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Beschreibung

Frontiers in Clinical Drug Research – Anti infectives is a book series that brings updated reviews to readers interested in learning about advances in the development of pharmaceutical agents for the treatment of infectious diseases. The scope of the book series covers a range of topics including the chemistry, pharmacology, molecular biology and biochemistry of natural and synthetic drugs employed in the treatment of infectious diseases. Reviews in this series also include research on multi drug resistance and pre-clinical / clinical findings on novel antibiotics, vaccines, antifungal agents and antitubercular agents. Frontiers in Clinical Drug Research – Anti infectives is a valuable resource for pharmaceutical scientists and postgraduate students seeking updated and critically important information for developing clinical trials and devising research plans in the field of anti infective drug discovery and epidemiology.
The seventh volume of this series features these interesting reviews:
- Nucleic acid and peptide aptamers as potential antiviral drugs
- Host-directed, antibiotic-adjuvant combination, and antibiotic-antibiotic combination for treating multidrug-resistant (mdr) gram-negative pathogens
- Bioactive substances as anti-infective strategies against clostridioides difficile
- Anti-toxoplasma drug discovery and natural products: a brief overview
- Development of antimalarial and antileishmanial drugs from amazonian biodiversity

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Table of Contents
BENTHAM SCIENCE PUBLISHERS LTD.
End User License Agreement (for non-institutional, personal use)
Usage Rules:
Disclaimer:
Limitation of Liability:
General:
PREFACE
List of Contributors
Nucleic Acid and Peptide Aptamers as Potential Antiviral Drugs
Abstract
1. INTRODUCTION
1.1. The in vitro Selection Methods for Peptide and Nucleic Acid Aptamers
1.2. MRNA Display
1.3. Ribosome Display
1.4. SELEX (Systematic Evolution of Ligands by Exponential Enrichment) for Nucleic Acid Aptamers
1.4.1. Cell-SELEX
1.4.2. Bead-Based SELEX
1.5. Post-SELEX Modifications
1.6. Modification of Peptide Aptamers for Therapeutic Applications
2. Aptamers in Viral Diagnosis
2.1. Aptamers in Diagnosis of Hepatitis B Virus (HBV)
2.2. Aptamers in Diagnosis of Hepatitis C Virus (HCV)
2.3. Aptamers in Diagnosis of Human Immunodeficiency Virus (HIV)
2.4. Aptamers in Diagnosis of Influenza
2.5. Aptamers in Diagnosis of Arboviruses
2.6. Aptamers in Diagnosis of SARS Virus
2.7. Aptamers in Diagnosis of Ebola Virus
2.8. Aptamer in Diagnosis of SARS-COV-2
2.9. Aptamers in Diagnosis of Human Papilloma Virus (HPV)
2.10. Aptamer in Diagnosis of Herpes Simplex Virus (HSV)
3. Potentially Therapeutic Aptamers Against Viral Proteins
3.1. Aptamers Against Human Immunodeficiency Virus (HIV) Proteins
3.1.1. Reverse Transcriptase (RT)
3.1.2. Integrase (IN)
3.1.3. Other proteins of HIV-1
3.2. Aptamers Against Hepatitis C Virus (HCV) Proteins
3.2.1. Non-Structural Proteins (NS) of HCV
3.2.2. Structural Proteins of HCV
3.3. Aptamers Against Hepatitis B Virus (HBV) Proteins
3.4. Aptamers Against Severe Acute Respiratory Syndrome (SARS) Coronavirus Proteins
3.5. Aptamers Against Influenza Virus Proteins
4. CONCLUDING REMARKS
CONSENT FOR PUBLICATION
CONFLICT OF INTEREST
ACKNOWLEDGEMENTS
REFERENCES
Host-Directed, Antibiotic-Adjuvant Combination, and Antibiotic-Antibiotic Combination for Treating Multidrug-Resistant (MDR) Gram-Negative Pathogens
Abstract:
INTRODUCTION
MDR Gram-Negative Pathogens (GNPs)
Mechanism of Resistant Drugs
Esbl-Producing Enterobacteriaceae
Carbapenem-Resistant Enterobacteriaceae (CRE)
MDR A. Baumannii
Host-Directed Therapies
Antibiotic-Adjuvant Combination Therapy
Antibiotic-Antibiotic Combination Therapy
Treatment of Mdr K. Pneumoniae
Treatment of Mdr P. Aeruginosa
Treatment of Mdr A. Baumannii
Treatment of Mdr E. Coli
CONCLUDING REMARKS
CONSENT FOR PUBLICATION
CONFLICT OF INTEREST
ACKNOWLEDGEMENTS
REFERENCES
Bioactive Substances as Anti-infective Strategies Against Clostridioides Difficile
Abstract
INTRODUCTION
PATHOGENESIS AND EPIDEMIOLOGY oF C. DIFFICILE
Current Approaches In The Treatment of CDI
Initial Episodes of CDI
Fulminant Episodes of CDI
Recurrence of CDI
First Recurrence of CDI
Second or Subsequent Recurrence of CDI
Fecal Microbiota Transplantation
Promising Candidate Antibiotics For The Prevention/-treatment of Cdi As Alternative To Standard Therapies
Cadazolid
CRS3123
Nitazoxanide
Ramoplanin
Ridinilazole
Surotomycin
Tigecycline
Other Promising Anti-infective Strategies For The Prevention/treatment of CDI
Vaccines
Monoclonal Antibodies
Non-Toxigenic Spores
Bacteriophages
Probiotics
Bacteriocins
Lantibiotics
Thiopeptides
Sactibiotics
Synthetic Polymers
CONCLUDING REMARKS
CONSENT FOR PUBLICATION
CONFLICT OF INTEREST
ACKNOWLEDGEMENTS
REFERENCES
Anti-Toxoplasma Drug Discovery and Natural Products: a Brief Overview
Abstract
INTRODUCTION
Ethnobotanical Records
In vitro Activity Against T. gondii
Pleopeltis Crassinervata
Vernonia Colorata
Sophora Flavescens and Torilis Japonica
Ginkgo Biloba
Azadirachta Indica and Melia Azedarach
Psidium Guajava and Tinospora Crispa
Eurycoma Longifolia
Myristica Fragrans
Astragulus Membraneceus and Scutellaria Baicalensis
Sambucus Nigra
Balsamociteus Camerunensis
Jatropha Curcas
Shorgum Bicolor
Achillea Millefolium and hypericum Perforatumen
Cola Gigantea, Tectona Grandis and Vernonia Amigdalina
Anti-T. gondii in vivo and in vitro activity
Zingiber Officinale (ginger), Ginkgo Biloba and Glycyrrhiza Glabra
Thymus Broussonetii
Bunium Persicum
Thymus Vulgaris
Echinaceae Purpurea
Nigella Sativa
Berberis Vulgaris and Saturja Khuzestanica
Artemisia Annua
Piper Betle, P. Sarmentosum and P. Nigrum
Allium Paradoxum, Feijoa Sellowiana and Quercus Castaneifolia
Araucaria Heteropil
Aloe Vera and Eucaliptus
CONCLUDING REMARKS
CONSENT FOR PUBLICATION
CONFLICT OF INTEREST
ACKNOWLEDGEMENTS
REFERENCES
Development of Antimalarial and Antileishmanial Drugs from Amazonian Biodiversity
Abstract
INTRODUCTION
Chemical Studies and Evaluation of Biological Activities of Species that are more Frequently Cited in the Literature
CONCLUSION
CONSENT FOR PUBLICATION
CONFLICT OF INTEREST
ACKNOWLEDGEMENTS
REFERENCES
Frontiers in Clinical Drug Research-Anti Infectives
(Volume 7)
Edited by
Atta-ur-Rahman, FRS
Honorary Life Fellow,
Kings College,
University of Cambridge,
Cambridge,
UK

