clinic and on individuals receiving CAB/RPV LA at a traditional HIV clinic. After 6 months, participants were interviewed about their experience. Providers involved in the implementation were also interviewed about their experiences. Only one participant (out of 5) who received CAB/RPV LA at the alternative clinic received consistent treatment, whereas 17 out of 18 participants receiving CAB/RPV LA at the traditional clinic site were adherent. Participants and providers believed that LAI had potential for making treatment adherence easier, but identified several barriers, including discrepancies between patients' desires and their lifestyles, impact of LAI on interactions with the medical system, risk of resistance accompanying sub-optimal adherence, and need for a very high level of resources. While LAI has major potential benefits for high-risk patients, these benefits must be balanced with the complexities of implementation. Despite challenges that impacted study outcomes, improving treatment outcomes for PLWH requires addressing SDoH and substance use.


Assuntos
Fármacos Anti-HIV , Estudos de Viabilidade , Infecções por HIV , Adesão à Medicação , Rilpivirina , Humanos , Infecções por HIV/tratamento farmacológico , Feminino , Masculino , Adulto , Fármacos Anti-HIV/administração & dosagem , Fármacos Anti-HIV/uso terapêutico , Pessoa de Meia-Idade , Adesão à Medicação/estatística & dados numéricos , Rilpivirina/administração & dosagem , Rilpivirina/uso terapêutico , Injeções , Preparações de Ação Retardada , Pesquisa Qualitativa , Acessibilidade aos Serviços de Saúde , Determinantes Sociais da Saúde , Entrevistas como Assunto , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Piridonas , Dicetopiperazinas
16.
AIDS Patient Care STDS ; 38(6): 275-285, 2024 06.
Artigo em Inglês | MEDLINE | ID: mdl-38686517

RESUMO

Long-acting injectable (LAI) cabotegravir/rilpivirine (CAB/RPV) for antiretroviral therapy (ART) could benefit many people with HIV (PWH). However, its impact will largely be determined by providers' willingness to prescribe it and PWH's willingness to take it. This study explores the perceived barriers and facilitators of LAI CAB/RPV implementation among PWH and HIV care providers in Florida, a high prevalence setting. Semi-structured qualitative interviews were conducted in English with 16 PWH (50% non-Hispanic White, 50% cis men, and 94% on oral ART) and 11 providers (27% non-Hispanic Black, 27% Hispanic, 73% cis women, and 64% prescribed LAI CAB/RPV) throughout the state. Recruitment occurred between October 2022 and October 2023 from HIV clinics. Interviews were recorded, professionally transcribed, and then double coded using thematic analysis. The Consolidated Framework for Implementation Research guided the interview guide and coding. While PWH viewed LAI CAB/RPV as effective, predominant barriers included administration via injection, challenges of attending more clinic visits, and a feeling that this made HIV the center of one's life. Providers additionally expressed concerns about the development of integrase resistance. Barriers noted by PWH and providers outside of the clinic included transportation, stigma, access inequities, and payor issues. Within clinics, providers identified the need for extra staffing and the increased burden on existing staff as barriers. These barriers decreased the perceived need for LAI CAB/RPV among PWH and providers, especially with the high effectiveness of oral ART. Many of the identified barriers occur outside of the clinic and will likely apply to other novel long-acting ART options.


Assuntos
Fármacos Anti-HIV , Infecções por HIV , Piridonas , Pesquisa Qualitativa , Rilpivirina , Humanos , Infecções por HIV/tratamento farmacológico , Infecções por HIV/psicologia , Feminino , Masculino , Florida , Piridonas/administração & dosagem , Fármacos Anti-HIV/administração & dosagem , Fármacos Anti-HIV/uso terapêutico , Adulto , Rilpivirina/administração & dosagem , Rilpivirina/uso terapêutico , Pessoa de Meia-Idade , Pessoal de Saúde/psicologia , Preparações de Ação Retardada , Entrevistas como Assunto , Atitude do Pessoal de Saúde , Injeções , Dicetopiperazinas
17.
J Biochem Mol Toxicol ; 38(4): e23708, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38597299

RESUMO

Halomonas pacifica CARE-V15 was isolated from the southeastern coast of India to determine its genome sequence. Secondary metabolite gene clusters were identified using an anti-SMASH server. The concentrated crude ethyl acetate extract was evaluated by GC-MS. The bioactive compound from the crude ethyl acetate extract was fractionated by gel column chromatography. HPLC was used to purify the 3,6-diisobutyl-2,5-piperazinedione (DIP), and the structure was determined using FTIR and NMR spectroscopy. Purified DIP was used in an in silico molecular docking analysis. Purified DIP exhibits a stronger affinity for antioxidant genes like glutathione peroxidase (GPx), glutathione-S-transferase (GST), and glutathione reductase (GSR). Using in silco molecular docking analysis, the protein-ligand binding affinities of GSR (-4.70 kcal/mol), GST (-5.27 kcal/mol), and GPx (-5.37 kcal/mol) were measured. The expression of antioxidant genes were investigated by qRT-PCR. The in vivo reactive oxygen species production, lipid peroxidation, and cell death levels were significantly (p ≤ 0.05) increased in OA-induced group, but all these levels were significantly (p ≤ 0.05) decreased in the purified DIP pretreated group. Purified DIP from halophilic bacteria could thus be a useful treatment for neurological disorders associated with oxidative stress.


