ᓫᇛᏛ ༤ኈㄽᩥ
ᢠ
HBV
⸆ࢆ┠ᣦࡋࡓ᪂つ
4 ′
ಟ㣭ࢾࢡࣞ࢜ࢩࢻㄏᑟయࡢ タィྜᡂDesign and synthesis of novel
4′-modified nucleoside analogues as anti-HBV drugs
௧ඖᖺᗘ
㨣ሯ ࿃
┠
┠ ḟ
➨㸯❶ ⥴ ㄽ
➨㸯⠇
B
ᆺ ⫢ ⅖➨㸯㡯
HBV
ឤ ᰁ... ... 1
➨㸰㡯
HBV
ឤ ᰁ ᚋ ࡢ ⮬ ↛ ⤒ 㐣... ... 2
➨㸱㡯
HBV
ឤ ᰁ ⒪... ... 4
➨㸰⠇
HBV
➨㸯㡯HBV
ࡢ ࣛ ࣇ ࢧ ࢡ ࣝ... 6
➨㸰㡯 ⸆ ⪏ ᛶ
HBV... 8
➨㸱⠇
NAs
➨㸯㡯 ⌧ ᅾ ᢎ ㄆ ࡉ ࢀ ࡚ ࠸ ࡿNAs
ࡢ ≉ ᚩ... 9
➨㸰㡯
4′-
⨨ NAs... 11
➨㸱㡯
4′-
⨨ NAs
ࡢ ❧ య 㓄 ᗙ... ... 14
➨㸲㡯 ᢠ
HBV
ά ᛶ ࢆ ᭷ ࡍ ࡿ4′-
⨨ NAs... 15
➨㸰❶
4′ -
ࢪ ࢻ-5-
࣓ ࢳ ࣝ-4-
⨨ ࣆ ࣜ ࣑ ࢪ ࣥ ࢾ ࢡ ࣞ ࢜ ࢩ ࢻ 㛵 ࡍ ࡿ ᳨ ウ ➨㸯⠇ ᗎ... ... 17
➨㸰⠇
4′ - ࢪ ࢻ -5-࣓ ࢳ ࣝ -4-⨨ ࣆ ࣜ ࣑ ࢪ ࣥ ࢾ ࢡ ࣞ ࢜ ࢩ ࢻ ࡢ
ྜ ᡂ... 19
➨㸱⠇
4′ - ࢪ ࢻ -5-࣓ ࢳ ࣝ -4-⨨ ࣆ ࣜ ࣑ ࢪ ࣥ ࢾ ࢡ ࣞ ࢜ ࢩ ࢻ ࡢ
ᢠHBV
ά ᛶ ཬ ࡧ ⣽ ⬊ ẘ ᛶ ホ ౯... 22
➨㸲⠇ ⪃ ᐹ
... .... 23
➨㸱❶
4′ -
⨨ ࢯ ࢾ ࢡ ࣞ ࢜ ࢩ ࢻ 㛵 ࡍ ࡿ ᳨ ウ ➨㸯⠇ ᗎ... ... 24
➨㸰⠇
4′ -⨨ ࢯ ࢾ ࢡ ࣞ ࢜ ࢩ ࢻ ࡢ ྜ ᡂ 㛵 ࡍ ࡿ ᳨ ウ
➨㸯㡯4′-
⨨ ࢯ ࢾ ࢡ ࣞ ࢜ ࢩ ࢻ ࡢ ྜ ᡂ ィ ⏬... 27
➨㸰㡯
4′-
࢚ ࢳ ࢽ ࣝ- 3′-
࢚ ࢟ ࢯ ࣓ ࢳ ࣞ ࣥ ࢯ ࢪ ࢹ ࢜ ࢟ ࢩ ࢢ ࣀ ࢩ ࣥࡢ ྜ ᡂ
... ... 27
➨㸱㡯
4′-
ࢩ ࣀ ࢯ ࢪ ࢹ ࢜ ࢟ ࢩ ࢹ ࣀ ࢩ ࣥ ࡢ ྜ ᡂ... 30
➨㸲㡯
2-
࣑ ࣀ- 4′-
ࢩ ࣀ ࢯ ࢪ ࢹ ࢜ ࢟ ࢩ ࢹ ࣀ ࢩ ࣥ ࡢ ྜ ᡂ... 33
➨㸳㡯
4′-
ࢩ ࣀ ࢯ ࢪ ࢹ ࢜ ࢟ ࢩ ࢹ ࣀ ࢩ ࣥ ࣜ ࣥ 㓟 ࣉ ࣟ ࢻ ࣛ ࢵ ࢢࡢ ྜ ᡂ
... ... 34
➨㸱⠇
4′ -⨨ ࢯ ࢾ ࢡ ࣞ ࢜ ࢩ ࢻ ࡢ ᢠ ࢘ ࣝ ࢫ ά ᛶ ཬ ࡧ
⣽ ⬊ ẘ ᛶ ホ ౯
... ... 35
➨㸲⠇ ⪃ ᐹ
... .. 36
➨㸲❶ ⥲ ᣓ
... .. 39
ㅰ ㎡
... ... 41
ᐇ 㦂 ࡢ 㒊
... . 43
ཧ ⪃ ᩥ ⊩
... 71
␎
␎ ㄒ ⾲
[A]
Ac : acetyl ADV : Adefovir
AIBN : 2,2 ′-azobis (isobutyronitrile)
APCI : atmospheric aressure chemical ionization
aq : aqua
AZT : 3′ -azido-3′ -dehydroxythymidine [B]
Bz : benzoyl
[C]
calcd. : calculated
cccDNA : covalently closed circular DNA CC
5 0: 50% cytotoxic concentration CDI : 1,1 ′-carbonyldiimidazole [D]
dATP : 2′ -deoxy adenosine triphosphate DABCO : 1,4-diazabicyclo [2.2.2] octane DBU : 1,8-diazabicyclo [5.4.0] undec-7-ene DCM : dichloromethane
dCTP : 2′ -deoxy cytidine triphosphate ddC : 2′,3′-dideoxycytidine
ddI : 2′,3′-dideoxyinosine
DDQ : 2,3-dichloro-5,6-dicyano-p -benzoquinone dGTP : 2′ -deoxy guanosine triphosphate
DIAD : diisopropyl azodicarboxylate DMAP : N ,N-dimethyl-4-aminopyridine DMF : N ,N-dimethylformamide
DMP : Dess-Martin periodinane DMSO : dimethyl sulfoxide DMTr : 4,4 ′-dimethoxytrityl
d4T : 2′,3′-didehydro- 2′-deoxythymidine
[E]
EC
5 0: half maximal (50%) effective concentration
EDC : 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide ESI : electrospray ionization
Et : ethyl
ETV : Entecavir [H]
HBe : hepatitis B virus envelope HBs : hepatitis B virus surface HBV : hepatitis B virus
HCV : hepatitis C virus
HIV : human immunodeficiency virus [I]
IFN : interferon
isoddA : 2′,3′-dideoxy isoadenosine [L]
LAM : Lamivudine LP : lone pair [M]
m CBA : m -chlorobenzoic acid
m CPBA : m -chloroperoxybenzoic acid Me : methyl
mRNA : messenger RNA MS 3A : molecular sieve 3
ύMS : mass spectrometry
MTT : 3-(4,5-di-methylthiazol-2-yl)-2,5-diphenyltetrazolium bromide [N]
Nap : (2-naphthalenyl) methyl NAs : nucleoside analogues n -BuLi : n -butyllithium
NMR : nuclear magnetic resonance nor-AZADO : 9-azanoradamantane-N -oxyl
NTCP : Na
+-taurocholate cotransporting polypeptide
[P]
PCR : polymerase chain reaction pgRNA : pregenomicRNA
PMB : p -methoxybenzyl PPh
3: triphenylphosphine PTSA : p -toluenesulfonic acid [Q]
QOL : quality of life [R]
rcDNA : relaxed circular DNA [T]
TAF : Tenofovir alafenamide
TBAF : tetrabutylammonium fluoride
TBA-HS : tetrabutylammonium hydrogen sulfate TBDPS : tert -butyldiphenylsilyl
TBS : tert -butyldimethylsilyl
TCDI : 1,1 ′-thiocarbonyldiimidazole TCID
5 0: tissue culture infectious dose 50%
TDF : Tenofovir disoproxyl TEA : triethylamine
TFA : trifluoroacetic acid THF : tetrahydrofuran TIPS : triisopropylsilyl
TTP : thymidine triphosphate
1
➨
1❶ ⥴
⥴ ㄽ➨
1⠇ B
ᆺ ⫢ ⅖➨
1
㡯HBV
ឤ ᰁHBV (B
ᆺ ⫢ ⅖ ࢘ ࣝ ࢫ)
ࡢ ឤ ᰁ ⪅ ᩘ ࡣ ୡ ⏺ ࡛ ⣙2
൨5,700
ே ࠸ ࡿ ᥎ ᐃ ࡉ ࢀ ࡚ ࠾ ࡾ,
[ 1 ] ᮏ 㑥 ࡛ ࡣ ே ཱྀ ࡢ ⣙1%
ࡀ ឤ ᰁ ࡋ ࡚ ࠸ ࡿ ⪃ ࠼ ࡽ ࢀ ࡚ ࠸ࡿ
.
[ 2 ]HBV
ឤ ᰁ ࡋ,
៏ ᛶ ⫢ ⅖ ࢆ ᘬ ࡁ ㉳ ࡇ ࡋ ࡓ ሙ ྜ,
⫢ ◳ ኚ ࡸ ⫢ ࡀ ࢇ 㐍 ᒎ ࡍ ࡿ ࡇ ࡀ ▱ ࡽ ࢀ
, 2010
ᖺ ࠾ ࡅ ࡿ ୡ ⏺ ࡢ ⫢ ࡀ ࢇ ࡢ ⣙ ༙ ᩘ ࡣHBV
ឤ ᰁ ㉳ ᅉ ࡋ ࡚ ࠸ ࡿ ࡇ ࡀ ሗ ࿌ ࡉ ࢀ ࡓ.
[ 3 ] ࡉ ࡽ , 2015
ᖺ ࡣ ୡ ⏺ ࡛887,000
ே ࡀ
B
ᆺ ⫢ ⅖ ࡢ ྜ ే ࡼ ࡗ ࡚ Ṛ ஸ ࡋ ࡚ ࠸ ࡿ ࡇ ࡀ ሗ ࿌ ࡉ ࢀ ࡓ.
[ 1 ] ≉ ,
ࣇ ࣜ ࢝ ࡸ ༡ ⡿
,
᪥ ᮏ ࢆ 㝖 ࡃ ࢪ ࡛ ࡣ 㧗 ࠸ ᭷ ⋡ ࡀ ☜ ㄆ ࡉ ࢀ ࡚ ࠾ ࡾ, HBV
ឤ ᰁ ᑐ ⟇ ࡣ ୡ ⏺ ⓗ ࡞ ㄢ 㢟 ࡞ ࡗ ࡚ ࠸ ࡿ.
[ 4 ]HBV
ࡢ ឤ ᰁ ⤒ ㊰ ࡣ ឤ ᰁ ⪅ ࡢ ⾑ ᾮ ࡸ ⢭ ᾮ ࡢ ᥋ ゐ ࡛ ࠶ ࡾ,
ฟ ⏘ ࡼ ࡿ ᆶ ┤ ឤ ᰁ ᛶ ΅ ࡸ ㍺ ⾑,
㏱ ᯒ ࡼ ࡿ Ỉ ᖹ ឤ ᰁ ࡀ ࡞ ཎ ᅉ ࡞ ࡿ
.
ᮏ 㑥 ࡛ ࡣ
,
ᆶ ┤ ឤ ᰁ ᑐ ⟇ ࡋ ࡚1985
ᖺ B
ᆺ ⫢ ⅖ ࣡ ࢡ ࢳ ࣥ ࡢ ⏝ ࡀ 㛤 ጞ ࡉ ࢀ,
ࡑ ࡢ ⩣ ᖺ ࡽ ࢢ ࣟ ࣈ ࣜ ࣥ 〇 ࡢ ే ⏝ ࡀ ⾜ ࢃ ࢀ ࡿ ࡼ ࠺ ࡞ ࡗ ࡓ.
⌧ ᅾ ࡣ ዷ ፬ デ ࡚HBV
ࡢ ࢫ ࢡ ࣜ ࣮ ࢽ ࣥ ࢢ ᳨ ᰝ ࡀ ⾜ ࢃ ࢀ, HBV
ࡢ ᆶ ┤ ឤ ᰁ ࡣ ⴭ ࡋ ࡃ ῶ ᑡ ࡋ ࡓ.
[ 4 ] ࡋ ࡋ ࡞ ࡀ ࡽ,
Ỉ ᖹ ឤ ᰁ ࡣ ῶ ᑡ ࡏ ࡎ,
㏆ ᖺ ࡛ ࡣ ᣢ ⥆ ឤ ᰁ ࡞ ࡾ ࡸ ࡍ ࠸ ࢤ ࣀ ࢱ ࣉA
ࡢHBV
ឤ ᰁ ࡀ ቑ ຍ ഴ ྥ ࠶ ࡿ.