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PREFACE

The 7th volume of Frontiers in Clinical Drug Research – Anti Infectives comprises five chapters that cover a variety of topics including antivirals, treatments against some gram negative and gram negative bacteria, and an overview on a few antiprotozoal drugs that target specific pathogens.

In chapter 1, Evran et al., focus on aptamers with antiviral activity, as well as the use of aptamers in viral detection platforms. They also give an overview of aptamers developed against viruses, and discuss the major hurdles in aptamer use, as well as the strategies to improve the drug potential of aptamers.

In chapter 2, Leowattana et al. discuss host-directed, antibiotic-adjuvant combinations and antibiotic-antibiotic combination for treating Multidrug-Resistant (MDR) gram- negative pathogens (Acinetobacter, Enterobacteriaceae, Pseudomonas,etc.).

In chapter 3, Barbosa and Teixeira explore the current therapeutic approaches and advances in the search for alternative solutions to inhibit the opportunistic pathogen C. difficile.

Rivera-Fernández et al. in chapter 4 of the book, review the in vitro and in vivo activities of extracts, fractions, and isolated compounds obtained from different plants against Toxoplasma gondii, the pathogen that causes toxoplasmosis. This chapter presents information on potential leads for novel therapeutic agents for this disease.

In the last chapter of the book by Percário et al., the author describe the main Amazonian species used to treat malaria and leishmaniasis in Brazilian folk medicine, relating ethnobotanical results to chemical studies, evaluation of activities, and toxicity. Several promising compounds of plants used in traditional Amazonian medicine are described

I would like to thank all the authors for their excellent contributions that will be of great interest. Also, I would like to thank the editorial staff of Bentham Science Publishers, particularly Mr. Mahmood Alam (Editorial Director) of Bentham Science Publishers, Mr. Obaid Sadiq (In-charge Books Department) and Miss Asma Ahmed (Senior Manager Publications) for their support.

