The entry inhibitor DS003 (BMS-599793): a BMS-806 analogue, provides superior activity as a pre-exposure prophylaxis candidate

Objective: Small molecule inhibitors able to bind to gp120 and prevent CD4(+)-induced HIV-1 envelope conformational change provide an important class of inhibitors. Currently, only Fostemsavir is approved for HAART, which makes this class of inhibitors attractive candidates for prevention. We assessed the activity of DS003 (BMS-599793), an analogue of BMS-378806, in different mucosal tissues and elucidated its mechanism of action. Design: Preclinical analysis was performed with human mucosal tissue models as surrogates of in-vivo activity. Methods: Antiviral efficacy of DS003 was assessed in mucosal tissue explants (ecto-cervical, penile and colorectal) and in trans-infection models (co-cultures of dendritic or mucosal migratory cells with CD4(+) T cells) with several dosing times (2, 24 h and sustained) and in combination with a fusion inhibitor. Binding of DS003 to gp120 was assessed by flow cytometry and bio-layer interferometry and further probed in competitive studies using soluble CD4(+) (sCD4(+)) and an anti-CD4(+) induced antibody, 17b. Results: In all models, the inhibitory activity of DS003 was increased with longer periods of exposure and by combination with a fusion inhibitor. Pre-exposure to sCD4(+) impeded DS003 binding to viral envelope. In contrast, DS003 did not impact subsequent binding of sCD4(+). Furthermore, sCD4(+)-induced epitope exposure as assessed by 17b binding was significantly reduced in the presence of DS003. Conclusion: DS003 inhibits HIV-1 infection by binding to or near the CD4(+) binding site of gp120, preventing CD4(+)-induced conformational change essential for viral fusion. These data highlight the potential of DS003 for development as a pre-exposure prophylaxis candidate.