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Shepherd AJ, Rice AS, Smith MT. Angiotensin II type 2 receptor signalling as a pain target: Bench, bedside and back-translation. Curr Opin Pharmacol 2023; 73:102415. [PMID: 38041933 DOI: 10.1016/j.coph.2023.102415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/12/2023] [Accepted: 11/13/2023] [Indexed: 12/04/2023]
Abstract
Translating promising preclinical pain relief data for novel molecules from drug discovery to positive clinical trial outcomes is challenging. The angiotensin II type 2 (AT2) receptor is a clinically-validated target based upon positive proof-of-concept clinical trial data in patients with post-herpetic neuralgia. This trial was conducted because AT2 receptor antagonists evoked pain relief in rodent models of neuropathic pain. EMA401 was selected as the drug candidate based upon its suitable preclinical toxicity and safety profile and good pharmacokinetics. Herein, we provide an overview of the discovery, preclinical and clinical development of EMA401, for the alleviation of peripheral neuropathic pain.
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Affiliation(s)
- Andrew J Shepherd
- The MD Anderson Pain Research Consortium and the Laboratories of Neuroimmunology, Department of Symptom Research, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Andrew Sc Rice
- Pain Research, Department of Surgery & Cancer, Imperial College London, London, UK
| | - Maree T Smith
- School of Biomedical Sciences, The University of Queensland, St Lucia Campus, Brisbane, Queensland, Australia.
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Smith MT. Nonopioid analgesics discovery and the Valley of Death: EMA401 from concept to clinical trial. Pain 2022; 163:S15-S28. [PMID: 35984369 PMCID: PMC10578428 DOI: 10.1097/j.pain.0000000000002675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 04/22/2022] [Accepted: 04/28/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Maree T Smith
- Centre for Integrated Preclinical Drug Development, School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Inhibition of the angiotensin II type 2 receptor AT 2R is a novel therapeutic strategy for glioblastoma. Proc Natl Acad Sci U S A 2022; 119:e2116289119. [PMID: 35917342 PMCID: PMC9371711 DOI: 10.1073/pnas.2116289119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Glioblastoma (GBM) is an aggressive malignant primary brain tumor with limited therapeutic options. We show that the angiotensin II (AngII) type 2 receptor (AT2R) is a therapeutic target for GBM and that AngII, endogenously produced in GBM cells, promotes proliferation through AT2R. We repurposed EMA401, an AT2R antagonist originally developed as a peripherally restricted analgesic, for GBM and showed that it inhibits the proliferation of AT2R-expressing GBM spheroids and blocks their invasiveness and angiogenic capacity. The crystal structure of AT2R bound to EMA401 was determined and revealed the receptor to be in an active-like conformation with helix-VIII blocking G-protein or β-arrestin recruitment. The architecture and interactions of EMA401 in AT2R differ drastically from complexes of AT2R with other relevant compounds. To enhance central nervous system (CNS) penetration of EMA401, we exploited the crystal structure to design an angiopep-2-tethered EMA401 derivative, A3E. A3E exhibited enhanced CNS penetration, leading to reduced tumor volume, inhibition of proliferation, and increased levels of apoptosis in an orthotopic xenograft model of GBM.
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Rice ASC, Dworkin RH, Finnerup NB, Attal N, Anand P, Freeman R, Piaia A, Callegari F, Doerr C, Mondal S, Narayanan N, Ecochard L, Flossbach Y, Pandhi S. Efficacy and safety of EMA401 in peripheral neuropathic pain: results of 2 randomised, double-blind, phase 2 studies in patients with postherpetic neuralgia and painful diabetic neuropathy. Pain 2021; 162:2578-2589. [PMID: 33675631 DOI: 10.1097/j.pain.0000000000002252] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/09/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT The analgesic efficacy and safety of 2 phase 2b studies of EMA401 (a highly selective angiotensin II type 2 receptor antagonist) in patients with postherpetic neuralgia (EMPHENE) and painful diabetic neuropathy (EMPADINE) were reported. These were multicentre, randomised, double-blind treatment studies conducted in participants with postherpetic neuralgia or type I/II diabetes mellitus with painful distal symmetrical sensorimotor neuropathy. Participants were randomised 1:1:1 to either placebo, EMA401 25 mg, or 100 mg twice daily (b.i.d) in the EMPHENE and 1:1 to placebo or EMA401 100 mg b.i.d. in the EMPADINE. The primary outcome for both the studies was change in weekly mean of the 24-hour average pain score, using a numeric rating scale from baseline to week 12. Both the studies were prematurely terminated due to preclinical hepatotoxicity on long-term dosing, although not observed in these studies. Out of the planned participants, a total of 129/360 (EMPHENE) and 137/400 (EMPADINE) participants were enrolled. The least square mean reduction in numeric rating scale pain score was numerically in favour of EMA401 100 mg arm in both EMPHENE (treatment difference: -0.5 [95% confidence interval: -1.6 to 0.6; P value: 0.35]) and EMPADINE (treatment difference: -0.6 [95% confidence interval: -1.4 to 0.1; P value: 0.10]) at the end of week 12. However, as the studies were terminated prematurely, no firm conclusion could be drawn but the consistent clinical improvement in pain intensity reduction across these 2 studies in 2 different populations is worth noting.