Atta-ur-Rahman, FRS Kings College University of Cambridge Cambridge UK

List of Contributors

Antônio R. Q. GomesPost-Graduate Program in Pharmaceutical Innovation, Federal University of Pará, Belém, PA, BrazilCanan ÖzyurtDepartment of Chemistry and Chemical Processing Technologies, Lapseki Vocational School, Canakkale Onsekiz Mart University, Canakkale, Lapseki, TurkeyElba Carrasco-RamírezDepartamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Coyoacán, MexicoElisa Vega ÁvilaDepartamento de Ciencias de la Salud, Universidad Autónoma Metropoli-tana, Unidad Iztapalapa, MexicoEzgi ManDepartment of Biochemistry, Ege University, Faculty of Science, Izmir, TurkeyHeliton P. C. BrígidoPost-Graduate Program in Pharmaceutical Innovation, Federal University of Pará, Belém, PA, BrazilJhony Anacleto-SantosDoctorado en Ciencias Biológicas y de la Salud, Universidad Autónoma Metropolitana, Mexico Departamento de Ciencias Naturales, Universidad Autónoma Metropoli-tana, Unidad Cuajimalpa, MexicoJoana BarbosaUniversidade Católica Portuguesa, CBQF - Centro de Biotecnologia e Química Fina—Laboratório Associado, Escola Superior de Biotecnologia, Porto, PortugalJuliana Correa-Barbosa3Post-Graduate Program in Pharmaceutical Sciences, Federal University of Pará, Belém, PA, BrazilKelly C. O. AlbuquerquePost-Graduate Program in Biodiversity and Biotechnology of the BIONORTE Network, Federal University of Pará, Belém, PA, BrazilMerve GültanDepartment of Biochemistry, Ege University, Faculty of Science, Izmir, TurkeyMaria Fâni DolabelaPost-Graduate Program in Pharmaceutical Sciences, Federal University of Pará, Belém, PA, Brazil Post-Graduate Program in Biodiversity and Biotechnology of the BIONORTE Network, Federal University of Pará, Belém, PA, BrazilNorma Rivera-FernándezDepartamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Coyoacán, MexicoÖzge UğurluDepartment of Biochemistry, Ege University, Faculty of Science, Izmir, Turkey Department of Medical Services and Techniques, Hatay Vocational School of Health Services, Hatay Mustafa Kemal University, Tayfur Sökmen Campus, Alahan-Antakya/ Hatay, TurkeyPathomthep LeowattanaTivanon Medical Clinics, Tivanon Road, Muang, Nonthaburi, ThailandPaula TeixeiraUniversidade Católica Portuguesa, CBQF - Centro de Biotecnologia e Química Fina—Laboratório Associado, Escola Superior de Biotecnologia, Porto, PortugalPerla Yolanda López CamachoDepartamento de Ciencias Naturales, Universidad Autónoma Metropoli-tana, Unidad Cuajimalpa, MexicoRicardo Mondragón-FloresDepartamento de Bioquímica, Centro de Investigación y Estudios Avan-zados del Instituto Politécnico Nacional (CINVESTAV-IPN), Zacatenco, MexicoSandro PercárioPost-Graduate Program in Biodiversity and Biotechnology of the BIONORTE Network, Federal University of Pará, Belém, PA, BrazilSerap EvranDepartment of Biochemistry, Ege University, Faculty of Science, Izmir, TurkeyTawithep LeowattanaDepartment of Medicine, Faculty of Medicine, Srinakharinwirot University, Sukhumvit 23, Wattana District, Bangkok, ThailandWattana LeowattanaDepartment of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Rajavithi road, Rachatawee, Bangkok, Thailand

Nucleic Acid and Peptide Aptamers as Potential Antiviral Drugs

Serap Evran1,*,Özge Uğurlu1,2,Ezgi Man1,Merve Gültan1,Canan Özyurt3
1 Ege University, Faculty of Science, Department of Biochemistry, 35100, Izmir, Turkey
2 Department of Medical Services and Techniques, Hatay Vocational School of Health Services, Hatay Mustafa Kemal University, Tayfur Sökmen Campus 31060, Alahan-Antakya/ Hatay, Turkey
3 Department of Chemistry and Chemical Processing Technologies, Lapseki Vocational School, Canakkale Onsekiz Mart University, Canakkale, Lapseki, Turkey

Abstract

Aptamers with target-specific binding properties have emerged as an alternative to antibodies. Nucleic acid aptamers are short single-stranded oligonucleotides that can fold into unique three-dimensional structures. Nucleic acid aptamers are selected from random libraries in vitro by using the SELEX (Systematic Evolution of Ligands by Exponential Enrichment) technology. Likewise, peptide aptamers are short peptides that can be selected in vitro by using different strategies including phage display, ribosome display, or mRNA display. Aptamers are superior to antibodies with regard to ease of production, high stability, small size, and low cost. Therefore, aptamers find broad use in different biotechnological and therapeutic applications. Among them, aptamer use in virus detection and antiviral therapy is one of the attractive applications. The present Covid-19 pandemic and life-threatening viral infections reveal the need for rapid therapeutic solutions that can efficiently target viral mechanisms. In this respect, the chapter is mainly focused on aptamers with antiviral activity, as well as the use of aptamers in viral detection platforms. First, we summarize aptamer selection technologies that can be performed in vitro. Among them, we briefly explain ribosome display, mRNA display and SELEX (Systematic Evolution of Ligands by Exponential Enrichment) technologies. Then, we review aptamers targeting viral proteins and viral invasion mechanisms. In addition, we give an overview of aptamers developed against viruses. We also discuss the major hurdles in aptamer use, as well as the strategies to improve the drug potential of aptamers.

