One of the most notable successes of rational pharmaceutical design has been the development of drugs that inhibit the protease cleaving the polyproteins of the HIV into their structural and catalytic protein components (1, 2). Several of these inhibitors are currently used as components of “highly active antiretroviral therapy” for treating HIV infection and AIDS (2, 3). Given the similar chemistry involved in all peptide bond hydrolysis reactions, as well as the different sequence contexts of the polyprotein cleavage sites, the ability of these drugs to specifically target the HIV protease and not the hundreds of other proteases required for human health—digestive enzymes, enzymes of the coagulation pathway, enzymes of the complement cascade, proteases involved in protein maturation and transport—is truly remarkable. However, in a recent issue of PNAS, Coffinier et al. (4) demonstrate that these drugs do inhibit at least one unrelated protease and that this inhibition could conceivably account for some of the side effects of these pharmaceuticals. They show that HIV protease inhibitors, including lopinavir, a first-line widely used member of the saquinavir family, can also inhibit ZMPSTE24, a distinct protease involved in the conversion of farnesylprelamin A to lamin A, a key structural component of the nuclear lamina (Fig. 1). In recent years, genetic defects in the conversion of farnesylprelamin A to lamin A in humans have been shown to cause severe progeroid disorders (e.g., restrictive dermopathy, Hutchinson–Gilford progeria syndrome) (6–8). These findings suggest that the inhibition of prelamin A processing by HIV protease inhibitors may result in some of the same disease phenotypes observed in the genetic prelamin A-processing disorders.
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