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Zhi J, Li F, Jiang X, Bai R. Thyroid receptor β: A promising target for developing novel anti-androgenetic alopecia drugs. Drug Discov Today 2024; 29:104013. [PMID: 38705510 DOI: 10.1016/j.drudis.2024.104013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/22/2024] [Accepted: 04/29/2024] [Indexed: 05/07/2024]
Abstract
Androgenetic alopecia (AGA) significantly impacts the self-confidence and mental well-being of people. Recent research has revealed that thyroid receptor β (TRβ) agonists can activate hair follicles and effectively stimulate hair growth. This review aims to comprehensively elucidate the specific mechanism of action of TRβ in treating AGA from various perspectives, highlighting its potential as a drug target for combating AGA. Moreover, this review provides a thorough summary of the research advances in TRβ agonist candidates with anti-AGA efficacy and outlines the structure-activity relationships (SARs) of TRβ agonists. We hope that this review will provide practical information for the development of effective anti-alopecia drugs.
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Affiliation(s)
- Jia Zhi
- School of Pharmacy, Hangzhou Normal University, Hangzhou, 311121, P.R. China; Key Laboratory of Elemene Class Anti-tumor Chinese Medicines, Engineering Laboratory of Development and Application of Traditional Chinese Medicines, Collaborative Innovation Center of Traditional Chinese Medicines of Zhejiang Province, Hangzhou Normal University, Hangzhou 311121, PR China
| | - Feifan Li
- School of Pharmacy, Hangzhou Normal University, Hangzhou, 311121, P.R. China; Key Laboratory of Elemene Class Anti-tumor Chinese Medicines, Engineering Laboratory of Development and Application of Traditional Chinese Medicines, Collaborative Innovation Center of Traditional Chinese Medicines of Zhejiang Province, Hangzhou Normal University, Hangzhou 311121, PR China
| | - Xiaoying Jiang
- School of Pharmacy, Hangzhou Normal University, Hangzhou, 311121, P.R. China; Key Laboratory of Elemene Class Anti-tumor Chinese Medicines, Engineering Laboratory of Development and Application of Traditional Chinese Medicines, Collaborative Innovation Center of Traditional Chinese Medicines of Zhejiang Province, Hangzhou Normal University, Hangzhou 311121, PR China.
| | - Renren Bai
- School of Pharmacy, Hangzhou Normal University, Hangzhou, 311121, P.R. China; Key Laboratory of Elemene Class Anti-tumor Chinese Medicines, Engineering Laboratory of Development and Application of Traditional Chinese Medicines, Collaborative Innovation Center of Traditional Chinese Medicines of Zhejiang Province, Hangzhou Normal University, Hangzhou 311121, PR China.
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Mészáros L, Himmler M, Schneider Y, Arnold P, Dörje F, Schubert DW, Winkler J. Sobetirome rescues α-synuclein-mediated demyelination in an in vitro model of multiple system atrophy. Eur J Neurosci 2024; 59:308-315. [PMID: 38086536 DOI: 10.1111/ejn.16215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/17/2023] [Accepted: 11/21/2023] [Indexed: 01/23/2024]
Abstract
Multiple system atrophy (MSA) is a rare and rapidly progressive atypical parkinsonian disorder characterized by oligodendroglial cytoplasmic inclusions containing α-synuclein (α-syn), demyelination, inflammation and neuronal loss. To date, no disease-modifying therapy is available. Targeting α-syn-driven oligodendroglial dysfunction and demyelination presents a potential therapeutic approach for restricting axonal dysfunction, neuronal loss and disease progression. The present study investigated the promyelinogenic potential of sobetirome, a blood-brain barrier permeable and central nervous system selective thyromimetic in the context of an in vitro MSA model. Oligodendrocyte precursor cells (OPCs) were obtained from transgenic mice overexpressing human α-syn specifically in oligodendrocytes (MBP29 mouse line), a well-described MSA model, and non-transgenic littermates. mRNA and protein expression analyses revealed a substantial rescue effect of sobetirome on myelin-specific proteins in control and α-syn overexpressing oligodendrocytes. Furthermore, myelination analysis using nanofibres confirmed that sobetirome increases both the length and number of myelinated segments per oligodendrocyte in primary murine α-syn overexpressing oligodendrocytes and their respective control. These results suggest that sobetirome may be a promising thyromimetic compound targeting an important neuropathological hallmark of MSA.
