在 HIV Gag 切割位点突变体和对现有药物类别具有耐药性的分离株中,未观察到 Lenacapavir(GS-6207)表型耐药性。

Absence of Lenacapavir (GS-6207) Phenotypic Resistance in HIV Gag Cleavage Site Mutants and in Isolates with Resistance to Existing Drug Classes.

机构信息

Gilead Sciences, Inc., Foster City, California, USA

Gilead Sciences, Inc., Foster City, California, USA.

出版信息

Antimicrob Agents Chemother. 2021 Feb 17;65(3). doi: 10.1128/AAC.02057-20.

Abstract

Lenacapavir (LEN; GS-6207) is a potent first-in-class inhibitor of HIV-1 capsid with long-acting properties and the potential for subcutaneous dosing every 3 months or longer. In the clinic, a single subcutaneous LEN injection (20 mg to 750 mg) in people with HIV (PWH) induced a strong antiviral response, with a >2.3 mean log decrease in HIV-1 RNA at day 10. HIV-1 Gag mutations near protease (PR) cleavage sites have emerged with the use of protease inhibitors (PIs). Here, we have characterized the activity of LEN in mutants with Gag cleavage site mutations (GCSMs) and mutants resistant to other drug classes. HIV mutations were inserted into the pXXLAI clone, and the resulting mutants ( = 70) were evaluated using a 5-day antiviral assay. LEN EC fold change versus the wild type ranged from 0.4 to 1.9 in these mutants, similar to that for the control drug. In contrast, reduced susceptibility to PIs and maturation inhibitors (MIs) was observed. Testing of isolates with resistance against the 4 main classes of drugs ( = 40) indicated wild-type susceptibility to LEN (fold change ranging from 0.3 to 1.1), while reduced susceptibility was observed for control drugs. HIV GCSMs did not impact the activity of LEN, while some conferred resistance to MIs and PIs. Similarly, LEN activity was not affected by naturally occurring variations in HIV Gag, in contrast to the reduced susceptibility observed for MIs. Finally, the activity of LEN was not affected by the presence of resistance mutations to the 4 main antiretroviral (ARV) drug classes. These data support the evaluation of LEN in PWH with multiclass resistance.

摘要

仑卡帕韦(LEN;GS-6207)是一种高效的新型 HIV-1 衣壳抑制剂,具有长效作用,有望每 3 个月或更长时间进行一次皮下给药。在临床中,单次皮下注射 LEN(20 毫克至 750 毫克)可诱导 HIV 感染者(PWH)产生强烈的抗病毒反应,第 10 天 HIV-1 RNA 平均下降超过 2.3 对数。使用蛋白酶抑制剂(PI)后,在蛋白酶(PR)切割位点附近出现了 HIV-1 Gag 突变。在此,我们研究了 LEN 在 Gag 切割位点突变(GCSMs)和对其他药物类别耐药的突变体中的活性。将 HIV 突变插入 pXXLAI 克隆中,使用 5 天抗病毒测定法评估得到的突变体( = 70)。在这些突变体中,与野生型相比,LEN 的 EC 倍数值变化范围为 0.4 至 1.9,与对照药物相似。相比之下,观察到对 PI 和成熟抑制剂(MI)的敏感性降低。对具有对 4 种主要药物类别耐药的分离株的测试( = 40)表明 LEN 对野生型具有敏感性(倍数值变化范围为 0.3 至 1.1),而对照药物的敏感性降低。HIV GCSMs 不影响 LEN 的活性,而有些突变体则对 MI 和 PI 产生耐药性。同样,与 MI 观察到的敏感性降低相反,HIV Gag 中的天然变异对 LEN 的活性没有影响。最后,LEN 的活性不受对 4 种主要抗逆转录病毒(ARV)药物类别的耐药突变的影响。这些数据支持在具有多种耐药性的 PWH 中评估 LEN。

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