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McMahon JH, Evans VA, Lau JSY, Symons J, Zerbato JM, Chang J, Solomon A, Tennakoon S, Dantanarayana A, Hagenauer M, Lee S, Palmer S, Fisher K, Bumpus N, Heck CJS, Burger D, Wu G, Zuck P, Howell BJ, Zetterberg HH, Blennow K, Gisslen M, Rasmussen TA, Lewin SR. Neurotoxicity with high-dose disulfiram and vorinostat used for HIV latency reversal. AIDS 2022; 36:75-82. [PMID: 34586085 DOI: 10.1097/qad.0000000000003091] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to examine whether administering both vorinostat and disulfiram to people with HIV (PWH) on antiretroviral therapy (ART) is well tolerated and can enhance HIV latency reversal. DESIGN Vorinostat and disulfiram can increase HIV transcription in PWH on ART. Together, these agents may lead to significant HIV latency reversal. METHODS Virologically suppressed PWH on ART received disulfiram 2000 mg daily for 28 days and vorinostat 400 mg daily on days 8-10 and 22-24. The primary endpoint was plasma HIV RNA on day 11 relative to baseline using a single copy assay. Assessments included cell-associated unspliced RNA as a marker of latency reversal, HIV DNA in CD4+ T-cells, plasma HIV RNA, and plasma concentrations of ART, vorinostat, and disulfiram. RESULTS The first two participants (P1 and P2) experienced grade 3 neurotoxicity leading to trial suspension. After 24 days, P1 presented with confusion, lethargy, and ataxia having stopped disulfiram and ART. Symptoms resolved by day 29. After 11 days, P2 presented with paranoia, emotional lability, lethargy, ataxia, and study drugs were ceased. Symptoms resolved by day 23. CA-US RNA increased by 1.4-fold and 1.3-fold for P1 and P2 respectively. Plasma HIV RNA was detectable from day 8 to 37 (peak 81 copies ml-1) for P2 but was not increased in P1 Antiretroviral levels were therapeutic and neuronal injury markers were elevated in P1. CONCLUSION The combination of prolonged high-dose disulfiram and vorinostat was not safe in PWH on ART and should not be pursued despite evidence of latency reversal.
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Affiliation(s)
- James H McMahon
- Department of Infectious Diseases, Alfred Hospital and Monash University
| | - Vanessa A Evans
- The Peter Doherty Institute for Infection and Immunity, The University of Melbourne and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Jillian S Y Lau
- Department of Infectious Diseases, Alfred Hospital and Monash University
| | - Jori Symons
- The Peter Doherty Institute for Infection and Immunity, The University of Melbourne and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Jennifer M Zerbato
- The Peter Doherty Institute for Infection and Immunity, The University of Melbourne and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Judy Chang
- The Peter Doherty Institute for Infection and Immunity, The University of Melbourne and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Ajantha Solomon
- The Peter Doherty Institute for Infection and Immunity, The University of Melbourne and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Surekha Tennakoon
- The Peter Doherty Institute for Infection and Immunity, The University of Melbourne and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Ashanti Dantanarayana
- The Peter Doherty Institute for Infection and Immunity, The University of Melbourne and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Michelle Hagenauer
- Department of Infectious Diseases, Alfred Hospital and Monash University
| | - Sulggi Lee
- University of California San Francisco, San Francisco, California, USA
| | - Sarah Palmer
- The Westmead Institute for Medical Research, University of Sydney, Sydney, Westmead, Australia
| | - Katie Fisher
- The Westmead Institute for Medical Research, University of Sydney, Sydney, Westmead, Australia
| | | | | | - David Burger
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Guoxin Wu
- Department of Infectious Disease & Vaccine Research, Merck & Co., Inc., Kenilworth, New Jersey, USA
| | - Paul Zuck
- Department of Infectious Disease & Vaccine Research, Merck & Co., Inc., Kenilworth, New Jersey, USA
| | - Bonnie J Howell
- Department of Infectious Disease & Vaccine Research, Merck & Co., Inc., Kenilworth, New Jersey, USA
| | - Henrik H Zetterberg
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square
- UK Dementia Research Institute at UCL, London, UK
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Magnus Gisslen
- Department of Infectious Diseases at Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden
| | - Thomas A Rasmussen
- The Peter Doherty Institute for Infection and Immunity, The University of Melbourne and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Sharon R Lewin
- Department of Infectious Diseases, Alfred Hospital and Monash University
- The Peter Doherty Institute for Infection and Immunity, The University of Melbourne and Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Service, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria
