Novel <i>bis</i> -Tetrahydrofuranylurethane-Containing Nonpeptidic Protease Inhibitor (PI) UIC-94017 (TMC114) with Potent Activity against Multi-PI-Resistant Human Immunodeficiency Virus In Vitro

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<jats:title>ABSTRACT</jats:title> <jats:p> We designed, synthesized, and identified UIC-94017 (TMC114), a novel nonpeptidic human immunodeficiency virus type 1 (HIV-1) protease inhibitor (PI) containing a 3( <jats:italic>R</jats:italic> ),3a( <jats:italic>S</jats:italic> ),6a( <jats:italic>R</jats:italic> )- <jats:italic>bis</jats:italic> -tetrahydrofuranylurethane ( <jats:italic>bis</jats:italic> -THF) and a sulfonamide isostere which is extremely potent against laboratory HIV-1 strains and primary clinical isolates (50% inhibitory concentration [IC <jats:sub>50</jats:sub> ], ∼0.003 μM; IC <jats:sub>90</jats:sub> , ∼0.009 μM) with minimal cytotoxicity (50% cytotoxic concentration for CD4 <jats:sup>+</jats:sup> MT-2 cells, 74 μM). UIC-94017 blocked the infectivity and replication of each of HIV-1 <jats:sub>NL4-3</jats:sub> variants exposed to and selected for resistance to saquinavir, indinavir, nelfinavir, or ritonavir at concentrations up to 5 μM (IC <jats:sub>50</jats:sub> s, 0.003 to 0.029 μM), although it was less active against HIV-1 <jats:sub>NL4-3</jats:sub> variants selected for resistance to amprenavir (IC <jats:sub>50</jats:sub> , 0.22 μM). UIC-94017 was also potent against multi-PI-resistant clinical HIV-1 variants isolated from patients who had no response to existing antiviral regimens after having received a variety of antiviral agents. Structural analyses revealed that the close contact of UIC-94017 with the main chains of the protease active-site amino acids (Asp-29 and Asp-30) is important for its potency and wide spectrum of activity against multi-PI-resistant HIV-1 variants. Considering the favorable pharmacokinetics of UIC-94017 when administered with ritonavir, the present data warrant that UIC-94017 be further developed as a potential therapeutic agent for the treatment of primary and multi-PI-resistant HIV-1 infections. </jats:p>

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