Keywords: Antiviral aptamer, Aptasensor, Diagnostic aptamers, DNA aptamer, MRNA display, Peptide aptamer, Ribosome display, RNA aptamer, SELEX, Therapeutic aptamers.
*Corresponding author Serap Evran: Ege University, Faculty of Science, Department of Biochemistry, 35100, Izmir, Turkey; Tel: +90 232 3112304; Fax: +90 232 3115485; E-mail:[email protected]

1. INTRODUCTION

Nucleic acid aptamers and peptide aptamers with antibody-like binding properties are promising therapeutic agents. Several aptamers are currently evaluated under clinical phase studies, but the majority of studies are focused on metabolic diseases. In this chapter, we aim to highlight the potential use of aptamers as novel antiviral agents, and their importance in diagnosis and monitoring viral infections.

The first section of the chapter gives an overview of the in vitro selection methods used to identify peptide and nucleic acid aptamers. Here, only some methods developed for selection from combinatorial libraries are given. This section is divided into three sub-sections as 1.1, 1.2 and 1.3 to introduce the methods of mRNA display, ribosome display and SELEX. The SELEX section is further divided into 1.4.1 and 1.4.2 to summarize two of the SELEX methods, namely cell-SELEX and bead-based SELEX. The final sub-sections 1.5 and 1.6 explore the modification strategies to improve the stability properties of aptamers for therapeutic use.

The second section of the chapter is devoted to aptamers used for the detection of viruses. The sub-sections 2.1-2.9 summarize the studies for diagnosis of Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), Human Immunodeficiency Virus (HIV), Influenza, Arboviruses, SARS virus, Ebola Virus, SARS-CoV-2, and Human Papilloma Virus (HPV).

The third section of the chapter is devoted to the aptamers targeting viral proteins. Aptamers developed against several proteins of HIV, HCV, HBV, SARS, and Influenza are summarized under the sections 3.1-3.5.

1.1. The in vitro Selection Methods for Peptide and Nucleic Acid Aptamers

Directed evolution is a powerful tool to develop proteins with superior function and binding properties [1]. One critical step of directed evolution is the screening or selection of improved variants from a large library [2]. Advances in molecular techniques have allowed the design of highly diverse libraries of nucleic acids, peptides and antibodies [3]. To meet the demand for working with large libraries, protein display technologies have been developed for the selection, isolation and identification of proteins with the desired properties [4,5]. Display techniques are basically divided into two groups: (i) cell-free and (ii) cell-based. Cell-based approaches such as bacterial display, yeast display, mammalian cell display and phage display have some limitations regarding the efficiency of recovery and library diversity [6]. Although phage display has been widely used to select proteins and peptides with improved binding properties [7], cell-free display methods have emerged as an alternative to overcome the limitations associated with living cells [8].

Ribosome display and mRNA display are cell-free methods, which rely on in vitro transcription and translation of the newly formed peptide along with its encoding mRNA. Thereby, ribosome display and mRNA display can establish a direct link between phenotype and genotype. In vitro display and selection approach consists of 3 steps: (i) designing the initial library, (ii) performing repetitive rounds to obtain the desired characteristics, (iii) screening and characterizing the selected variants [9]. Engineered antibodies, proteins, as well as peptides for various applications in diagnostics and therapeutics have been identified by in vitro selection methods [10]. Ribosome display and mRNA display enable identification of high-affinity proteins or peptide aptamers [11,12], whereas SELEX (Systematic Evolution of Ligands by Exponential enrichment) method allows in vitro nucleic acid aptamer selection. As shown in Table 1, those in vitro methods allow working with libraries of large size. Cell-based approaches are limited by cell growth and replication [13]. In contrast, in vitro selection methods allow precise control of many parameters like pH, temperature, buffer conditions, and ionic strength [14]. Auxiliary components including the binding target and reaction substrates can be easily added to the selection medium, thereby eliminating the toxic effect problem that may be encountered in cell-based display methods [15].

Table 1Library size of in vitro selection methods.In vitro methodSize of libraryReferencesSELEX1014-1015[16]mRNA display1012-1013[14]Ribosome display1013-1014[17]

1.2. MRNA Display

mRNA display is based on the formation of a covalent link between the target peptide/protein and the mRNA encoding it. For this aim, 3' end of mRNA is modified with puromycin, an antibiotic molecule that acts like an aminoacylated tRNA. Upon translation of the modified mRNA, puromycin enters the A region of the ribosome and forms a peptide bond with the C-terminal of the polypeptide. In this way, the puromycin-modified mRNA is covalently linked to the peptide [18]. This generates a stable link between genotype and phenotype. In addition, this stable covalent bond allows selection under stringent conditions. In mRNA display method, all steps including protein expression are performed in vitro (Fig. 1) [19]. Cell-free translation is generally performed using eukaryotic cell lysates obtained from wheat germ or rabbit, which offer a wider post-translational modification repertoire compared to bacterial in vivo expression systems. For a tighter control of protein expression conditions, the PURE (protein synthesis using recombinant elements) translation system can also be used [20]. This system consists of purified components such as tRNA, ribosome, amino acids, release factors and aminoacyl tRNA synthetases required for E. coli translation [21].

