ABSTRACT:A high-throughput screen based on a viral replication assay was used to identify inhibitors of the human cytomegalovirus. Using this approach, hit compound 1 was identified as a 4 μM inhibitor of HCMV that was specific and selective over other herpes viruses. Time of addition studies indicated compound 1 exerted its antiviral effect early in the viral life cycle. Mechanism of action studies also revealed that this series inhibited infection of MRC-5 and ARPE19 cells by free virus and via direct cell-to-cell spread from infected to uninfected cells. Preliminary structure−activity relationships demonstrated that the potency of compound 1 could be improved to a low nanomolar level, but metabolic stability was a key optimization parameter for this series. A strategy focused on minimizing metabolic hydrolysis of the N1-amide led to an alternative scaffold in this series with improved metabolic stability and good pharmacokinetic parameters in rat. KEYWORDS: HCMV, cell-to-cell spread, replication inhibitors, antiviral agents A lthough infection with human cytomegalovirus (HCMV) does not lead to disease in healthy individuals, it can cause end-organ disease in the fetus, in the allograft recipient, in bone marrow transplant patients, and in AIDS patients. 1 Since HCMV infects approximately 60% of people in the developed world and over 99% in developing countries, the risk of morbidity and mortality due to HCMV disease is a significant problem for public health on a global scale. 1 Furthermore, a recent study has linked HCMV infection to increased mortality in the general population in the US. The current gold standard therapy for HCMV infection is either gancyclovir or its prodrug valgancyclovir. 2 However, when resistance or poor tolerability arise with these medications, second line options frequently suffer from lack of efficacy due to poor bioavailability, modest potency, and poor tolerability due to their toxicity at efficacious exposures. 2 Thus, a significant gap in treatment options exists, which has led to substantial efforts to develop new drugs to treat this opportunistic infection. There has been a sustained effort to discover an effective HCMV vaccine for the prevention of HCMV infection and although there have been positive outcomes in a number of clinical proof of concept studies, no marketed vaccine yet exists. 3 Currently, the leading edge in the discovery of new small molecule therapeutic agents includes the ongoing development of maribavir, letermovir, and brincidofovir, inhibitors of UL97, terminase, and HCMV polymerase, respectively. 1 These compounds have all demonstrated positive clinical proof of concept in phase II studies and may represent the next generation of therapy options for patients that have or are at risk of developing HCMV disease.Due to the significant unmet medical need for patients at risk for HCMV-related end organ disease, a drug discovery effort aimed at discovery of potent and selective inhibitors of HCMV replication was initiated at Boehringer Ingelheim. In the se...