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Mosher E, Bumpus N. Naturally‐Occurring Mutations to Muscle‐Type Creatine Kinase Differentially Impact Canonical and Pharmacological Activities in Vitro. FASEB J 2021. [DOI: 10.1096/fasebj.2021.35.s1.03461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Eric Mosher
- Pharmacology and Molecular SciencesJohns Hopkins University School of MedicineBaltimoreMD
| | - Namandje Bumpus
- Pharmacology and Molecular SciencesJohns Hopkins University School of MedicineBaltimoreMD
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Seneviratne H, Hendrix C, Bumpus N. The Enzymatic Activities of Nucleoside Triphosphate Diphosphohydrolases Towards Tenofovir Diphosphate and Their Spatial Distributions in Human Colorectal Tissue. FASEB J 2021. [DOI: 10.1096/fasebj.2021.35.s1.02825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Herana Seneviratne
- Pharmacology and Molecular SciencesJohns Hopkins University School of MedicineBaltimoreMD
| | - Craig Hendrix
- Medicine ‐ Clinical PharmacologyJohns Hopkins University School of MedicineBaltimoreMD
| | - Namandje Bumpus
- Pharmacology and Molecular SciencesJohns Hopkins University School of MedicineBaltimoreMD
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McGuire MR, Mosher E, Myers S, Bumpus N, Espenshade P. PGRMC1 Stabilizes Cytochromes P450 And Is Required for Activity
In Vivo. FASEB J 2020. [DOI: 10.1096/fasebj.2020.34.s1.04859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Tillotson J, Bumpus N. Impact of Adenylate Kinases and Naturally Occurring Adenylate Kinase 2 Variants on the Phosphorylation of the Anti‐HIV Drug Tenofovir. FASEB J 2018. [DOI: 10.1096/fasebj.2018.32.1_supplement.564.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Joseph Tillotson
- Department of Medicine‐Division of Clinical PharmacologyJohns Hopkins UniversityBaltimoreMD
| | - Namandje Bumpus
- Department of Medicine‐Division of Clinical PharmacologyJohns Hopkins UniversityBaltimoreMD
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Elliott JH, McMahon JH, Chang CC, Lee SA, Hartogensis W, Bumpus N, Savic R, Roney J, Hoh R, Solomon A, Piatak M, Gorelick RJ, Lifson J, Bacchetti P, Deeks SG, Lewin SR. Short-term administration of disulfiram for reversal of latent HIV infection: a phase 2 dose-escalation study. Lancet HIV 2015; 2:e520-9. [PMID: 26614966 DOI: 10.1016/s2352-3018(15)00226-x] [Citation(s) in RCA: 190] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 10/27/2015] [Accepted: 10/27/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND In vitro, disulfiram activated HIV transcription in a primary T-cell model of HIV latency and in a pilot clinical study increased plasma HIV RNA in individuals with adequate drug exposure. We assessed the effect of disulfiram on HIV transcription in a dose-escalation study. METHODS In this prospective dose-escalation study, to optimise disulfiram exposure we included adults with HIV on suppressive antiretroviral therapy, with plasma HIV RNA of less than 50 copies per mL and a CD4 cell count greater than 350 cells per μL. Participants were allocated sequentially to one of three dosing groups (500 mg, 1000 mg, and 2000 mg) and received disulfiram daily for 3 days. Only the staff who did laboratory assays were masked to group assignment. The primary endpoint was change in cell-associated unspliced HIV RNA in CD4 cells. The primary analysis method was a negative binomial regression, with the number of copies as the outcome variable and the input total RNA or plasma volume as an exposure variable, which is equivalent to modelling copies or input. We used these models to estimate changes from before disulfiram to timepoints during and after disulfiram administration. This study is registered with ClinicalTrials.gov, number NCT01944371. FINDINGS Of 34 participants screened for eligibility at The Alfred Hospital (Melbourne, VIC, Australia), and San Francisco General Hospital (San Francisco, CA, USA), 30 people were enrolled between Sept 24, 2013, and March 31, 2014. The estimated fold increases in cell-associated unspliced HIV RNA from baseline were 1·7 (95% CI 1·3-2·2; p<0·0001) to the timepoint during disulfiram treatment and 2·1 (1·5-2·9; p<0·0001) to the timepoint after disulfiram in the 500 mg group; 1·9 (1·6-2·4; p<0·0001) and 2·5 (1·9-3·3; p<0·0001) in the 1000 mg group; and 1·6 (1·2-2·1; p=0·0026) and 2·1 (1·5-3·1; p=0·0001) in the 2000 mg group. No deaths occurred, and no serious adverse events were noted. Disulfiram was well tolerated at all doses. INTERPRETATION Short-term administration of disulfiram resulted in increases in cell-associated unspliced HIV RNA at all doses, consistent with activating HIV latency. Disulfiram may be suited for future studies of combination and prolonged therapy to activate latent HIV. FUNDING The Foundation for AIDS Research (amfAR); National Institute of Allergy and Infectious Diseases, National Institutes of Health; Australian National Health and Medical Research Council.
