The long-range goal of this proposal is to continue to evaluate the potential role of neurokinin-1 receptor (NK1R) antagonists as anti HIV-1 agents in vivo. Aprepitant is the only FDA approved substance P antagonist. We have demonstrated in our previous work that NKIR antagonists, in general and aprepitant, in particular, have significant anti HIV-1 activity in vitro possibly mediated through CCR5 down-regulation, although some of our in vitro data suggests that these compounds have some antiviral activity in CXCR4 viruses. Aprepitant is metabolized primarily by CYP3A4 with minor metabolism by CYPIA2 and CYP2C19. This metabolic pathway suggests that aprepitant will interact favorably with the protease inhibitor ritonavir (a potent inhibitor of CYP3A4), as do many ofthe current available antlretrovirals. We will examine the safety and the PK characteristics of the NKI R antagonist, aprepitant, in HIV-infected subjects with well controlled viral replication receiving ritonavir containing antiretroviral therapy. Our hypothesis is that aprepitant will be safe, tolerable and that with the concomitant administration of the protease inhibitor ritonavir, we will be able to attain the therapeutic levels necessary to achieve antiviral activity predicted by both by our in vitro studies and our pharmacokinetic and pharmacodynamic (PK/PD) modeling. We will also examine the antiviral activity of an optimized dose of aprepitant administered for two weeks as an "add on" drug in patients with evidence of virologic failure on a protease inhibitor containing regimen. Further, we hypothesize that aprepitant will improve depressive symptoms, decrease anxiety and improve sleep quality in patients with HIV infection.

Public Health Relevance

We will examine the safety and PK characteristics of aprepitant in HIV-infected subjects with well controlled viral replication, receiving ritonavir containing antiretroviral therapy. We hypothesize that aprepitant will be safe, tolerable, and will demonstrate antiviral activity. We will also examine the antiviral activity of aprepitant, optimized as an add-on drug in patients with evidence of virologic failure on a protease inhibitor containing regimen. This study is a proof-of-principal of NKI R antagonists for adjuvant therapy for neuroAIDS.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project--Cooperative Agreements (U01)
Project #
Application #
Study Section
Special Emphasis Panel (ZMH1-ERB-X)
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Children's Hospital of Philadelphia
United States
Zip Code
Barrett, Jeffrey S; Bajaj, Gaurav; McGuire, Jennifer et al. (2014) Modeling and simulation approach to support dosing and study design requirements for treating HIV-related neuropsychiatric disease with the NK1-R antagonist aprepitant. Curr HIV Res 12:121-31
Tuluc, Florin; Meshki, John; Spitsin, Sergei et al. (2014) HIV infection of macrophages is enhanced in the presence of increased expression of CD163 induced by substance P. J Leukoc Biol 96:143-50
Schwartz, Lynnae; Spitsin, Sergei V; Meshki, John et al. (2013) Substance P enhances HIV-1 infection in human fetal brain cell cultures expressing full-length neurokinin-1 receptor. J Neurovirol 19:219-27
Spitsin, Sergei; Tuluc, Florin; Meshki, John et al. (2013) Analog of somatostatin vapreotide exhibits biological effects in vitro via interaction with neurokinin-1 receptor. Neuroimmunomodulation 20:247-55
Barrett, Jeffrey S; McGuire, Jennifer; Vezina, Heather et al. (2013) PET measurement of receptor occupancy as a tool to guide dose selection in neuropharmacology: are we asking the right questions? J Clin Psychopharmacol 33:725-8
Spitsin, Sergei; Stevens, Kathleen E; Douglas, Steven D (2013) Expression of substance P, neurokinin-1 receptor and immune markers in the brains of individuals with HIV-associated neuropathology. J Neurol Sci 334:18-23
Khan, Mohammad M; Douglas, Steven D; Benton, Tami D (2012) Substance P-neurokinin-1 receptor interaction upregulates monocyte tissue factor. J Neuroimmunol 242:1-8
Meshki, John; Douglas, Steven D; Hu, Mingyue et al. (2011) Substance P induces rapid and transient membrane blebbing in U373MG cells in a p21-activated kinase-dependent manner. PLoS One 6:e25332
Douglas, Steven D; Leeman, Susan E (2011) Neurokinin-1 receptor: functional significance in the immune system in reference to selected infections and inflammation. Ann N Y Acad Sci 1217:83-95
Monaco-Shawver, Linda; Schwartz, Lynnae; Tuluc, Florin et al. (2011) Substance P inhibits natural killer cell cytotoxicity through the neurokinin-1 receptor. J Leukoc Biol 89:113-25