Tetrahydroquinolin-3-yl carbamate glucocorticoid receptor agonists with reduced PEPCK activation

Non-steroidal Dissociated Glucocorticoid Receptor Agonists

Synthetic glucocorticoids, such as dexamethasone and prednisolone, are amongst the most commonly used drugs due to their potent and efficacious anti-inflammatory and immunosuppressive properties. However, their long-term and/or high-dose administration is limited by a number of deleterious side-effects, including glucocorticoid-induced diabetes and osteoporosis. Glucocorticoids exert their effects through binding to the glucocorticoid receptor. Since the discovery of multiple differentiated down-stream functions of the glucocorticoid-bound receptor, such as gene transrepression and transactivation, researchers in academia and industry have been on a quest to discover novel glucocorticoids that achieve functional selectivity, hence dissociating the desired anti-inflammatory from the undesired side-effects. This review describes the current state of discovery and development of non-steroidal glucocorticoid receptor agonists. Several small-molecule drug candidates have advanced into clinical trials, and have shown promising early biomarker data, as well as beneficial effects in topical applications. However, a clinically efficacious and systemically available glucocorticoid with significantly reduced side-effects as compared to current steroidal drugs, the “Holy Grail” in immunology, is still elusive.

Non-steroidal dissociated glucocorticoid agonists: indoles as A-ring mimetics and function-regulating pharmacophores

We report a SAR of non-steroidal glucocorticoid mimetics that utilize indoles as A-ring mimetics. Detailed SAR is discussed with a focus on improving PR and MR selectivity, GR agonism, and in vitro dissociation profile. SAR analysis led to compound (R)-33 which showed high PR and MR selectivity, potent agonist activity, and reduced transactivation activity in the MMTV and aromatase assays. The compound is equipotent to prednisolone in the LPS-TNF model of inflammation. In mouse CIA, at 30 mg/kg compound (R)-33 inhibited disease progression with an efficacy similar to the 3 mg/kg dose of prednisolone.