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Affiliation(s)
- Andrew S C Rice
- Department of Surgery and Cancer, Pain Research, Imperial College London, London, United Kingdom
| | - Robert H Dworkin
- Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, NY, United States
| | - Nanna B Finnerup
- Department of Clinical Medicine, Danish Pain Research Center, Aarhus University, Aarhus, Denmark
| | - Nadine Attal
- INSERM U987, Ambroise Paré Hospital, APHP, Boulogne-Billancourt, Paris, France
- Université Versailles Saint Quentin- en Yvelines (UVSQ), Versailles, France
| | - Praveen Anand
- Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Roy Freeman
- Center for Autonomic and Peripheral Nerve Disorders, Beth Israel Deaconess Medical Center, Harvard Medical School Boston, Boston, MA, United States
| | | | | | - Christie Doerr
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, United States
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Guo Y, Huang X, Liao W, Meng L, Xu D, Ye C, Chen L, Hu T. Discovery and Optimization of Highly Potent and Selective AT 2R Antagonists to Relieve Peripheral Neuropathic Pain. ACS OMEGA 2021; 6:15412-15420. [PMID: 34151119 PMCID: PMC8210434 DOI: 10.1021/acsomega.1c01866] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/10/2021] [Indexed: 05/08/2023]
Abstract
The angiotensin II type 2 receptor (AT2R) has attracted much attention as a potential target for the relief of neuropathic pain, which represents an area of unmet clinical need. A series of 1,2,3,4-tetrahydroisoquinolines with a benzoxazole side-chain were discovered as potent AT2R antagonists. Rational optimization resulted in compound 15, which demonstrated both excellent antagonistic activity against AT2R in vitro and analgesic efficacy in a rat chronic constriction injury model. Its favorable physicochemical properties and oral bioavailability make it a promising therapeutic candidate for neuropathic pain.
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Affiliation(s)
- Yanghui Guo
- Shanghai
Institute of Drug Discovery, Zhejiang Hisun
Pharmaceutical Co., Ltd., Building 25, 301 Minqiang Road, Shanghai 201612, China
| | - Xiangui Huang
- Shanghai
Institute of Drug Discovery, Zhejiang Hisun
Pharmaceutical Co., Ltd., Building 25, 301 Minqiang Road, Shanghai 201612, China
| | - Weiwei Liao
- Shanghai
Institute of Drug Discovery, Zhejiang Hisun
Pharmaceutical Co., Ltd., Building 25, 301 Minqiang Road, Shanghai 201612, China
| | - Lichen Meng
- Shanghai
Institute of Drug Discovery, Zhejiang Hisun
Pharmaceutical Co., Ltd., Building 25, 301 Minqiang Road, Shanghai 201612, China
| | - Daiwang Xu
- Shanghai
Institute of Drug Discovery, Zhejiang Hisun
Pharmaceutical Co., Ltd., Building 25, 301 Minqiang Road, Shanghai 201612, China
| | - Cheng Ye
- Shanghai
Institute of Drug Discovery, Zhejiang Hisun
Pharmaceutical Co., Ltd., Building 25, 301 Minqiang Road, Shanghai 201612, China
| | - Lei Chen
- Shanghai
Institute of Drug Discovery, Zhejiang Hisun
Pharmaceutical Co., Ltd., Building 25, 301 Minqiang Road, Shanghai 201612, China
- Zhejiang
Hisun Pharmaceutical Co., Ltd., 46 Waisha Road, Taizhou, Zhejiang 318000, China
| | - Taishan Hu
- Shanghai
Institute of Drug Discovery, Zhejiang Hisun
Pharmaceutical Co., Ltd., Building 25, 301 Minqiang Road, Shanghai 201612, China
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