Fig. (1)) Schematic representation of mRNA display.

mRNA display has several advantages over many in vivo and in vitro methods [22]. The covalent link between genotype and phenotype has a twofold benefit. Recovery of variants becomes easier, and harsh selection conditions that are not possible for many in vivo methods can be applied. Harsh conditions enable the development of proteins resistant to extreme pH, high temperature and high salt concentrations, which is particularly useful for enzyme engineering [23]. mRNA display has proven to be a powerful tool for peptide design, in vitro protein selection, studying molecular interactions, drug design, and protein engineering [24-27]. The developed ligands attract attention due to their superior properties and very high (nanomolar to picomolar) affinities [28].

1.3. Ribosome Display

Ribosome display has been developed as an alternative method to screen target-binding proteins/peptides against a variety of target molecules [29-30]. Ribo-some display is an approach in which genotype and phenotype are combined through the formation of a stable triple mRNA ribosome-protein complex [31]. It enables the enrichment of high-affinity variants with the desired property from a large library through repetitive cycles of affinity-based selection and PCR amplification [32]. In this approach, transcription, translation and selection are carried out cell-free in vitro [18].

Fig. (2)) Schematic representation of ribosome display.

Ribosome display basically consists of those steps; (i) preparation of DNA library, (ii) in vitro transcription and translation, (iii) selection and recovery of mRNA, (iv) reverse transcription and PCR step for the next round of selection. Formation of the non-covalent polypeptide-ribosome-mRNA complex is the most critical issue in this approach. The absence of a stop codon in mRNA ensures that the newly synthesized peptide and the mRNA encoding it remain attached to the ribosome Fig. (2) [32]. On the other hand, ribosome display suffers from nuclease-hypersensitive mRNA and low stability of the triple complex. Here, the PURE (protein synthesis using recombinant elements) system offers a solution

so that the rate of mRNA recovery increases and more stable ternary complexes are produced [33].

Ribosome display is a powerful approach for high-efficiency selection of peptides and proteins. Compared to phage display, ribosome display offers a faster scanning and more efficient selection [34]. The cell-free ribosome display has been used successfully for in vitro selection of specific binders for more than 20 years [35]. Ribosome display is performed not only to increase the binding affinity but also the stability of proteins. For this aim, redox potential is changed by addition of dithiothreitol (DTT) during the ribosome complex generation step. Thus, correct folding of the antibodies is ensured [36]. Single-chain antibody fragments against viruses, bacteria, drugs, hormones, proteins and pesticides have been developed by using the ribosome display method [37]. This approach can also be combined with high-throughput microarray methods to add a new dimension to protein-protein interaction analysis [38]. Simultaneous scanning can be performed for various massive peptides [39]. Ribosome display has proven a useful tool in different research areas, such as diagnosis and treatment of cancer infectious diseases, autoimmune and metabolic diseases, allergic disorders, and drug design [40-46].

1.4. SELEX (Systematic Evolution of Ligands by Exponential Enrichment) for Nucleic Acid Aptamers

Nucleic acid aptamers are single-stranded DNA or RNA sequences that can bind to their targets due to their folded structure, which is specified by their sequences. Aptamers bind to the target molecule through hydrogen bonding, stacking of aromatic rings, van der Waals interactions, salt bridges, and electrostatic interactions [47]. The term aptamer is derived from the Latin words 'aptus' - 'fit' and 'merus' - 'particle' [48]. Aptamers are selected by in vitro selection - Systematic Evolution of Ligands by Exponential Enrichment SELEX [49,50]. SELEX process consists of incubation, elution and amplification steps (Fig. 3). DNA or RNA libraries containing ~1014-1015 different oligonucleotides are first incubated with the target molecule. Then, sequences that show no or less affinity to the target are removed from the SELEX medium by using different approaches. The sequences bound to the target are amplified and used in the next round. After the SELEX is completed, cloning and characterization steps are performed [51].

Fig. (3)) Schematic representation of SELEX.

As summarized in Table 2, aptamers have several advantages over antibodies in terms of chemical synthesis, high stability, high affinity and possibility of post-SELEX modification [52,53]. The molecular weight of the aptamers ranges from 10 to 30 kDa. With these properties, they are smaller molecules than antibodies [54]. Compared to antibodies, aptamers are highly advantageous due to low immunogenicity and cost. These properties highlight the aptamers as potential next-generation therapeutics [55,56]. Aptamers bind to a wide range of molecules, such as peptides, proteins, viruses, cells, tissues, nucleotides, antibiotics, toxins, and metal ions with high affinity and specificity [57,58]. Aptamers have been actively used in a variety of biomedical applications including molecular imaging, treatment and diagnosis of diseases, detection of biomarkers, and targeted drug delivery [59-67]. In addition, aptamers can be used in chromatography [68], Western-blot [69], surface plasmon resonance (SPR) [70], biosensors and micro-arrays [71]. Since the first introduction of SELEX technology, several protocols including bead-based SELEX, microarray-based SELEX, capture-SELEX, capillary electrophoresis SELEX, microfluidic SELEX, in silico SELEX, in vivo SELEX, and cell-SELEX have been proposed [16,72].

