W20 CNS Drugs: Crossing the BBB (MM) Flashcards

1
Q

What is the Blood-Brain Barrier? (definition)
2 other barriers?

A

A biological barrier at the blood-to-brain interface, effectively separating the brain from the rest of the body

blood-CSF barrier (BCB) and the arachnoid barrier

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2
Q

BBB info:
Features of the BBB:
Components of the BBB? (4)

A
  • Microvascular endothelial cells lining the cerebral capillaries penetrating the brain and spinal cord of humans (and most mammals)
  • Largest blood-brain exchange (12-18 m2 surface area)
  • Protects the brain against blood-borne agents including drugs and other exogenous compounds
  1. Tight Junctions
  2. Absence of fenestrations
  3. Active transport mechanisms (influx and efflux)
  4. Drug metabolising enzymes in brain endothelial cells
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3
Q

What are the ways molecules can cross the BBB? (5)

A
  • Passive diffusion
  • Active efflux
  • CMT- carrier mediated transport
  • Transcytosis
  • Cells diapedesis
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4
Q

What is Passive diffusion?
The molecules transported have what features?

A
  • Passive = Energy not required
  • Lipid-soluble molecules (logD)
  • Low polar surface area
  • Low molecular weight
  • Small molecules do not necessarily cross the BBB (98% of all small molecules do not cross, only 5% of the >7000 drugs in CMC database treat the CNS)
    e.g. gases- o2, co2, ethanol, nicotine,caffeine (lipid-soluble)
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5
Q

What is Active efflux (and influx)?
What molecules are transported?

A
  • Active = ATP required (via specific transport proteins)
  • Xenobiotics, metabolites, toxins, drugs
  • Many transport from endothelium to blood
  • Some are bi-directional transporters

Efflux- brain into blood e.g .P-gp that pumps xenobiotics out and back into bloodstream
Influx- blood into brain

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6
Q

What is Carrier-Mediated Transport?
What molecules are transported?
Which family of transporters is CMT part of?

A
  • There are many essential polar molecules
  • Glucose, amino acids (non-lipid soluble)
  • CMTs are encoded genes within the Solute Carrier Transporter Gene Family
  • Preferential distribution across both sides of BBB confers polarised behaviour of BBB
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7
Q

What are the 2 types of Transcytosis?
What molecules are transported?

A
  1. RMT (Receptor-mediated transcytosis)
    * Molecules are too large to use CMT (peptide bonds)
    * Regulatory proteins, hormones, growth factors
    * Specific receptors on the cell surface are responsible
  2. AMT (Adsorptive-mediated transcytosis)
    * Positively charged, large molecules
    * Histone, protamine, cationic proteins
    * Cell surface binding sites (+ve proteins, -ve cell surface electrostatic interactions)
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8
Q

What is Cell Diapedesis?
What molecules are transported?

A
  • Most common example is Neutrophils (WBC) that provide defense against invading
    microorganisms and so must be able to cross the endothelial BBB.
  • Also used for tissue repair but if not controlled can lead to inflammation (e.g. arthritis, vascular inflammation etc)
  • Can be manipulated to transport drugs across the BBB

=the passage of cells through the intact vessel wall, the movement of leukocytes out of the circulatory system and towards the site of tissue damage or infection

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9
Q

To make a drug favourable in crossing the BBB:
What is Lipinski’s Rule of 5?

A
  • 5 or fewer Hydrogen Bond Donors (HBD)
  • 10 or fewer Hydrogen Bond Acceptors (HBA)
  • Molecular weight under 500 g/mol or daltons
  • LogP less than 5 (Actually: 0-3 for CNS)
    Note: Use LogD
  • 10 or fewer rotatable bonds*

*A single non-ring bond, attached to a non-terminal, non-hydrogen atom. Amide C-N not included due to their high barrier of rotation

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10
Q

What is Polar Surface Area?
Measured in?
Amount of oral biovailability
Amount to cross CNS?

A
  • The surface area of the molecule taken up by polar atoms
  • Sometimes will see TPSA – Topological Polar
    Surface Area
  • Measured in squared Angstroms ( Å2)
  • Oral Bioavailability<140 Å2
  • To cross into CNS <90 Å2
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11
Q

What are the Ideal Characteristics for CNS Drugs?

A
  • HBD: 5 or fewer
  • HBA: 10 or fewer
  • MW: 450 g/mol or less
  • RB: 10 or fewer
  • LogD: 0-3
  • PSA: <90 Å
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12
Q

What are some Chemical Methods for Drug Delivery to the CNS (4)

A
  • Lipophilic Analogues
  • Prodrugs
  • Chemical Delivery Systems
  • Molecular Packaging

These involve the transformation of the chemical structure of drugs to improve their unsatisfactory physiochemical properties (solubility, membrane penetration etc.) These
changes will change their functionalities.