[ 5 ] -[ 7 ] ࡇ ࡢࡼ ࠺ ࡞ ែ ࢆ ៧ ៖ ࡋ
, WHO
ࡣ ங ඣ ࡀHBV
࣡ ࢡ ࢳ ࣥ ࢆ ᥋ ✀ ࡍ ࡿ ࠕ ࣘ ࢽ ࣂ࣮ ࢧ ࣝ ࣡ ࢡ ࢳ ࢿ ࣮ ࢩ ࣙ ࣥ ࠖ ࢆ ⾜ ࠺ ࡼ ࠺ ່ ࿌ ࡋ ࡚ ࠾ ࡾ
,
㆟ ㄽ ࡀ ⾜ ࢃ ࢀ ࡚ ࠸ࡿ
.
[ 8 ] ࡋ ࡋ ࡞ ࡀ ࡽ,
ࡍ ࡚ ࡢ ឤ ᰁ ࢆ ๓ 㜵 ࡄ ࡇ ࡣ ⌧ ᐇ ⓗ ࡛ ࡣ ࡞ ࠸.
ࡑ ࡢ ࡓ ࡵ
, HBV
ឤ ᰁ ࠾ ࡅ ࡿ ⮬ ↛ ⤒ 㐣 ࢆ ▱ ࡾ,
ឤ ᰁ ⪅ ࡢ デ ᩿ ཬ ࡧ ⒪ ἲ ࡢ☜ ❧ 㺃ᨵ Ⰻ ࢆ ⾜ ࠺ ࡇ ࡣ ឤ ᰁ ⪅ ࡢ
QOL
ࢆ ᨵ ၿ ࡍ ࡿ ୖ ࡛ 㔜 せ ࡛ ࠶ ࡿ.
2
➨
2
㡯HBV
ឤឤ ᰁ ᚋ ࡢ ⮬ ↛ ⤒ 㐣HBV
ឤ ᰁ ࡋ ࡓ ሙ ྜ,
୍ 㐣 ᛶ ឤ ᰁ ࢆ ᘬ ࡁ ㉳ ࡇ ࡍ ሙ ྜ ,
ᣢ ⥆ ឤ ᰁ ࡞ ࡿ ሙ ྜ ࡀ ࠶ ࡿ.
୍ 㐣 ᛶ ឤ ᰁ ࡢ ከ ࡃ ࡣ ண ᚋ Ⰻ ዲ ࡛ ࠶ ࡿ ࡀ,
⛥ ⫢ ⅖ ࢆ ᘬ ࡁ㉳ ࡇ ࡍ ࡇ ࡀ ࠶ ࡾ
,
ࡑ ࡢ ሙ ྜ,
⮴ Ṛ ⋡ ࡣ70-80%
࡛ ࠶ ࡿ.
[ 9 ] ୍ ᪉,
ᣢ ⥆ ឤ ᰁ ࡞ ࡗ ࡓ ሙ ྜ
,
៏ ᛶ ⫢ ⅖ ࢆ ⤒ ࡚ ⫢ ࡀ ࢇ ࡞ ࡾ,
ண ᚋ Ⰻ ࡞ ࡿ ࡇ ࡶ ᑡ ࡞ ࡃ ࡞ ࠸.
ᣢ ⥆ ឤ ᰁ ࢆ ᘬ ࡁ ㉳ ࡇ ࡍ ☜ ⋡ ࡣ ᖺ 㱋 ࡼ ࡗ ࡚ ࡁ ࡃ ␗ ࡞ ࡗ ࡚ ࠾ ࡾ,
᪂ ⏕ ඣ ࡢ ሙ ྜ ࡣ ⣙95%, 1-5
ṓ ࡢ ሙ ྜ20-30%,
ᡂ ே ࡢ ሙ ྜ5%
ᮍ ‶ ࡢ ☜ ⋡ ࡛ ᣢ ⥆ ឤ ᰁ ࢆ ᘬ ࡁ ㉳ ࡇ ࡍ.
[ 1 0 ] ᣢ ⥆ ឤ ᰁ ⪅ ࡢ ከ ࡃ ࡣ ≧ ࡢ ࡞ ࠸ ↓ ೃ ᛶ ࢟ ࣕࣜ ࡞ ࡿ
.
ࡇ ࡢ ↓ ೃ ᛶ ࢟ ࣕ ࣜ ࡢ ᮇ 㛫 ࢆ ձ ච ᐶ ᐜ ᮇ ࡪ.
ච ᐶ ᐜ ᮇ ࡢ ᮇ 㛫 ࡣ ಶ ே ᕪ ࡀ ࡁ ࡃ,
ᩘ ᖺ 㹼 ༑ ᩘ ᖺ ࡢ ᖜ ࡀ ࠶ ࡿ.
ච ᐶ ᐜ ᮇ ࡀ ⤊ࢃ ࡿ ⫢ ⅖ ࡢ ≧ ࢆ ࿊ ࡋ ጞ ࡵ ࡿ
.
ࡇ ࡢ ⫢ ⅖ ࢆ Ⓨ ࡋ ࡚ ࠸ ࡿ ᮇ 㛫 ࢆ ղ ච ᛂ⟅ ᮇ
,
ࡶ ࡋ ࡃ ࡣ ճ ప ቑ Ṫ ᮇ ࡪ.
ච ᛂ ⟅ ᮇ ప ቑ Ṫ ᮇ ࡢ 㐪 ࠸ ࡣHBV
࣐࣮ ࢝ ࣮ ࡢ ≧ ែ ࡛ ༊ ู ࡉ ࢀ ࡿ
.
ࡑ ࡢ ᚋ,
୍ ᪦ ៏ ᛶ ⫢ ⅖ ࡀ ⤊ ᜥ ࡋ,
⫢ ⅖ ࡢ ≧ࢆ ࿊ ࡉ ࡞ ࡃ ࡞ ࡗ ࡓ ᮇ 㛫 ࢆ մ ᐶ ゎ ᮇ ࡪ
. (Fig.1 )
ᣢ ⥆ ឤ ᰁ ࡢ ≧ ែ ࡣ ࡁ ࡃ ศ ࡅ ࡚ ࡇ ࡢ
4
ẁ 㝵 ศ 㢮 ࡉ ࢀ ࡿ ࡀ,
ឤ ᰁ ⪅ ࡀ ࡢ ẁ 㝵 ࠶ ࡿ ࡢ ࢆ ุ ᩿ ࡍ ࡿ ୖ ࡛ 㔜 せ ࡞ ࣐ ࣮ ࢝ ࣮ ࡀHBe
ᢠ ཎ, HBe
ᢠ య,
3
HBs
ᢠ ཎ, HBs
ᢠ య ࡛ ࠶ ࡿ.
ࡇ ࢀ ࡽ ࡢ ࣐ ࣮ ࢝ ࣮ ࡢ ⮫ ᗋ ⓗ ព ࢆTable 1
ࡲ ࡵ ࡓ
.
HBe
ᢠ ཎ ࡣHBV
࠾ ࡅ ࡿ ቑ Ṫ ࡢ ά Ⓨ ࡉ ࢆ ⾲ ࡍ. HBe
ᢠ ཎ ࡀ 㝧 ᛶ ࡛ ࠶ ࡿ ሙྜ
, HBV
ࡀ ά Ⓨ ቑ Ṫ ࡋ ࡚ ࠾ ࡾ,
ឤ ᰁ ຊ ࡀ 㧗 ࡃ,
⫢ ⅖ ࡣ ቑ ᝏ ࡍ ࡿ.
୍ ᪉, HBe
ᢠ ཎ ࡀ 㝜 ᛶ ࡢ ሙ ྜ, HBV
ࡢ ቑ Ṫ ࡀ ᢚ ไ ࡉ ࢀ ࡚ ࠸ ࡿ ࡇ ࡀ ♧ ၀ ࡉ ࢀ ࡿ.
ࡲ ࡓ
, HBs
ᢠ ཎ ࡣHBV
ឤ ᰁ ࡋ ࡚ ࠸ ࡿ ྰ ࢆ ⾲ ࡍ.
ࡘ ࡲ ࡾ, HBs
ᢠ ཎ ࡀ 㝧 ᛶ ࡛ ࠶ ࢀ ࡤ,
ឤ ᰁ ⪅ ࡢ య ෆ HBV
ࡀ Ꮡ ᅾ ࡍ ࡿ ࡇ ࢆ ⾲ ࡋ, HBs
ᢠ ཎ ࡀ 㝜 ᛶ ࡛ ࠶ ࢀ ࡤ,
య ෆ ࡽHBV
ࡀ 㝖 ཤ ࡉ ࢀ ࡚ ࠸ ࡿ ࡇ ࢆ ⾲ ࡍ.
ࡲ ࡓ, HBe
ᢠ య ཬ ࡧ, HBs
ᢠ య ࡣ ឤ ᰁ ⪅ ⏤ ᮶ ࡢ ᢠ య ࡛ ࠶ ࡿ. HBe
ᢠ య ࡢ 㝧 ᛶ ࡣHBV
ࡢ ቑ Ṫ ࡀ ప ୗ ࡋ,
ឤ ᰁ ຊ ࡀ ప ࠸ ࡇ ࢆ ⾲ ࡋ, HBs
ᢠ య 㝧 ᛶ ࡣHBV
ᑐ ࡍ ࡿ ච ࢆ⋓ ᚓ ࡋ ࡚ ࠸ ࡿ ࡇ ࢆ ⾲ ࡍ
.
[ 6 ]ࡑ ࡋ ࡚
, HBe
ᢠ ཎ HBe
ᢠ య ࡣ ≉ Ṧ ࡞ 㛵 ಀ ࠶ ࡿ ࡇ ࡀ ▱ ࡽ ࢀ ࡚ ࠸ ࡿ. HBe
ᢠ ཎ 㝧 ᛶ ࡢ 㝿 ࡣHBe
ᢠ య ࡣ 㝧 ᛶ ࡞ ࡽ ࡎ, HBe
ᢠ ཎ ࡀ 㝜 ᛶ ࡞ ࡗ ࡓ ᚋ HBe
ᢠ య ࡣ 㝧 ᛶ ࡞ ࡿ.
ࡇ ࡢ ⌧ ㇟ ࡢ ࡇ ࢆ ࢭ ࣟ ࢥ ࣥ ࣂ ࣮ ࢪ ࣙ ࣥ ࡪ.
ඛ ㏙ ࡋ ࡓ ࡼ ࠺ , HBe
ᢠ ཎ 㝧 ᛶ ࡣHBV
ࡀ ά Ⓨ ቑ Ṫ ࡋ ࡚ ࠸ ࡿ ࡇ ࢆ ⾲ ࡋ,
⫢ ኚ ࡀ 㐍 ⾜ ࡋ ࡚ ࠸ ࡿ ࡇ ࢆ ♧ ၀ ࡍ ࡿ
.
ࡑ ࡢ ࡓ ࡵ,
ᣢ ⥆ ឤ ᰁ ⪅ ࡗ ࡚ ࢭࣟ ࢥ ࣥ ࣂ ࣮ ࢪ ࣙ ࣥ ࡀ ࠸ ᪩ ࡃ ⏕ ࡌ ࡿ ࡀ ண ᚋ ࢆ ᨵ ၿ ࡍ ࡿ ୖ ࡛
,
㠀 ᖖ 㔜 せ ࡞ ࡿ.
[ 4 ] ,[ 6] ,[11] -[ 14 ]ࡍ ࡞ ࢃ ࡕ
, HBV
ឤ ᰁ ࡋ ࡓ ሙ ྜ,
᪩ ᮇ ᳨ ᰝ ࢆ ⾜ ࠸,
㐺 ࡋ ࡓ ⒪ ࢆ ⾜ ࠺ ࡇ ࡀ ᝈ ⪅ ࡢQOL
ྥ ୖ ࠾ ࠸ ࡚ 㠀 ᖖ 㔜 せ ࡞ ࡿ.
4
➨
3
㡯HBV
ឤឤ ᰁ ⒪⌧ ᅾ
, HBV
ឤ ᰁ ࡢ ⒪ ࡣNAs (
᰾ 㓟 ࢼ ࣟ ࢢ)
IFN (
ࣥ ࢱ ࣮ ࣇ ࢙ࣟ ࣥ
)
〇 ࡀ ⏝ ࡉ ࢀ ࡚ ࠸ ࡿ.
ᮏ 㑥 ࡛ ࡣ ᭱ ึ IFN
〇 ࡢ ⏝ ࡀ 㛤 ጞ ࡉ ࢀ ࡓ.