Table 2Comparison of aptamers and antibodiesFeatureAptamersAntibodiesSize6- 30 kDa150- 180 kDaManufacturein vitro SELEX method Chemical synthesis 2-8 weeksin vivo Biological system 6 monthsStabilityTemperatureLong shelf-life, very stable Highly resistant (up to 95° C)limited shelf-life Highly susceptibleModificationConvenientRestrictedBatch to batch variationLowSignificantPotential TargetsWide range: small molecules to large molecules, ions, toxins, viral particlesimmunogenic molecules

1.4.1. Cell-SELEX

Unlike conventional methods based on known targets, cell-SELEX does not require prior knowledge about the target protein. In the classical approach, target protein is obtained from living cells by overexpression and purification. However, these processes are costly and time-consuming. In addition, purified proteins may be less stable than their natural forms. Possible conformational differences in the target protein can adversely affect aptamer selection [73]. In cell-SELEX, target protein in the living cell preserves its natural conformation. Thus, the selected aptamers can recognize their target in its natural conformation. Cell-SELEX can be applied against virtually any cell line, parasite, virus and bacteria [74]. Since target molecules are in their active and natural form in the cell, the selected aptamers can be used directly for cellular imaging, diagnosis and therapy [75]. Cell-SELEX enables development of high affinity aptamers against specific molecules in the target cell. These aptamers are capable of separating target cells from other cells, which could be useful for cell profiling, cell capture, cell and tissue imaging, cell detection, drug delivery, diagnosis and treatment [76,77].

Although cell-SELEX consists of similar incubation, elution and amplification steps, it requires more cycles and longer time compared to the classical approach [78]. Up to 35 rounds may be required to obtain high affinity sequences. In addition, any damage to target cell can affect selection results [79]. Cell number, initial library design, separation method, the number of selection rounds and temperature are the critical factors. The interference of dead cells is one important problem in cell-SELEX. Non-specific binding of aptamer library to dead cells adversely affects aptamer selection. In order to avoid this problem and remove dead cells from the environment, fluorescence activated cell sorter (FACS) and microbead-based methods have been developed [80,81]. Another critical factor is temperature. Cell-SELEX is usually carried out at 4°C, but binding characteristics of aptamers may differ at the physiological temperature [82].

1.4.2. Bead-Based SELEX

One of the commonly used strategies in SELEX is immobilizing the target molecule on a solid support material of sepharose, agarose or sephadex. After the protein-bound beads are incubated with initial library, aptamer-target protein complex can be easily separated [83,84]. Bead-based SELEX is advantageous in many ways. It can be easily adapted to different targets such as peptides, proteins and small molecules. Aptamer selection is much faster and more practical than conventional SELEX methods. Selection conditions can be changed easily [85].

1.5. Post-SELEX Modifications

Despite the great potential of aptamers as therapeutics, attack by nucleases and renal filtration can limit their use. Post-SELEX modification to increase stability and affinity of aptamers is a critical stage to avoid these possible risks. As one of the post-SELEX strategies, truncation allows removing nucleotides that are not involved in target binding, which may result in enhanced affinity [86-88].

Aptamers can be chemically modified to impart nuclease stability. Sugar rings, bases, and linkages are the best candidates for different modifications [89]. Modification of oligonucleotides according to their mirror image (Spiegelmers) is a straightforward approach. Usually, nucleases recognize the D-form (native) but not the L-form. L-aptamers can bind their targets with high specificity like D-aptamers, but do not activate the immune system. Epitope-selective Spiegelmers developed against troponin complex subunits [90] and L-aptamer targeting D-vasopressin [91] are among the successful examples. In addition, 2'-Amino modification [92,93] and 2'-Fluoro modification are common post-SELEX strategies [94,95]. It has been shown that non-specific interaction tendencies of aptamers for human neutrophil elastase can be reduced by 2′-F purine modification [94]. This study shows that 2'-modifications provide more than increasing thermal stability and nuclease resistance. Similarly, 2'-O-CH3 modification has been shown to improve several properties, such as nuclease resistance and thermal stability [96,97]. As another post-SELEX strategy, locked nucleic acid (LNA) modifications can also be introduced into aptamers. In a study targeting the trans-activating responsive (TAR) element of HIV-1 genome, 2′-O-methyl aptamer containing two LNA residues in the loop has been shown to inhibit TAR-dependent transcription [98]. 3' or 5'-end-capping of aptamers with biotin, streptavidin, cholesterol, PEG, proteins, amine, and phosphate are other modifications for biosensor and therapeutic applications [99,100].

Most aptamers in clinical trials contain a thiophosphate backbone, which is responsible for reduced thermal stability. Besides, aptamers with thiophosphate substitutions may show more nonspecific interactions than unmodified aptamers [101,102]. Phosphodiester bonds can be replaced with methylphosphonate or phosphorothioate linkage [103]. As shown for α thrombin-PS2 RNA aptamer with phosphorodiothionate (PS2) linkages, the binding affinity can be increased dramatically (from nanomolar to picomolar range) [104].

SOMAmers (Slow off-rate modified aptamers) have become popular due to their superior affinity and kinetic properties, as well as nuclease resistance [105]. In a very recent study, SOMAmers have been used for proteomic screening [106]. SOMAmers have also been utilized successfully for isolation of cells from the complex medium [107]. Such studies reveal the high potential of SOMAmers for extraction and detection of viral factors and viruses from real human samples.

