Angiotensin receptor blockade and neprilysin (NEP) inhibition together offer potential benefits for the treatment of hypertension and heart failure. LCZ696 is a novel single molecule comprising molecular moieties of valsartan and NEP inhibitor prodrug AHU377 (1:1 ratio). Oral administration of LCZ696 caused dose-dependent increases in atrial natriuretic peptide immunoreactivity (due to NEP inhibition) in Sprague-Dawley rats and provided sustained, dose-dependent blood pressure reductions in hypertensive double-transgenic rats. In healthy participants, a randomized, double-blind, placebo-controlled study (n = 80) of single-dose (200-1200 mg) and multiple-dose (50-900 mg once daily for 14 days) oral administration of LCZ696 showed that peak plasma concentrations were reached rapidly for valsartan (1.6-4.9 hours), AHU377 (0.5-1.1 hours), and its active moiety, LBQ657 (1.8-3.5 hours). LCZ696 treatment was associated with increases in plasma cGMP, renin concentration and activity, and angiotensin II, providing evidence for NEP inhibition and angiotensin receptor blockade. In a randomized, open-label crossover study in healthy participants (n = 56), oral LCZ696 400 mg and valsartan 320 mg were shown to provide similar exposure to valsartan (geometric mean ratio [90% confidence interval]: AUC(0-infinity) 0.90 [0.82-0.99]). LCZ696 was safe and well tolerated. These data support further clinical development of LCZ696, a novel, orally bioavailable, dual-acting angiotensin receptor-NEP inhibitor (ARNi) for hypertension and heart failure.
The steroid compound cyproterone acetate was identified in a high-throughput screen for glucocorticoid receptor (GR) binding compounds. Cyproterone (Schering AG) is clinically used as an antiandrogen for inoperable prostate cancer, virilizing syndromes in women, and the inhibition of sex drive in men. Despite its progestin properties, cyproterone shares a similar pharmacological profile with the antiprogestin mifepristone (RU486; Roussel Uclaf SA). The binding affinities of cyproterone and RU486 for the GR and progesterone receptor were similar (K d , 15-70 nM). Both compounds were characterized as competitive antagonists of dexamethasone without intrinsic transactivating properties in rat hepatocytes (K i , 10 -30 nM). In osteosarcoma cells, RU486 revealed a higher potency than cyproterone acetate to prevent responses to dexamethasoneinduced GR transactivation and NFB transrepression. Upon administration to Sprague-Dawley rats, both compounds were found to be orally bioavailable and to inhibit transactivation of liver GR. Molecular docking of cyproterone acetate and RU486 into the homology model for the GR ligand binding domain illustrated overlapping steroid scaffolds in the binding pocket. However, in contrast to RU486, cyproterone lacks a bulky side chain at position C11 that has been proposed to trigger active antagonism of nuclear receptors by displacing the C-terminal helix of the ligand-binding domain, thereby affecting activation function 2. Cyproterone may therefore inhibit transactivation of the GR by a molecular mechanism recently described as passive antagonism. New therapeutic profiles may result from compounds designed to selectively stabilize the inactive and active conformations of certain nuclear receptors.Glucocorticoids are steroid hormones that are essential for normal growth and development, for liver and immune functions, and for mediating the stress response. Synthetic derivatives of glucocorticoids, such as dexamethasone, have immunosuppressive, anti-inflammatory, osteocatalytic, proteolytic, and hyperglycemic activities and are used to treat various pathological conditions (Sapolsky et al., 2000). The GR is a ligand-activated intracellular transcriptional regulator that is a member of the nuclear receptor superfamily. In the absence of a ligand, the GR is retained in the cytoplasm by association with chaperone proteins. Upon ligand binding, the GR dissociates from chaperones, dimerizes, and translocates into the nucleus. In the nucleus, the hormone-bound GR can modulate transcription of target genes by direct interaction with specific DNA sequences, called glucocorticoid response elements (GRE) in GR responsive promoters (Karin, 1998). Alternatively, activated GR can interact with nuclear factor B (NF-B) or with activator protein 1 (AP-1) to repress gene expression induced by these proinflammatory transcription factors. The anti-inflammatory and immunesuppressive properties of glucocorticoids have been largely attributed to the transrepression of NF-B and AP-1 function, whereas...
The synthesis of three series of dicarboxylic acid dipeptide neutral endopeptidase 24.11 (NEP) inhibitors is described. In particular, the amino butyramide 21a exhibited potent NEP inhibitory activity (IC50 = 5.0 nM) in vitro and in vivo. Blood levels of 21a were determined using an ex vivo method by measuring plasma inhibitory activity in conscious rats, mongrel dogs, and cynomolgus monkeys. Free drug concentrations were 10-1500 times greater than the inhibitory constant for NEP over the course of a 6 h experiment. A good correlation of free drug concentrations was obtained when comparing values determined by the ex vivo analysis to those calculated from direct HPLC measurements. Plasma atrial natriuretic factor (exogenous) levels were elevated in rats and dogs after oral administration of 19a. Urinary volume and urinary sodium excretion were also potentiated in anesthetized dogs treated with 21a.
Sacubitril is an ethyl ester prodrug of LBQ657, the active neprilysin (NEP) inhibitor, and a component of LCZ696 (sacubitril/valsartan). We report herein the three-dimensional structure of LBQ657 in complex with human NEP at 2 Å resolution. The crystal structure unravels the binding mode of the compound occupying the S1, S1’ and S2’ sub-pockets of the active site, consistent with a competitive inhibition mode. An induced fit conformational change upon binding of the P1’-biphenyl moiety of the inhibitor suggests an explanation for its selectivity against structurally homologous zinc metallopeptidases.
