AGENTS FOR THE PREVENTION AND TREATMENT OF SEXUALLY TRANSMITTED DISEASES-II FIELD OF THE INVENTION This invention relates to the prevention and treatment of sexually transmitted diseases, and in particular it relates to the use of a dendrimer having naphthyl disulphonate or naphthyl trisulphonate terminal groups as a topically applied agent in prophylaxis or therapeutic treatment of these diseases.

BACKGROUND OF THE INVENTION The global incidence, morbidity, and mortality of sexually transmitted diseases (STDs) caused by HIV, HSV, and other viral and microbial pathogens is estimated at several hundred millions individuals worldwide. One approach for the control the transmission of STDs is the use of topically applied, female/male-controlled vaginal, or rectal microbicides that inactivate the relevant pathogens. Consequently, the development of new, safe, topical microbicides for intravaginal or intrarectal use for the prevention and treatment of STDs is an important target for novel drug development.

International Patent Application Nos. PCT/AU95/00350 (WO 95/34595) and PCT/AU99/00763 (WO 00/15240), the contents of which are incorporated herein by reference, disclose a new class of polyvalent agents-the dendrimers, highly branched macromolecules with a definite envelope of polyanionic or cationic surface groups, which have been shown to exhibit a range of antiviral and antimicrobial activity with minimal toxicity. Unlike small molecular structures of most antivirals, these dendrimers are a class of polyvalent, highly branched macromolecular compounds formed by iterative reaction sequences starting from an initial core molecule with successive layers or stages being added in successive"generations"to build up a three-dimensional, highly ordered polymeric compound. Dendrimers are characterised by the following features: i. an initiator core which may have one or more reactive sites and be point-like or of significant size so as to effect the final topology of the dendrimer ; ii. layers of branched repeating units attached to the initiator core; iii. functional terminal groups (such as anionic-or

cationic-containing moieties) attached to the surface of the dendrimer, optionally through linking groups.

These macromolecular compounds are synthesised from monomeric building blocks with multiple branches or tree-like structures, and the outside surface of the molecule carries a number of functional groups that lead to recognition by a biological receptor.

In antiviral and antimicrobial testing, one of these dendrimer structures has unexpectedly shown exceptional activity against a broad spectrum of microorganisms associated with sexually transmitted diseases, that makes it an agent of choice for the development of a vaginal or rectal microbicide for the prophylaxis and treatment of sexually transmitted diseases.

SUMMARY OF THE INVENTION According to the present invention, there is provided a compound of the formula I : I wherein K represents L-lysyl ; and R represents a group of the formula II or a group of the formulaIII:

or a pharmaceutically acceptable salt thereof.

Suitable pharmaceutically acceptable base addition salts include, but are not limited to, metallic salts such as the aluminium, calcium, lithium, magnesium, potassium, sodium and zinc salts, as well as organic salts made from organic amines such as N, N'-dibenzyl- ethylenediamine, chloroprocaine, diethanolamine, ethylenediamine, dicyclohexylamine, meglumine (N-methylglucamine) and procaine, quaternary amines such as choline, and sulphonium and phosphonium salts.

Particularly preferred compounds of the present invention are the compounds referred to herein as SPL-7015 and SPL-7032, the structure of which consist of a polylysine branched (polymer) dendrimer scaffold synthesised by an iterative reaction from a benzhydrylamine core molecule with the active surface group consisting of 32 naphthyl di-or tri-sulphonic acid groups as sodium salts. Each of the naphthyl-disulphonate functional surface groups is

attached to the polylysine branched dendrimer scaffold with an amidocarboxy-ethylene- carboxyamido (or succinyl-diamido) linkage to the epsilon and alpha amino groups of the terminal 16 lysine groups.

The present invention also provides a topical pharmaceutical composition for prophylactic or therapeutic treatment of sexually transmitted diseases in a human patient, which comprises a compound of the formula I above or a pharmaceutically acceptable salt thereof, in association with at least one pharmaceutically acceptable, topical carrier or diluent.

In another aspect, the present invention also provides a method for the prophylactic or therapeutic treatment of sexually transmitted diseases in a human patient, which comprises topical administration to the patient of an effective amount of a compound of the formula I above or a pharmaceutically acceptable salt thereof.

In yet another aspect, the invention provides use of a compound of the formula I above or a pharmaceutically acceptable salt thereof in the manufacture of a medicament for topical administration in the prophylactic or therapeutic treatment of sexually transmitted diseases in a human patient.

DETAILED DESCRIPTION OF THE INVENTION Compounds of the formula I, and their pharmaceutically acceptable salts are novel compounds which have unexpectedly shown exceptional activity against a broad spectrum of pathogens associated with sexually transmitted diseases.

As described above, the compounds SPL-7015 and SPL-7032 are preferred compounds of the present invention, and have been found to exhibit significant antiviral activity, particularly against viral and microbial vectors of the most common sexually transmitted diseases.

SPL-7015 and SPL-7032 exhibits a broad-spectrum antiviral activity with high efficacy and minimal cell or animal toxicity against vectors of several of the most important vaginally or rectally sexually transmitted diseases. High activity has been determined against genital Herpes virus-2 (HSV-2) both in in vitro cell tests and in vivo in an animal (mouse) model test and in vitro cell tests against Herpes virus-1 (HSV-1) and Human Immunodeficiency viruses (HIV-1, and HIV-2). It has also been shown to be active against the causative agent of genital warts, Human Papillomavirus (HPV), and against the bacterial vector of non-specific urethritis, Chlaniydia trachoniatis. In cell tests, SPL-7015 and SPL-7032 have also shown activity against viral strains of Herpes virus-2 resistant to currently used modified nucleoside based antiviral agents. Furthermore SPL-7032 is active in CD4-dependant and CD4-independent HIV transmission assays, and was effective at preventing HIV-1 attachment and fusion. SPL-7032 has been shown not to inhibit the growth of various species of beneficial Lactobacillus. In addition SPL-7032 has been shown to be effective in the prevention of infection of human peripheral blood monocular cells (PBMCs) with either HIV-1 RoJo or SIV 89.6pd.

Accordingly, these compounds are useful in prophylaxis and therapeutic treatment of sexually transmitted diseases as a topical microbicide agent intended for application to the vaginal or rectal mucosa to protect against sexually transmitted infections.

