Mohamed Zamzamy, Sophie Post, Wing Hang Ip, Elin Hahlin, Sebastian Kühn, Andrea Pirosu, Christian Conze, Martin Baumdick, Madeleine J Bunders, Britta F Zecher, Angelique Hoelzemer, Stephan Linder, Niklas Arnberg, Thomas Dobner, Marcus Altfeld, Sebastian Schloer
Background and purpose: Human adenovirus (HAdV) causes respiratory or gastrointestinal tract infections depending on the virus subtype. While HAdV infections are generally self-limiting in immunocompetent people, they can result in significant morbidity and mortality in immunocompromised adults and children. Due to the limited availability of effective therapeutic options, there is an urgent need for novel therapeutics to combat HAdV infection and mitigate its severity.
Experimental approach: Here, we have repurposed the clinically well-used antifungal, itraconazole, to control HAdV infection. We tested the antiviral potential of the itraconazole and the mTOR inhibitor Ku-63794 on the production of infectious HAdV in A549 and Caco-2 cells as well as human intestinal organoids (HIOs). Additionally, we evaluated the benefit of a combination of these host-directed drugs with the direct-acting antiviral brincidofovir.
Key results: Pharmacological treatment with itraconazole significantly reduced virus titres in different in vitro models, including HIOs. Treatment with itraconazole impairs HAdV entry by entrapping incoming virus particles in endolysosomes and by promoting autophagy in HAdV-infected cells. Moreover, combining itraconazole with brincidofovir, a cidofovir derivative currently under clinical evaluation for anti-HAdV applications, demonstrated a synergistic effect in reducing HAdV titres.
Conclusion and implications: Given the gastrointestinal toxicity associated with brincidofovir, its combination with the host-directed drug itraconazole allowed lower brincidofovir doses to be used to decrease HAdV titres, thereby minimizing adverse drug effects while maintaining antiviral efficacy.
{"title":"Synergistic antiviral activity against human adenovirus through combination of itraconazole and brincidofovir.","authors":"Mohamed Zamzamy, Sophie Post, Wing Hang Ip, Elin Hahlin, Sebastian Kühn, Andrea Pirosu, Christian Conze, Martin Baumdick, Madeleine J Bunders, Britta F Zecher, Angelique Hoelzemer, Stephan Linder, Niklas Arnberg, Thomas Dobner, Marcus Altfeld, Sebastian Schloer","doi":"10.1111/bph.70258","DOIUrl":"https://doi.org/10.1111/bph.70258","url":null,"abstract":"<p><strong>Background and purpose: </strong>Human adenovirus (HAdV) causes respiratory or gastrointestinal tract infections depending on the virus subtype. While HAdV infections are generally self-limiting in immunocompetent people, they can result in significant morbidity and mortality in immunocompromised adults and children. Due to the limited availability of effective therapeutic options, there is an urgent need for novel therapeutics to combat HAdV infection and mitigate its severity.</p><p><strong>Experimental approach: </strong>Here, we have repurposed the clinically well-used antifungal, itraconazole, to control HAdV infection. We tested the antiviral potential of the itraconazole and the mTOR inhibitor Ku-63794 on the production of infectious HAdV in A549 and Caco-2 cells as well as human intestinal organoids (HIOs). Additionally, we evaluated the benefit of a combination of these host-directed drugs with the direct-acting antiviral brincidofovir.