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Replies to #87822 on Biotech Values
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Preciouslife1

01/04/10 7:10 PM

#88473 RE: DewDiligence #87822

Multitasking May Be Achilles Heel for Hepatitis C

Dentzer et al. Determinants of the Hepatitis C Virus Nonstructural Protein 2 Protease Domain Required for Production of Infectious Virus. Journal of Virology, 2009; 83 (24): 12702 DOI: 10.1128/JVI.01184-09

Despite its tiny genome, the hepatitis C virus packs a mean punch. The virus is a microcosm of efficiency, and each of its amino acids plays multiple roles in its survival and ability to sidestep attack. But new research from Rockefeller University suggests that this fancy footwork and multitasking could be the key to bringing down the virus. The work, which focuses on a once-ignored protein, provides insights on how drug therapy for sufferers of the disease might be improved.

The protein, NS2, which is one of the 10 proteins that make up the hepatitis C virus, gained momentum as a plausible drug target in 2006, when Charles M. Rice, head of the Laboratory of Virology and Infectious Disease, and his team solved the structure of its protease domain. The domain spans the second half of NS2 and acts like a molecular scissor, cleaving itself from its neighbor, NS3. (At first, the 10 proteins that make up the virus are strung together in a continuous chain, which is later cleaved by various enzymes.) By that time, it's also known to aid in the production of infectious virus particles.

Now Rice and his team have dissected the nooks and crannies of this protease domain down to the amino acids that make them up, and have mapped which amino acids are responsible for churning out infectious particles, and distinguished them from those involved in the cleaving process. During the researchers' meticulous poking and prodding, deleting and replacing, one amino acid in particular caught their attention: the protein's very last one.

"When we changed or deleted the terminal leucine -- leucine 217 -- infectious virus production shut down," says graduate student Thomas Dentzer, who led the research. "But what really intrigued us was leucine 217's position."

After the protease makes its cut, leucine 217 remains in a protein fold that makes up the protease's active site. Although the active site isn't involved in making infectious virus particles, Dentzer and Rice -- who is also Maurice R. and Corinne P. Greenberg Professor in Virology and scientific director of the Center for the Study of Hepatitis C at Rockefeller -- showed that it is essential for the protease's cleaving activity. With both functions mapping to this tiny region of NS2, the researchers suggest that drugs targeting this area might be able to pack a double punch against the virus.

Since the hepatitis C virus has an uncanny ability to mutate and evade detection just when the body's immune forces are closing in, punching several phases of the virus's life cycle simultaneously may be a better approach than dealing one phase a forceful blow. "A double punch may give the immune system time to attack the virus before it mutates," says Dentzer. "So this is a good therapeutic target to explore."

The fact that this amino acid is exposed on the virus's surface makes the finding all the more exciting and suggests that it is involved in protein-protein interactions during the life cycle of the virus. "We not only have a target that can weaken the virus, but a target that is also accessible," says Rice. "It is a lead that can really help us move forward.

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DewDiligence

01/10/10 9:08 PM

#88812 RE: DewDiligence #87822

HCV: Most Likely to Succeed (IMHO)

[Downgraded VRTX’s VX-813/VX-985 by two
notches (from paragraph #5 to paragraph #7).]



The following paragraphs are in descending order of likelihood of success. There is no claim of completeness here; i.e. paragraphs 3-7 do not necessarily mention all of the applicable drug candidates within the grouping.

Please see #msg-42396728 for the distinction between a nucleoside and a nucleotide, and see #msg-43114117 for some historical perspective from the HIV arena.


1. The two leading protease inhibitors: Telaprevir (VRTX/JNJ; phase-3) and Boceprevir (MRK; phase-3). The Telaprevir program is further advanced, so let’s call Telaprevir and Boceprevir 1a and 1b, respectively. Both drugs have shown very impressive efficacy in phase-2 trials, although neither has a completely clean safety profile (see references below).

Telaprevir in the treatment-naïve setting: phase-3 program: #msg-27623529 (ADVANCE study), #msg-26228377 (both studies); phase-2b program: #msg-29019931 (PROVE-1/2 trials made simple), #msg-28746843 (PROVE-1/2 detailed results); C208 study of BID vs TID dosing: #msg-43114192.