ࡋ ࡋ ࡞ ࡀ ࡽ, IFN
〇 ࡣ ᢞ ⤒ ㊰ ࡀ ⓶ ୗ ὀ ᑕ ࡞ ࡗ ࡚ ࡋ ࡲ ࠺ ,
స⏝ ࡀ ከ ᒱ ࢃ ࡓ ࡾ
,
㛫 ㉁ ᛶ ⫵ ⅖ ࡞ ࡢ 㔜 ⠜ ࡞ స ⏝ ࡶ ሗ ࿌ ࡉ ࢀ ࡚ ࠸ ࡓ.
[ 1 5 ]ࡑ ࡢ ࡓ ࡵ
,
స ⏝ ࡀ ẚ ㍑ ⓗ ᑡ ࡞ ࡃ,
⤒ ཱྀ ᢞ ࡀ ྍ ⬟ ࡞ ⒪ ⸆ ࡀ ᮃ ࡲ ࢀ ࡚࠸ ࡓ
.
ࡇ ࠺ ࡋ ࡓ ୰, HIV (ࣄ ࢺ ච ࢘ ࣝ ࢫ )
ᑐ ࡋ ࡚ ⏝ ࡉ ࢀ ࡚ ࠸ ࡓNAs
࡛ ࠶ ࡿLAM (1)
ࡀHBV
ࡢ ㏫ ㌿ ࢆ 㜼 ᐖ ࡍ ࡿ ࡇ ࡀ Ⓨ ぢ ࡉ ࢀ,
ᮏ 㑥 ࡛ ࡣ2000
ᖺ ࡽLAM
ࡢ ⏝ ࡀ 㛤 ጞ ࡉ ࢀ ࡓ.
ࡋ ࡋ, LAM
ࡣ 㛗 ᮇ ᢞ ࡀ ᚲ せ࡛ ࠶ ࡾ
,
ࡑ ࡢ ⤖ ᯝ,
⪏ ᛶ ᰴ ࡢ ฟ ⌧ క ࠺ ࣈ ࣞ ࢡ ࢫ ࣝ ࣮ ࡀ ሗ ࿌ ࡉ ࢀ ࡓ.
[ 1 6]ࡑ ࡢ ᚋ
, ADV ( 2)
ࡢ ⏝ ࡀ2004
ᖺ 㛤 ጞ ࡉ ࢀ, ADV
ࡣLAM
⪏ ᛶ ᰴ ᑐ ࡋ࡚ ࡶ ᭷ ຠ ࡛ ࠶ ࡗ ࡓ
.
[ 1 7 ] ࡉ ࡽ LAM
⪏ ᛶ ᰴ ᑐ ࡋ, LAM
ADV
ࢆ ే ⏝ ࡍ ࡿ ࡇ ࡛,
ࡼ ࡾ 㧗 ࠸ ᢠHBV
ຠ ᯝ ࢆ Ⓨ ࡋ,
୧ ᑐ ࡍ ࡿ ⪏ ᛶ ᰴ ࡢ ฟ ⌧ ࣜ ࢫ ࢡ ࡀ ప ୗ ࡍ ࡿ ࡇ ࡀ ሗ ࿌ ࡉ ࢀ ࡓ.
[ 1 8 ] -[ 1 9] ࡋ ࡋ ࡞ ࡀ ࡽ, ADV
ࡢ స ⏝ ࡋ ࡚⭈ 㞀 ᐖ ࡀ ☜ ㄆ ࡉ ࢀ ࡚ ࠾ ࡾ
,
⭈ ᶵ ⬟ ࡀ ప ୗ ࡋ ࡚ ࠸ ࡿ ሙ ྜ,
ᢞ 㔞 ࢆ ㄪ ᩚ ࡍ ࡿ ᚲ せ ࡀ ࠶ ࡗ ࡓ.
[ 2 0 ] ࡑ ࡢ ᚋ, 2006
ᖺ ⌧ ᅾ ࡢ ➨ ୍ 㑅 ᢥ ⸆ ࡛ ࠶ ࡿETV (3 )
ࡢ ⏝ ࡀ 㛤 ጞ ࡉ ࢀ ࡓ
. ETV
ࡣ ༢ ࡛ 㠀 ᖖ ᢠHBV
ά ᛶ ࡀ 㧗 ࡃ, 0.5 mg/day
࠸࠺ ᴟ ᚤ 㔞 ࡛ ᙉ ຊ
HBV
ࡢ ቑ Ṫ ࢆ ᢚ ไ ࡍ ࡿ(LAM:100 mg/day, ADV:10 mg/day).
ࡉ ࡽ , ETV
ࡣ ⪏ ᛶ ᰴ ࡀ ฟ ⌧ ࡋ ࡃ ࡃ,
స ⏝ ࡀ 㠀 ᖖ ᑡ ࡞ ࠸ ࠸ ࠺ ඃ ࢀ ࡓ ≉ 㛗 ࡀ ࠶ ࡿ
.
ࡓ ࡔ ࡋ,
⪏ ᛶ ᰴ ࡀ ⏕ ࡌ ࡃ ࠸ ࡢ ࡣETV
ࢆHBV
ឤ ᰁ ⒪ ࡢ ึ ᮇ ࡽ ⏝ 㛤 ጞ ࡋ ࡓ ሙ ྜ ࡛ ࠶ ࡾ,
᪤ LAM
࡛ ⒪ ࢆ 㛤 ጞ ࡋ, LAM
⪏ ᛶ ᰴ ࡀ ⏕ ࡌ ࡚ ࠸ ࡿ ≧ ែ ࡛ 㛗 ᮇ ᢞ ࢆ ⾜ ࡗ ࡓ ሙ ྜ, ETV
⪏ ᛶ ᰴ ࡢ ฟ ⌧ ࡀ ☜ ㄆ ࡉ ࢀ ࡚ ࠸ ࡿ.
[ 2 1 ] ࡑ ࡢ ᚋ, TDF (4 )
ࡀ2014
ᖺ ⏝ ࡀ 㛤 ጞ ࡉ ࢀ ࡓ ࡀ, TDF
ࡣ ⫢ ⮚ ࡢ ྾ ຠ ⋡ ࡀ ᝏ ࡃ, 300 mg/day
ࡢ ᢞ ࡀ ᚲ せ ࡛ ࠶ ࡗ ࡓ.
[ 2 2 ] ࡇ ࡢ ㄢ 㢟 ࢆ ゎ Ỵ ࡍ ࡿ ࡓ ࡵ, Tenofovir
ࢆ ࣍ ࢫ ࣍ ࣥ ࣑ ࢹ ࣮ ࢺ ࡛ ಟ 㣭 ࡋ ࡓTAF (5)
ࡀ 㛤 Ⓨ ࡉ ࢀ, 2017
ᖺ ⏝ ࡀ 㛤 ጞ ࡉ ࢀ ࡓ. TAF
ࡣTDF
ࡼ ࡾ ࡶ ⫢ ⮚ ຠ ⋡ ⓗ ྲྀ ࡾ ㎸ ࡲ ࢀ ࡿ ࡓ ࡵ
, 25 mg/day
ࡢ ᢞ ࡛TDF
ྠ ➼ ࡢ ຠ ᯝ ࢆ ♧ ࡍ.
[ 2 3 ] ࡑ ࡢ ࡓ ࡵ ⾑ ୰ ⃰ ᗘ ࢆ ప ࡃ ᢚ ࠼ ࡿ ࡇ ࡀ ྍ ⬟ ࡛ ࠶ ࡾ,
స ⏝ ࡢ ప ῶ ࡀ ᮇ ᚅ ࡉ ࢀ࡚ ࠸ ࡿ
. (Fig.2)
5
᭱ ㏆ ሗ ࿌ ࡉ ࢀ ࡓ ᪂ つ
NAs
ࡋ ࡚ ࡣ,
ࢩ ࢡ ࣟ ࣉ ࣟ ࣃ ࣥ ⎔ ࡢ ᑟ ධ ࡼ ࡾ,
ࢩ ࢡ ࣟ ࢾ ࢡ ࣞ ࢜ ࢩ ࢻ ࡢ 㓄 ᗙ ᅛ ᐃ ࢆ ⾜ ࡗ ࡚ ᢠ ࢘ ࣝ ࢫ ά ᛶ ࢆ ቑ ᙉ ࡋ ࡓBesifovir dipivoxil ( 6 )
[ 2 4 ] -[ 2 5] ࡀ2019
ᖺ ࡽ 㡑 ᅜ ࡛ ⏝ 㛤 ጞ ࡉ ࢀ ࡚ ࠸ ࡿ.
ࡉࡽ
, NAs
ࡸIFN
␗ ࡞ ࡿ స ⏝ ᶵ ᗎ ࢆ ᣢ ࡘ ᢠHBV
⸆ ࡢ 㛤 Ⓨ ࡀ 㐍 ࢇ ࡛ ࠸ࡿ
.
[ 2 6 ] ᚋ ㏙ ࡍ ࡿNTCP
ཷ ᐜ య ࡢDane
⢏ Ꮚ ࡢ ⤖ ྜ ࢆ 㜼 ᐖ ࡍ ࡿMyrcludex-
B
ࡣ2019
ᖺ ࡽPhase2
ࡢ ⮫ ᗋ ヨ 㦂 ࡀ ⾜ ࢃ ࢀ ࡚ ࠸ ࡿ.
[ 2 7 ] -[ 2 9] ࡉ ࡽ , HBV
࢝ࣉ ࢩ ࢻ 㔜 ྜ ࢆ 㜼 ᐖ ࡍ ࡿ
Morphothiadine (7 )
[ 3 0 ] ࡸHBV DNA
㌿ ᅉ Ꮚ ࢆ 㜼 ᐖ ࡍ ࡿNitazoxanide ( 8)
[ 3 1 ] -[ 3 3]ࡶ2019
ᖺ ࡽPhase2
ࡢ ⮫ ᗋ ヨ 㦂 ࡀ 㐍 ⾜ ୰ ࡛ ࠶ࡿ
. (Fig.3)
6
➨
2⠇ HBV
➨
1㡯 HBV
ࡢࡢ ࣛ ࣇ ࢧ ࢡ ࣝHBV
ࡣ ࣊ ࣃ ࢻ ࢼ ࢘ ࣝ ࢫ ⛉ ᒓ ࡋ ࡚ ࠾ ࡾ, HBV
ࣅ ࣜ ࢜ ࣥ ࡣDane
⢏ Ꮚ ࡤ ࢀ ࡚ ࠸ ࡿ
. Dane
⢏ Ꮚ ࡣ3.2kbp
ࡢ ࡞ ᮏ 㙐DNA (relaxed circular DNA, rcDNA)
ࡀ ࢾ ࢡ ࣞ ࢜ ࢝ ࣉ ࢩ ࢻ ᑒ ධ ࡉ ࢀ,
ࡉ ࡽ ࡑ ࡢ ࿘ ᅖ ࢆ ࢚ ࣥ ࣋ࣟ ࣮ ࣉ ࡀ そ ࡗ ࡓ ᵓ 㐀 ࢆ ࡋ ࡚ ࠸ ࡿ
.
[ 3 4 ]HBV
ࡣ1964
ᖺ Ⓨ ぢ ࡉ ࢀ ࡚ ࡽ 㛗 ࠸ ᮇ 㛫, HBV
ឤ ᰁ ࡍ ࡿ ᇵ 㣴 ⣽ ⬊ ࡀ࡞ ࡗ ࡓ ࡓ ࡵ
,
◊ ✲ ࡀ 㜼 ࡲ ࢀ ࡚ ࠸ ࡓ.
ࡋ ࡋ ࡞ ࡀ ࡽ, 2012
ᖺ HBV
ࡀ ⫢ ⣽⬊ ධ ࡋ
,
ឤ ᰁ ࢆ ᡂ ❧ ࡉ ࡏ ࡿ ࡓ ࡵ ࡢ ཷ ᐜ యࠕNTCP (Na
+౫ Ꮡ ᛶ ⫹ Ồ 㓟 ࢺ ࣛࣥ ࢫ ࣏ ࣮ ࢱ ࣮
)ࠖ ࡀ Ⓨ ぢ ࡉ ࢀ ࡓ .
[ 3 5 ] ࡇ ࡢ ࡇ ࡼ ࡾ, NTCP
ࢆ Ⓨ ⌧ ࡋ ࡓ ⣽ ⬊ᰴ ࡀ ᶞ ❧ ࡉ ࢀ
,
ᢠHBV
ά ᛶ ࢆ ᭷ ࡍ ࡿ ྜ ≀ ࡢ ࢫ ࢡ ࣜ ࣮ ࢽ ࣥ ࢢ ࡸ ヲ ⣽ ࡞HBV
ቑ Ṫ 㐣 ⛬ ࡢ ◊ ✲ ࡀ ྍ ⬟ ࡞ ࡾ, HBV
㛵 ࡍ ࡿ ◊ ✲ ࡣ ᛴ ㏿ Ⓨ ᒎ ࡋ ࡓ.