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13
Q

What are Lipophilic Analogues?

A
  • Lipid solubility is a key factor in passive diffusion across BBB
  • Making drug molecules more lipophilic is logical
  • Involves adding lipid groups to polar ends of drug molecules
  • Can lead to poor tissue distribution
  • Can be detrimental to oxidative metabolism by CYP-450 and other enzymes
  • Also lowers PSA so can change bioavailability (especially oral drugs)
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14
Q

What are Prodrugs?
Usually used to make a drug..?

A
  • Compounds that, on administration, must undergo chemical conversion by a metabolic process before becoming an active pharmacological agent
  • Used to make the drug more lipophilic (usually)
  • Some prodrugs alter the original tissue distribution, efficacy and/or toxicity of the parent drug
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15
Q

Chemical delivery system:
What are they?
3 main classes?

A
  • Inactive chemical derivatives of a drug obtained by one or more chemical modifications.
  • Provide site-specific or site-enhanced delivery of the drug through multistep transformations
  • There are three main classes of CDS:
    1. Enzymatic Physiochemical CDS
    2. Site-specific Enzyme-activated CDS
    3. Receptor-based CDS
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16
Q

Chemical Delivery Systems (CDS)
2 types of bioremovable moieties?

A
  • Two types of bioremovable moieties are introduced to convert the drug into an inactive precursor:
    1. Targetor: Responsible for targeting,
    site-specificity and lock-in
    2. Modifier: Lipophilizers, protect
    certain functions, prevent unwanted or premature metabolic conversions
  • Sequential metabolic conversions disengage the modifier and then the target once they have completed their roles
17
Q

What is Molecular Packaging?
What are its 3 benefits?

A
  • Primarily used for peptides
  • The peptide unit forms part of a bulky molecule, dominated by groups that prevent recognition by peptidases and allow for direct passage through BBB
  • Can achieve 3 goals simultaneously:
    1. Increased lipophilicity (enhance passive transport)
    2.Prevention of premature degradation (by enzymes especially)
    3. Exploits lock-in mechanism to make targeting possible
18
Q

Features of Levodopa?

A
  • Used for the treatment of Parkinson’s Disease
  • Precursor for dopamine
  • Converted into dopamine by DOPA decarboxylase in the brain
  • Given with carbidopa or benserazide
    -These inhibit DOPA decarboxylase
  • They do not cross the BBB so minimises peripheral degradation (and also side effects such as nausea, vomiting and hypertension
19
Q

Features of Donepezil?

A
  • Used for the treatment of Alzheimer’s Disease
    (over 400 drugs being investigated currently)
  • Selectively and reversibly inhibits the
    acetylcholinesterase enzyme (cholinesterase
    inhibitor)
  • Thus enhances cholinergic transmission
  • Transported across the BBB by an organic cation transporter – Carrier Mediated Transport

It is a competitive inhibitor of acetylcholinesterase

20
Q

Features of Methylphenidate?

A
  • First-line stimulant used to treat ADHD (previously chronic fatigue, depression, psychosis)
  • Dopamine and norepinephrine transporter
    stimulants
  • Enters the brain (and tissue) via passive diffusion
  • There are 4 isomers with slightly different rates of diffusion and metabolism
  • Metabolism can happen by a number of different pathways
21
Q

What is a diastereomer vs enantiomer?

A

Enantiomers are a pair of molecules that exist in two forms that are mirror images of one another but cannot be superimposed one upon the other( chiral) . Diastereomers are defined as compounds with the same molecular formula and sequence of bonded elements but are non-superimposable non-mirror images

22
Q

Explain why?
a) Levodopa can pass the BBB but Carbidopa cannot
b) Levodopa can pass the BBB but Benserazide cannot
c) Levodopa can pass the BBB but dopamine cannot

A

Too hydrophilic and Levodopa uses L-amino acid transporters.

23
Q

What is passive diffusion?

A
  • Passive = Energy not required
  • Lipid-soluble molecules (logD)
  • Low polar surface area
  • Low molecular weight
  • Small molecules do not necessarily cross the BBB (98% of all small molecules do not cross, only 5% of the >7000 drugs in CMC database treat the CNS)
24
Q

Escitalopram is the pure S-enantiomer of
Citalopram.
(a) What effect does this have on the drug’s
ability to cross the BBB?
(b) Is escitalopram or citalopram more potent?
Why?

A

a) No impact- exact same characteristics
b) Escitalopram is 150x more potent as it does not contain R-enantiomers which has a dampening effect on the activity of the S-enantiomer