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Affiliation(s)
- Lisa Mészáros
- Department of Molecular Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Marcus Himmler
- Institute of Polymer Materials, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
- KeyLab Advanced Fiber Technology, Bavarian Polymer Institute, Fürth, Germany
| | - Yanni Schneider
- Department of Molecular Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Philipp Arnold
- Institute of Functional and Clinical Anatomy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Frank Dörje
- Pharmacy Department, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Dirk W Schubert
- Institute of Polymer Materials, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
- KeyLab Advanced Fiber Technology, Bavarian Polymer Institute, Fürth, Germany
| | - Jürgen Winkler
- Department of Molecular Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
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Haraguchi T, Hamamoto Y, Kuwata H, Yamazaki Y, Nakatani S, Hyo T, Yamada Y, Yabe D, Seino Y. Effect of Roxadustat on Thyroid Function in Patients With Renal Anemia. J Clin Endocrinol Metab 2023; 109:e69-e75. [PMID: 37597171 DOI: 10.1210/clinem/dgad483] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/06/2023] [Accepted: 08/17/2023] [Indexed: 08/21/2023]
Abstract
CONTEXT Roxadustat, a hypoxia-inducible factor prolyl hydroxylase (HIF-PH) inhibitor, a recently developed class of drugs for treatment of anemia in chronic kidney disease (CKD), is reported to have a structure unlike that of other HIF-PH inhibitors but similar to that of triiodothyronine and bind to the thyroid hormone receptor in vitro. However, reports on the effects of roxadustat on thyroid function are limited and not detailed, and it remains unknown whether other HIF-PH inhibitors also affect thyroid function. OBJECTIVE To compare the effect of roxadustat with daprodustat, another HIF-PH inhibitor, on thyroid function in patients with renal anemia in CKD. METHODS This retrospective observational study included a total of 26 patients with anemia in CKD who were treated with roxadustat or daprodustat; thyroid-stimulating hormone (TSH) and free thyroxine (FT4) were measured before and after treatment with the drugs. RESULTS After initiation of roxadustat, TSH showed a significant decrease (2.4732 [1.7858-4.9016] μIU/mL before treatment and 0.659 [0.112-2.005] μIU/mL after treatment, P < .05); FT4 showed a significant decrease (0.93 [0.84-1.05] ng/dL before treatment and 0.70 [0.53-0.85] ng/dL after treatment, P < .01). After daprodustat initiation, neither TSH nor FT4 showed a significant change (TSH: 3.044 [1.853-4.171] μIU/mL before treatment and 2.893 [1.866-4.894] μIU/mL after treatment, P = .635; FT4 was 0.93 [0.81-1.00] ng/dL before treatment and 0.97 [0.87-1.05] ng/dL after treatment, P = .328). CONCLUSION Roxadustat decreases TSH and FT4 levels while daprodustat does not.
