Project Group 5 "Systems Medicine of Infectious Disease", Robert Koch Institute, Nordufer 20, 13353 Berlin, Germany.
International Max-Planck Research School "Biology and Computation" (IMPRS-BAC), Ihnestrasse 63-73, 14195 Berlin, Germany.
Viruses. 2021 Jul 13;13(7):1354. doi: 10.3390/v13071354.
The combination of the two nucleoside reverse transcriptase inhibitors (NRTI) tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC) is used in most highly active antiretroviral therapies for treatment of HIV-1 infection, as well as in pre-exposure prophylaxis against HIV acquisition. Administered as prodrugs, these drugs are taken up by HIV-infected target cells, undergo intracellular phosphorylation and compete with natural deoxynucleoside triphosphates (dNTP) for incorporation into nascent viral DNA during reverse transcription. Once incorporated, they halt reverse transcription. In vitro studies have proposed that TDF and FTC act synergistically within an HIV-infected cell. However, it is unclear whether, and which, direct drug-drug interactions mediate the apparent synergy. The goal of this work was to refine a mechanistic model for the molecular mechanism of action (MMOA) of nucleoside analogues in order to analyse whether putative direct interactions may account for the in vitro observed synergistic effects. Our analysis suggests that depletion of dNTP pools can explain apparent synergy between TDF and FTC in HIV-infected cells at clinically relevant concentrations. Dead-end complex (DEC) formation does not seem to significantly contribute to the synergistic effect. However, in the presence of non-nucleoside reverse transcriptase inhibitors (NNRTIs), its role might be more relevant, as previously reported in experimental in vitro studies.
两种核苷逆转录酶抑制剂(NRTI)替诺福韦酯富马酸(TDF)和恩曲他滨(FTC)的联合使用,用于治疗 HIV-1 感染的大多数高效抗逆转录病毒疗法,以及预防 HIV 感染的暴露前预防。作为前药给药,这些药物被 HIV 感染的靶细胞摄取,在细胞内磷酸化,并与天然脱氧核苷三磷酸(dNTP)竞争,在逆转录过程中掺入新生的病毒 DNA。一旦掺入,它们就会阻止逆转录。体外研究表明,TDF 和 FTC 在感染 HIV 的细胞内协同作用。然而,尚不清楚是否存在以及哪些直接药物相互作用介导了明显的协同作用。这项工作的目的是改进核苷类似物作用机制的机制模型(MMOA),以分析潜在的直接相互作用是否可以解释体外观察到的协同作用。我们的分析表明,在临床相关浓度下,dNTP 池的耗竭可以解释 HIV 感染细胞中 TDF 和 FTC 之间的表观协同作用。死端复合物(DEC)的形成似乎不会对协同作用有显著贡献。然而,在非核苷逆转录酶抑制剂(NNRTIs)存在的情况下,其作用可能更为重要,正如先前在实验性体外研究中报道的那样。
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