1.6. Modification of Peptide Aptamers for Therapeutic Applications

Low stability of peptide aptamers is one of the most important problems in therapeutic applications. As a result of protease degradation, the half-life may decrease to minutes. Peptide aptamers, like nucleic acid aptamers, can acquire many different improved properties with modifications [108]. Modification of the peptide backbone by different strategies, such as cyclization, mirror image transformation, retro-inversion, and peptidomimetics usage is a useful approach to increase peptide stability [109,110]. It has been suggested that the peptide synthesized in the reverse order of the natural peptide would have a side chain structure and target binding affinity similar to the parent peptide and impart resistance to proteases. This strategy has been successfully used for Prosaptide peptides to improve bioactivity [111,112]. In addition to these modifications, conjugating peptide aptamers with functional proteins is also useful. For this aim, it is possible to design genetic fusion proteins and make different modifications according to the purpose.

2. Aptamers in Viral Diagnosis

Viruses are agents that multiply in living cells of host organisms and cause infection. When viruses enter the cell, they can stay in the dormant phase for a long time or they can start the infection immediately. There are several severe diseases that are caused by viruses such as Covid-19, SARS MERS, Spanish flu, hepatitis, cervical cancer, influenza, and human immunodeficiency virus (HIV). Today, the new type of coronavirus is still a major health threat. Rapid spread of Covid-19 in a short time around the world, reveals the urgent need for fast, cheap and sensitive viral diagnostic platforms. Detection methods for diagnosis of viral infections can be generally divided as gene-based or antibody-based approaches. Gene-based methods rely on polymerase chain reaction (PCR), including real-time PCR, LAMP (loop mediated isothermal amplification-based assay), NASBA (nucleic acid sequencing-based amplification). Antibody-based approaches are used to detect viral proteins and host antibodies [113]. As summarized in (Table 3), each approach has some advantages and disadvantages.

Table 3Advantages and disadvantages of methods for viral infection diagnosis.MethodTargetProsConsRef.PCR based methodsNucleic acidLow detection limit SensitiveSpecialized equipments, need experts, time- consuming, contamination, false positive[114]Antibody based methodsIgG, IgMRapid, cheap, no need experts, portablePost-infection, not specific[115]Viral cultureVirusSpecificTime-consuming (6-10 days), low sensitivity, safety[116]Antigen TestsViral antigenPortable, point-of-care, sensitive, early detection is possibleSensitivity changes with commercial assay[115]

In general, current diagnostic tools are highly expensive and time-consuming. For that reason, aptamers with superior properties have great potential to be used in diagnostic tools. Aptamers can chemically synthesized and easily modified with biotin, polyethylene glycol (PEG) or fluorescent dyes. Moreover, unlike antibodies, they do not show batch-to-batch variations.

2.1. Aptamers in Diagnosis of Hepatitis B Virus (HBV)

HBV, a member of Hepadnaviridae family is a partially double-stranded DNA virus. HBV genome is composed of ~3200 base pairs. Hepatitis B virus surface antigen (HBsAg) is the most studied and used antigen in diagnosis of HBV in blood samples [117]. HBsAg is the first virological marker to appear in blood circulation [118]. Recombinant HBsAg is used to induce neutralizing antibodies for vaccination [119]. Despite the effective vaccination, HBV is still the cause of deaths [119]. In hospitals, enzyme-linked immunosorbent assay (ELISA) kits are commonly used to detect HBsAg. Conventional methods detect HBsAg 6-8 weeks after the infection [118]. Therefore, new sensitive and fast methods are urgently needed for detection of HBV. Xi et al. [118] obtained three aptamers against HBsAg by using SELEX. The selected aptamers were immobilized onto the carboxylated magnetic nanoparticles to develop a chemiluminescence aptasensor platform. Detection limit of the aptasensor was found 0.1 ng/mL in serum samples, which was five times lower than the limit of enzyme-linked immunosorbent assay (ELISA). Additionally, the authors tested the serum samples from hepatitis A and hepatitis C patients, as well as a mixed sample of hepatitis A, B and C to evaluate the specificity of selected aptamer. The authors found that hepatitis A and C did not interfere with the detection. Mohsin et al. [120] developed a highly sensitive electrochemical aptasensor to detect HBsAg. They used the previously developed aptamer [118] and increased the detection limit to 0.0014 fg/mL by using the carbon electrode modified with gold nanoparticles [120]. Also, the aptasensor allowed detection of HBsAg in the range of 0.5-2.0 fg/mL with good recovery in real human serum samples. The selectivity of aptasensor was tested with prostate-specific antigen, vitamin C, glucose and fetal bovine serum.