[ 3 6 ] -[ 3 7]
HBV
ࡣ ≉ ␗ ࡞ ࣛ ࣇ ࢧ ࢡ ࣝ ࢆ ᙧ ᡂ ࡋ ࡚ ࠸ ࡿ ࡇ ࡀ ▱ ࡽ ࢀ ࡚ ࠾ ࡾ, Dane
⢏ Ꮚ ࡣ
NTCP
᥋ ╔ ࡋ( Fig.4,
ձ),
ධ ࡍ ࡿ( Fig.4,
ղ).
ࡑ ࡢ ᚋ,
⬺ Ẇ ࢆ⤒ ࡚
rcDNA
ࡀ ᰾ ෆ ⛣ ⾜ ࡍ ࡿ(Fig.4,
ճ).
᰾ ෆ ⛣ ⾜ ࡋ ࡓrcDNA
ࡣ ᐟ ࡢ ᣢ ࡘ 㓝 ⣲ ࡼ ࡗ ࡚
covalently closed circular DNA (cccDNA)
ࡤ ࢀ ࡿ7
㠀 ᖖ Ᏻ ᐃ ࡞
DNA
ኚ ࡉ ࢀ ࡿ( Fig.4,
մ).
ࡑ ࡢ ᚋ, cccDNA
ࡽ ᐟ ࡢDNA
౫ Ꮡ ᛶRNA
࣏ ࣜ ࣓ ࣛ ࣮ ࢮ ࡼ ࡗ ࡚3.5 kb
ࡢpgRNA
ࡤ ࢀ ࡿmRNA
㌿ ࡉ ࢀ ࡿ( Fig.4,
յ).
ࡉ ࡽ cccDNA
ࡽ ࡢ ㌿ ࡛ ࡣ, pgRNA
ຍ ࠼
, 3
✀ 㢮 ࡢmRNA
ࡀ ㌿ ࡉ ࢀ, mRNA
ࡽ ㏫ ㌿ 㓝 ⣲ ࡸ ࢝ ࣉ ࢩ ࢻ ➼ ࡢ࢘ ࣝ ࢫ ⏤ ᮶ ࡢ ࢱ ࣥ ࣃ ࢡ ㉁ ࡀ ⩻ ヂ ࡉ ࢀ ࡿ
(Fig.4,
ն).
ࡑ ࡢ ᚋ, pgRNA
ࡣ ⩻ ヂ ࡉ ࢀ ࡓ ࢝ ࣉ ࢩ ࢻ ෆ ᑒ ධ ࡉ ࢀ( Fig.4,
շ),
࢝ ࣉ ࢩ ࢻ ෆ Ꮡ ᅾ ࡍ ࡿ ㏫ ㌿ 㓝 ⣲ ࡼ ࡗ ࡚ ㏫ ㌿ ࢆ ཷ ࡅrcDNA
ࡀ ྜ ᡂ ࡉ ࢀ ࡿ(Fig.4,
ո). rcDNA
ࢆ ྵࡴ ࢾ ࢡ ࣞ ࢜ ࢝ ࣉ ࢩ ࢻ ࡣ
,
࢚ ࣥ ࣋ ࣟ ࣮ ࣉ ࢆ ᙧ ᡂ ࡋ ࡘ ࡘDane
⢏ Ꮚ ࡞ ࡾ ⬺ 㞳 ࡍ ࡿ( Fig.4 ,
չ).
ࡇ ࡢcccDNA
ࡽ ࡢ ୍ 㐃 ࡢ ὶ ࢀ( Fig.4 ,
յ-չ )
ࢆ ⧞ ࡾ ㏉ ࡍ ࡇ ࡛HBV
ࡣ ቑ Ṫ ࡍ ࡿ.
[ 3 8 ] -[ 4 1 ] ࡑ ࡢ ࡓ ࡵ, B
ᆺ ⫢ ⅖ ࢆ ᰿ ࡍ ࡿ ࡣcccDNA
ࢆ 㝖 ࡍ ࡿ ᚲ せ ࡀ ࠶ ࡿ ࡀ, cccDNA
ࡢ 㝖 ࡣ ᅔ 㞴 ࡛ ࠶ ࡾ,
⌧ ᅾ ࡢ ⒪ ἲ ࡛ ࡣ
HBV
ࡢ ቑ Ṫ ࢆ ᢚ ไ ࡍ ࡿ ࡲ ࡗ ࡚ ࠸ ࡿ.
8
➨
2
㡯 ⸆⸆ ⪏ ᛶHBV
๓ 㡯 ࡛ ♧ ࡋ ࡓ ࡼ ࠺
HBV
ࡣ ㏫ ㌿ ࢆ ⾜ ࠺ ࡓ ࡵ,
㑇 ఏ Ꮚ ኚ ␗ ࡀ ⏕ ࡌ ࡸ ࡍ࠸
.
ࡋ ࡓ ࡀ ࡗ ࡚,
㑇 ఏ Ꮚ ኚ ␗ ࢆ ㏻ ࡌ ࡚ ⸆ ⪏ ᛶ ᰴ ࡀ ฟ ⌧ ࡋ ࡸ ࡍ ࡃ,
≉ , NAs
ᑐ ࡍ ࡿ ⸆ ⪏ ᛶ ᰴ ࡢ ฟ ⌧ ࡀ ၥ 㢟 ࡞ ࡗ ࡚ ࠸ ࡿ. NAs
ࡣHBV
ࡢ ㏫ ㌿ ࡢ 㐣 ⛬ ࢆ 㜼 ᐖ ࡍ ࡿ ࡇ ࡛ ᢠ
HBV
స ⏝ ࢆ ♧ ࡍ ࡀ,
ࡇ ࡢ స ⏝ ࡣHBV
ࡢ ቑ Ṫࢆ ᢚ ไ ࡍ ࡿ ࡶ ࡢ ࡛ ࠶ ࡾ
,
᰿ ࡣ ⮳ ࡽ ࡞ ࠸.
ࡑ ࡢ ࡓ ࡵ, NAs
ࡢ ⏝ ࢆ ୰ Ṇ ࡋ ࡓ ሙ ྜ,
ࡧHBV
ࡀ ቑ Ṫ ࡋ,
⒪ ๓ ࡢ ≧ ែ ᡠ ࡿ ࡇ ࡀ ሗ ࿌ ࡉ ࢀ ࡚ ࠸ ࡿ.
ࡇ ࡢ ࡇ ࡽ 㛗 ᮇ ⓗ ࡞ ண ᚋ ᨵ ၿ ࡢ ࡓ ࡵ NAs
ࡢ ᢞ ࡣ ཎ ๎ ࡋ ࡚ ୰ Ṇ ࡏ ࡎ,
⥅ ⥆ ᢞ ࡼ ࡗ ࡚HBV
ࡢ ቑ Ṫ ࢆ ᢚ ไ ࡋ ⥆ ࡅ ࡿ ᚲ せ ࡀ ࠶ ࡿ.
[ 4 2 ] ࡋ ࡋ࡞ ࡀ ࡽ
,
㛗 ᮇ ᢞ ࡣ ⸆ ⪏ ᛶ ᰴ ࡢ ฟ ⌧ ࣜ ࢫ ࢡ ࢆ 㧗 ࡵ ࡚ ࡋ ࡲ ࠸,
⸆ ⪏ ᛶ ᰴ ࡀ ฟ ⌧ ࡋ ࡓ ሙ ྜ,
ࣈ ࣞ ࢡ ࢫ ࣝ ࣮ ࢆ ᘬ ࡁ ㉳ ࡇ ࡍ.
⸆ ⪏ ᛶ ⋓ ᚓ ࡢ ᶵ ᗎ 㛵 ࡍ ࡿ ◊ ✲ ࡣ ┒ ࢇ ࠾ ࡇ ࡞ ࢃ ࢀ ࡚ ࠾ ࡾ
, NAs
ᑐ ࡍ ࡿ ⪏ ᛶ ᰴ ࠾ ࠸ ࡚ ㏫ ㌿ 㓝 ⣲ ࡢ ࣑ ࣀ 㓟 ኚ ␗ ⟠ ᡤ ࡀ ሗ ࿌ ࡉ ࢀ ࡚ ࠸ ࡿ.
[ 4 1 ] -[ 4 6] ᭱ ࡶ 㧗 ࠸ 㢖 ᗘ ࡛ ⏕ ࡌ ࡿ
LAM
⪏ ᛶ ᰴ ࡣ ㏫ ㌿ 㓝 ⣲ ࡢ204
␒ ┠ ࡢ ࣓ ࢳ ࢜ࢽ ࣥ ࡀ ࣂ ࣜ ࣥ ࡶ ࡋ ࡃ ࡣ ࢯ ࣟ ࢩ ࣥ ኚ ␗ ࡋ
,
ࡉ ࡽ 180
␒ ┠ ࡢ ࣟ ࢩ ࣥ ࡀ ࣓ ࢳ ࢜ ࢽ ࣥ ኚ ␗ ࡍ ࡿ ࡇ ࡛ ⏕ ࡌ ࡿ.
[ 4 1 ] , [4 2 ] ࡉ ࡽ , LAM
⪏ ᛶ ᰴ ࡣETV
ᑐ ࡍ ࡿ ឤ ཷ ᛶ ࡀ ప ୗ ࡋ
,
㏫ ㌿ 㓝 ⣲ ࡢ184
␒ ┠ ࢺ ࣞ ࢜ ࢽ ࣥ, 202
␒ ┠ ࡢ ࢭࣜ ࣥ ࡶ ࡋ ࡃ ࡣ
250
␒ ┠ ࡢ ࣓ ࢳ ࢜ ࢽ ࣥ ࡀ ኚ ␗ ࡍ ࡿ ࡇ ࡛ETV
ᑐ ࡍ ࡿ ⸆ ⪏ ᛶ ࢆ ⋓ ᚓ ࡍ ࡿ ࡇ ࡀ ሗ ࿌ ࡉ ࢀ ࡚ ࠸ ࡿ
.
[ 4 5 ] ࡲ ࡓ, TDF
ཬ ࡧTAF
ᑐ ࡋ ࡚ ⪏ ᛶ ࢆ ⋓ ᚓ ࡋ ࡓ ࡢ ሗ ࿌ ࡣ ᑡ ࡞ ࠸ ࡶ ࡢ ࡢ, LAM
ཬ ࡧETV
୧ ⪏ ᛶ ࢘ ࣝ ࢫ ᑐ ࡋ ࡚TDF
ࡢ ᢞ ୰ ⸆ ⪏ ᛶ ᰴ ࡢ ฟ ⌧ ࢆ ㉳ ࡇ ࡋ ࡓ ࡀ ሗ ࿌ ࡉ ࢀ ࡓ.
[ 4 6 ]ࡇ ࡢ ࡼ ࠺
,
⸆ ⪏ ᛶ ᰴ ࡢ ฟ ⌧ ࡣ ⒪ ⏝ ࡛ ࡁ ࡿ ⸆ ࡢ 㑅 ᢥ ⫥ ࡀ ᑡ ࡞ ࡃ ࡞ ࡗ ࡚ ࡋ ࡲ ࠺ ࡇ ࡽ, HBV
ឤ ᰁ ⪅ ࡢ ண ᚋ ┤ ⤖ ࡍ ࡿ ၥ 㢟 ࡛ ࠶ ࡿ.
ࡑ ࡢ ࡓ ࡵ,
⸆ ⪏ ᛶ ᰴ ᑐ ࡋ ࡚ ࡶ ຠ ᯝ ࢆ ♧ ࡋ,
ࡘ,
ᙉ ຊ ࡞ ᢠHBV
స ⏝ ࡼ ࡗ࡚ ⸆ ⪏ ᛶ ࡢ ⋓ ᚓ ࢆ チ ࡉ ࡎ
,
ప ⣽ ⬊ ẘ ᛶ ࡢ ᪂ つNAs
ࡢ 㛤 Ⓨ ࡀ ồ ࡵ ࡽ ࢀ ࡚ ࠸ࡿ
.
9
➨
3⠇ NAs
➨
1㡯 ⌧
⌧ ᅾ ᢎ ㄆ ࡉ ࢀ ࡚ ࠸ ࡿNAs
ࡢ ≉ ᚩNAs
ࡣHBV
ࡢ ࣛ ࣇ ࢧ ࢡ ࣝ ࠾ ࠸ ࡚pgRNA
ࡽrcDNA
ࢆ ྜ ᡂ ࡍ ࡿ㏫ ㌿ ࢆ 㜼 ᐖ ࡍ ࡿ
.
㏫ ㌿ ࡣ ࣄ ࢺ ࡢ ⣽ ⬊ ࡛ ࡣ ࢇ ⾜ ࢃ ࢀ ࡚ ࠸ ࡞ ࠸ ࡓ ࡵ,
㏫ ㌿ ࢆ 㜼 ᐖ ࡍ ࡿ ࡇ ࡛ ṇ ᖖ ࡞ ⣽ ⬊ ࡢ ά ື ࢆ ᐖ ࡍ ࡿ ࡇ ࡞ ࡃ
, HBV
ࡢ ࣛ ࣇ ࢧ ࢡ ࣝ ࡢ ࡳ ࢆ 㜼 ᐖ ࡛ ࡁ ࡿ
.