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Affiliation(s)
- Julian H Elliott
- Department of Infectious Diseases, Monash University and Alfred Hospital, Melbourne, VIC, Australia
| | - James H McMahon
- Department of Infectious Diseases, Monash University and Alfred Hospital, Melbourne, VIC, Australia
| | - Christina C Chang
- Department of Infectious Diseases, Monash University and Alfred Hospital, Melbourne, VIC, Australia; The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia
| | - Sulggi A Lee
- University of California San Francisco, San Francisco, CA, USA
| | | | | | - Rada Savic
- University of California San Francisco, San Francisco, CA, USA
| | - Janine Roney
- Department of Infectious Diseases, Monash University and Alfred Hospital, Melbourne, VIC, Australia
| | - Rebecca Hoh
- University of California San Francisco, San Francisco, CA, USA
| | - Ajantha Solomon
- The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia
| | - Michael Piatak
- AIDS and Cancer Virus Program, Leidos Biomedical Research Inc, Frederick National Laboratory, Frederick, MD, USA
| | - Robert J Gorelick
- AIDS and Cancer Virus Program, Leidos Biomedical Research Inc, Frederick National Laboratory, Frederick, MD, USA
| | - Jeff Lifson
- AIDS and Cancer Virus Program, Leidos Biomedical Research Inc, Frederick National Laboratory, Frederick, MD, USA
| | - Peter Bacchetti
- University of California San Francisco, San Francisco, CA, USA
| | - Steven G Deeks
- University of California San Francisco, San Francisco, CA, USA
| | - Sharon R Lewin
- Department of Infectious Diseases, Monash University and Alfred Hospital, Melbourne, VIC, Australia; The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia.
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Yang KH, Hendrix C, Bumpus N, Elliott J, Tanner K, Mauck C, Cranston R, McGowan I, Richardson-Harman N, Anton PA, Kashuba ADM. A multi-compartment single and multiple dose pharmacokinetic comparison of rectally applied tenofovir 1% gel and oral tenofovir disoproxil fumarate. PLoS One 2014; 9:e106196. [PMID: 25350119 PMCID: PMC4211672 DOI: 10.1371/journal.pone.0106196] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 07/28/2014] [Indexed: 11/24/2022] Open
Abstract
This Phase 1, randomized, two-site (United States), double-blind, placebo-controlled study enrolled 18 sexually abstinent men and women. All received a single 300-mg dose of oral tenofovir disoproxil fumarate (TDF) and were then randomized 2∶1 to receive single and then seven daily rectal exposures of vaginally-formulated tenofovir (TFV) 1% gel or a hydroxyethyl cellulose (HEC) placebo gel. Blood, colonic biopsies and rectal and vaginal mucosal fluids were collected after the single oral TDF, the single topical TFV gel dose, and after 7 days of topical TFV gel dosing for extracellular analysis of TFV and intracellular analysis of the active metabolite tenofovir diphosphate (TFVdp) in peripheral blood mononuclear cells (PBMCs) and isolated mucosal mononuclear cells (MMC), including CD4+ and CD4- cell subsets. With a single rectal dose, TFV plasma concentrations were 24–33 fold lower and half-life was 5 h shorter compared to a single oral dose (p = 0.02). TFVdp concentrations were also undetectable in PBMCs with rectal dosing. Rectal tissue exposure to both TFV and TFVdp was 2 to 4-log10 higher after a single rectal dose compared to a single oral dose, and after 7 daily doses, TFVdp accumulated 4.5 fold in tissue. TFVdp in rectal tissue homogenate was predictive (residual standard error, RSE = 0.47) of tissue MMC intracellular TFVdp concentration, with the CD4+ cells having a 2-fold higher TFVdp concentration than CD4- cells. TFV concentrations from rectal sponges was a modest surrogate indicator for both rectal tissue TFV and TFVdp (RSE = 0.67, 0.66, respectively) and plasma TFV (RSE = 0.38). TFV penetrates into the vaginal cavity after oral and rectal dosing, with rectal dosing leading to higher vaginal TFV concentrations (p<0.01).
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Affiliation(s)
- Kuo-Hsiung Yang
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina, United States of America
- * E-mail:
| | - Craig Hendrix
- Departments of Medicine and Pharmacology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Namandje Bumpus
- Departments of Medicine and Pharmacology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Julie Elliott
- Center for HIV Prevention Research, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Karen Tanner
- Department of Biostatistics, UCLA School of Public Health, Los Angeles, California, United States of America
| | | | - Ross Cranston
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Ian McGowan
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | | | - Peter A. Anton
- Center for HIV Prevention Research, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Angela D. M. Kashuba
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina, United States of America
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VanAusdall JL, Bumpus N. An Increase in Expression of the ER Stress Responsive Protein IRE1α Occurs in Response to the Anti‐HIV Drug Efavirenz in Primary Human Hepatocytes. FASEB J 2013. [DOI: 10.1096/fasebj.27.1_supplement.890.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Namandje Bumpus
- Pharmacology and Molecular SciencesJohns Hopkins School of MedicineBaltimoreMD
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Bumpus N, Savas U, Johnson EF. Regulation of cyp4a31 by AMP‐activated protein kinase and peroxisome proliferator activated receptor alpha. FASEB J 2010. [DOI: 10.1096/fasebj.24.1_supplement.757.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Namandje Bumpus
- Department of Molecular and Experimental MedicineThe Scripps Research InstituteLa JollaCA
| | - Uzen Savas
- Department of Molecular and Experimental MedicineThe Scripps Research InstituteLa JollaCA
| | - Eric F Johnson
- Department of Molecular and Experimental MedicineThe Scripps Research InstituteLa JollaCA
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