The present invention also provides a topical pharmaceutical composition for prophylactic or therapeutic treatment of sexually transmitted disease in a human patient, which comprises a compound of formula I or salt thereof as described above, in association with at least one pharmaceutically acceptable, topical carrier or diluent.

The formulation of such compositions is well known to persons skilled in this field.

Suitable pharmaceutically acceptable carriers and/or diluents include any and all conventional solvents, dispersion media, fillers, solid carriers, aqueous solutions, coatings, antibacterial and anti fungal agents, isotonic, and absorption enhancing or delaying agents, activity enhancing or delaying agents and the like. The use of such media and agents for pharmaceutically active substances is well known in the art, and it is described, by way of example, in Remington's Phaf-frzaceutical Sciences, 18th Edition, Mack Publishing

Company, Pennsylvania, USA. Except insofar as any conventional carrier and/or diluent is incompatible with the active ingredient, use thereof in the pharmaceutical compositions of the present invention is contemplated. Supplementary active ingredients including agents having antiviral or antimicrobial activity can also be incorporated into the compositions of this invention.

It is especially advantageous to formulate compositions in dosage unit form for ease of administration and uniformity of dosage. Dosage unit form as used herein refers to physically discrete units suited as unitary dosages for the human subjects to be treated ; each unit containing a predetermined quantity of active ingredient calculated to produce the desired therapeutic effect in association with the required pharmaceutical carrier and/or diluent. The specifications for the novel dosage unit forms of the invention are dictated by and directly dependent on (a) the unique characteristics of the active ingredient and the particular therapeutic effect to be achieved, and (b) the limitations inherent in the art of compounding such an active ingredient for the particular treatment.

As previously described, the present invention also provides a method for the prophylactic or therapeutic treatment of sexually transmitted diseases in a human patient by topical administration to the patient of an effective amount of a compound of formula I or salt thereof as described above. In addition, the present invention provides the use of a compound of formula I or salt thereof as described above in the manufacture of a medicament for topical administration in such prophylactic or therapeutic treatment of sexually transmitted diseases.

A variety of topical administration routes are available. The particular mode selected will depend, of course, upon the particular condition being treated and the dosage required for prophylactic or therapeutic efficacy. The methods of this invention, generally speaking, may be practiced using any mode of administration that is medically acceptable, meaning any mode that produces prophylactic or therapeutic levels of the active component of the invention without causing clinically unacceptable adverse effects. Such modes of administration include the vaginal, rectal, and trans-dermal routes. Suitable formulations for topical, particularly vaginal or rectal, administration include solutions, suspensions, gels, lotions and creams as well as discrete units such as suppositories and

microencapsulated suspensions. Other delivery systems can include sustained release delivery systems which can provide for slow release of the active component of the invention, including sustained release gels, creams, suppositories, or capsules. Many types of sustained release delivery systems are available. These include, but are not limited to : (a) erosional systems in which the active component is contained within a matrix, and (b) diffusional systems in which the active component permeates at a controlled rate through a polymer.

The active component of the present invention is administered in prophylactically or therapeutically effective amounts. A prophylactically or therapeutically effective amount means that amount necessary at least partly to attain the desired effect, or to delay the onset of, inhibit the progression of, or halt altogether, the onset or progression of the particular condition being treated. Such amounts will depend, of course, on the particular condition being treated, the severity of the condition and individual patient parameters including age, physical condition, size, weight and concurrent treatment. These factors are well known to those of ordinary skill in the art and can be addressed with no more than routine experimentation. It is preferred generally that a maximum dose be used, that is, the highest safe dose according to sound medical judgment. It will be understood by those of ordinary skill in the art; however, that a lower dose or tolerable dose may be administered for medical reasons, psychological reasons or for virtually any other reasons.

Generally, at intervals to be determined by the prophylaxis or treatment of pathogenic states, intra-vaginal or intra-rectal doses of active component will be from about 0.01 mg/kg per day to 1000 mg/kg per day. Small doses (0.01-1 mg) may be administered initially, followed by increasing doses up to about 1000 mg/kg per day. In the event that the response in a subject is insufficient at such doses, even higher doses (or effective higher doses by a different, more localised delivery route) may be employed to the extent patient tolerance permits. Multiple doses per day can be contemplated to achieve appropriate systemic levels of compounds.

In a particularly preferred aspect, the present invention provides the use of SPL-7015 or SPL-7032 as a broad spectrum vaginal or rectal microbicide useful in the prevention and

treatment of viral and microbial sexually transmitted diseases. SPL-7015 and SPL-7032 are water soluble and can be used in solution, or formulated in a suitable vehicle in the form of gel, lotion, cream or suppository or microencapsulated suspension in aqueous or non-aqueous solvents, together with enhancers or delayers of its activity, agents for its enhanced or delayed absorption on topical application, or agents to enhance adhesion to vaginal/rectal epithelial or mucosal layers.

Throughout this specification and the claims which follow, unless the context requires otherwise, the word"comprise", or variations such as"comprises"or"comprising", will be understood to imply the inclusion of a stated step or steps or integer or group of integers but not the exclusion of any other step or steps or integer or group of integers.

Further features of the present invention will be apparent from the following Examples which are included by way of illustration, not limitation, of the invention.

EXAMPLE 1 A. PreparationofBHAlyslys21ys41ys81ysl6 TFA32 1. N, N'-Di-t-Boc-L-Lysine (DBL) L-Lysine. HCl (1.83kg; 10mol) was dissolved in a solution of sodium hydroxide (880g; 22mol) in water (201) and the resulting solution diluted with t-butanol (151). Di-t-butyl dicarbonate (4.48kg; 20.5mol) was then added dropwise over 1 hour during which time the reaction mixture became milky and warm (30-350C). The mixture was left to stir overnight to give a clear solution. The solution was extracted with petroleum (40-60°C) (2 X 101) and the organic phase extracted with sat. NaHC03 solution (3 X 41). The combined aqueous layers were cooled in an ice bath and acidified carefully to pH 2 with 1M KHS04 solution. The turbid mixture was then extracted with ether (4 X 161) and the combined organic layers washed with water (2 X 81), dried (MgS04) and concentrated with a bath temperature of <30° to give a quantitative yield of N, N'-di-t-Boc-L-Lysine as a very viscous oil.