ࡲ ࡓ,
㏫ ㌿ 㓝 ⣲ ࡣ ୍ ⯡ ⓗ ࡞DNA
࣏ ࣜ ࣓ ࣮ࣛ ࢮ ẚ ㍑ ࡋ ࡚ ᇶ ㉁ ≉ ␗ ᛶ ࡀ ప ࠸ ࡇ ࡀ ▱ ࡽ ࢀ ࡚ ࠸ ࡿ
.
[ 4 7 ] -[ 48 ] ࡇ ࡢ ࡇ ࡣ,
㏫ ㌿ 㓝 ⣲ ࡀ ࢾ ࢡ ࣞ ࢜ ࢳ ࢻ 㢮 ఝ ࡋ ࡚ ࠸ ࡿ ྜ ≀ ࢆ ㄗ ࡗ ࡚ ྲྀ ࡾ ㎸ ࡳ
, DNA
ෆ ⤌ ࡳ ㎸ ࡴ ࡇ ࢆ ♧ ၀ ࡍ ࡿ.
NAs
ࡣ ⣽ ⬊ ྲྀ ࡾ ㎸ ࡲ ࢀ ࡓ ᚋ ୕ ࣜ ࣥ 㓟 య(
ࡶ ࡋ ࡃ ࡣ ࣜ ࣥ 㓟 య)
࡞ ࡗ ࡚ స ⏝ ࢆ ♧ ࡍ.
ࣜ ࣥ 㓟 ࡉ ࢀ ࡓNAs
ࡣdATP, dGTP, dCTP, TTP
ࡢ ࠸ ࡎ ࢀ ➇ ྜ ࡋ ࡚ ㏫ ㌿ 㓝 ⣲ ྲྀ ࡾ ㎸ ࡲ ࢀ
, HBV DNA
⤌ ࡳ ㎸ ࡲ ࢀ ࡿ. DNA
⤌ ࡳ ㎸ ࡲ ࢀ ࡓ
NAs
ࡣ5 ′
ࡽ3 ′
᪉ ྥ ࡢDNA
ఙ 㛗 ࢆ 㜼 ᐖ ࡍ ࡿ. (Fig.5 )
ࡇ ࡢ ࡼ ࠺ ㏫ ㌿ 㓝 ⣲ ࢆ 㜼 ᐖ ࡋ ࡚ ᢠ ࢘ ࣝ ࢫ స ⏝ ࢆ ♧ ࡍ
NAs
ࡣ, HIV
10
⒪ ࡢ ศ 㔝 ࠾ ࠸ ࡚ ࡁ ࡃ ◊ ✲ 㺃㛤 Ⓨ ࡀ 㐍 ᒎ ࡋ ࡚ ࡁ ࡓ
. 1985
ᖺ,
ᙜ ࡣ ࡢ ࡛ ࠶ ࡗ ࡓ
HIV
ឤ ᰁ ᑐ ࡋ ࡚ ᭱ ึ ࡢNAs
࡛ ࠶ ࡿAZT ( 9)
ࡀ ‶ ᒇ ࡽ ࡼ ࡗ ࡚ 㛤 Ⓨ ࡉ ࢀ, HIV
ឤ ᰁ ࡢ ண ᚋ ࡣ ⓗ ᨵ ၿ ࡋ ࡓ.
[ 4 9 ] -[ 5 0] ࡑ ࡢ ᚋ, AZT
ࡢ ᵓ 㐀 ⓗ ≉ ᚩ ࡽ ከ ࡃ ࡢNAs
ࡀ 㛤 Ⓨ ࡉ ࢀ, HIV
ࡢ Ṛ ஸ ⋡ ࡣ 㢧 ⴭ ప ୗ ࡋ ࡓ. HIV
⒪ 㐺 ᛂ ࡀ ࠶ ࡿ ௦ ⾲ ⓗ ࡞NAs
ࢆFig.6
ࡲ ࡵ ࡓ.
᭱ ึ 㛤 Ⓨ ࡉ ࢀ ࡓ
AZT
ࡣ ࢳ ࣑ ࢪ ࣥ ࡢ3 ′ ࡢ Ỉ 㓟 ᇶ ࢆ ࢪ ࢻ ᇶ ⨨ ࡋ
ࡓNAs
࡛ ࠶ ࡿ. AZT
ࡣHIV
ࡀ ㏫ ㌿ ࡼ ࡗ ࡚DNA
ࢆ ఙ 㛗 ࡍ ࡿ 㝿, TTP
➇ ྜ ࡋ ࡚ ㏫ ㌿ 㓝 ⣲ ྲྀ ࡾ ㎸ ࡲ ࢀ
, HIV
ࡢDNA
⤌ ࡳ ㎸ ࡲ ࢀ ࡿ.
ࡑ ࡋ ࡚,
ḟ ࡢ ఙ 㛗 ࠾ ࠸ ࡚, 3′
ࡢ Ỉ 㓟 ᇶ ࡀ Ꮡ ᅾ ࡋ ࡞ ࠸ ࡓ ࡵDNA
ࡢ ఙ 㛗 ࡀ Ṇ ࡋ,
㏫ ㌿ ࡀ 㜼 ᐖ ࡉ ࢀ ࡿ
.
[ 5 1 ] ࡇ ࡢ 㜼 ᐖ ᙧ ᘧ ࡣAZT
௨ 㝆 ࡢNAs
࠾ ࠸ ࡚ ࡶ ⏝ ࠸ࡽ ࢀ ࡚ ࠾ ࡾ
, ddI (10 )
ࡣ ࣀ ࢩ ࣥ ࡢ2′
3′ ࡢ Ỉ 㓟 ᇶ ࡀ Ỉ ⣲ ⨨ ࡉ ࢀ
ࡓNAs
࡛ ࠶ ࡿ. ddI
ࡣ ⣽ ⬊ ෆ ྲྀ ࡾ ㎸ ࡲ ࢀ ࡓ ᚋ,
୕ ࣜ ࣥ 㓟 య ࡞ ࡾ,
ࡉ ࡽ ⣽ ⬊ ෆ ࡢ 㓝 ⣲ ࡼ ࡗ ࡚ ࣉ ࣜ ࣥ
6
ࡀ ࣑ ࣀ ᇶ ⨨ ࡉ ࢀ ࡚ddATP
࡞ࡿ
. ddATP
ࡣdATP
➇ ྜ ࡋ ࡚ ㏫ ㌿ 㓝 ⣲ ྲྀ ࡾ ㎸ ࡲ ࢀ, AZT
ྠ ᵝ DNA
ࡢ ఙ 㛗 ࢆ Ṇ ࡋ ࡚ ㏫ ㌿ ࢆ 㜼 ᐖ ࡍ ࡿ.
[ 5 2 ] ࡲ ࡓ, ddC (11 )
ࡣ ࢹ ࢜ ࢟ ࢩ ࢩ ࢳ ࢪࣥ ࡢ
3′ ࡢ Ỉ 㓟 ᇶ ࢆ Ỉ ⣲ ⨨ ࡋ ࡓ NAs
࡛ ࠶ ࡾ,
ά ᛶ య ࡣdCTP
➇ ྜ ࡋ, DNA
ࡢ ఙ 㛗 ࢆ Ṇ ࡍ ࡿ.
⥆ ࠸ ࡚ ⏝ ࡀ 㛤 ጞ ࡉ ࢀ ࡓ2′,3 ′-endo-olefin
ᵓ 㐀 ࢆ᭷ ࡍ ࡿ
d4T (12 )
ࡣTTP
➇ ྜ ࡋ, DNA
ఙ 㛗 ࢆ Ṇ ࡍ ࡿ.
ࡲ ࡓ
,
ඛ ㏙ ࡋ ࡓ ࡼ ࠺ HBV
ᑐ ࡋ ࡚ ⏝ ࡉ ࢀ ࡿNAs
࡛ ࠶ ࡿLAM
ࡸADV, TDF, TAF
ࡶ3′
┦ ᙜ ࡍ ࡿ ⨨ ࡢ Ỉ 㓟 ᇶ ࢆ ᭷ ࡋ ࡚ ࠸ ࡞ ࠸ ࡓ ࡵ, DNA
ఙ 㛗ࢆ ᢚ ไ ࡋ
,
㏫ ㌿ 㜼 ᐖ స ⏝ ࢆ ♧ ࡍ.
ࡋ ࡋ, ETV
ࡣ3 ′ ┦ ᙜ ࡍ ࡿ ⨨ ࡢ
Ỉ 㓟 ᇶ ࢆ ᭷ ࡋ ࡚ ࠸ ࡿ ࡶ ࢃ ࡽ ࡎ ㏫ ㌿ 㜼 ᐖ స ⏝ ࢆ ᭷ ࡋ ࡚ ࠸ ࡿ. ETV
ࡣ㏫ ㌿ ࡼ ࡗ ࡚
HBV
ࡢDNA
ෆ ྲྀ ࡾ ㎸ ࡲ ࢀ ࡓ ᚋ,
ᩘ ሷ ᇶ ఙ 㛗 ࡋ, DNA
ࡢ ఙ 㛗 ࡀ Ṇ ࡍ ࡿ.
ࡇ ࡢ ࡇ ࡣETV
ࡼ ࡗ ࡚DNA
ࡢ ❧ య 㓄 ᗙ ࡀ ኚ ࡋ,
㏫㌿ 㓝 ⣲ ࡀ ㄆ ㆑ ࡛ ࡁ ࡞ ࡃ ࡞ ࡿ ࡇ ㉳ ᅉ ࡍ ࡿ ⪃ ࠼ ࡽ ࢀ ࡿ
.
[ 5 3 ] -[ 54 ]11
ࡇ ࡢ
ETV
ࡢ ࡼ ࠺ 3 ′
ࡢ Ỉ 㓟 ᇶ ࢆ ᭷ ࡍ ࡿ ࡶ 㛵 ࢃ ࡽ ࡎ ㏫ ㌿ 㓝 ⣲ ࢆ 㜼 ᐖ ࡍ ࡿNAs
ࡋ ࡚, 4 ′-
⨨ NAs
ࡀ ▱ ࡽ ࢀ ࡚ ࠸ ࡿ. 4′-
⨨ NAs
ࡣ,
ᙉ ࠸ ᢠ ࢘ ࣝ ࢫ స ⏝ ࢆ ♧ ࡋ
,
⸆ ⪏ ᛶ ᰴ ࡢ ຠ ᯝ ࢆ ᭷ ࡋ ࡚ ࠸ ࡿ ྜ ≀ ࡀ ᩘ ከ ࡃ ሗ ࿌ ࡉ ࢀ ࡚ ࠸ ࡿ ࡇ ࡽ ὀ ┠ ࢆ 㞟 ࡵ ࡚ ࠸ ࡿ.
➨
2
㡯4 ′-
⨨⨨ NAs
4 ′-⨨ NAs
ࡣ ⢾ ࡢ4 ′ ࢚ ࢳ ࢽ ࣝ ᇶ ,
ࢪ ࢻ ᇶ ཬ ࡧ ࢩ ࣀ ᇶ ࡞ ࡢ ⨨ ᇶ ࢆ ᑟ ධ ࡋ ࡓ ࢾ ࢡ ࣞ ࢜ ࢩ ࢻ ࡛ ࠶ ࡿ. ( Fig.7)
⌧ ᅾ,
Ḣ ⡿ ࡛ ᢠHIV
⸆ ࡋ ࡚ ⏝ ࡉ ࢀ ࡚ ࠸ ࡿ
Censavudine ( 13)
ࡣ4′
࢚ ࢳ ࢽ ࣝ ᇶ ࢆ ᣢ ࡘ4′-
⨨ NAs
࡛࠶ ࡿ
.
ࡲ ࡓ,
⌧ ᅾPhase2
ࡢ ⮫ ᗋ ヨ 㦂 ࡀ ⾜ ࢃ ࢀ ࡚ ࠸ ࡿIslatravir (14)
ࡣ4′
࢚ ࢳ ࢽ ࣝ ᇶ ࢆ ᭷ ࡍ ࡿ ࢾ ࢡ ࣞ ࢜ ࢩ ࢻ ࡛ ࠶ ࡾ
, 3′ Ỉ 㓟 ᇶ ࢆ ᣢ ࡘ ࡶ
ࢃ ࡽ ࡎ
,
㏫ ㌿ 㓝 ⣲ 㜼 ᐖ స ⏝ ࢆ ♧ ࡍ. 4′-
⨨ NAs
◊ ✲ ࡢ Ṕ ྐ ࡣ1956
ᖺ Streptomyces calvus
ࡽNucleocidin ( 15 )
ࡀ ༢ 㞳 ࡉ ࢀ ࡓ ࡇ ጞ ࡲ ࡿ.