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Affiliation(s)
- Takuya Haraguchi
- Center for Diabetes, Endocrinology and Metabolism, Kansai Electric Power Hospital, Osaka 553-0003, Japan
- Yutaka Seino Distinguished Center for Diabetes Research, Kansai Electric Power Medical Research Institute, Kobe 650-0047, Japan
- Department of Diabetes, Endocrinology and Metabolism/Department of Rheumatology and Clinical Immunology, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
| | - Yoshiyuki Hamamoto
- Center for Diabetes, Endocrinology and Metabolism, Kansai Electric Power Hospital, Osaka 553-0003, Japan
- Yutaka Seino Distinguished Center for Diabetes Research, Kansai Electric Power Medical Research Institute, Kobe 650-0047, Japan
| | - Hitoshi Kuwata
- Center for Diabetes, Endocrinology and Metabolism, Kansai Electric Power Hospital, Osaka 553-0003, Japan
- Yutaka Seino Distinguished Center for Diabetes Research, Kansai Electric Power Medical Research Institute, Kobe 650-0047, Japan
| | - Yuji Yamazaki
- Center for Diabetes, Endocrinology and Metabolism, Kansai Electric Power Hospital, Osaka 553-0003, Japan
- Yutaka Seino Distinguished Center for Diabetes Research, Kansai Electric Power Medical Research Institute, Kobe 650-0047, Japan
| | - Susumu Nakatani
- Center for Diabetes, Endocrinology and Metabolism, Kansai Electric Power Hospital, Osaka 553-0003, Japan
- Yutaka Seino Distinguished Center for Diabetes Research, Kansai Electric Power Medical Research Institute, Kobe 650-0047, Japan
| | - Takanori Hyo
- Center for Diabetes, Endocrinology and Metabolism, Kansai Electric Power Hospital, Osaka 553-0003, Japan
- Yutaka Seino Distinguished Center for Diabetes Research, Kansai Electric Power Medical Research Institute, Kobe 650-0047, Japan
| | - Yuichiro Yamada
- Center for Diabetes, Endocrinology and Metabolism, Kansai Electric Power Hospital, Osaka 553-0003, Japan
- Yutaka Seino Distinguished Center for Diabetes Research, Kansai Electric Power Medical Research Institute, Kobe 650-0047, Japan
| | - Daisuke Yabe
- Yutaka Seino Distinguished Center for Diabetes Research, Kansai Electric Power Medical Research Institute, Kobe 650-0047, Japan
- Department of Diabetes, Endocrinology and Metabolism/Department of Rheumatology and Clinical Immunology, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
| | - Yutaka Seino
- Center for Diabetes, Endocrinology and Metabolism, Kansai Electric Power Hospital, Osaka 553-0003, Japan
- Yutaka Seino Distinguished Center for Diabetes Research, Kansai Electric Power Medical Research Institute, Kobe 650-0047, Japan
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Li L, Song Y, Shi Y, Sun L. Thyroid Hormone Receptor-β Agonists in NAFLD Therapy: Possibilities and Challenges. J Clin Endocrinol Metab 2023; 108:1602-1613. [PMID: 36746649 DOI: 10.1210/clinem/dgad072] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 02/08/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is a progressive metabolic liver disease with an unknown pathogenesis and no FDA-approved drug treatment to date. Hypothyroidism has been identified as a risk factor for NAFLD as thyroxine is required for regulating metabolism in adults. Thyroxine has been shown to reduce fat in the livers of murine models with experimentally induced NAFLD. The use of synthetic thyroxine has been shown to increase lipid metabolism leading to weight loss; however, thyroxine has also been shown to cause many side effects, especially in the heart. Overcoming these cardiac side effects involves designing agonists specific to one of the 2 gene subtypes for the thyroid hormone (TH) receptor (TR), TRβ. While the other TH receptor subtype, TRα, is mainly expressed in the heart and is responsible for thyroxine's cardiac function, TRβ is mainly expressed in the liver and is involved in liver function. Using TRβ-specific agonists to treat NAFLD can prevent cardiac and other adverse side effects. Several TRβ-specific agonists have shown positive therapeutic effects in NAFLD animal models and have entered clinical trials. We seek to provide a comprehensive updated reference of TRβ-specific agonists in this review and explore the future therapeutic potential of TRβ-specific activation in the treatment of NAFLD.