2. N, N'-Di-t-Boc-L-Lysine 4-nitrophenyl ester (DBLONp)

A solution of dicyclohexylcarbodiimide (DCC) (2.06kg; 10mol) in ethyl acetate (51) was added dropwise to an ice-cold stirred solution of Di-t-Boc-L-lysine (DBL) (3.46kg; 1 Omol) and 4-nitrophenol (NpOH) (1. 39kg ; 10mol) in ethyl acetate (151) under nitrogen. After the addition was complete the mixture was allowed to warm to room temperature and stirred overnight. The resulting white suspension was then filtered and the filtrate concentrated to give a yellowish solid residue. The residue was recrystallised from ether to give N, N'-di-t- Boc-L-lysine 4-nitrophenyl ester as a white solid (yield ca. 60%). More of the product can later be isolated from the mother liquors.

3. BHAlys. 2HCl A solution of DCC (41.2g; 0.2mol) in dry dichloromethane (200ml) was added to an ice- cold solution of DBL (69.2g; 0.2mol) and benzhydrylamine (BHA) (36.65g; 0.2mol) in dichloromethane (600ml). The mixture was stirred at 0° for 30 minutes and then at room temperature for 3 hours. The resulting suspension was filtered and a tlc (pet. ether/EtOAc, 9: 1) of the filtrate showed no starting material. The filtrate was washed with 5% HC1, water, sat. NaHCO3 and water; then dried (MgS04) and concentrated to give a foam.

Trifluoroacetic acid (TFA) (400ml) was added to a stirred solution of the foam in dry dichloromethane (200ml) at room temperature. There was initially vigorous gas evolution which stopped after ca. 15 minutes; tlc (EtOAc) showed no starting material. The solution was stirred for an additional 2 hours and then concentrated to give a brownish oil. This oil was dissolved in dry acetonitrile (600ml) and a saturated solution of HC1 gas dissolved in absolute ethanol (ca. 360ml) added with swirling. A white solid soon began to crystallise and the mixture was left to stand for 1 hour at room temperature to complete crystallisation. The mixture was filtered and the solid washed with dry acetonitrile, then dried to give BHAlys. 2HCl as a white powder (yield ca. 80%).

4. BHAlyslys2Boc4 Triethylamine (39.5ml; 0.283mol) was added to a stirred solution of BHAlys. 2HCl (54.4g; 0.14mol) in dry DMF (300ml). A white suspension formed which was stirred for 15 minutes when DBLONp (262g; 0.56mol) was added. The mixture immediately became yellow and was stirred for 3 hours, maintaining the pH of the mixture at 8-9 by addition of triethylamine. The reaction mixture was then added slowly to a large volume of vigorously

stirred water and the mixture stirred overnight. The precipitate was collected by filtration and washed with water (3X) and dried to give a yellowish solid. This solid was powdered and then washed successively with ether until the ether showed no yellow colour on treatment with aqueous NaOH. The remaining solid was dried to give BHAlyslys2Boc4 as a white powder (yield ca. 70%).

5. BHAIyslys2lys4 Bocg Trifluoroacetic acid (600ml) was added to a solution of BHAlyslys2Boc4 (116g; 0.12mol) in dry dichloromethane (600ml) and there was an immediate vigorous evolution of gas.

The solution was stirred for 2 hours and the concentrated to give a viscous oil. This oil was dissolved in dry DMF (500ml) and the pH of the solution adjusted to 8-9 with triethylamine. DBLONp (460g; 0.99mol) was then added and the yellow solution stirred for 2 days at room temperature with periodic pH adjustment with triethylamine to maintain the pH above 8. The reaction was then precipitated into water and worked up as described above to give BHAlyslys2lys4Bocg as a white powder (yield ca. 100%).

6. BHAlyslys2lys4lys8Boc16 Trifluoroacetic acid (11) was added to a solution of BHAlyslys2lys4Bocg (200g; 0.106mol) in dry dichloromethane (11) and there was an immediate vigorous evolution of gas. The solution was stirred for 2 hours and the concentrated to give a viscous oil. This oil was dissolved in dry DMF and the pH of the solution adjusted to 8-9 with triethylamine.

DBLONp (782g; 1.67mol) was then added and the yellow solution stirred for 2 days at room temperature with periodic pH adjustment with triethylamine to maintain the pH above 8. The reaction was then precipitated into water and worked up as described above to give BHAlyslys2lys4lysgBocl6 as a white powder (yield ca. 100%).

7. BHAlyslys21ys41yss lysin Boc32 Trifluoroacetic acid (1. 61) was added to a mixture of BHAlyslys21ys4lysgBocl6 (300g; 0.081mol) in dry dichloromethane (800ml) and there was an immediate vigorous evolution of gas. The solution was stirred for 2 hours and the concentrated to give a viscous oil. This oil was dissolved in dry DMF (1.21) and the pH of the solution adjusted to 8-9 with

triethylamine. DBLONp (1030g; 2.21mol) was then added and the yellow solution stirred for 2 days at room temperature with periodic pH adjustment with triethylamine to maintain the pH above 8. The reaction was then precipitated into water and worked up as described above to give BHAlyslys2lys4lysglysl6Boc32 as a white powder (yield ca. 100%).

8. BHAlyslys2lys4lyssIysi6TFA32 Trifluoroacetic acid (168ml) was added in one portion to a suspension of the t- butyloxycarbonate (Boc) protected polylysine core BHAlyslys21ys41ysg1ys16Boc32 (20g) in dichloromethane (350ml) and the reaction was stirred for 14 hours at ambient temperature.

The reaction mixture was concentrated in vacuo, dissolved in H20 (200ml) and freeze dried to give BHAlyslys21ys41ys81ys16TFA32 (17. 5g, 83%) as an off-white solid.

B. Preparation of SPL 7032 and SPL7015 (i) BHA lyslys21ys41ysslysl6lNH-CO-CH2CH2COO Na] 32 BHA lyslys21ys41ysslysl6TFA32 was dissolved in DMF to prepare a 15% w/v solution and adjusted to pH8 with triethylamine. Succinic anhydride (1. 5eq per primary amino group on the dendrimer) was added in one portion and once dissolved, the pH of the reaction mixture was adjusted to 9 with triethylamine. The reaction was stirred for 14h at ambient temperature under a nitrogen atmosphere. The reaction mixture was diluted in 1 in 10 with Ha0 and pumped across a 5kD Pall Gelman ultrafiltration membrane. During the ultrafiltration process, NaHCO3 was added to the re-circulating solution. The bulk of the water was removed in vacuo and the remaining solution freeze dried to give the BHA lyslys21ys41ys8lysl6 [NH-CO-CH2CH2COO Na] 32 as a white solid in a 70% yield.

