Syntheses of cyclic prodrugs of RGD peptidomimetics with various macrocyclic ring sizes: evaluation of physicochemical, transport and antithrombic properties

Progress of thrombus formation and research on the structure-activity relationship for antithrombotic drugs

Many populations suffer from thrombotic disorders such as stroke, myocardial infarction, unstable angina and thromboembolic disease. Thrombus is one of the major threatening factors to human health and the prevalence of cardio-cerebrovascular diseases induced by thrombus is growing worldwide, even some persons got rare and severe blood clots after receiving the AstraZeneca COVID vaccine unexpectedly. In terms of mechanism of thrombosis, antithrombotic drugs have been divided into three categories including anticoagulants, platelet inhibitors and fibrinolytics. Nowadays, a large number of new compounds possessing antithrombotic activities are emerging in an effort to remove the inevitable drawbacks of previously approved drugs such as the high risk of bleeding, a slow onset of action and a narrow therapeutic window. In this review, we describe the causes and mechanisms of thrombus formation firstly, and then summarize these reported active compounds as potential antithrombotic candidates based on their respective mechanism, hoping to promote the development of more effective bioactive molecules for treating thrombotic disorders.

Macrocyclic Prodrugs of a Selective Nonpeptidic Direct Thrombin Inhibitor Display High Permeability, Efficient Bioconversion but Low Bioavailability

The only oral direct thrombin inhibitors that have reached the market, ximelagatran and dabigatran etexilat, are double prodrugs with low bioavailability in humans. We have evaluated an alternative strategy: the preparation of a nonpeptidic, polar direct thrombin inhibitor as a single, macrocyclic esterase-cleavable (acyloxy)alkoxy prodrug. Two homologous prodrugs were synthesized and displayed high solubilities and Caco-2 cell permeabilities, suggesting high absorption from the intestine. In addition, they were rapidly and completely converted to the active zwitterionic thrombin inhibitor in human hepatocytes. Unexpectedly, the most promising prodrug displayed only moderately higher oral bioavailability in rat than the polar direct thrombin inhibitor, most likely due to rapid metabolism in the intestine or the intestinal wall. To the best of our knowledge, this is the first in vivo ADME study of macrocyclic (acyloxy)alkoxy prodrugs, and it remains to be established if the modest increase in bioavailability is a general feature of this category of prodrugs or not.

Pathways and progress in improving drug delivery through the intestinal mucosa and blood-brain barriers

One of the major hurdles in developing therapeutic agents is the difficulty in delivering drugs through the intestinal mucosa and blood-brain barriers (BBB). The goal here is to describe the general structures of the biological barriers and the strategies to enhance drug delivery across these barriers. Prodrug methods used to improve drug penetration via the transcellular pathway have been successfully developed, and some prodrugs have been used to treat patients. The use of transporters to improve absorption of some drugs (e.g., antiviral agents) has also been successful in treating patients. Other methods, including blocking the efflux pumps to improve transcellular delivery, and modulation of cell-cell adhesion in the intercellular junctions to improve paracellular delivery across biological barriers, are still in the investigational stage.

Cell Adhesion Molecules for Targeted Drug Delivery

Rapid advancement of the understanding of the structure and function of cell adhesion molecules (i.e., integrins, cadherins) has impacted the design and development of drugs (i.e., peptide, proteins) with the potential to treat cancer and heart and autoimmune diseases. For example, RGD peptides/peptidomimetics have been marketed as anti-thrombic agents and are being investigated for inhibiting tumor angiogenesis. Other cell adhesion peptides derived from ICAM-1 and LFA-1 sequences were found to block T-cell adhesion to vascular endothelial cells and epithelial cells; these peptides are being investigated for treating autoimmune diseases. Recent findings suggest that cell adhesion receptors such as integrins can internalize their peptide ligands into the intracellular space. Thus, many cell adhesion peptides (i.e., RGD peptide) were used to target drugs, particles, and diagnostic agents to a specific cell that has increased expression of cell adhesion receptors. This review is focused on the utilization of cell adhesion peptides and receptors in specific targeted drug delivery, diagnostics, and tissue engineering. In the future, more information on the mechanism of internalization and intracellular trafficking of cell adhesion molecules will be exploited for delivering drug molecules to a specific type of cell or for diagnosis of cancer and heart and autoimmune diseases.

Peptide Motifs for Cell-Surface Intervention

The discovery of new antimicrobial and anticancer drugs, and overcoming the problem of resistance to current anti-infective and anticancer drug therapies require innovation in the pharmaceutical and scientific research community. A further challenge of drug design is to make the therapeutic agent specific, long lasting, of minimal toxicity, and affordable. Microbial and cancer cell surfaces present molecular features that can differentially prefocus drugs within the human host. This property can localize drugs near cell-surface targets, thereby reducing opportunities for adverse effects, or the emergence of drug resistance caused by intracellular drug and target modification and by the induction of drug efflux pumps. The solubility demands on cell-surface targeting drugs should also be less stringent than for those drugs requiring transmembrane transport or internalization in order to reach intracellular targets. Cationic peptides have provided an increasingly important research focus in this regard. Although the cationic antimicrobial peptides are distributed widely in nature and provide localized primary defenses against microbial attack, the susceptibility of L-peptides to proteolysis and the known properties of successful antimicrobials have led to a focus on circularized peptides, D,L-peptides, and peptides containing unusual amino acids. New on the scene as lead antifungal agents are D-octapeptides and their derivatives that were developed from a combinatorial library produced through solid-phase peptide synthesis protocols. These peptides contain an amidated C-terminal tri-arginine motif, which confers membrane impermeability and focuses the peptides near the fungal cell surface. To date, the octapeptides and their derivatives also require some aromaticity, preferably the indole ring of tryptophan. In some cases, a single 4-methoxy-2,3,6-trimethylbenzenesulfonyl moiety remaining on the peptide after incomplete cleavage of the peptide from the solid phase produces a peptide with activity, whereas the parent shows little or no activity in the screen. Recent research advances that support the polycationic cell surface approach include the RGD (Arg-Gly-Asp) tripeptide and its mimetics, as well as aminoglycoside arginine drugs (e.g. neomycin coupled to small arginine polymers) and prodrugs. In the case of polycationic peptides, D-peptides could be used for intravenous injection and direct-surface drug applications, but mimetics will probably be needed for oral delivery.