title: HCV796: A selective nonstructural protein 5B polymerase inhibitor with potent anti-hepatitis C virus activity in vitro, in mice with chimeric human livers, and in humans infected with hepatitis C virus.
abstract: Anti-hepatitis C virus (HCV) drug development has been challenged by a lack of experience with inhibitors inclusive of in vitro, animal model, and clinical study. This manuscript outlines activity and correlation across such a spectrum of models and into clinical trials with a novel selective nonstructural protein 5B (NS5B) polymerase inhibitor, HCV796. Enzyme assays yielded median inhibitory concentration (IC(50)) values of 0.01 to 0.14 microM for genotype 1, with half maximal effective concentration (EC(50)s) of 5 nM and 9 nM against genotype 1a and 1b replicons. In the chimeric mouse model, a 2.02 +/- 0.55 log reduction in HCV titer was seen with monotherapy, whereas a suboptimal dose of 30 mg/kg three times per day in combination with interferon demonstrated a 2.44 log reduction (P = 0.001 versus interferon alone) Clinical outcomes in combination with pegylated interferon and ribavirin have revealed additive efficacy in treatment naïve patients. Abnormal liver function test results were observed in 8% of HCV-796 patients treated for over 8 weeks, resulting in suspension of further trial activity.
  
  
  CONCLUSIONS
  The RNA-dependent RNA polymerase inhibitor HCV796 demonstrated potent anti-HCV activity consistently through enzyme inhibition assays, subgenomic replicon, and chimeric mouse studies. Strong correlations of outcomes in the mouse model were seen with subsequent clinical trials, including a plateau in dose-related antiviral activity and additive impact from combination therapy with interferon. These outcomes demonstrate the utility of the range of in vitro and in vivo models now available for anti-HCV drug development and support the potential utility of polymerase inhibitors in future combination therapies for HCV treatment.
authors.affiliation: KMT Hepatech, Inc, Edmonton, Alberta, Canada. norm.kneteman@capitalhealth.ca
authors.forename: Norman M
authors.initials: NM
authors.lastname: Kneteman
authors.forename: Anita Y M
authors.initials: AY
authors.lastname: Howe
authors.forename: Tiejun
authors.initials: T
authors.lastname: Gao
authors.forename: Jamie
authors.initials: J
authors.lastname: Lewis
authors.forename: Dan
authors.initials: D
authors.lastname: Pevear
authors.forename: Gary
authors.initials: G
authors.lastname: Lund
authors.forename: Donna
authors.initials: D
authors.lastname: Douglas
authors.forename: David F
authors.initials: DF
authors.lastname: Mercer
authors.forename: D Lorne J
authors.initials: DL
authors.lastname: Tyrrell
authors.forename: Frederick
authors.initials: F
authors.lastname: Immermann
authors.forename: Inder
authors.initials: I
authors.lastname: Chaudhary
authors.forename: John
authors.initials: J
authors.lastname: Speth
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Villano
authors.forename: John
authors.initials: J
authors.lastname: O'Connell
authors.forename: Marc
authors.initials: M
authors.lastname: Collett
mesh_terms: D000818:Animals; D000998:Antiviral Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001572:Benzofurans / Q000494:pharmacology / Q000627:therapeutic use*; D004195:Disease Models, Animal; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004791:Enzyme Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D016174:Hepacivirus / Q000187:drug effects* / Q000502:physiology; D006526:Hepatitis C / Q000188:drug therapy*; D022781:Hepatocytes / Q000637:transplantation; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use; D008099:Liver / Q000187:drug effects* / Q000473:pathology / Q000821:virology*; D051379:Mice; D016513:Mice, SCID; D011092:Polyethylene Glycols; D011994:Recombinant Proteins; D012093:Replicon / Q000187:drug effects; D012254:Ribavirin / Q000627:therapeutic use; D013449:Sulfonamides / Q000494:pharmacology / Q000627:therapeutic use*; D017361:Viral Nonstructural Proteins / Q000037:antagonists & inhibitors*; D012324:RNA-Dependent RNA Polymerase
chemical_list: D000998:Antiviral Agents; D001572:Benzofurans; D004791:Enzyme Inhibitors; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011092:Polyethylene Glycols; D011994:Recombinant Proteins; D012254:Ribavirin; D013449:Sulfonamides; D017361:Viral Nonstructural Proteins; C539481:HCV 796; C087036:NS-5 protein, hepatitis C virus; D012324:RNA-Dependent RNA Polymerase; C417083:peginterferon alfa-2b