(ii) BHA lyslys2lys4lysslys16 [NH-CO-CH2CH2CONH-3, 6,8-Naphthyl-(SO3Na) 3] 32- SPL-7032 BHA lyslys2lys41ys81ys16 [NH-CO-CH2CH2CONa] 32 was dissolved in water to prepare a 5% w/v solution. Amino-naphthalene-3,6,8-trisulphonic acid (1. 5 eq per carboxylate on the dendrimer) was added in one portion and the pH of the solution adjusted to 4-5 by the addition of either 5% aqueous HCl or 1M NaOH as necessary. A solution of 1- (3-

dimethylaminopropyl)-3-ethylcarbodiimide hydrochloride (EDCI. HCI) (1. 5eq per carboxylate on the dendrimer) in water was added dropwise to the reaction mixture and the pH adjusted to 4-5 after the addition was complete. The reaction was stirred at ambient temperature with periodic monitoring of the pH to maintain it in the range 4-5. After 2 hours at ambient temperature a further portion of EDCI was added and again the pH was maintained between 4 and 5 during an additional 2h reaction period. Saturated aqueous NaHCO3 was added, the reaction stirred overnight and the reaction mixture was pumped across a lOkD Pall Gelman ultrafiltration membrane. The bulk of the water was removed in vacuo and the remaining solution ion-exchanged (IR120, Na form) and freeze dried to give SPL7032 as a white solid in a 85% yield.

(iii) BHA lyslys21ys41ys81ys16 [NH-CO-CH2CH2CONH-3, 6-Naphthyl- (S03Na)] 32- SPL 7015 Following the general method outlined in preparation of SPL 7032 the dendrimer SPL 7015 was prepared starting from 1-aminonapththalene-3, 6-disulphonic acid in a 93% yield.

EXAMPLE 2 Biological Activity of SPL 7015 and SPL7032 A. Activity Against Human Immunodeficiency Virus The human immunodeficiency virus strains used were HIV-1 (IIIB) L and HIV-2 (ROD) 2.

Anti-retroviral activity and cytotoxicity measurements were carried out in parallel. They were based on the viability of MT-4 cells that had been infected with HIV and then exposed to various concentrations of the test compounds. After the MT-4 cells were allowed to proliferate for 5 days, the number of viable cells was quantified by a tetrazolium-based colorimetric 3- (4, 5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) procedure in 96-well microtrays. 3 In all of these assays, viral input (viral multiplicity of infection, MOI) was 0.01, or 100 times the 50% cell culture infective dose (CCIDSo). The 50% antivirally inhibitory concentration (ECso) was defined as the compound concentration required to protect 50%

of the virus-infected cells against viral cytopathicity. The 50% cytotoxic concentration (CCso) was defined as the compound concentration required to reduce the viability of mock-infected cells by 50%. The > symbol is used to indicate the highest concentration at which the compounds were tested and still found non-cytotoxic. Average EC50 and CC50 values for several separate experiments are presented as defined above. As a rule, the individual values did not deviate by more than 2-fold up or down from the EC50 and CC50 values. SI is the antiviral selectivity index CC50/EC50.

Table. HIV Activity Compound Strain EC50 Rg/ml EC90 CC50 SI gg/ml R2/ml SPL-7015 IIIB 0.55 2.61 >125 >230 ROD 2.78 7. 39 >88 >40 SPL-7032 IIIB 0.48 2. 44 >125 >269 ROD 2.99 6.4 >88 >33 IIIB = HIV-1 ROD= HIV-2 EC90 = Effective concentration to reduce viral plaque 90%.

(i) Methods for the CD4-dependent and CD4-independent HIV Transmission Inhibition Assays, HIV Attachment and Fusion, and Inhibition of Lactobacillus sp.

Growth.

Cells and virllses : HIV-1IIIB, and the, HeLa CD4 LTR p-gal, GHOST X4/R5, and HL2/3 cell lines were obtained from the NIH AIDS Research and Reference Reagent Program (Bethesda, MD), and maintained as recommended. ME180 cells were obtained from the American Type Culture Collection (Manassas, VA).

Test Material Handling and Storage : Compounds are typically solubilized in 100% DMSO and stored at-80°C until tested, unless alternative solvents and storage conditions are specified by the sponsor. Frozen stocks are thawed at room temperature, pre-warmed for 15 min at 37°C and vortexed prior to preparation of working solutions in tissue culture medium. During all stages of

compound dilution and handling, compounds are protected from incidental light by opaque coverings and by storage and dilution in opaque or amber-colored tissue culture plastics.

Additionally, incidental room and laminar flow tissue culture hoods light exposure is controlled by reducing total fluorescent lighting in the laboratory by 50%. The final DMSO concentration is 0.25% at the highest test concentration.

CD4-Irldepefzclent HITI Transmission Inhibition Assay : ME180 cells, a CD4 negative, X4 positive cervical epithelial cell line is maintained in RPMI 1640 supplemented with 10% fetal bovine serum, glutamine and antibiotics.

Twenty-four h prior to the assay ME180 cells are trypsonized, washed and seeded in 96- well flat bottom microtiter plates at a density of 2 x 103 cells per well. On the day of the assay, H9 cells chronically infected with the SK1 clinical isolate of HIV-1 (H9-SK1) are treated with freshly made mitomycin C (200 pg/ml) for 60 minutes at 37°C. This concentration of mitomycin C is sufficient to result in cell death, but allows virus transmission to occur. After mitomycin C treatment the H9-SK1 cells are washed three times with tissue culture medium. Test compounds are added to the ME180 monolayer followed by 2 x 104 H9-SK1 cells. The ME180 cells are co-cultured with H9-SK-1 cells and test material for 4 h, and the H9-SK1 cells are removed by washing the ME180 monolayer three times with PBS. At 24 and 48 h post assay initiation the wells are again washed three times with PBS to ensure removal of the H9-SK1 cells, and culture continued in test material free media. At six days post-co-cultivation, supernatants are collected and evaluated for p24 antigen expression by ELISA. Cell viability is assessed by XTT dye reduction. Compounds which are judged as active in the first test are retested with or without the addition of mucin. Testing in the presence of mucin is carried out by addition of20011g/ml of porcine mucin (Sigma Chemical Co., St Louis, MO) to the transmission reactions. Transmission intervals and washing without replacement of mucin or compound are carried as described above. All determinations are performed in triplicate with serial l/2 Log, dilution of the test materials.