Assuntos
Acetatos , Antioxidantes , Halomonas , Fármacos Neuroprotetores , Animais , Antioxidantes/farmacologia , Antioxidantes/metabolismo , Peixe-Zebra/metabolismo , Fármacos Neuroprotetores/farmacologia , Ácido Okadáico/metabolismo , Ácido Okadáico/farmacologia , Simulação de Acoplamento Molecular , Estresse Oxidativo , Glutationa Peroxidase/metabolismo , Glutationa Redutase/metabolismo , Dicetopiperazinas/metabolismo , Dicetopiperazinas/farmacologia , Glutationa Transferase/metabolismo
18.
Fitoterapia ; 175: 105946, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38575087

RESUMO

Four compounds (1-4) featuring with an L-rhodinose and spiroketal, possess uncommon continuous hydroxy groups in the macrolide skeleton, and a dichloro-diketopiperazine (5) were isolated from a marine derived Micromonospora sp. FIMYZ51. The determination of the relative and absolute configurations of all isolates was achieved by extensive spectroscopic analyses, single-crystal X-ray diffraction analysis, and ECD calculations. According to structural characteristic and genomic sequences, a plausible biosynthetic pathway for compound 1-4 was proposed and a spirocyclase was inferred to be responsible for the formation of the rare spirocyclic moiety. Compounds 1-4 exhibited potent antifungal activities which is equal to itraconazole against Aspergillus niger. Compounds 1-5 exhibited different degree of inhibitory activities against opportunistic pathogenic bacteria of endocarditis (Micrococcus luteus) with MIC values ranging from 0.0625 µg/mL to 32 µg/mL. Compounds 2 and 3 showed moderate cytotoxicity against drug-resistant tumor cell lines (Namalwa and U266). The result not only provides active lead-compounds, but also reveal the potential of the spirocyclase gene resources from Micromonospora sp., which highlights the promising potential of the strain for biomedical applications.


Assuntos
Dicetopiperazinas , Macrolídeos , Micromonospora , Compostos de Espiro , Estrutura Molecular , Dicetopiperazinas/farmacologia , Dicetopiperazinas/isolamento & purificação , Dicetopiperazinas/química , Compostos de Espiro/farmacologia , Compostos de Espiro/isolamento & purificação , Compostos de Espiro/química , Linhagem Celular Tumoral , Humanos , Macrolídeos/farmacologia , Macrolídeos/isolamento & purificação , Macrolídeos/química , Antibacterianos/farmacologia , Antibacterianos/isolamento & purificação , Antibacterianos/química , Antifúngicos/farmacologia , Antifúngicos/isolamento & purificação , Antifúngicos/química , Testes de Sensibilidade Microbiana , China , Antineoplásicos/farmacologia , Antineoplásicos/isolamento & purificação , Antineoplásicos/química , Furanos
19.
AIDS Behav ; 28(7): 2175-2182, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38605250

RESUMO

The FDA's approval of long-acting injectable cabotegravir pre-exposure prophylaxis (LAI PrEP) as an alternative to daily oral PrEP represents a crucial development in HIV prevention, particularly for American Black cisgender women who face high HIV-1 risks. Yet, uptake may be hindered by racial and gender inequities. Addressing these requires learning from the roll-out of oral PrEP, creating culturally tailored PrEP campaigns, and enhancing provider training to meet Black women's needs. Tools for discussing PrEP within personal relationships and product preference research tailored to Black women's needs are essential for effective LAI PrEP delivery. Deliberative implementation of LAI PrEP must employ strategies that are community-sensitive, -responsive, and -inclusive. It should prioritize the incorporation of Black women's voices in decision-making and should promote community-led strategies. By addressing historical injustices and fostering trust, healthcare systems can enhance LAI PrEP uptake by Black women. Emphasizing a community-centered approach that ensures health equity and acknowledges the crucial role that social media and Black-led organizations play in promoting PrEP awareness and adoption within Black communities is necessary for successful implementation.


Assuntos
Fármacos Anti-HIV , Negro ou Afro-Americano , Infecções por HIV , Profilaxia Pré-Exposição , Humanos , Profilaxia Pré-Exposição/métodos , Feminino , Infecções por HIV/prevenção & controle , Negro ou Afro-Americano/psicologia , Fármacos Anti-HIV/administração & dosagem , Estados Unidos , Preparações de Ação Retardada , Injeções , Piridonas , Dicetopiperazinas
20.
Org Lett ; 26(16): 3349-3354, 2024 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-38607994

RESUMO

UbiA-type prenyltransferases (PTases) are significant enzymes that lead to structurally diverse meroterpenoids. Herein, we report the identification and characterization of an undescribed UbiA-type PTase, FtaB, that is responsible for the farnesylation of indole-containing diketopiperazines (DKPs) through genome mining. Heterologous expression of the fta gene cluster and non-native pathways result in the production of a series of new C2-farnesylated DKPs. This study broadens the reaction scope of UbiA-type PTases and expands the chemical diversity of meroterpenoids.


Assuntos
Dicetopiperazinas , Dimetilaliltranstransferase , Prenilação , Dimetilaliltranstransferase/metabolismo , Dimetilaliltranstransferase/química , Dimetilaliltranstransferase/genética , Dicetopiperazinas/química , Dicetopiperazinas/metabolismo , Estrutura Molecular , Família Multigênica
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