Case Study 1 - ACE inhibitors Flashcards

1
Q

Identifying the Pharmacophore

A
  • It provides need-to-know information about the active conformation of the active drug
  • Relative position in space of groups that interact with the receptor, e.g. H-bond acceptors and donors (generalised bonding pharmacophore)
  • A 2- or 3-dimensional map of the site of association
  • Knowledge of the binding site structure can be used to ‘reverse engineer’ the pharmacophore, by specifying the position of key functional groups.
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2
Q

The Active Conformation

A
  • The active conformation must be identified in order to confirm the 3D pharmacophore
  • Conformational analysis helps to identify all possible conformations and their activities (in silico)
  • Conformational analysis is difficult for flexible molecules with rotatable bonds that have many degrees of freedom
  • The active conformation must be compared to series of rigidified molecular architectures also
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3
Q

Rigidification

A
  • Endogenous ligands (lead compounds) are often simple yet flexible and fit several targets due to many different active conformations
  • Rigidify analogue molecule to limit conformations – impose conformational restraint
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4
Q

Simplification

A
  • Naturally-occurring lead compounds are often complex and difficult to synthesize
  • Simplifying the molecule makes the synthesis of analogues easier, quicker and cheaper
  • Must retain the pharmacophore
  • Simpler structures may fit the binding site easily with a concommitant increase in activity
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5
Q

Structure-Based Drug Design

A
  • Crystallise target protein with bound lead compound and acquire structure by X-ray crystallography
  • Identify binding interactions between ligand and target (in silico molecular modelling)
  • Identify vacant sites for additional binding interactions (in silico)
  • Design and ‘fit’ analogues into binding site (in silico)
  • Choose lead compounds for synthesis
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6
Q

National Medal for Technology

A
  • Bristol-Myers Squibb in 1998
  • “For extending and enhancing human life through innovative pharmaceutical research and development.”
  • Bristol-Myers Squibb developed angiotensin converting enzyme (ACE) inhibitors, used to treat hypertension in patients with cardiovascular disorders
  • The development of captopril (and enalapril) is an excellent example rational drug design, in this case where the structure of the receptor is unknown
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7
Q

• Hypertension can be induced by:

A

• Disease of the CNS and peripheral nervous system
• Abnormalities of hormonal systems
• Abnormalities of kidneys and peripheral vasculature
- High arterial blood pressure causes hypertension

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8
Q

Hypertension types

A

• Primary
No obvious cause though family history, smoking,
alcoholism or obesity may predispose a patient

• Secondary
Well-defined condition that can be identified: renal disease; tumours; drug side-effects; pregnancy

• Isolated systolic hypertension
Occurs mostly in elderly patients (age >60 yo)
Systolic >160 mm Hg; Diastolic within normal limits
Associated with high incidence of strokes

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9
Q

Reflex Control of Blood Pressure

A
  • Baroreceptor mechanism
  • Pressure sensing areas throughout vasculature
  • Alters the autonomic outflow
  • Continuous monitoring, fast response
  • Renin-angiotensin system
  • Long term control of pressure
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10
Q

Renin

A
  • Proteolytic enzyme

* Secreted from the juxtaglomerular cells (kidney)

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11
Q

Renin-Angiotensin System

A
  • Renin is secreted into the blood in the kidneys by the juxtaglomerular apparatus
  • Angiotensinogen is produced by the liver
  • Renin cleaves angiotensinogen to give angiotensin I
  • Angiotensin Converting Enzyme (ACE) cleaves angiotensin I to give angiotensin II during passage through the lungs
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12
Q

Renin-Angiotensin System

• Angiotensin II

A
  • Angiotensin II constricts the renal efferent arteriole greater than the afferent arteriole
  • Angiotensin II increases or maintains the glomerular filtration pressure
  • High levels of aldosterone conserve salt and water and therefore increase blood volume
  • Increased angiotensin II levels is often a physiological response to renal artery stenosis
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13
Q

Renin-Angiotensin System - what increases bp

A
  • Renin release is under feedback control from Angiotensin II release
  • Angiotensin II is a vasoconstrictor – INCREASED BLOOD PRESSURE
  • Angiotensin II stimulates the adrenal cortex to release aldosterone, which in turn acts at the kidney to cause sodium and water retention – INCREASED BLOOD PRESSURE
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14
Q

Angiotensin Converting Enzyme

A
  • Endothelial cell membrane-bound glycoprotein
  • Mr 129 kDa, 26% polysaccharide, one Zn atom per in the active site of the enzyme
  • Primary structure of ACE not determined until 1988, after the development of ACE inhibitors
  • Multiple substrates are processed by the enzyme
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15
Q

Snake Venom and ACE Inhibitors

A

• Range of peptidic ACE inhibitors isolated from the Brazilian Arrowhead viper Bothrops jararaca
Snake Venom and ACE Inhibitors
•Most potent was Teprotide (SQ20881): pGlu-Trp-Pro-Arg-Pro-Gln-Ile-Pro-Pro