CD4-Dependent HIV Transmission Inhibition Assay : The CD4-independent HIV transmission inhibition assay is carried out essentially as described for the CD4-independent transmission assay except for the use of the CD4 positive GHOST (3) X4/R5 cell line. This cell line is derived from the HOS (human

osteosarcoma) cell line that is negative for HIV coreceptor and CD4 expression. The cell line is engineered to express T4 (CD4), R5 and X4 via non-selectable retroviral vectors and an HIV-2 LTR hGFP construct with a hygromycin selectable marker. The cell lines are handled and cultured as described above for the CD4-independent HIV inhibition assay, with the exception that 2.5 x 104 GHOST (3) X4/R5 and 5 x 102 mitomycin C treated H9/SK-1 cells are used in the assay. Addition of compounds, mitomycin C treatment and post-transmission washing to remove the H9/SK-1 cells are performed as described above to allow comparability of the two antiviral assays. Virus replication is assessed at 24 h post infection, following 3 washes, by measurement of cell-associated p24 by ELISA to ensure a single round of infection in the presence of CD4. Compound toxicity and cell viability are assessed by XTT dye reduction. Compounds which are judged as active in the first test are retested with or without the addition of mucin. Testing in the presence of mucin is carried out by addition of 200 pg/ml of porcine mucin (Sigma Chemical Co., St Louis, MO) in tissue culture medium to the transmission reactions. Transmission intervals and washing without replacement of mucin or compound are carried as described above. All determinations are performed in triplicate with serial l/2 Logl0 dilution of the test materials.

Lactobacillus Assay : Lactobacillus crispatzls and Lactobacillus jensenii were obtained from the American Type Tissue Culture Collection and grown in Lactobacilli MRS broth (Difco, Fisher Scientific, Pittsburgh, PA). This medium allows efficient growth of the Lactobacilli under anaerobic conditions. Bacillus stocks are produced and frozen in 15% glycerol at-80°C for use in the sensitivity assay. To assess the effect of compounds on L. crispatus and L. jensez growth, 10 ml of MRS media is inoculated with a stab from the glycerol bacterial stock.

The culture is placed in a Gas Pak CO2 bag and incubated for 24 h at 37°C. The next day the lactobacillus cultures are diluted to an OD of 0.06 at a wavelength of 670 nm.

Compounds are diluted and placed into a 96 well flat bottomed plate and the Lactobacillus sp. added. Commercially available Penicillin/Streptomycin solution at a high test concentration of 1.25 U/ml and 1.25 Rg/ml, respectively, are used as the positive control.

The plates are again incubated for 24 h at 37° C in a Gas Pak CO2 bag and bacterial growth determined by measurement of optical density at 490 nm in a molecular devices

plate reader. All determinations are performed with 6 1/2 log dilutions from a high test concentration in triplicate.

Virus Attachment Assay : This assay is designed to detect compounds that interact with the cell and block virus attachment, and/or compounds which interact with the forming attachment/fusion complex.

The attachment assay is performed with HeLa CD4 LTR (3-gal cells. HeLa CD4 LTR (3-gal cells are routinely cultured with the required selection antibiotics. Twenty-four h prior to initiation of the assay the cells are trypsinized, counted and 1 x 104 cells placed in a 0.2 cm well in media without selection antibiotics. At 24 h media is removed and compound in media placed on the cells and incubated for 15 min at 37°C. A known titer of the IIIB strain of HIV is then added to the wells and the incubation continued for 1 h. At the end of the incubation the wells are washed 3 times with media and the culture continued for 40 to 48 h. At termination of the assay, media is removed and p-galactosidase enzyme expression determined by chemiluminescence per manufacturers instructions (Tropix Gal- screenTM, Bedford Mass.) by a single step chemiluminescent method using a single solution to lyse the cells and detect p-galactosidase enzyme activity. Compound toxicity is monitored on a sister plate by XTT dye reduction. All determinations are performed in triplicate with serial 1/2 Logl0 dilution of the test materials. The virus adsorption interval of 1 h is sufficiently short that AZT, which requires phosphorylation to its active tri- phosphate form (AZT-TTP), is not active in this assay.

Fusion Assay : The fusion assay assesses the ability of compounds to block cell-to-cell fusion mediated by HIV-1 Env and CD4 expressed on separate cells. This assay is sensitive to inhibitors of both the gpl20/CD4 interaction and inhibitors of the X4 coreceptor. First, 5 x 103 HeLa CD4 LTR (3-gal cells are placed in microtiter wells and incubated overnight. The following day the media is removed and the HeLa CD4 LTR p-gal cells are incubated for 1 h at 37°C in fresh media with test compound. Following the incubation 5 x 103 HL2/3 cells are added and the incubation continued for 40 to 48 h. At 40 to 48 h P-galactosidase enzyme expression is detected by chemiluminescence (Tropix Gal-screenTM, Tropix, Bedford, MA). Compound toxicity is monitored on a sister plate using XTT dye reduction.

All determinations are performed in triplicate with serial l/2 Logl0 dilution of the test materials.

P24 Afatigen ELISA : ELISA kits are purchased from Coulter Electronics, and detection of supernate or cell- associated p24 antigen is performed according to the manufacturer's instructions. For cell- associated p24, cell lysates are produced by lysis of the well contents in 25 to 50 til of Coulter supplied virus lysis buffer, and assayed following 1 round of freeze/thaw. All p24 determinations are performed following serial dilution of the samples to ensure absorbances in the linear range of the standard p24 antigen curve. The standard curve is produced using manufacturer supplied standards and instructions. Data are obtained by spectrophotometric analysis at 450 nm using a Molecular Devices Vmax plate reader. Final concentrations are calculated from the optical density values using the Molecular Devices Soft Max software package and expressed in pg/ml p24 antigen.