</p><p><strong>Key results: </strong>Pharmacological treatment with itraconazole significantly reduced virus titres in different in vitro models, including HIOs. Treatment with itraconazole impairs HAdV entry by entrapping incoming virus particles in endolysosomes and by promoting autophagy in HAdV-infected cells. Moreover, combining itraconazole with brincidofovir, a cidofovir derivative currently under clinical evaluation for anti-HAdV applications, demonstrated a synergistic effect in reducing HAdV titres.</p><p><strong>Conclusion and implications: </strong>Given the gastrointestinal toxicity associated with brincidofovir, its combination with the host-directed drug itraconazole allowed lower brincidofovir doses to be used to decrease HAdV titres, thereby minimizing adverse drug effects while maintaining antiviral efficacy.</p>","PeriodicalId":9262,"journal":{"name":"British Journal of Pharmacology","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145630289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>Among the molecular targets for treating disorders of neuronal excitability, such as epilepsy, chronic pain and conditions involving excitotoxicity (e.g. stroke or traumatic brain injury), the K<sub>v</sub>7 (KCNQ) family of voltage-gated potassium channels stands out as particularly promising. Several biophysical properties make K<sub>v</sub>7 channels well-suited for this role. They have activation voltage threshold near the resting membrane potential of many neurons, they do not inactivate and have slow activation and deactivation kinetics (Jones et al., <span>2021</span>). Owing to these characteristics, a fraction of K<sub>v</sub>7 channels remains conductive in a neuron at rest, controlling firing threshold and rheobase. Gradual increase of K<sub>v</sub>7 channel activity during sustained depolarization or continuous firing introduces self-tuning or ‘accommodation’ in firing patterns.</p><p>There are five K<sub>v</sub>7 subunits in mammals, K<sub>v</sub>7.1–K<sub>v</sub>7.5, and these are encoded by <i>KCNQ1</i>-<i>KCNQ5</i> genes. K<sub>v</sub>7.1 is mainly expressed in the cardiovascular system and epithelia, while K<sub>v</sub>7.2–K<sub>v</sub>7.5 are mostly neuronal, responsible for so-called M-type K<sup>+</sup> current in these cells (Jones et al., <span>2021</span>). Generic mutations causing loss of K<sub>v</sub>7 function often result in pathological hyperexcitability (epilepsies, cardiac arrhythmias and pain) (Jones et al., <span>2021</span>). Conversely, pharmacological activation or enhancement of K<sub>v</sub>7 activity is widely recognised therapeutic strategy for management of hyperexcitability symptoms. Two K<sub>v</sub>7 activators have been clinically used as a painkiller (flupirtine) and anticonvulsant (retigabine), and a number of other clinically used drugs may have K<sub>v</sub>7 activation among their mechanisms of action. These include painkillers, celecoxib (Du et al., <span>2011</span>) and paracetamol (Ray et al., <span>2019</span>) and a vasodilator, fasudil (Zhang et al., <span>2016</span>).