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“The sovereign Lord has filled me with his spirit.
He has chosen me and sent me to bring good news to the poor, To heal the broken-hearted, to announce release to the captives, And freedom to those in prison. He has sent me to proclaim that the time will come When the Lord will save his people and defeat their enemies” Excerpt from the passage from Isaiah 61 read at the inauguration of Jean Bertrand Aristide
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Throughout the class we will explore how
we can use basic science to guide the design of new treatments for disease
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Retroviruses reverse the central dogma A retrovirus causes AIDS
A series of basic science discoveries have given us substantial insight into the cause of AIDS Retroviruses reverse the central dogma A retrovirus causes AIDS
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Potential Therapies- Life Cycle of HIV-1
Let’s start where the field started: with reverse transcriptase Picture courtesy of Frank Church
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Here’s the enzyme synthesizing a DNA complement
To the HIV RNA genome
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Let’s zoom in on this step
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RT adds a DNA nucleotide complementary to
Each RNA nucleotide in the HIV genome
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Here’s the chemistry:
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If we get rid of this hydroxyl group,
the enzyme can’t add another nucleotide
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AZT (azidothymidine) is an exact match to the T nucleotide but
without the hydroxyl group!
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The result…
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How did we get here?
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The success of sulfa drugs in inhibiting bacterial metabolism
inspired two scientists at Wellcome Research Labs to investigate other metabolic pathways George Hitchings Gertrude Elion Nobelprize.org and
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The success of sulfa drugs in inhibiting bacterial metabolism
inspired two scientists at Wellcome Research Labs to investigate other metabolic pathways They started just as people figured out That DNA is the genetic material! George Hitchings Gertrude Elion Nobelprize.org and
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They looked for derivatives of nucleotides
That inhibited synthesis of DNA and RNA George Hitchings Gertrude Elion Nobelprize.org and
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They looked for derivatives of nucleotides
That inhibited synthesis of DNA and RNA First drugs against leukemia George Hitchings Gertrude Elion Suppresses immune system (first kidney transplants) Nobelprize.org and
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When Hitchings became Vice President for Research
Elion was promoted to Head of the Department of Experimental Therapy (without a Ph.D!) and her group continued to explore these pathways George Hitchings Gertrude Elion Nobelprize.org and
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When Hitchings became Vice President for Research
Elion was promoted to Head of the Department of Experimental Therapy (without a Ph.D!) and her group continued to explore these pathways Treats gout and being tested against the Leishmania parasite George Hitchings Gertrude Elion They also explored mechanism of action Of acyclovir and its affect on Herpes virus Nobelprize.org and
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For all this hard work …. George Hitchings Gertrude Elion
Nobelprize.org and
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Others followed their lead
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Jerome Horwitz--first synthesized AZT in 1964
as a possible anticancer drug
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But it failed!
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The first treatment option: a time line
Februrary 1985 Scientists at National Cancer Institute and at Burroughs Wellcome Collaborate to study effect of AZT on HIV in cell culture
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The first treatment option: a time line
Februrary 1985 Scientists at National Cancer Institute and at Burroughs Wellcome Collaborate to study effect of AZT on HIV in cell culture September 1986 Early clinical trials showed that AZT slowed down the attack of HIV.
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The first treatment option: a time line
Februrary 1985 Scientists at National Cancer Institute and at Burroughs Wellcome Collaborate to study effect of AZT on HIV in cell culture September 1986 Early clinical trials showed that AZT slowed down the attack of HIV. The AZT clinical trial: one group of patients received AZT and the other received placebo. At the end of six months, only one patient in the AZT group was dead, whilst there were 19 deaths among the placebo group. The clinical trial was stopped early, because it was thought to be unethical to deny the patients of the placebo groups a better chance of survival. Fischl M. A., et al. (1987)''The Efficacy of azidothymidine (AZT) in the treatment of patients with AIDS and AIDS-related complex, a double-blind, placebo-controlled trial', The New England Journal Of Medicine, Vol. 317: , Number 4 FDA approved March 20, 1987!
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The first treatment option: a time line
August 1989 First large clinical trial of AZT in asymptomatic patients showed that it slowed progression of disease The day after the press conference, Burroughs Wellcome stock rose 32%.
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The first treatment option: a time line
August 1989 First large clinical trial of AZT in asymptomatic patients showed that it slowed progression of disease The day after the press conference, Burroughs Wellcome stock rose 32%. The high price of AZT angered many people; a year's supply cost ~$7,000 In September, the cost of the drug was cut by 20%.
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Thus the early response of HIV to AZT was superb
Does this sound familiar? Does it make you worried?
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The bad news came quickly and was not unexpected
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The bad news came quickly and was not unexpected
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Mutations altering amino acids
In the AZT binding site of Reverse transcriptase Led to resistance
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By the early 1990s resistance was a serious problem
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How do we get around this???
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Used in patients by October 1989
Same concept, new drugs! Inosine ddI Used in patients by October 1989
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Same concept, new drugs! Cytodine ddC FDA approved Summer 1991
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If you treat patients with ddI or ddC ALONE What will happen?
Cytodine ddC FDA approved Summer 1991
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So how do you get around this??
Cytodine ddC FDA approved Summer 1991
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If it worked for TB…..
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If it worked for TB….. September 1995
Two clinical trials, the Delta trial and the ACTG175 trial, showed that combinations of AZT with ddI or ddC were more effective than AZT alone in delaying disease progression and prolonging life.
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Tinkering with nucleotides To make new drugs
Chemists keep Tinkering with nucleotides To make new drugs Retroviruses. CSHL Press Fig
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www.web-books.com/.../ Infectious/AIDS_Treat.htm
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www.web-books.com/.../ Infectious/AIDS_Treat.htm
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