XTTStai7çingfor Cell Viability and Con1pound Cyotoxicity : TC50 values for the test materials are derived by measuring the reduction of the tetrazolium dye XTT (2,3-bis (2-methoxy-4-nitro-5-sulfophenyl)-5-[(phenylamino) carbonyl]-2H- tetrazolium hydroxide) in replicate microtiter plates containing cell and compound without virus. XTT is metabolized by the mitochondrial enzyme NADPH oxidase in metabolically active cells to a soluble formazan product, allowing the rapid quantitative analysis cell viability and compound cytotoxicity. XTT solution is prepared daily as a stock of 1 mg/mL in PBS. Phenazine methosulfate (PMS) solution is prepared at 15 mg/mL in PBS and stored in the dark at-20°C. XTT/PMS stock is prepared immediately before use by diluting the PMS 1: 100 into PBS and adding 40 pL1 per mL of XTT solution. Fifty microliters of XTT/PMS are added to each well of the plate and the plate incubated for 4 h at 37°C. The 4 h incubation has been empirically determined to be within the linear response range for MTS dye reduction with the indicated numbers of cells for each assay.

Adhesive plate sealers are used in place of the lids, the sealed plate is inverted several times to mix the soluble formazan product and the plate is read at 450 nm with a Molecular Devices Vmax 96 well plate format spectrophotometer.

Data analysis Dextran sulfate (positive) and dextran (negative) are used as controls for the CD4- dependent and CD4-independent HIV transmission inhibition assays. The sulfonic acid dye Chicago Sky Blue is used as a positive control for the attachment and fusion assays. 4 Commercially available Penicillin (10, OOOU/ml) Streptomycin (10.0 mg/ml) solution is used as a positive control for the Lactobacillus sensitivity assay. For each compound, where appropriate, an ICso (concentration inhibiting virus replication or transmission by 50%), ID50 (concentration inhibiting 50% growth of Lactobacilli) TC50 (concentration resulting in a 50% reduction in cell viability) and a therapeutic index (TI: TC50/IC50or ID50) is calculated by linear regression.

RESULTS OF THE CD4-DEPENDENT AND CD4-INDEPENDENT HIV TRANSMISSION INHIBITION ASSAYS CD4-Independent CD4-Dependent Transmission Assay Transmission Assay (units) (units) Exp Compound Mucin IC50 TC50 TI IC50 TC50 TI Comments .# Dextran 1 - 1.1 >50 >46 0.158 >50 >316 Control Sulfate 2 + 0.16 >50 >309 0.158 >50 >316 compound Dextran 1 - >100 >100 - >100 >100 - Control 2 + >100 >100 - >100 >100 - compound SPL-7032 1-3. 2 >100 >31 0.413 >100 >242 2 + 1.0 >100 >100 0.25 >100 >316

Results of the Lactobacillus sp. Testing Compound Units L. crispatus (ID50) L jenseiaii (ID50) Comments Penicillin/ Control Dilution1 1:150,00 1:180,000 Streptomycin Compound SPL-7032, ug/ml >50 >50

1 The starting concentrations of Penicillin and Streptomycin are 1.25 U/ml and 1.25 g/ml, respectively.

Inhibition of HIV Virus Attachment and Fusion Attachment Assay /ml Fusion Assay (g/ml) Compound ICso TCgo TI ICgo TCgo TIComments Chicago Sky 0.38 >10 >26 0.70 >100 >143 Control compound, Blue Average 2 experiments SPL-7032 0.32 >50 >156 0.52 >50 >96 High test at 50 due to limited compound

(ii) Activity of SPL-7032 Against HIV-1 RoJo and SIV 89.6pd METHODS Viruses Human immunodeficiency virus type 1 (HIV-1) strain RoJo is a low passage pediatric isolate derived in the laboratories of Southern Research Institute (SRI). The SHIV89.6pd was obtained from Mark Lewis at SRI and stocks grown in human PBMCs for antiviral testing.

PBMC Isolation and Blasting : Peripheral blood monocular cells (PBMCs) were obtained from normal hepatitis and HIV-1 negative donors by ficoll hypaque gradient separation. Briefly, anti-coagulated blood was diluted 1: 1 with Dulbecco's phosphate buffered saline without Ca++ and Mg++ (PBS) and layered over 14 mL of Lymphocyte separation media in a 50 ml centrifuge tube.

Tubes were then centrifuged for 30 minutes at 600 X g. Banded PBLs were gently aspirated from the resulting interface and subsequently washed 2X with PBS by low speed centrifugation. The mononuclear cells were counted, viability determined by Trypan Blue dye exclusion and resuspended in RPMI 1640 medium supplemented with 15 % FBS (heat inactivated), 2 mM L-glutamine, 100 U/mL penicillin, 100 µg/mL streptomycin, and 10 llg/mL gentamycin with 2 Rg/mL phytohemagluttin (PHA) at 1 X 106 cells/mL. The cells were cultured for 48 to 72 h at 37°C, 5% CO2. Following incubation, cells were collected by centrifugation, washed and resuspended in RPMI 1640 supplemented with 15 % FBS (heat inactivated), 2 mM L-glutamine, 100 U/mL penicillin, 100 pg/mL skeptomycin, and

10 llg/mL gentamycin with 20 U/mL recombinant IL-2 (R & D Systems, Minneapolis, MN). IL-2 was included in the culture medium to maintain the cell division-initiated by the PHA mitogenic stimulation. The cells were cultured in IL-2 for 72 hours and then used for viral challenge.

PBMC Assay : Human peripheral blood mononuclear cells from a minimum of 2 donors, that have been blasted with PHA and IL-2, were counted, viability determined by Trypan Blue dye exclusion and mixed in equal ratios. Pooled donors were used to minimize the variability observed between individual donors which results from quantitative and qualitative differences in HIV infection and overall response to the PHA and IL-2 of primary lymphocyte populations. The cells were resuspended at 1 x 106 cells/mL in RPMI 1640 without phenol red supplemented with 15% Fetal Bovine Serum (heat inactivated), 2 mM L-glutamine, 100 U/mL penicillin, 100 llg/mL streptomycin, 10 llg/mL gentamycin and IL-2 (20 U/mL, R&D Systems, Minneapolis, MN). Fifty microliters of cells were then distributed to the inner 60 wells of a 96 well round bottom microtiter culture plate in a standard format developed by the Infectious Disease Research department of Southern Research Institute. Each plate contains cell control wells (cells only), virus control wells (cells plus virus), and experimental wells (drug plus cells plus virus). Serially diluted compounds are added to the microtiter plate followed by the appropriate pre-titered strain of HIV-1 or SHIV-1. All samples were assayed in triplicate with a replicate plate without virus for the determination of compound toxicity. The final volume per well was 200, uL.