Telaprevir in the second-line setting: phase-3 program (REALIZE study): #msg-32901932; phase-2 program: #msg-37316151 (PROVE-3 study), #msg-42965441 (‘107’ open-label extension for PROVE-1/2 failures).

Boceprevir in the treatment-naïve setting: phase-3 program (SPRINT-2 and RESPOND-2): #msg-29474929; phase-2b program: #msg-42086185 (AASLD 2009 abstract re SPRINT-1), #msg-37298987, (interim SPRINT-1 results at EASL 2009), #msg-37298085 (EPO usage), #msg-31190433 (Dew’s musings on SPRINT-1 data).

Boceprevir in the second-line setting: phase-3 (RESPOND-2) study: #msg-29474929.


2. ITMN-191 (a/k/a/ RG7227) and RG7128, the two oral drugs that Roche is testing in the INFORM-1 study that does not include interferon or ribavirin: #msg-43185247 (AASLD 2009), #msg-37309589 (EASL 2009), #msg-37312942 (viral-load chart from EASL 2009 with annotations by ghmm), #msg-37208214 (Apr 2009 PR on expanded trial design), #msg-37209844 (clinicaltrials.gov listing).

ITMN-191 (ITMN/Roche; phase-2b) is a protease inhibitor: #msg-44330890 (slide presentation); #msg-43632598, #msg-43674521, #msg-43666728 (liver tox causes dosing adjustment in phase-2b); #msg-40679281 (original phase-2b design); #msg-42016434, #msg-43666728 (boosting with ritonavir).

RG7128 (VRUS/Roche; phase-2b) is a nucleoside polymerase inhibitor: #msg-43836489, #msg-34746768.

Although ITMN-191 and RG7128 are not necessarily the best drugs in their respective classes, the fact that Roche is testing them in INFORM-1 gives them a leg up on competing drugs at the same stage of development, IMO.


3. Other agents in phase-2b or later: Albuferon/Zalbin/Joulferon (HGSI/NVS; BLA and MAA submitted): #msg-36140577 (phase-3 data), #msg-36254180 (lack of SPA!), #msg-34770426 (new trial with monthly dosing); BI 201335 (B-I; phase-2b), a protease inhibitor: #msg-42086185, #msg-33564560; and Locteron (Biolex; phase-2b), a long-acting interferon made in transgenic plants that may qualify for the 505b2 approval pathway: #msg-37298340 (phase-2a data from EASL 2009), #msg-37178496 (phase-2b design), #msg-40953698 (manufacturing agreement).


4. Agents in phase-1b or phase-2a that use an established MoA. These include ACH-1625 (ACHN;phase-1b), a protease inhibitor: #msg-44560695, #msg-44566075; BMS-650032 (BMY, phase-2), a protease/NS3 inhibitor: #msg- 44700187, #msg-40361108; TMC435 f/k/a/ TMC435350 (Medivir/JNJ; phase-2b), a protease inhibitor: #msg-37298740, #msg-43361309; SCH 900518 a/k/a/ Narlaprevir (MRK; phase-2a), a protease inhibitor: #msg-43169835 (interim phase-2a data), #msg-34338549 (final phase-1b data); GS9190 (GILD; phase-2), a non-nucleoside polymerase inhibitor that GILD is testing in an all-oral combination with GILD’s newly disclosed protease inhibitor GS9256: #msg-42717806; IDX184 (IDIX; phase-1b), a nucleotide polymerase-inhibitor: #msg-36392616 (EASL 2009 abstract), #msg-34763865 (PR for trial commencement), #msg-26915921 (how IDX184 is better than NM283); PSI-7851 (VRUS, phase-1b), a nucleotide polymerase inhibitor: #msg-40115833; IFN-alpha-XL (FLML; phase-2a): #msg-44688995; ABT-450 (ABT/Enanta, phase-1), a protease inhibitor: #msg-35708745; VCH-222 (VRTX, phase-1b), a non-nucleoside “thumb” polymerase inhibitors that VRTX acquired from ViroChem (VCH-759 is a backup): #msg-37089807; IFN-Lambda (BMY/ZGEN; phase-2): #msg-34768182 (BMY partnership), #msg-43123220 (final phase-1b data), #msg-43360640 (start of phase-2); MK-7009 (MRK, phase-2a), a protease inhibitor: #msg-34337398, #msg-34335327; ABT-333 (ABT, phase-1b), a polymerase inhibitor: #msg-42098204; and ANA598 (ANDS, phase-2), a non-nucleoside “palm” polymerase inhibitor: #msg-44635086 (interim phase-2 PR), #msg-44647384 (interim tabular data), #msg-44645147 (musings on interim data), #msg-40064675 (musings on phase-1b data).


