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Antimicrobial Agents and Chemotherapy, September 2008, p. 3267-3275, Vol. 52, No. 9
0066-4804/08/$08.00+0     doi:10.1128/AAC.00498-08
Copyright © 2008, American Society for Microbiology. All Rights Reserved.

Combinations of Cyclophilin Inhibitor NIM811 with Hepatitis C Virus NS3-4A Protease or NS5B Polymerase Inhibitors Enhance Antiviral Activity and Suppress the Emergence of Resistance {triangledown}

Joanna E. Mathy, Sue Ma, Teresa Compton, and Kai Lin*

Novartis Institutes for Biomedical Research, Inc., 500 Technology Square, Cambridge, Massachusetts 02139

Received 16 April 2008/ Returned for modification 17 May 2008/ Accepted 19 June 2008

Chronic hepatitis C virus (HCV) infection remains a major global health burden while current interferon-based therapy is suboptimal. Efforts to develop more effective antiviral agents mainly focus on two viral targets: NS3-4A protease and NS5B polymerase. However, resistant mutants against these viral specific inhibitors emerge quickly both in vitro and in patients, particularly in the case of monotherapy. An alternative and complementary strategy is to target host factors such as cyclophilins that are also essential for viral replication. Future HCV therapies will most likely be combinations of multiple drugs of different mechanisms to maximize antiviral activity and to suppress the emergence of resistance. Here, the effects of combining a host cyclophilin inhibitor NIM811 with other viral specific inhibitors were investigated in vitro using HCV replicon. All of the combinations led to more pronounced antiviral effects than any single agent, with no significant increase of cytotoxicity. Moreover, the combination of NIM811 with a nucleoside (NM107) or a non-nucleoside (thiophene-2-carboxylic acid) polymerase inhibitor was synergistic, while the combination with a protease inhibitor (BILN2061) was additive. Resistant clones were selected in vitro with these inhibitors. Interestingly, it was much more difficult to develop resistance against NIM811 than viral specific inhibitors. No cross-resistance was observed among these inhibitors. Most notably, NIM811 was highly effective in blocking the emergence of resistance when used in combination with viral protease or polymerase inhibitors. Taken together, these results illustrate the significant advantages of combining inhibitors targeting both viral and host factors as key components of future HCV therapies.

* Corresponding author. Mailing address: Novartis Institutes for Biomedical Research, Inc., 500 Technology Square, Cambridge, MA 02139. Phone: (617) 871-7579. Fax: (617) 871-5867. E-mail: kai.lin{at}novartis.com

{triangledown} Published ahead of print on 30 June 2008.

Antimicrobial Agents and Chemotherapy, September 2008, p. 3267-3275, Vol. 52, No. 9
0066-4804/08/$08.00+0     doi:10.1128/AAC.00498-08
Copyright © 2008, American Society for Microbiology. All Rights Reserved.



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