The assay was incubated for 6 days in a humidified atmosphere at 37°C, 5% CO2, after which supernatants were collected, for analysis of RT activity and sister plates analyzed for cell viability by MTS dye reduction. Wells were also examined microscopically and any abnormalities noted.

MTS staining for cell viability : At assay termination the assay plates were stained with the soluble tetrazolium- based dye MTS (CellTiter Reagent Promega, Madison, WI) to determined cell viability and quantify compound toxicity. MTS is metabolized by the mitochondria enzymes of metabolically active cells to a soluble formazan product, allowing the rapid quantitative

analysis of cell viability and compound cytotoxicity. This reagent is a single stable solution that does not require preparation before use. At termination of the PBMC assay 20 u. L of MTS reagent was added per well, and the wells are incubated for 4 h at 37°C. T Adhesive plate sealers were used in place of the lids, the sealed plate was inverted several times to mix the soluble formazan product and the plate was read spectrophotometrically at 490 nm with a Molecular Devices Vmax plate reader.

Reverse Transcriptase Assay : Reverse transcriptase activity was measured in cell-free supernatants. Tritiated thymidine triphosphate (NEN) (TTP) was resuspended in distilled H20 at 5 Ci/mL. Poly rA and oligo dT were prepared as a stock solution which was kept at-20°C. The RT reaction buffer was prepared fresh on a daily basis and consists of 125 I1L 1.0 M EGTA, 125 pL dH20,110 L 10% SDS, 50 uL 1.0 M Tris (pH 7.4), 50 I1L 1.0 M DTT, and 40 I1L 1. 0 M MgC12. These three solutions were mixed together in a ratio of 2 parts TTP, 1 part poly rA : oligo dT, and 1 part reaction buffer. Ten microliters of this reaction mixture was placed in a round bottom microtiter plate and 15 IAL of virus containing supernatant was added and mixed. The plate was incubated at 37°C in a water bath with a solid support to prevent submersion of the plate and incubated for 60 minutes. Following reaction, the reaction volume was spotted onto pieces of DE81 paper, washed 5 times for 5 minutes each in a 5% sodium phosphate buffer, 2 times for 1 minute each in distilled water, 2 times for 1 minute each in 70% ethanol, and then dried. Opti-Fluor O was added to each sample and incorporated radioactivity was quantitated utilizing a Wallac 1450 Microbetaplus liquid scintillation counter.

Data Analysis : IC 50 (50%, inhibition of virus replication), TC50 (50% reduction in cell viability) and a therapeutic index (TI, ICso/TCSo) are provided. AZT has been used as a relevant positive control compound for the individual assays.

Results The results of the antiviral evaluations performed are summarized in the following Table: Summary of the Antiviral Activity of SPL-7032 in PBMCs HIV-1 RoJo Infected PBMCs SHIV 89.6pd Infected PBMCs Compound (Rg/ml) (Rg/ml) IC50 TC50 TI IC50 TC50 TI SPL-7032 6. 5 >100 >15. 5 0. 05 >100 >2000 AZT (tam) 0.005 >1 >200 0. 002 >1 >500

B. Activity Against Herpesviruses-HSV-1 and HSV-2 (i) Virus plaque reduction assay General Method HSV standard strains G (HSV-2) and F (HSV-1) were used in the tests. Virus input for a 6- well plate was 100 pfu/well. HSV susceptible cell line, Vero cells, were used in the virus yield reduction assay. For cytotoxicity test, an epithelial cell line, Hela-229 cells, was employed.

The antiviral effects of SPL-7015 and SPL-7032 were determined by modified plaque reduction assay. Confluent cells were washed with PBS and subsequently infected with HSV (100 pfu/well) for 1 h at 37°C and tilting every 10 min. After viral inoculum was removed, infected cells were washed with PBS and overlaid with 0.5% methylcellulose in culture medium (equal volume of 1% methylcellulose mixed with 2 x culture medium).

The cells were incubated at 37°C for 2 days for HSV-2 infection and 3 days for HSV-1.

When plaque size was adequate, the cells were fixed with 10% formalin for 10 min. The plaques were subsequently stained with 0.5% crystal violet for 10 min. The dye was removed by washing with tap water and left to dry in a fume hood. The plaques were then counted.

All data were generated from duplicate experiments. Mean plaque counts in test wells were compared with mean plaque counts in control wells.

ECso's (concentrations giving a 50% reduction in the plaque count of the inoculum) were calculated. Anti-viral activities and cytotoxicity measurements were carried out in parallel in the same strain of cells. The 50% cytotoxic concentration (CC50) was defined as the compound concentration required to reduce the viability of mock-infected cells by 50%.

Pre-infection treatment method Culture medium was removed from confluent Vero cells in 6-well plate. and washed with 1 ml of PBS. 1 ml culture medium containing SPL-7013 at concentration of 0, 0.01,0.03, 0.1,0.3,1,3,10, and 30 llg/ml was added to each well and incubated at 37°C for 1 h.

Following pre-incubation of the cells with dendrimer, the cells were then infected with 100 pfu/well of either HSV-1 or HSV-2. The infections were incubated at 37°C for 1 h with tilting every 10 min. After the inoculum was removed, the infected cells were covered with 1.5 ml of 0.5% methylcellulose diluted with 2 x culture medium for plaque assay.

Treatment of Infected Cells Confluent Vero cells were washed with PBS. The cells were then infected with 100 pfu/well of either HSV-1 or-2 at 37°C for 1 h. Following removal of viral inoculum, the infected cells were washed once with PBS and covered with 0.5% methylcellulose containing dendrimer at concentrations of 0, 0.03,0.1,0.3,1,3,10,30, and 100 u. g/ml.

The cells were incubated at 37°C for 2 (HSV-2) or 3 (HSV-1) days for plaque assay.

Cytotoxicity of dendrimer Culture medium was removed from confluent Hela-229 cells in 24-well plates by pump.

