Improvements in in vitro ADME tools and pharmacokinetic
prediction models have helped to shift attrition rates in early clinical
trials from poor exposure to drug safety concerns, such as drug-induced
liver injury (DILI). Assessing a new chemical entity’s potential
for liver toxicity is an important consideration for the likely success
of new drug candidates. Reactive intermediates produced during drug
metabolism have been implicated as a cause of DILI, and their formation
has been correlated to the addition of a black box warning on a drug
label. In this work, we will present contemporary examples of the
bioactivation of atypical structures usually regarded as benign and
often used by medicinal chemists when attempting to avoid bioactivation.
Medicinal chemistry strategies used to derisk bioactivation will be
discussed, and an emphasis will be placed on the necessity of a multidisciplinary
approach.