[ 5 5 ]1971
ᖺ ࡣMoffatt
ࡽ ࡼ ࡗ ࡚16
ࡽ4′,5′- exo-olefin
ᵓ 㐀17
ࢆ ⤒ ⏤ ࡋ,
ຍ ᛂ ࡚
4 ′
ࣇ ࢵ ⣲ ࢆ ᑟ ධ ࡋ18
ࡋ ࡓ ᚋ,
ࡉ ࡽ ᩘ ᕤ ⛬ ࢆ ⤒ ࡚15
ࡢ ྜ ᡂ ࡀ 㐩 ᡂ ࡉ ࢀ ࡓ. (Scheme 1)
[ 5 5 ]12
ࡑ ࡢ ᚋ
, 1992
ᖺ ࡣ, Maag
ࡽ ࡼ ࡗ ࡚4 ′ ࢪ ࢻ ᇶ ࢆ ᑟ ධ ࡋ ࡓ 4 ′-
ࢪ ࢻNAs (19 -22 )
ࡀ ྜ ᡂ ࡉ ࢀ,
ᢠHIV
ά ᛶ ࡀ ぢ ฟ ࡉ ࢀ ࡓ. (Table 2)
[ 5 6 ]௨ 㝆
,
ᵝ ࠎ ࡞ ⨨ ᇶ ࢆ ᣢ ࡘ4′ -
⨨ NAs
ࡢ ྜ ᡂ ཬ ࡧ,
ᢠ ࢘ ࣝ ࢫ ά ᛶ ࡢ ホ ౯ ࡀ ⾜ ࢃ ࢀ, 4′
ࣇ ࣝ ࢜ ࣟ ࣓ ࢳ ࣝ ᇶ ࢆ ᭷ ࡍ ࡿ23
ࡸ ࢺ ࣜ ࢰ ࣮ ࣝ ᇶ ࢆ ᭷ ࡍ ࡿ24 ,
࣓ ࢺ ࢟ ࢩ ᇶ ࢆ ᭷ ࡍ ࡿ25,
ࢩ ࣀ ᇶ ࢆ ᭷ ࡍ ࡿ26 , 27
➼ ࡀ ᢠHIV
స ⏝ ࢆ ᣢ ࡘ ࡇ ࡀ ሗ ࿌ ࡉ ࢀ ࡓ. (Fig.8)
[ 5 6 ] -[ 6 1] ࡇ ࢀ ࡽ4 ′-⨨ NAs
ࡀ3 ′ Ỉ 㓟 ᇶ ࢆ
ᣢ ࡘ ࡶ ࢃ ࡽ ࡎ,
ᢠ ࢘ ࣝ ࢫ ά ᛶ ࢆ ♧ ࡍ ᶵ ᗎ ࡣ,
⢾ ࡢ ❧ య 㓄 ᗙ ࡢ ኚ ㉳ ᅉ ࡍ ࡿ ⪃ ࠼ ࡽ ࢀ ࡿ
.
13
14
➨
3
㡯4 ′-
⨨⨨ NAs
ࡢ ❧ య 㓄 ᗙࢾ ࢡ ࣞ ࢜ ࢩ ࢻ ࠾ ࡅ ࡿ ⢾ ࡢ ❧ య 㓄 ᗙ ࡣ
C2 ′-endo/C3′- exo
ᆺ(South
ᆺ)
C2 ′- exo/C3 ′-endo
ᆺ(North
ᆺ)
ࡀ Ꮡ ᅾ ࡋ,
❧ య 㞀 ᐖ ࡢ ࡁ ࠸ ሷ ᇶ 㒊 ࡀ ࢚ ࢡ ࢺ ࣜ ࣝ ࡞ ࡿ
South
ᆺ ࡀ Ᏻ ᐃ ࡞ ࡿ.
ࡋ ࡋ, 4 ′
ࢪ ࢻ ᇶ ࡸ ࢚ ࢳ ࢽ ࣝ ᇶ,
ࢩ ࣀ ᇶ ࢆ ᭷ ࡋ ࡚ ࠸ ࡿ ᵓ 㐀 ࡢ ሙ ྜ, North
ᆺ ࡀ Ᏻ ᐃ ࡞ ࡿ. (Fig.9 )
4 ′-
⨨ NAs
ࡀNorth
ᆺ 㓄 ᗙ ࢆ ࡿ ሙ ྜ,
ሷ ᇶ 㒊 4 ′
ࡢ ⨨ ᇶ ࡀ ࡶ ࢟ ࢩ ࣝ ࢆ ༨ ࡵ ࡿ ࡓ ࡵ
,
ࡁ ࡞ ❧ య Ⓨ ࡀ ⏕ ࡌ,
Ᏻ ᐃ ࡞ ࡿ.
ࡋ ࡋ ࡞ ࡀ ࡽNorth
ᆺ ࡀ Ᏻ ᐃ ࡞ ࡿ ࡢ ࡣ ࣀ ࣐ ࣮ ຠ ᯝ ࡀ 㛵 ࡋ ࡚ ࠸ ࡿ.
[ 6 2 ] ࣀ࣐ ࣮ ຠ ᯝ ࡣ
,
ဨ ⎔ ࢆ ᙧ ᡂ ࡍ ࡿ 㓟 ⣲ ࡢ 㠀 ඹ ᭷ 㟁 Ꮚ ᑐ 4′
ࡢ 㟁 Ꮚ ồ ᘬ ᛶ ⨨ ᇶ ࡢ
σ*
⤖ ྜ ࡢ ┦ స ⏝ ࡼ ࡗ ࡚ 㠀 ඹ ᭷ 㟁 Ꮚ ᑐ ࡀ 㠀 ᒁ ᅾ ࡋ,
Ᏻ ᐃ ࡍࡿ ࡇ ࡛ ⏕ ࡌ ࡿ
. (Fig.10 )
ࡋ ࡓ ࡀ ࡗ ࡚, 4′ ❅ ⣲ ཎ Ꮚ ࡸ 㓟 ⣲ ཎ Ꮚ ,
ࣁ ࣟ ࢤࣥ ࡞ ࡀ ⤖ ྜ ࡋ ࡚ ࠸ ࡿ ሙ ྜ
,
ࣀ ࣐ ࣮ ຠ ᯝ ࡼ ࡗ ࡚North
ᆺ 㓄 ᗙ ࡀ Ᏻ ᐃ ࡞ ࡿ
.
15
ࡋ ࡋ
,
㟁 Ꮚ ồ ᘬ ᛶ ᇶ ࡛ ࡣ ࡞ ࠸ ࢚ ࢳ ࢽ ࣝ ᇶ ࠾ ࠸ ࡚ ࡣ ྠ ᵝ ࡢ ࣀ ࣐ ࣮ ຠ ᯝ ࡣ ᮇ ᚅ ࡛ ࡁ ࡞ ࠸.
ࡶ ࢃ ࡽ ࡎ, 4′
࢚ ࢳ ࢽ ࣝ ᇶ ࢆ ᭷ ࡍ ࡿIslatravir
ࡢ ሙ ྜ ࡶNorth
ᆺ ࡀ Ᏻ ᐃ ࡛ ࠶ ࡿ Kirby
ࡽ ࡼ ࡗ ࡚ ሗ ࿌ ࡉ ࢀ ࡓ.
[ 6 3 ] ࡑ ࡢ ⌮⏤ ࡋ ࡚ ࡣ ဨ ⎔ ࢆ ᙧ ᡂ ࡍ ࡿ 㓟 ⣲ ཬ ࡧ
, 3′ ࡢ 㓟 ⣲ ࢚ ࢳ ࢽ ࣝ ᇶ ࡢ π*㌶ 㐨
ࡢ ┦ స ⏝ ࡼ ࡿ ࡶ ࡢ ࡔ ㄝ ᫂ ࡉ ࢀ ࡚ ࠸ ࡿ. (Fig.11 )
ࡇ ࡢ ࡼ ࠺
4′-
⨨ NAs
ࡣ ❧ య 㓄 ᗙ ࡀ ㏻ ᖖ ࡢ ࢾ ࢡ ࣞ ࢜ ࢩ ࢻ ␗ ࡞ ࡿ ࡇ ࡛DNA
ࡢ ఙ 㛗 ࢆ Ṇ ࡋ,
࢘ ࣝ ࢫ ࡢ ㏫ ㌿ ࢆ 㜼 ᐖ ࡍ ࡿ ⪃ ࠼ ࡽ ࢀ ࡿ.
➨
4㡯 ᢠ
ᢠHBV
ά ᛶ ࢆ ᭷ ࡍ ࡿ4′-
⨨ NAs
๓ 㡯 ࡛ ㏙ ࡓ ࡼ ࠺
, 4′-
⨨ NAs
ࡣ ᢠHIV
ά ᛶ ࢆ ♧ ࡋ,
⮫ ᗋ ᒎ 㛤 ࡀ 㐍 ࢇ࡛ ࠸ ࡿ ࡶ ࡢ ࡀ ࠶ ࡿ
.
ࡋ ࡓ ࡀ ࡗ ࡚, HIV
ྠ ࡌ ࡃ ㏫ ㌿ 㓝 ⣲ ࢆ ᭷ ࡍ ࡿHBV
ᑐ ࡋ ࡚ ࡶ4 ′-⨨ NAs
ࡢ ᢠ ࢘ ࣝ ࢫ ά ᛶ ࡀ ᮇ ᚅ ࡉ ࢀ ࡿ.
ࡑ ࡇ ࡛,
ඹ ྠ ◊ ✲ ඛ࡛ ࠶ ࡿ ‶ ᒇ ᩍ ᤵ ࡢ ࢢ ࣝ ࣮ ࣉ ࡼ ࡾ
,
ከ ᩘ ࡢ4 ′-⨨ NAs
ࡢ ᢠHBV
ά ᛶ ࡀ ホ ౯ ࡉ ࢀ ࡓ.
ᢠHBV
ά ᛶ ࢆ ᭷ ࡍ ࡿ4′-
⨨ NAs
ࡢ ᵓ 㐀 ࢆFig.12
♧ ࡍ.
16
ࣉ ࣜ ࣥ ࢾ ࢡ ࣞ ࢜ ࢩ ࢻ ࡢ
4 ′ ࢩ ࣀ ᇶ ࢆ ᑟ ධ ࡋ ࡓ CdG ( 28 )
ࡸCAdA (29 )
ࡣ 㠀 ᖖ ᙉ ຊ ࡞ ᢠHBV
ά ᛶ(EC
5 0HBV WT= 0.0004 μ M)
ࢆ ᣢ ࡕ, ETV
⪏ ᛶ ᰴ ᑐ ࡋ ࡚ ࡶ ᙉ ࠸ ᢠ
HBV
స ⏝(EC
5 0HBV ETV-R= 0.04-0.07 μ M)
ࢆ ⥔ ᣢ ࡋ ࡚ ࠸ ࡓ.
ࡉ ࡽ ὀ ┠ ࡍ ࡁ ࡣ, ETV
ࡢ4′ ࢩ ࣀ ᇶ ࢆ ᑟ ධ ࡋ ࡓ CMCdG ( 30 )
ࡀETV
࡛ ࡣ ᢠHBV
ά ᛶ ࡀ ⴭ ࡋ ࡃ ప ୗ ࡋ ࡓ ⪏ ᛶ ᰴ ࡢ ά ᛶ ࢆ ᭷ ࡋ ࡚ ࠸ ࡿ(ETV:EC
5 0HBV E TV-R= 64.037 μ M, CMCdG:EC
5 0HBV E TV-R= 2.657 μ M)
ࡇ ࡛࠶ ࡿ
.
ࡋ ࡋ ࡞ ࡀ ࡽ,
ࡇ ࡢ ⣔ ⤫ ࡢNAs
ࡣ ⣽ ⬊ ẘ ᛶ ࢆ ᭷ ࡋ ࡚ ࠸ ࡿ(CC
5 0H ep G2= 2.6-89 μ M)
ࡇ ࡀ ㄢ 㢟 ࡞ ࡗ ࡚ ࠸ ࡿ.
[ 6 4 ] [6 5 ]ࡇ ࡢ ࡼ ࠺
4 ′-⨨ NAs
ࡣ ᙉ ຊ ࡞ ᢠHBV
ά ᛶ ࢆ ᣢ ࡕ,
⸆ ⪏ ᛶ ᰴ ᑐ ࡋ࡚ ࡶ ຠ ᯝ ࡀ ࠶ ࡿ ࡇ ࡀ ♧ ࡉ ࢀ ࡓ
.