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Affiliation(s)
- Limei Li
- Research Center for Translational Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200120, China
| | - Yan Song
- Department of Endocrinology and Metabolism, Changzheng Hospital, Naval Medical University, Shanghai 200003, China
| | - Yongquan Shi
- Department of Endocrinology and Metabolism, Changzheng Hospital, Naval Medical University, Shanghai 200003, China
| | - Liangliang Sun
- Department of Endocrinology and Metabolism, Changzheng Hospital, Naval Medical University, Shanghai 200003, China
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Cheng H, Wang XB, Zhi Y, Liu B, Liu N, Li MJ, Mu YL. A Pyridazinone Compound for Effectively Treating Non-alcoholic Steatohepatitis by Targeting THRβ. Front Chem 2022; 10:888587. [PMID: 35620649 PMCID: PMC9127185 DOI: 10.3389/fchem.2022.888587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 03/17/2022] [Indexed: 11/23/2022] Open
Abstract
Developing effective therapies and medicines to conquer nonalcoholic steatohepatitis (NASH) is of great significance for public health and is faced with a major challenge. The activation of the thyroid hormone receptor agonist THRβ could be regulated by target drugs that has brought huge potential to the treatment of NASH. In this work, pyridazinone compound YWS01125 was synthesized for the first time. In this study, an ultra-performance liquid chromatography–tandem mass spectrometry (UPLC-MS/MS) method for YWS01125 determination was established, and the pharmacokinetics of YWS01125 was evaluated. The half-life values (t1/2)of three different doses of YWS01125 was 189.12 ± 95.27, 152.64 ± 37.98, and 181.95 ± 64.25 min, respectively, and the tissue distribution studies demonstrated that YWS01125 was quickly distributed to various tissues. With successful application in the pharmacokinetics study of YWS01125, the UPLC-MS/MS method has shown characteristics of high sensitivity, rapidity, and good selectivity.
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Affiliation(s)
- Hao Cheng
- School of Pharmacy and Pharmaceutical Sciences, Shandong First Medical University, Jinan, China
- Institute of Materia Medica, Shandong Academy of Medical Sciences, Jinan, China
- Key Laboratory for Biotech-Drugs Ministry of Health, Jinan, China
- Key Laboratory for RareUncommon Diseases of Shandong Province, Jinan, China
| | - Xiao-Bo Wang
- Institute of Materia Medica, Shandong Academy of Medical Sciences, Jinan, China
- Key Laboratory for RareUncommon Diseases of Shandong Province, Jinan, China
| | - Ying Zhi
- School of Pharmacy and Pharmaceutical Sciences, Shandong First Medical University, Jinan, China
- Institute of Materia Medica, Shandong Academy of Medical Sciences, Jinan, China
- Key Laboratory for Biotech-Drugs Ministry of Health, Jinan, China
- Key Laboratory for RareUncommon Diseases of Shandong Province, Jinan, China
| | - Bo Liu
- School of Pharmacy and Pharmaceutical Sciences, Shandong First Medical University, Jinan, China
- Institute of Materia Medica, Shandong Academy of Medical Sciences, Jinan, China
- Key Laboratory for Biotech-Drugs Ministry of Health, Jinan, China
- Key Laboratory for RareUncommon Diseases of Shandong Province, Jinan, China
| | - Na Liu
- School of Pharmacy and Pharmaceutical Sciences, Shandong First Medical University, Jinan, China
| | - Meng-Jun Li
- School of Pharmacy and Pharmaceutical Sciences, Shandong First Medical University, Jinan, China
| | - Yan-Ling Mu
- School of Pharmacy and Pharmaceutical Sciences, Shandong First Medical University, Jinan, China
- Institute of Materia Medica, Shandong Academy of Medical Sciences, Jinan, China
- Key Laboratory for Biotech-Drugs Ministry of Health, Jinan, China
- Key Laboratory for RareUncommon Diseases of Shandong Province, Jinan, China
- *Correspondence: Yan-Ling Mu,
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Diphenyl-Methane Based Thyromimetic Inhibitors for Transthyretin Amyloidosis. Int J Mol Sci 2021; 22:ijms22073488. [PMID: 33800546 PMCID: PMC8038088 DOI: 10.3390/ijms22073488] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/23/2021] [Accepted: 03/25/2021] [Indexed: 12/17/2022] Open