The cells were then washed once with I ml of PBS. 1 ml culture medium containing dendrimers at concentrations of 0, 100,500, and 1000 pg/ml was added to each well. The cells were incubated at 37°C incubator for 2 days. At end of incubation, the medium was removed and the cells washed with PBS. 500 ttl of 0.01% neutral red (in PBS) was subsequently added to each well, and incubated at 37°C for 30 min. The dye was then removed and the cells washed twice with 1 ml PBS per well. The dye was extracted by addition of 500 1ll of 50 % ethanol and 1 % glacial acetic acid in PBS to each well and

incubated at room temperature for 15 min with gentle shaking at 120-150 rpm. 100 p1 extracted dye from each well was put into 96-well plate and the absorbance at 550 nm was read on an ELISA reader.

Table of Activity Against HSV-1 and HSV-2 Compound Treatment ECsog/ml) CCgog/ml) SPL-7015 PT/HSV-2 0.53 >1000 PT/HSV-1 0.83 >1000 INF/HSV-2 10. 41 >1000 INF/HSV-1 4. 46 >1000 SPL-7032PT/HSV-2Oj58>1000 PT/HSV-1 0.54 >1000 INF/HSV-2 2. 66 >1000 INF/HSV-1 3.93 >1000

PT = Pre-infection treatment INF = Treatment of infected cells.

(ii) Herpes Virus-2. Efficacy in an Animal Model The efficacy of SPL-7015 and SPL-7032 were tested in a genital HSV prevention test in the mouse (strain MS) model. A dose of 15 1ll of 100 mg/ml, or lOmg/ml of the compound was instilled into the vagina of 16 animals 20 sec before HSV-2 infection. SPL-7015 and SPL-7032 prevented infection and disease in all animals tested compared to controls. Total mortality in three days of the same number of control infected mice was used as an end- point of the tests.

Table of HSV-2 genital tract infection and disease treatment in the mouse

Compound Concentration Number Animals Protected Against Animals Disease (%) Infection (%) Animals SPL-7015 100 12 9/12 (75%) 8/12 (67%) 100 16 15/16 (94%) 15/16 (94%) SPL-7032 100 12 11/12 (92%) 11/12 (92%) 100 16 16/16 (100%) 15116 (94%) PBSControl 12 0/12 (0%) 0/12 (0%) All animals treated 20 sec. prior to infection.

C. Human Papillomavirus (HPV). Inhibition of Human Epithelial Cell Uptake.

SPL-7015 was evaluated for its ability to inhibit the binding and uptake of human papillomavirus virus-like particles to a human epithelial cell line.

The compound was tested at a range of six dilutions as inhibitor of binding and of uptake of Papillomavirus fluorochrome-tagged Virus-Like-Particles (VLPs) of human papillomavirus type 6b. The VLPs was allowed to bind and to be taken up into the epithelial cells in the presence of SPL-7015. Assay of binding and uptake was determined using flow cytometry and inhibition of binding was reported as a percentage with respect to the binding observed in the absence of inhibitor. The tests were performed in two independent assays Methods Cells. The human epidermoid carcinoma cell line A431 was purchased from the American Type Culture Collection at passage 30 (CRL-1555, Batch F-13530) and maintained in DMEM in 10% FCS.

Human papillomavirus type 6b VLPs were grown and purified according to standard operating procedures. Particles were labelled with a fluorochrome.

The compound was re-dissolved in sterile water to the concentrations of 5 mM and used fresh for the first assay before being frozen at-20°C. It was then thawed for the second assay.

Uptake Assay.

A T75 flask of A431 cells was washed with 10ml of PBS/EDTA (0.05%) for 5 minutes at 37°C before being treated with 2ml trypsin for a further 5 minutes at 37°C. DMEM/10% FCS (10ml) was added to cells, the cells centrifuged atlOOOx g for 5 minutes at RT, and re- suspended in full media at 3x105 cells/ml in al5ml tube. Cell were incubated at 37°C for 2 hours with inversion every 20 minutes so as to allow re-expression of cell surface proteins.

Cells were centrifuged at 100xg for 5 minutes at RT, and re-suspended in serum-free DMEM at 3x105 cells/100, L and 100 I1L of suspension was placed in an 1. 5ml, tube.

Compound was added to cells at the following six dilutions in lOuL ofPBS : 100 uM 10µM, 1.0µM, 100nM, 10nM, l. OnM.

Cells were incubated with compound for 30 min at 37°C before labelled VLPs (200ng) were added. As a positive control VLPs only, were added to cells and the negative control was cells with VLPs added but incubated on ice. The cells were mixed and incubate at 37°C for 2 hours. Cells were washed once with 1 ml PBS and fixed in FACS buffer (P13S/4% paraformaldehyde). Analysis was carried out on a Coulter FACS machine.

Analysis.

Results were analysed using WinLisT. Initially forward/side scatter were used to analyse cell size and live cells were gated. The mean fluorescent intensities (MFI) of this gate was generated and used for further analyses. Uptake was reported as the percentage with respect to the binding observed for VLPs alone (100%) verses cells with VLPs incubated on ice (0%).

Results SPL-7015. Maximal inhibition of uptake (15% uptake) was observed at the highest concentration tested (loom) with increasing viral uptake occurring as the concentration of 7015 decreased. Compound 7015 was the best blocker at the InM level.

D. Clalamydia trachomatis infection. Efficacy of SPL-7015 and SPL-7032 in an Animal Model.

Female mice (strain MS) were treated either in the upper or the lower genital tract with a 15pLL instillation of lOOmg/mL solution of SPL-7015 or SPL-7032,20 sec prior to infection with C. trachomatis. Lower genital tract infection is defined by isolation of the organism by culture from vaginal swab samples collected on days 3 or 6 post challenge. For upper genital tract infection the definition is isolation of the organism by culture from the upper genital tract tissue harvested on day 10 post challenge. Phosphate buffer PBS treated mice were used as controls.

Effects on C. trachomatis Genital Tract Infection in Mice Animals Protected Against Infection Group No. Animals Time Lower Upper Tract (%) Trace (5) Group 1 SPL-7032 100 mg/ml 16-20sec 5 (32%) 1 (6%) PBS 16-20 sec 1 (7%) 1 (6%) SPL-7015 100 mg/ml 16-20 sec 9 (56%) 9 (56%) PBS 16-20 sec 3 (19%) 3 (19%) Persons skilled in this art will appreciate that variations and modifications may be made to the invention as broadly described herein, other than those specifically described without departing from the spirit and scope of the invention. It is to be understood that this invention extends to include all such variations and modifications.

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Molecular cloning and polymorphism of the human immunodeficiency virus type 2. Nature 1986,324,691-695.

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