ᢠHBV
ά ᛶ ࢆ ♧ ࡍ ⌮ ⏤ ࡋ ࡚ ࡣ,
⢾ ࡢ ❧ య 㓄 ᗙ ࡀ ኚ ࡍ ࡿ ࡇ ຍ ࠼, HBV
㏫ ㌿ 㓝 ⣲ CdG
୕ ࣜ ࣥ 㓟 ࡀ ⤖ ྜ ࡍ ࡿ 㝿, A87, F88, P177, L180, M204, D205
ࡽ ࡞ ࡿ Ỉ ✵ 㛫 ࢩ ࣀ ᇶ ࡀ ධ ࡾ㎸ ࡳ
,
ᙉ ࡃ ⤖ ྜ ࡍ ࡿ ࡓ ࡵ ⪃ ࠼ ࡽ ࢀ ࡚ ࠸ ࡿ.
[ 5 8 ]4 ′-
⨨ NAs
ࡣ ⌧ ᅾ,
⮫ ᗋ ⌧ ሙ ࡛HBV
ឤ ᰁ ⒪ ⸆ ࡋ ࡚ ⏝ ࠸ ࡽ ࢀ ࡚ ࠾ࡽ ࡎ
,
ࡘ ᪤ Ꮡ ࡢ ⸆ ≀ ࡣ ᵓ 㐀 స ⏝ ᶵ ᗎ ࡀ ␗ ࡞ ࡿ.
ࡑ ࡇ ࡛,
⪏ ᛶ ᰴ ᑐ ࡋ ࡚ ࡶ ᙉ ຊ ࡞ ᢠHBV
ά ᛶ ࢆ ♧ ࡋ,
ẘ ᛶ ࡢ ప ࠸NAs
ࡢ 㛤 Ⓨ ࢆ ┠ ᣦ ࡋ ࡚,
᪂ つ4 ′-⨨ NAs
ࢆ ྜ ᡂ ࡋ,
ᵓ 㐀 ά ᛶ ┦ 㛵 ◊ ✲ ࢆ ⾜ ࠺ ࡇ ࡋ ࡓ.
17
➨
2
❶4 ′-
ࢪ ࢻ-5-
࣓ ࢳ ࣝ-4-
⨨ ࣆ ࣜ ࣑ ࢪ ࣥ ࢾ ࢡ ࣞ ࢜ ࢩ ࢻ 㛵 ࡍ ࡿ ᳨ ウ➨
1⠇ ᗎ
ᗎඛ ㏙ ࡋ ࡓ ࡼ ࠺
4 ′-
⨨ ࢾ ࢡ ࣞ ࢜ ࢩ ࢻ ࡣ ᢠHBV
ά ᛶ ࢆ ᭷ ࡍ ࡿ ࡶ ࡢ ࡀ ᩘ ከ ࡃ ሗ ࿌ ࡉ ࢀ ࡚ ࠸ ࡿ.
ᡃ ࠎ ࡢ ᡤ ᒓ ࡍ ࡿ ◊ ✲ ᐊ ࡛ ࡶ4 ′-
ࢪ ࢻ ࣉ ࣜ ࣥ ࢾ ࢡ ࣞ࢜ ࢩ ࢻ ࡛ ࠶ ࡿ
AdG (31)
ࡸAAdA (32 )
ࡀ ᙉ ຊ ࡞ ᢠHBV
ά ᛶ ࢆ ᭷ ࡋ ࡚ ࠸ ࡿ ࡇ (EC
5 0HBV= 0.006-0.009 μ M)
ࢆ ሗ ࿌ ࡋ ࡓ.
[ 6 6 ] ࡋ ࡋ ࡞ ࡀ ࡽ, AdG
ࡸAAdA
ࡣ ⣽ ⬊ ẘ ᛶ ࢆ ᭷ ࡋ ࡚ ࠾ ࡾ(CC
5 0M T-4= 4.6-4.9 μ M),
ẘ ᛶ ㍍ ῶ ࡢ ࡓ ࡵ4 ′-
ࢪ ࢻ ࢾ ࢡ ࣞ ࢜ ࢩ ࢻ ࡢ ᵓ 㐀 ᭱ 㐺 ࡀ ᚲ せ ⪃ ࠼ ࡓ. (Fig.13 )
ࡑ ࡇ ࡛
,
ሷ ᇶ ᵓ 㐀 ࡋ ࡚ ࣆ ࣜ ࣑ ࢪ ࣥ ╔ ┠ ࡋ ࡓ.
⌧ ᅾ Ḣ ⡿ ࡛HBV
ឤ ᰁ ⒪ ⸆ ࡋ ࡚ ⏝ ࡉ ࢀ ࡚ ࠸ ࡿ
Telbivudine (33)
ࡣ ሷ ᇶ 㒊 ࡋ ࡚ ࢳ ࣑ ࣥ ࢆ ᭷ ࡋ ࡚ ࠸ ࡿ.
ࡋ ࡋ ࡞ ࡀ ࡽ,
ሷ ᇶ 㒊 ࡀ ࢳ ࣑ ࣥ ࡢ4′-
ࢪ ࢻ ࢳ ࣑ ࢪ ࣥ(34 )
ࡘ࠸ ࡚ ᢠ
HBV
ά ᛶ ࡣ ᮍ ☜ ㄆ ࡛ ࠶ ࡗ ࡓ.
ࡉ ࡽ ,
ሷ ᇶ 㒊 5-
࣓ ࢳ ࣝ ࢩ ࢺ ࢩ ࣥ ᵓ 㐀 ࢆ ᭷ ࡍ ࡿFddMeC (35 )
ࡀ ᢠHBV
ά ᛶ ࢆ ᭷ ࡍ ࡿ(EC
5 0HBV= 0.54 μ M)
ࡇ ࡀ ሗ ࿌ ࡉ ࢀ ࡚ ࠸ ࡓ
. (Fig.14)
[ 6 7 ]ࡲ ࡓ
,
ᢠHBV
ά ᛶ ࢆ ᭷ ࡋ ࡚ ࠸ ࡿFNC (36)
ࡘ ࠸ ࡚, N
4 ࣝ ࢟ ࣝ ࡋ ࡓNAs ( 37- 38)
ࡀ ᢠHBV
ά ᛶ ࢆ ⥔ ᣢ ࡋ ࡘ ࡘ ẘ ᛶ ࡀ ప ῶ ࡍ ࡿ ሗ ࿌ ࡉ ࢀ ࡓ.
( Fig.15)
[ 6 8 ] -[ 6 9]18
௨ ୖ ࡢ ▱ ぢ ࢆ ࡩ ࡲ ࠼
,
ሷ ᇶ ࡋ ࡚ ࢳ ࣑ ࣥ ࢆ ࡶ ࡘ4′-
ࢪ ࢻ ࢳ ࣑ ࢪ ࣥ( 34 )
ཬ ࡧ, 5-
࣓ ࢳ ࣝ ࢩ ࢺ ࢩ ࣥ ࢆ ࡶ ࡘ4′-
ࢪ ࢻ-2 ′-
ࢹ ࢜ ࢟ ࢩ-5-
࣓ ࢳ ࣝ ࢩ ࢳ ࢪ ࣥ( 39)
ࡀ ᢠHBV
ά ᛶ ࢆ ᭷ ࡋ ࡘ ࡘ,
ప ⣽ ⬊ ẘ ᛶ ࡢ ᢠHBV
⸆ ࣜ ࣮ ࢻ ᵓ 㐀 ࡞ ࡿ ⪃ ࠼ ࡓ
.
ࡲ ࡓ, N
4/ O
4 ࡢ ࣝ ࢟ ࣝ ࡼ ࡗ ࡚,
ẘ ᛶ ࡀ ࡉ ࡽ ప ῶ ࡍ ࡿ ࡇ ࢆ ᮇ ᚅ ࡋ ࡚
, NAs 40 -44
ࢆ タ ィ ࡋ ࡓ.
ࡍ ࡞ ࢃ ࡕ, 4′- ࢪ ࢻ -5-࣓ ࢳ ࣝ -4-⨨ ࣆ
ࣜ ࣑ ࢪ ࣥ ࢾ ࢡ ࣞ ࢜ ࢩ ࢻ
(34 , 39 -44 )
ࢆ ྜ ᡂ ࡋ ᢠHBV
ά ᛶ ཬ ࡧ ⣽ ⬊ ẘ ᛶ ࢆ ホ ౯ ࡍ ࡿ ࡇ ࡋ ࡓ. (Fig.16 )
19
➨
2
⠇4 ′-
ࢪ ࢻ- 5-
࣓ ࢳ ࣝ-4-
⨨ ࣆ ࣜ ࣑ ࢪ ࣥ ࢾ ࢡ ࣞ ࢜ ࢩ ࢻ ࡢ ྜ ᡂ34
ࡢ ྜ ᡂ ࡣMaag
ࡽ ࡢ ሗ ࿌ ๎ ࡗ ࡚ ⾜ ࡗ ࡓ. (Scheme 2)
[ 5 6 ]ࢳ ࣑ ࢪ ࣥ ࢆ ฟ Ⓨ ཎ ᩱ ࡋ ࡚
,
ࢵ ࣌ ࣝ ᛂ ࡚ 㑅 ᢥ ⓗ 5′ ࡢ Ỉ 㓟 ᇶ ࢆ
ࣚ ࢘ ⣲ ⨨ ࡋ ࡓ
45
ࢆ ྜ ᡂ ࡋ, E2
⬺ 㞳 ࡼ ࡗ ࡚, 4 ′,5′-exo-olefin
య46
ࢆ ྜ ᡂ ࡋ ࡓ. 46
ᑐ ࡋ ࡚ ࢪ ࣚ ࢘ ⣲ ࡢ ⨨ 㺃❧ య 㑅 ᢥ ⓗ ຍ ᛂ ࡼ ࡾ47
ㄏ ᑟ ࡋ ࡓ ᚋ, 3 ′
ࡢ Ỉ 㓟 ᇶ ࢆp-
࣓ ࢺ ࢟ ࢩ ࣋ ࣥ ࢰ ࣝ ࡛ ಖ ㆤ ࡋ48
ࡋ ࡓ. 48
ࢆ
mCPBA
ࡼ ࡿ ㉸ ཎ Ꮚ ౯ ࣚ ࢘ ⣲ ࡢ ᙧ ᡂ , p-
࣓ ࢺ ࢟ ࢩ ࣋ ࣥ ࢰ ࣝ ࡢ ࢝ ࣝ ࣎ ࢽ ࣝ 㓟 ⣲ ࡼ ࡿ ศ Ꮚ ෆ ồ ᰾ ⨨ ᛂ ࡚ ⎔ ≧ ᵓ 㐀 ࢆ ᙧ ᡂ ࡉ ࡏ,
⥆ ࡃ3-ࢡ ࣟ
ࣟ Ᏻ ᜥ 㤶 㓟 ࢽ ࢜ ࣥ ࡢ ồ ᰾ ⨨ ᛂ ࡼ ࡾ
49
ࢆ ྜ ᡂ ࡋ ࡓ.
ࡑ ࡢ ᚋ, 49
ࢆ7M
ࣥ ࣔ ࢽ ᛶ ࣓ ࢱ ࣀ ࣮ ࣝ ࡛ ⬺ ಖ ㆤ ࡍ ࡿ ࡇ ࡛ ┠ ⓗ ≀ ࡛ ࠶ ࡗ ࡓ34
ࢆ ᚓ ࡓ.
ࡉ ࡽ
,
ࣆ ࣜ ࣑ ࢪ ࣥ4
ࡢ ⨨ ࢆ ⾜ ࠺ ࡓ ࡵ, 49
ࡢ ࣆ ࣜ ࣑ ࢪ ࣥ4
ࢆ ά ᛶ ࡋ ࡓ 㘽 ୰ 㛫 య
50
ࢆ ྜ ᡂ ࡋ ࡓ. (Scheme 3)
20
㘽 ୰ 㛫 య
50
ࡢ ࣆ ࣜ ࣑ ࢪ ࣥ4
ࢆDABCO
࡛ ά ᛶ ࡋ,
ᑐ ᛂ ࡍ ࡿ ࣝ ࢥ ࣮ࣝ ࡼ ࡿ
S
NAr
ᛂ ࢆ ⾜ ࠸,
⬺ ಖ ㆤ ࡍ ࡿ ࡇ ࡛40- 41
ࢆ ྜ ᡂ ࡋ ࡓ. (Scheme 4 )
ࡲ ࡓ
,
㘽 ୰ 㛫 య50
ࢆ ᑐ ᛂ ࡍ ࡿ ࣑ ࣥ ࡛ ฎ ⌮ ࡍ ࡿ ࡇ ࡛, S
NAr
ᛂ ࡚39 , 42 -43
ࢆ ྜ ᡂ ࡋ ࡓ.
୍ ᪉,
㘽 ୰ 㛫 య50
ࡢ ࣆ ࣜ ࣑ ࢪ ࣥ4
ࢆDABCO
࡛ ά ᛶ ࡋ,
ࢩ ࢡ ࣟ ࣉ ࣟ ࣆ ࣝ ࣑ ࣥ ࡛ ฎ ⌮ ࡍ ࡿ ࡇ ࡛S
NAr
ᛂ ࡚ ྜ ≀44
ࢆ ᚓ ࡓ
. (Scheme 5)
21
ḟ ⠇ ࡚ ᢠ
HBV
ά ᛶ ホ ౯ ⤖ ᯝ ࢆ グ ㍕ ࡍ ࡿ.