The e antigen of hepatitis B (HBeAg) is released during hepatitis B virus replication. For that reason, HBeAg is a good marker of chronic infection and related with the risk of developing liver cancer and cirrhosis [121]. Although some treatment options are available, they can only suppress the replication of virus [119]. Therefore, monitoring the levels of HBeAg in serum has crucial importance to follow the success of therapy. Considering the increase in number of chronic HBV patients, there is a great demand for cheap, fast and sensitive detection methods for HBeAg. In order to detect HBeAg in serum samples, Liu et al. [121] developed a sandwich assay based on reporter and capture DNA aptamers. For this aim, the authors modified the previously developed aptamers [122]. The reporter aptamer was truncated to 40-mer from original 80-mer and modified with a G-quadruplex and two loops, which yielded a Kd value of 0.4 nM. Similar truncation and modification studies were performed on the capture aptamer, which displayed a Kd value of 1.2 nM. The sandwich assay achieved detection of HBeAg in the range of 0.1−60 ng/mL in real HBV serum samples.

2.2. Aptamers in Diagnosis of Hepatitis C Virus (HCV)

HCV belongs to the family of Flaviviridae. It is small, positive-sense single-stranded, enveloped RNA virus, which is known to cause acute liver disease. HCV contains a small genome of 9600 base pairs. With early diagnosis, the success of anti-HCV treatment can reach up to 98% [123].

Serological tests based on anti-HCV antibodies and molecular tests based on detection of HCV RNA are commonly used. However, these are expensive techniques that need special facilities and experts. In addition, these tests are not appropriate for patients with suppressed immune system and they can not identify HCV in the early phase. ELISA assays can achieve a detection limit of 10-14 M [124]. Aptamer-based biosensor platforms are promising for early HCV diagnosis. As summarized in Table 4, DNA or RNA aptamers were developed against different antigens.

Table 4Summary of DNA and RNA aptamer which can be used in diagnosis of HCV.AptamerTargetReferenceRNAHCV core antigen[125]DNAHCV core antigen[127]DNA (Bz-Du modified)E2[128]DNAEnvelope Glycoprotein E2[129]RNAHCV helicase[130]

In aptasensor studies, HCVcoreAg with a conserved protein structure was targeted because of the link between HCVcoreAg concentration and viral RNA [125-128]. The first aptamers to recognize HCV antigen in serum samples were developed by Lee et al. [125]. RNA aptamers were selected after nine SELEX rounds. The aptamers showed high affinity to HCV core antigen, but not to NS5 antigen. Due to their smaller size, aptamers can overcome the problems encountered in design of antibody-based nanowire sensors [123]. By taking this advantage, Malsagova et al. [123] reported a novel nanowire aptamer-sensitized biosensor to detect HCVcoreAg in serum samples. The authors used the previously developed DNA aptamer against HCVcoreAg [127]. They designed an aptasensor with a detection limit of 10-15 M capable of working in acidic and neutral buffer. Also, the aptasensor showed good reproducibility in real serum sample

Core protein is found in both infectious and non-infectious phases of HCV, but E2 protein is generally related with the infectious dose of HCV [128]. For that reason detection of E2 is valuable for diagnosis. Park et al. [128] performed SELEX by using 5-benzylaminocarbonyl-dUridine (Bz-dU) instead of thymine and obtained four aptamers with Kd values ranging between 0.8–4 nM. Then, the authors developed an Enzyme Linked Aptasorbent Assay (ELASA) to detect HCV E2 protein. The assay was based on using two aptamers for capture and detection purposes.

2.3. Aptamers in Diagnosis of Human Immunodeficiency Virus (HIV)

HIV is a member of lentivirus and a part of the retrovirus subgroup [131]. HIV affects the immune system by damaging CD4+ T cells and causes acquired immune deficiency syndrome (AIDS). Antiretroviral drugs are useful to prolong the life of patients with HIV but they cannot eliminate the HIV viruses from the body. HIV enters into cells through interaction between viral surface protein gp120 and host CD4 [132]. Enzyme-linked immunosorbent assay (ELISA) and real-time PCR are used to detect HIV infection in clinical samples. Combination of antigen/antibody immunoassays usually detects the HIV-1 and HIV-2 antibodies and p24 antigen of HIV-1 [132]. The detection range of commercial ELISA assays is 0.2–10 pg/mL for HIV-gp24 glycoprotein capsid antigen [133].

The vast majority of aptamer studies were focused on the therapeutic use of aptamers. Some studies showed that the obtained aptamers can also be used as diagnostic tools. Generally, aptamers were developed to recognize the viral transactivator (Tat), Rev and gp120 proteins [61]. Tat and Rev proteins are vital for viral replication [134]. Since Tat protein is an early sign of HIV exposure, it is useful for early detection of HIV, as well as it is a target for antiretrovirals [61]. Çağlayan and Üstündağ [133] developed a surface plasmon resonance enhanced total internal reflection ellipsometry (SPReTIRE) technique to detect Tat protein. The authors used 5 different antiTAT aptamers to detect TAT in the range of 1 nM −500 nM. Tombelli et al. [135] developed aptamer-based surface plasmon resonance (SPR) and quartz crystal microbalance (QCM) biosensors to detect Tat protein. High selectivity and sensitivity were obtained for both aptamer-based sensor platforms. The linear range of TAT protein was 0–1.25 and 0–2.5 ppm for QCM and SPR, respectively. Yamamoto et al. [136] obtained aptamer-derived oligomers against Tat protein. They designed the new aptamer by splitting two oligomers of RNATat