5. Very-early-stage compounds that use an established MoA. These include IDX375 (IDIX, preclinical), a non-nucleoside “palm” polymerase inhibitor: #msg-34334563, #msg-31043481; MK-3281 (MRK, phase-1), a non-nucleoside “thumb” polymerase inhibitor: #msg-42093301 (safety signal in AASLD 2009 abstract); PSI-938 and PSI-879 (VRUS, preclinical), a pair of purine-analog nucleotide prodrugs: #msg-39322313, #msg-42245955; ‘hyperglycosylated’ interferon (Alios BioPharma, preclinical): #msg-35612425; IDX316 (IDIX, preclinical), a macrocyclic protease inhibitor: #msg-41526366 (reason for selection over IDX136), #msg-37246670 (EASL 2009 PR), #msg-37315636 (EASL 2009 poster).


6. Agents in phase-2 or earlier that use a novel MoA. These include CF-102 (Can-Fite, phase-1/2), a polymerase inhibitor that purportedly induces apoptosis: #msg-39588570; BMS-790052 (BMY, phase-2), an NS5A inhibitor: #msg-33270670, #msg-44700187; MB11362 (Roche/MBRX, preclinical), MoA undisclosed: #msg-38456136; A-831 (AZN, status unknown), an NS5A inhibitor: #msg-16682361; a preclinical NS5A inhibitor from GSK (acquired from Genelabs): #msg-33209281, #msg-33211420; IL-7 (Cytheris, phase-1/2) an injectable immunomodulator: #msg-33152073; Debio 025 (Debiopharm, phase-2a), a cyclophilin inhibitor: #msg-37359213; NIM811 (NVS, status unknown), a cyclophilin inhibitor: #msg-36507550; GI-5005 (GlobeImmune, phase-2), an injectable immunomodulator: #msg-37298510; ACH-1095 (ACHN, preclinical), an NS4A inhibitor that GILD dropped while retaining the right to opt back in: #msg-41217537; an unnamed NS5A inhibitor that VRTX acquired from ViroChem (preclinical): #msg-36022752; an unnamed NS5A inhibitor from Presidio Pharma (status unknown): #msg-27791536; clemizole (Stanford University, preclinical), an NS4B inhibitor: #msg-39883747; nitazoxanide (Romark/Chugai, phase-2): #msg-35738696; ITX5061 (iTherX, phase-2a), MoA unknown: #msg-35319690; IMO-2125 (IDRA, phase-1), a TLR9 agonist: #msg-44746537; a preclinical entry inhibitor from PGNX: #msg-38519885; SPC3649 (Santaris, preclinical), MoA based on microRNA: #msg-44177354.


7. Programs that are nominally alive but are not active. These include ANA773 (ANDS, phase-1), an oral TLR7 modulator that ANDS discontinued in Jun 2009 and is nominally available for partnering: #msg-38418158; taribavirin (VRX, phase-2b), a “legacy” prodrug of ribavirin that has been floating around for a long time: #msg-38280961 (musings on final phase-2b data), #msg-37299101 (detailed 60-week data); and VX-813/VX-985 (VRTX, phase-1/preclinical), protease inhibitors that were previously touted as the backups to Telaprevir: #msg-45333927.


JMHO, FWIW