Chemistry of α‐Aminonitriles I: Introduction and Pathways to Uroporphyrinogen‐octanitriles. An introduction to experimental studies on the chemistry of α‐aminonitriles potentially relevant to the problems of prebiotic chemistry is presented. The framework of conditions wherein the investigation is chosen to be carried out implies both molecular oxygen and ‐ whenever feasible ‐ water to be excluded from reaction conditions. This study focusses on 2‐amino‐2‐propenenitrile (3) (Scheme 6) as central starting material of reaction sequences which aim at the nitrile forms of proteinogenic amino acids as well as at the aza forms of building blocks of biological cofactor molecules as their targets (Scheme 5). Schemes 13,16,23 as well as 25 and 26 summarize reaction sequences by which 3 is transformed within the defined framework of conditions into the thermodynamic (statistically controlled) mixture of the four isomeric uroperphyrinogen‐octanitriles 57–60. HPLC's of such mixtures document the dominance of the least symmetrical isomer whose constitutional pattern of peripheral substituents happens to be the one percent in all biological porphinoids. Preparative procedures for the synthesis of 3(Scheme 9), the β,β‐disubstituted pyrrol‐nitriles 30,53 and 54 (Scheme 19) as well as the porphyrinogenoctakis(propionitrile) and‐octakis(acetonitrile) 65 and 66, respectively (Scheme 24) are given.
Aldosterone is a key signaling component of the renin-angiotensin-aldosterone system and as such has been shown to contribute to cardiovascular pathology such as hypertension and heart failure. Aldosterone synthase (CYP11B2) is responsible for the final three steps of aldosterone synthesis and thus is a viable therapeutic target. A series of imidazole derived inhibitors, including clinical candidate 7n, have been identified through design and structure−activity relationship studies both in vitro and in vivo. Compound 7n was also found to be a potent inhibitor of 11β-hydroxylase (CYP11B1), which is responsible for cortisol production. Inhibition of CYP11B1 is being evaluated in the clinic for potential treatment of hypercortisol diseases such as Cushing's syndrome. KEYWORDS: Inhibitor, CYP11B2, aldosterone synthase, aldosterone, hypertension, enzyme, CYP11B1, Cushing's syndrome, cortisol O ne of the primary functions of aldosterone through the mineralocorticoid receptor (MR) is to effect retention of sodium and excretion of potassium by the kidney.1 The elevation of aldosterone causes an increase in blood pressure as well as facilitating other cardiac, renal, and vascular damage. Activation of the renin-angiotensin system (RAS) induces aldosterone production. As such, MR antagonists have been used in the treatment of heart failure.2−4 While both RAS inhibitors and MR antagonists have been shown to reduce some of the pathological effects of aldosterone, there are noted drawbacks. In the case of RAS inhibition, a reduction of aldosterone is realized initially; however, this is not maintained. 5,6 Likewise, MR antagonists do not reduce the level of aldosterone, and in fact, they have been shown to induce aldosterone production.7 Thus, it was thought that there would be therapeutic benefit in directly inhibiting aldosterone production.Aldosterone is produced in the zona glomerulosa of the adrenal gland by the enzymatic action of aldosterone synthase (CYP11B2) on deoxycorticosterone. 8,9 Clinical observations suggested that the racemic aromatase (CYP19) inhibitor fadrazole affected aldosterone levels and subsequent preclinical studies demonstrated that the R-enantiomer (FAD286, Figure 1) was a potent inhibitor of CYP11B2.10 From this understanding we embarked on a program to investigate the structure−activity relationship of the FAD286 scaffold and to gain a more extensive understanding of the potential of aldosterone synthase inhibition to treat aldosterone-driven pathologies.Relatively little was known about the impact of substitution at R 1 , although we quickly realized that, as with FAD286, chirality at this point of attachment was important. The impact of altering the size of the saturated ring was not understood at the outset. Preliminary structure−activity relationships (SAR) around the phenyl ring indicated that R 2 would be a most promising site for optimization.In general the compounds from series I (n = 1), series II (n = 2), and series III (n = 3) were prepared as outlined in Scheme 1. Intermed...
The design and preparation of ortho-substituted benzofused macrocyclic lactams are described. The benzofused macrocyclic lactams were designed as neutral endopeptidase 24.11 (NEP) inhibitors. Docking studies were carried out in a model of thermolysin (TLN) using the MACROMODEL and QXP modeling programs to select suitable ring sizes. These studies predicted that the 11-, 12-, and 13-membered ring macrocyclic lactams would be active in both enzymes TLN and NEP. Good predictability of experimental results, within this series, of binding to thermolysin and to a lesser extent to NEP was observed. A visual comparison, docked at the active site of TLN, is presented for thiorphan, a 10-membered ring macrocycle and an 11-membered ring benzofused macrocyclic lactam. Potent inhibition of both NEP and thermolysin was obtained. The 11-membered ring macrocycle 25a is the most potent inhibitor from this series of compounds (TLN IC50 = 68 nM; NEP IC50 = 0.9 nM). The effects of prodrug 44b administered at 10 mg/kg po on plasma atrial natriuretic peptide (ANP) levels in conscious rats was greater than 200% over a 4 h period.
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