</p><p>Although flupirtine and retigabine initially demonstrated clinical promise, both compounds were ultimately withdrawn from the market, mostly due to adverse effects. Retigabine was associated with blue skin discolouration, retinal pigmentation and urinary retention, while flupirtine carried a risk of hepatotoxicity. Current efforts in drug development are focused on identifying next-generation K<sub>v</sub>7 channel activators with superior pharmacological selectivity and safety. Yet, development of a new drug from scratch is a costly and time-consuming undertaking. In this context, screening libraries of already approved (or close to approval) drugs for potential repurposing represents a promising alternative strategy, offering the advantages of accelerated market entry and reduced development costs.</p><p>A new study by Lidia Carotenuto and co-authors, published in the British Journal of Pharmacology (Carotenuto et
在治疗神经元兴奋性紊乱的分子靶点中,如癫痫、慢性疼痛和涉及兴奋性毒性的疾病(如中风或创伤性脑损伤),Kv7 (KCNQ)电压门控钾通道家族尤其有前景。一些生物物理性质使得Kv7通道非常适合这个角色。它们在许多神经元的静息膜电位附近具有激活电压阈值,它们不会失活,并且具有缓慢的激活和失活动力学(Jones et al., 2021)。由于这些特性,一小部分Kv7通道在静止的神经元中保持导电,控制放电阈值和流变酶。在持续去极化或连续放电过程中,Kv7通道活动的逐渐增加引入了放电模式的自调谐或“调节”。哺乳动物中有5个Kv7亚基,Kv7.1-Kv7.5,这些亚基由KCNQ1-KCNQ5基因编码。Kv7.1主要表达于心血管系统和上皮细胞,而Kv7.2-Kv7.5主要是神经元细胞,负责这些细胞中所谓的m型K+电流(Jones et al., 2021)。导致Kv7功能丧失的基因突变通常会导致病理性高兴奋性(癫痫、心律失常和疼痛)(Jones et al., 2021)。相反,药物激活或增强Kv7活性被广泛认为是治疗高兴奋性症状的治疗策略。两种Kv7激活剂已在临床上用作止痛药(氟吡汀)和抗惊厥药(瑞加滨),许多其他临床使用的药物可能在其作用机制中具有Kv7激活作用。这些药物包括止痛药塞来昔布(Du等人,2011年)、扑热息痛(Ray等人,2019年)和血管扩张剂法舒地尔(Zhang等人,2016年)。虽然氟吡汀和瑞加滨最初表现出临床前景,但这两种化合物最终都退出了市场,主要是由于副作用。雷沙滨与蓝色皮肤变色、视网膜色素沉着和尿潴留有关,而氟吡汀则有肝毒性风险。目前药物开发的重点是鉴定具有优越药理选择性和安全性的下一代Kv7通道激活剂。然而,从头开始开发一种新药是一项昂贵且耗时的工作。在这种情况下,筛选已经批准(或接近批准)的药物库以进行潜在的重新利用是一种有希望的替代策略,具有加速市场进入和降低开发成本的优势。Lidia Carotenuto及其合著者发表在《英国药理学杂志》上的一项新研究(Carotenuto等人,2025)报告了通过再利用管道识别新的Kv7激活剂的努力。作者对来自Fraunhofer repurpose Library和EU-Openscreen Pilot Bioactive Library的约8000种化合物进行了高通量筛选,希望能找到安全有效的治疗癫痫的Kv7激活剂。筛选结果显示,JNJ-37822681(图1)是一种快速解离的D2受体拮抗剂,最初由强生公司开发用于治疗精神分裂症(Langlois et al., 2012)。该分子具有良好的生物利用度,良好的一般毒理学和安全性,目前正处于临床开发的后期阶段。作者首先使用荧光铊法筛选了针对中国仓鼠卵巢(CHO)细胞的化合物文库,这些细胞稳定过表达增强宏观电流突变的Kv7.3通道异构体(Kv7.3 A315T)。利加滨作为阳性对照。筛选确定了大约12种候选药物,其中包括瑞加滨和另一种已知的Kv7活化剂ML213。大多数新的候选药物在进一步的膜片钳实验中因其低效力和/或功效而被取消资格。然而,JNJ-37822681通过了验证,对Kv7.2、Kv7.4、Kv7.5同型异构体和Kv7.2/Kv7.3异构体的效价和疗效与瑞gabine相当,对Kv7.3的作用略弱。例如,瑞gabine和JNJ-37822681诱导Kv7.2/Kv7.3半电压的超极化位移分别为- 40和-37 mV, EC50分别为2.5和1.2 μM。JNJ-37822681与瑞加滨相似,对Kv7.1通道影响较小。利用Kv7.2与瑞gabine (PDB: 7CR2)配合物的低温电镜结构和分子对接模拟,作者能够将JNJ-37822681放入Kv7.2的瑞gabine结合口袋中。此外,对雷沙滨结合至关重要的Kv7.2 (W236L)中236位色氨酸的突变消除了JNJ-37822681的Kv7激活作用,证实了模型预测。然后,作者利用诱导多能干细胞(iPSC)技术测试了JNJ-37822681对人类iPSC衍生的皮质谷氨酸能神经元兴奋性的影响。 他们使用的皮质样谷氨酸能神经元分化自两名因KCNQ2功能缺失突变而患有遗传性癫痫的患者(KCNQ2发育性和癫痫性脑病;KCNQ2- dee),以及CRISPR/ cas9校正的等基因细胞系作为对照。在这些实验中,JNJ-37822681和瑞gabine在降低对照和DEE神经元的兴奋性和放电频率(使用膜片钳记录和多电极阵列系统的细胞外记录测量)方面同样有效。这两种化合物也可显著增强等基因对照神经元的M电流振幅。最后,作者使用了两种小鼠癫痫发作模型:戊四唑(PTZ)模型的全身性强直-阵挛性癫痫发作和遗传性癫痫易感DBA/2小鼠的听原反射性癫痫发作。在两种模型中,雷吉滨和JNJ-37822681显著减少了阵挛性和强直性癫痫发作,JNJ-37822681的效价与雷吉滨相似(PTZ)或略高(DBA/2)。综上所述,该研究确定并表征了具有良好安全性的新型Kv7激活剂,目前正作为抗精神病药物推向临床应用。该分子在Kv7通道中与瑞gabine结合袋结合,并具有相当的选择性。缺乏Kv7.1的活性是有利的,因为该亚基主要在心脏和血管组织中表达。因此,表现出显著Kv7.1相互作用的调节剂可能存在心血管风险。JNJ-37822681降低体外神经元兴奋性和体内癫痫发作严重程度,其效力和疗效与雷加滨相当。据推测,JNJ-37822681不会有皮肤变色的蓝色问题,这是雷沙滨所特有的,因为形成了色素二聚体。然而,JNJ-37822681可能仍有雷沙滨的其他非靶向副作用,如头晕、精神错乱、嗜睡和尿潴留。此外,由于JNJ-37822681是一种D2受体拮抗剂,它可能引发与这类药物相关的副作用,包括锥体外系症状和代谢问题。同样重要的是要注意,根据英国。葛兰素史克(GlaxoSmithKline)将有限的临床使用列为2017年停止使用瑞加滨(Trobalt/Potiga)的主要原因,而不是与疗效或安全性有关的担忧。因此,类似的化合物是否能获得更大的市场生存能力还有待确定。尽管如此,胡萝卜素及其合作者的研究证明了一种彻底而全面的策略,用于识别和描述治疗兴奋性障碍的新的临床相关Kv7通道打开剂。写了手稿。作者声明无利益冲突。