22
➨
3
⠇4 ′-
ࢪ ࢻ- 5-
࣓ ࢳ ࣝ-4-
⨨ ࣆ ࣜ ࣑ ࢪ ࣥ ࢾ ࢡ ࣞ ࢜ ࢩ ࢻ ࡢ ᢠHBV
ά ᛶᢠ
HBV
ά ᛶ ཬ ࡧ ⣽ ⬊ ẘ ᛶ ホ ౯ ࡣ,
ඹ ྠ ◊ ✲ ඛ ࡛ ࠶ ࡿ ᅜ ❧ ᅜ 㝿 ་ ⒪ ࢭ ࣥ ࢱ ࣮ ࡢ ‶ ᒇ ᩍ ᤵ ࡢ ࢢ ࣝ ࣮ ࣉ ౫ 㢗 ࡋ ࡓ.
ྛ ྜ ≀ ࡢ ᢠ
HBV
ά ᛶ ࡢ ホ ౯ ࡣreal-time PCR
ἲ ࢆ ⏝ ࠸ ࡓ.
ࢥ ࣛ ࣮ ࢤ ࣥ ࢥ ࣮ ࢺ ࡉ ࢀ ࡓ96 well plate
, HepG2 2.2.15
⣽ ⬊ ࢆ1 well
࠶ ࡓ ࡾ4
10
3ಶ ࡎ ࡘ ࡁ,
ᵝ ࠎ ࡞ ⃰ ᗘ ᕼ 㔘 ࡋ ࡓ ྛ ྜ ≀ ࢆ200 μ L
ຍ ࠼ ࡓ.
ࡲ ࡓ,
ࢥ ࣥ ࢺࣟ ࣮ ࣝ ࡋ ࡚ ྜ ≀ ⁐ ᾮ ࢆ ຍ ࠼ ࡞ ࠸
well
ࢆ స ᡂ ࡋ ࡓ. HepG2 2.2.15
⣽ ⬊ ࡣHBV
ࢆ ᣢ ⥆ ⏘ ⏕ ࡍ ࡿ ⣽ ⬊ ᰴ ࡛ ࠶ ࡾ, in vitro
ࡢ ᢠHBV
ά ᛶ ࢆ ホ ౯ ࡍ ࡿ 㝿 ỗ ⏝ ࡉ ࢀ ࡚ ࠸ ࡿ.
ࡇ ࡢwell plate
ࢆ37
Υ ࡢCO
2 ࣥ ࢟ ࣗ ࣋ ࣮ ࢱ ࣮ ࡛14
᪥ 㛫 ᇵ 㣴 ࡋ ࡓ.
ࡑ ࡢ 㝿, 3
᪥ ┠ 7
᪥ ┠ ᇵ 㣴 ୖ Ύ ࢆ 㝖 ཤ ࡋ,
ࡧ ྛ ⃰ ᗘ ㄪᩚ ࡋ ࡓ ྛ ྜ ≀ ࢆ ྵ ࡴ ᾮ య ᇵ ᆅ ࡋ ࡓ
.
ᇵ 㣴 ᚋ,
ᾮ య ᇵ ᆅ ୖ Ύ ࢆ ᅇ ࡋ, HBV DNA
ࢆ ᢳ ฟ ࡋ ࡓ.
ࡑ ࡢ ᚋ,
ᐃ 㔞 ⓗPCR
ࡼ ࡗ ࡚ ྛwell
࠾ ࡅ ࡿHBV DNA
㔞 ࢆ ᐃ ࡋ,
ࢥ ࣥ ࢺ ࣟ ࣮ ࣝ ࡢDNA
㔞 ẚ ㍑ ࡋ ࡚EC
5 0HBV್ ࢆ ⟬ ฟ ࡋ ࡓ.
୍ ᪉
,
⣽ ⬊ ẘ ᛶ ࡣ96 well plate
MT-2
⣽ ⬊ ࢆ1 well
࠶ ࡓ ࡾ2
10
3ಶ ࡎ ࡘ ࡁ,ྛ well
ᵝ ࠎ ࡞ ⃰ ᗘ ᕼ 㔘 ࡋ ࡓ ྛ ྜ ≀200 μ L
ࢆ ຍ ࠼ ࡓ ≧ ែ ࡛ ᇵ 㣴 ࡋ ࡓ.
ࡑ ࡢ ᚋ, Cell Counting Kit-8
ࢆ ⏝ ࠸ ࡚CC
5 0್ ࢆ ⟬ ฟ ࡋ ࡓྜ ᡂ ࡋ ࡓ
34, 39 -44
ཬ ࡧ ࣏ ࢪ ࢸ ࣈ ࢥ ࣥ ࢺ ࣟ ࣮ ࣝ ࡛ ࠶ ࡿETV
ࡢ ᢠHBV
ά ᛶ ⣽ ⬊ ẘ ᛶ ࡢ ホ ౯ ⤖ ᯝ ࢆTable 3
ࡲ ࡵ ࡓ.
᭱ ࡶ 㧗 ࠸ ᢠ
HBV
ά ᛶ ࢆ ♧ ࡋ ࡓ ྜ ≀ ࡣ34
࡛ ࠶ ࡾ, EC
5 0HBV= 0.63s0.29
23
μ M
࡛ ࠶ ࡗ ࡓ.
ࡲ ࡓ, 39
ࡶ ୰ ⛬ ᗘ ࡢ ᢠHBV
ά ᛶ ࡀ ☜ ㄆ ࡉ ࢀ, EC
5 0HBV= 5.99
s5.54μ M
࡛ ࠶ ࡗ ࡓ.
ࡇ ࢀ ࡽ34
ཬ ࡧ39
ࡣ ⣽ ⬊ ẘ ᛶ ࡣ ☜ ㄆ ࡉ ࢀ ࡞ ࡗ ࡓ(CC
5 0M T-2> 100 μM).
୍ ᪉
, N
4/ O
4 ࣝ ࢟ ࣝ య40 -44
ࡣ ⣽ ⬊ ẘ ᛶ ࡣ ☜ ㄆ ࡉ ࢀ ࡞ ࡗ ࡓ ࡶ ࡢ ࡢ,
ᢠHBV
ά ᛶ ࡶ ☜ ㄆ ࡉ ࢀ ࡞ ࡗ ࡓ.
ḟ ⠇ ࡚ ⤖ ᯝ ࡘ ࠸ ࡚ ⪃ ᐹ ࡍ ࡿ
.
➨
4⠇ ⪃
⪃ ᐹᮏ ❶ ࡛ ࡣ
,
ᢠHBV
ά ᛶ ࢆ ᣢ ࡘ ᪂ つNAs
ࡋ ࡚4′-
ࢪ ࢻ-5-
࣓ ࢳ ࣝ-4-
⨨ ࣆ ࣜ ࣑ ࢪ ࣥ ࢾ ࢡ ࣞ ࢜ ࢩ ࢻ ࢆ タ ィ ࡋ
,
ࡑ ࡢ ྜ ᡂ ࢆ 㐩 ᡂ ࡋ ࡓ.
4 ′- ࢪ ࢻ ࢳ ࣑ ࢪ ࣥ ࡢ ྜ ᡂ ࢆ 6
ᕤ ⛬,
㏻ ⟬ ⋡22.0%࡛ 㐩 ᡂ ࡋ ࡓ .
ࡲ ࡓ, 4′-
ࢪ ࢻ
-5-
࣓ ࢳ ࣝ-4-⨨ ࣆ ࣜ ࣑ ࢪ ࣥ ࢾ ࢡ ࣞ ࢜ ࢩ ࢻ ࡢ ྜ ᡂ ࡛ 㔜 せ ࡞ 㘽 ୰ 㛫 య 50
ࡢ ྜ ᡂ ࢆ6
ᕤ ⛬,
㏻ ⟬ ⋡17.3%࡛ 㐩 ᡂ ࡋ ࡓ .
ࡑ ࡢ ᚋ, S
NAr
ᛂ ࡼ ࡿ ሷ ᇶ 㒊4
ࡢ ⨨ ᡂ ຌ ࡋ,
⋡ ࡣ21.0-82.1%
࡛ ࠶ ࡗ ࡓ.
ᮏ ❶ ࡛ タ ィ ࡋ ࡓ ྜ ≀ ࡛ ᭱ ࡶ 㧗 ࠸ ᢠ
HBV
ά ᛶ ࢆ ᭷ ࡋ ࡚ ࠸ ࡓ ࡢ ࡣ34
࡛ ࠶ࡾ
(EC
5 0HBV= 0.63
s0.29μ M), 39
ࡶ ᢠHBV
ά ᛶ ࢆ ᭷ ࡋ ࡚ ࠸ ࡓ(EC
5 0HBV= 5.99
s5.54 μ M).
ࡲ ࡓ, 34
ཬ ࡧ39
ࡣ ⣽ ⬊ ẘ ᛶ ࡣ ☜ ㄆ ࡉ ࢀ ࡞ ࡗ ࡓ(CC
5 0M T-4> 100 μM)
ࡇ ࡽ34
ཬ ࡧ39
ࡣ ᭷ ᮃ ࡞ ࣜ ࣮ ࢻ ྜ ≀ ࡛ ࠶ ࡿ ⪃࠼ ࡽ ࢀ ࡿ
.
ࡉ ࡽ ⯆ ῝ ࠸ ࡇ , 4′-
ࢪ ࢻ ࢹ ࢜ ࢟ ࢩ ࢩ ࢳ ࢪ ࣥ ࡣ 㧗 ࠸ ẘ ᛶ ࡀ ☜ ㄆ ࡉ ࢀ ࡚ ࠸ ࡓ(CC
2 5M T-2= 0.21 μ M)
[ 5 6 ] ࡀ,
ሷ ᇶ ࡀ5-
࣓ ࢳ ࣝ ࢩ ࢺ ࢩ ࣥ ࡛࠶ ࡿ
39
ࡢ ሙ ྜ,
ᢠHBV
ά ᛶ ࢆ ⥔ ᣢ ࡋ ࡘ ࡘ ẘ ᛶ ࡀ ప ῶ ࡋ ࡓ.
ࡋ ࡓ ࡀ ࡗ ࡚,
ࣆ ࣜ ࣑ ࢪ ࣥ
5
࣓ ࢳ ࣝ ᇶ ࢆ ᭷ ࡍ ࡿ ࡇ ࡛ ẘ ᛶ ప ῶ ࡘ ࡞ ࡀ ࡿ ࡇ ࡀ ♧ ၀ ࡉ ࢀ ࡓ.
ࡲ ࡓ, FNC
ࡣN
4 ࣝ ࢟ ࣝ ࡍ ࡿ ࡇ ࡛ ⣽ ⬊ ẘ ᛶ ࢆ ప ῶ ࡋ ࡘ ࡘ,
ᢠHBV
ά ᛶ ࢆ ⥔ ᣢ ࡋ ࡚ ࠸ ࡓ ࡀ, 40- 44
ࡘ ࠸ ࡚ ࡣ ᢠHBV
ά ᛶ ࢆ ࿊ ࡉ ࡞ ࡗ ࡓ.
ࡇ ࡢ ࡇ ࡽ,
ࣆ ࣜ ࣑ ࢪ ࣥ5
࣓ ࢳ ࣝ ᇶ ࢆ ᭷ ࡋ,
ࡉ ࡽ N
4/ O
4 ࢆ ࣝ ࢟ࣝ ࡋ ࡓ ሙ ྜ
,
㏫ ㌿ 㓝 ⣲ ࡢ ᇶ ㉁ ࡞ ࡽ ࡎ ᢠHBV
ά ᛶ ࡣ ⴭ ࡋ ࡃ ప ୗ ࡍ ࡿ ࡇ ࡀ ♧ ၀ ࡉ ࢀ ࡓ.
௨ ୖ ࡢ ࡇ ࡽ,
ᢠHBV
ά ᛶ ࢆ ᭷ ࡍ ࡿ4′-
⨨ NAs
࠾ ࠸ ࡚
,
ሷ ᇶ 㦵 ᱁ ࡋ ࡚ ࢳ ࣑ ࣥ ཬ ࡧ5-
࣓ ࢳ ࣝ ࢩ ࢺ ࢩ ࣥ ࡀ ᭷ ᮃ ࡛ ࠶ ࡿ ⪃ ࠼ࡽ ࢀ ࡿ
.
ࡇ ࡢ ࡇ ࡣ ᚋ
,
ᢠHBV
ά ᛶ ࢆ ᭷ ࡍ ࡿ ᪂ つ4′-
⨨ NAs
ࢆ タ ィ ࡋ ࡚ ࠸ ࡃୖ ࡛ 㠀 ᖖ ᭷ ┈ ࡞ ሗ ࡛ ࠶ ࡿ