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16
Q

ACE and Carboxypeptidase A

A
  • Carboxypeptidase A is a monopeptidase
  • ACE is a dipeptidase

• Both enzymes are exopeptidases: they cleave residues from the ends of a protein
• Both enzymes require a free C-terminal CO2H
• Neither enzyme will hydrolyse an imino-acyl bond
i.e. will not hydrolyse an amide/peptide bond where the NHR component is proline
• Neither enzyme will hydrolyse a peptide with has a C-terminal dicarboxylic acid, e.g. Asp or Glu
• The active site of both enzymes contains zinc

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17
Q

The ACE Analogy

A
  • Proline chosen as the C-terminus residue following results with BPP5a and Teprotide
  • Zn site and the carboxyl binding site are further apart in ACE as compared to carboxypeptidase A
  • Two hydrophobic pockets are required for strong binding to the substrate in ACE
  • The non-scissile amide bond should be hydrogen- bonded to the enzyme
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18
Q

Captopril

A

Captopril 25 mg/day

  • reduction in systolic b.p. -21 mm Hg
  • reduction in diastolic b.p. -9 mm Hg

-Captopril is a tightly-binding competitive ACE inhibitor It is not active against other peptidases at concentrations <10-3 M, i.e. it is specific for ACE
• Marketed in the UK by Squibb as Capoten
• Rapid onset of response but T1/2 only 2 hours
• Side effects specific to captopril thiol group
Neutropenia; rash; nephrotic-range proteinuria; taste disturbances

19
Q

Enalapril

A

• Enalapril is a pro-drug: the diacid, enalaprilat,
is formed by metabolic processing in the liver
• Diacid has lower IC50 than captopril with fewer side effects (no thiol)
• Marketed in the UK by MSD as the maleate

20
Q

Me-Too Drugs

A

Ramipril -Indicated for use as prophylaxis
against adverse CVS events in susceptible patients over 55 yo

Perindopril

Trandolapril

21
Q

Chain extension

R: -CH3

A

Pharmacological activity

Analgesic (morphine)

22
Q

Chain extension

R: -CH2CH3

A

Pharmacological activity

Opioid agonist activity decreased

23
Q

Chain extension

R: -CH2CH2CH3

A

Pharmacological activity

Opioid antagonist activity increased

24
Q

Chain extension

R: -CH2CH2CH2CH3

A

Pharmacological activity

Inactive as opioid agonist or antagonist

25
Q

Chain extension
R: -CH2CH2CH2CH2CH3 AND
-CH2CH2CH2CH2CH2CH3

A

Pharmacological activity

Opioid antagonist activity increased

26
Q

Chain extension

R: -CH2CH2-benzene ring

A

Pharmacological activity

14X potency of morphine

27
Q

Rigidification may increase

A
  • May increase activity (more chance of the desired active conformation)
  • May increase selectivity (less chance of any other undesired active conformations)
  • However, the target molecule may now be more complex and more difficult to synthesise
28
Q

• The pharmacophore defines

A

• The pharmacophore defines the essential groups that are involved in binding to the desired receptor

29
Q

• Simple structures may be more..

A
  • Simple structures may be more selective and less toxic if excess, unnecessary functional groups are removed
  • Oversimplification can result in decreased selectivity and activity, and may lead to unwanted side effects
30
Q

Structure-Based Drug Design is based upon..

A

• Based upon interactions between the lead compound and the target binding site

31
Q

what is blood pressure

A

• Blood pressure is a function of the amount of blood pumped by the heart (cardiac output) and the resistance to blood flow by peripheral vasculature (total peripheral resistance)

32
Q

• Secretion of renin is increased by:

A
  • A fall in Na+ concentration
  • A fall in renal perfusion pressure
  • B-adrenoceptor agonists
  • Prostacyclin
33
Q

• Secretion of renin is inhibited by:

A
  • Angiotensin II (feedback control)

* Atrial natriuretic peptide

34
Q

• ACE creates

A

angiotensin II

35
Q

• ACE inactivates

A

bradykinin

36
Q

• Inhibition of ACE

A

should lower blood pressure

37
Q

• ACE has a high affinity for

A

peptides with an aromatic amino acid, e.g. Phe or Tyr, in the antipenultimate position

38
Q

• Side effects of ACE inhibitors

A

Hypotension; cough; hyperkalemia; renal failure; fetal anomalies; angioedema

39
Q

• 1st orally-active ACE inhibitor (1978)

A

Captopril

40
Q

Blood pressure (mm Hg) - normal

A

Systolic <130

Diastolic <85

41
Q

Blood pressure (mm Hg) - high normal

A

Systolic 130 - 139

Diastolic 85 - 89

42
Q

Blood pressure (mm Hg) - Mild hypertension:

A

Systolic 140 - 159

Diastolic 90 - 99

43
Q

Blood pressure (mm Hg) - Moderate hypertension:

A

Systolic 161 - 179

Diastolic 100 - 109

44
Q

Blood pressure (mm Hg) - Severe hypertension:

A

Systolic 180 - 209

Diastolic 110 - 119