{"title":"Improving Kv7 targeting anticonvulsants - will repurposing save the day?","authors":"Nikita Gamper","doi":"10.1111/bph.70290","DOIUrl":"10.1111/bph.70290","url":null,"abstract":"<p>Among the molecular targets for treating disorders of neuronal excitability, such as epilepsy, chronic pain and conditions involving excitotoxicity (e.g. stroke or traumatic brain injury), the K<sub>v</sub>7 (KCNQ) family of voltage-gated potassium channels stands out as particularly promising. Several biophysical properties make K<sub>v</sub>7 channels well-suited for this role. They have activation voltage threshold near the resting membrane potential of many neurons, they do not inactivate and have slow activation and deactivation kinetics (Jones et al., <span>2021</span>). Owing to these characteristics, a fraction of K<sub>v</sub>7 channels remains conductive in a neuron at rest, controlling firing threshold and rheobase. Gradual increase of K<sub>v</sub>7 channel activity during sustained depolarization or continuous firing introduces self-tuning or ‘accommodation’ in firing patterns.</p><p>There are five K<sub>v</sub>7 subunits in mammals, K<sub>v</sub>7.1–K<sub>v</sub>7.5, and these are encoded by <i>KCNQ1</i>-<i>KCNQ5</i> genes. K<sub>v</sub>7.1 is mainly expressed in the cardiovascular system and epithelia, while K<sub>v</sub>7.2–K<sub>v</sub>7.5 are mostly neuronal, responsible for so-called M-type K<sup>+</sup> current in these cells (Jones et al., <span>2021</span>). Generic mutations causing loss of K<sub>v</sub>7 function often result in pathological hyperexcitability (epilepsies, cardiac arrhythmias and pain) (Jones et al., <span>2021</span>). Conversely, pharmacological activation or enhancement of K<sub>v</sub>7 activity is widely recognised therapeutic strategy for management of hyperexcitability symptoms. Two K<sub>v</sub>7 activators have been clinically used as a painkiller (flupirtine) and anticonvulsant (retigabine), and a number of other clinically used drugs may have K<sub>v</sub>7 activation among their mechanisms of action. These include painkillers, celecoxib (Du et al., <span>2011</span>) and paracetamol (Ray et al., <span>2019</span>) and a vasodilator, fasudil (Zhang et al., <span>2016</span>).</p><p>Although flupirtine and retigabine initially demonstrated clinical promise, both compounds were ultimately withdrawn from the market, mostly due to adverse effects. Retigabine was associated with blue skin discolouration, retinal pigmentation and urinary retention, while flupirtine carried a risk of hepatotoxicity. Current efforts in drug development are focused on identifying next-generation K<sub>v</sub>7 channel activators with superior pharmacological selectivity and safety. Yet, development of a new drug from scratch is a costly and time-consuming undertaking. In this context, screening libraries of already approved (or close to approval) drugs for potential repurposing represents a promising alternative strategy, offering the advantages of accelerated market entry and reduced development costs.</p><p>A new study by Lidia Carotenuto and co-authors, published in the British Journal of Pharmacology (Carotenuto et","PeriodicalId":9262,"journal":{"name":"British Journal of Pharmacology","volume":"183 3","pages":"435-437"},"PeriodicalIF":7.7,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://bpspubs.onlinelibrary.wiley.com/doi/epdf/10.1111/bph.70290","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145630316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}