A novel class of HIV-1 inhibitors that targets the viral envelope and inhibits CD4 receptor binding.

BMS-378806 is a prototype of a new class of small molecule HIV-1 inhibitors that blocks viral attachment to cells. This compound exhibits potent inhibitory activity against a panel of HIV-1 laboratory and clinical isolates (M- and T-tropic), selective for HIV-1 and inactive against HIV-2, SIV and a panel of other viruses. BMS-378806 exhibits no significant cytotoxicity and displays many attractive pharmacological properties such as low protein binding, minimal serum effect on anti-HIV-1 potency, good oral bioavailability in animal species and a clean safety profile in initial animal toxicology studies. The compound binds to gp120 and blocks the attachment of the HIV-1 envelope protein to cellular CD4 receptors via a specific and competitive mechanism. BMS-378806 binds directly to gp120 at an approximately 1:1 stoichiometry, with a binding affinity similar to that of soluble CD4. Further confirmation that this class of compounds targets the envelope in infected cells was obtained through the isolation of resistant variants and the mapping of resistance substitutions to the HIV-1 envelope. In particular, two substitutions, M426L and M475I, are situated at or near the CD4 binding pocket of gp120. Recombinant HIV-1 carrying these two substitutions demonstrated significantly reduced susceptibility to inhibition. Using these HIV-1 gp120 resistant variants and gp120/CD4 contact site mutants, the potential BMS-378806 target site was localized to a specific region within the CD4 binding pocket of gp120. Together, the data show that BMS-378806 is the first of a new class of HIV inhibitors with the potential to become a valued addition to our current repertoire of antiretroviral drugs.