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Eliminating hepatitis B by antagonizing cellular inhibitors of apoptosis.

Abstract
We have shown that cellular inhibitor of apoptosis proteins (cIAPs) impair clearance of hepatitis B virus (HBV) infection by preventing TNF-mediated killing/death of infected cells. A key question, with profound therapeutic implications, is whether this finding can be translated to the development of drugs that promote elimination of infected cells. Drug inhibitors of cIAPs were developed as cancer therapeutics to promote TNF-mediated tumor killing. These drugs are also known as Smac mimetics, because they mimic the action of the endogenous protein Smac/Diablo that antagonizes cIAP function. Here, we show using an immunocompetent mouse model of chronic HBV infection that birinapant and other Smac mimetics are able to rapidly reduce serum HBV DNA and serum HBV surface antigen, and they promote the elimination of hepatocytes containing HBV core antigen. The efficacy of Smac mimetics in treating HBV infection is dependent on their chemistry, host CD4(+) T cells, and TNF. Birinapant enhances the ability of entecavir, an antiviral nucleoside analog, to reduce viral DNA production in HBV-infected animals. These results indicate that birinapant and other Smac mimetics may have efficacy in treating HBV infection and perhaps, other intracellular infections.
AuthorsGregor Ebert, Cody Allison, Simon Preston, James Cooney, Jesse G Toe, Michael D Stutz, Samar Ojaimi, Nikola Baschuk, Ueli Nachbur, Joseph Torresi, John Silke, C Glenn Begley, Marc Pellegrini
JournalProceedings of the National Academy of Sciences of the United States of America (Proc Natl Acad Sci U S A) Vol. 112 Issue 18 Pg. 5803-8 (May 05 2015) ISSN: 1091-6490 [Electronic] United States
PMID25902530 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
Chemical References
  • Antiviral Agents
  • DNA, Viral
  • Dipeptides
  • Hepatitis B Surface Antigens
  • Indoles
  • Inhibitor of Apoptosis Proteins
  • entecavir
  • Guanine
  • birinapant
Topics
  • Animals
  • Antiviral Agents (pharmacology)
  • CD4-Positive T-Lymphocytes (cytology)
  • DNA, Viral (blood)
  • Dipeptides (pharmacology)
  • Disease Models, Animal
  • Guanine (analogs & derivatives, pharmacology)
  • Hepatitis B (drug therapy, metabolism)
  • Hepatitis B Surface Antigens (blood)
  • Hepatitis B virus
  • Hepatocytes (cytology, metabolism, virology)
  • Immunophenotyping
  • Indoles (pharmacology)
  • Inhibitor of Apoptosis Proteins (antagonists & inhibitors, metabolism)
  • Liver (metabolism)
  • Mice
  • Mice, Inbred C3H
  • Mice, Inbred C57BL
  • Microscopy, Electron, Scanning
  • Plasmids (metabolism)

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