One
of the three subtypes of the peroxisome proliferator-activated
receptor (PPAR) functioning as a transcription factor is the PPARβ
or PPARδ. PPARδ is crucial to pathophysiological processes,
including metabolic disorders, liver diseases, and cardiovascular
diseases. In the past, the clinical development of PPARδ-selective
agonist drugs has been stalled due to potential safety-related issues.
Despite the elusiveness of such a drug, efforts continue in developing
drugs that target PPARδ due to advances in the knowledge of
the PPARδ receptor’s structure and functions. While several
preclinical and clinical studies are reported on PPARδ agonists,
there is limited data with no clinical evidence available for PPARδ-selective
antagonists. In this review, we mainly focus on the challenges of
PPARδ selectivity and the medicinal chemistry of most active
agonists discovered by different pharmaceutical companies and institutes.
With this in mind, we also provide an update on the development status
of PPARδ agonists that are undergoing clinical trials and their
therapeutic promise for the treatment of various diseases.