Abstract
Thyromimetics, whose physicochemical characteristics are analog to thyroid hormones (THs) and their derivatives, are promising candidates as novel therapeutics for neurodegenerative and metabolic pathologies. In particular, sobetirome (GC-1), one of the initial halogen-free thyromimetics, and newly synthesized IS25 and TG68, with optimized ADME-Tox profile, have recently attracted attention owing to their superior therapeutic benefits, selectivity, and enhanced permeability. Here, we further explored the functional capabilities of these thyromimetics to inhibit transthyretin (TTR) amyloidosis. TTR is a homotetrameric transporter protein for THs, yet it is also responsible for severe amyloid fibril formation, which is facilitated by tetramer dissociation into non-native monomers. By combining nuclear magnetic resonance (NMR) spectroscopy, computational simulation, and biochemical assays, we found that GC-1 and newly designed diphenyl-methane-based thyromimetics, namely IS25 and TG68, are TTR stabilizers and efficient suppressors of TTR aggregation. Based on these observations, we propose the novel potential of thyromimetics as a multi-functional therapeutic molecule for TTR-related pathologies, including neurodegenerative diseases.
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Meinig JM, Ferrara SJ, Banerji T, Banerji T, Sanford-Crane HS, Bourdette D, Scanlan TS. Structure-Activity Relationships of Central Nervous System Penetration by Fatty Acid Amide Hydrolase (FAAH)-Targeted Thyromimetic Prodrugs. ACS Med Chem Lett 2019; 10:111-116. [PMID: 30655956 DOI: 10.1021/acsmedchemlett.8b00501] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 12/04/2018] [Indexed: 02/06/2023] Open
Abstract
Thyroid hormone (TH) action is of clinical interest in treating demyelinating diseases of the central nervous system (CNS). Two amide prodrugs of sobetirome, a potent thyroid hormone agonist, were previously shown to significantly improve CNS selective distribution of the parent drug through hydrolysis in the CNS by fatty acid amide hydrolase (FAAH). This concept is elaborated upon here with a series of 29 amide prodrugs targeting FAAH. We identify that conservative aliphatic modifications such as the N-methyl (4), N-ethyl (5), N-fluoroethyl (15), and N-cyclopropyl (18) substantially favor selective CNS distribution of the parent drug in mice. Additionally, lead compounds exhibit moderate to good rates of hydrolysis at FAAH in vitro suggesting both enzymatic and physicochemical properties are important parameters for optimization. Both 4 and 15 were orally bioavailable while retaining appreciable CNS parent drug delivery following an oral dose. The pharmacokinetic parameters of 4 over 24 h postdose (i.v. and p.o.) were determined.
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Jakobsson T, Vedin LL, Parini P. Potential Role of Thyroid Receptor β Agonists in the Treatment of Hyperlipidemia. Drugs 2019; 77:1613-1621. [PMID: 28865063 PMCID: PMC5613055 DOI: 10.1007/s40265-017-0791-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Thyroid hormones have important effects on cellular development, growth, and metabolism and are necessary for the healthy function of almost all tissues. Hyperthyroid patients with excess thyroid hormone levels experience tachycardia, fatigue, muscle wasting, and osteoporosis. However, although high thyroid hormone levels have adverse effects, efforts have been made to harness the beneficial effects, such as reduced serum low-density lipoprotein (LDL) cholesterol levels, elevated basal metabolic rate, and weight loss. Thyroid hormones interact with nuclear thyroid hormone receptors (TRs), and cholesterol levels are reduced through TRβ, whereas extrahepatic adverse actions are primarily connected to TRα. Thus, to develop a useful compound for clinical use, efforts have been focusing on developing compounds with isomer-specific functions based on the structure of thyroid hormones, i.e., thyromimetics that are liver and/or TRβ specific. In this short review, we discuss the development of the early thyromimetics that enabled, through modern molecular techniques, the progress towards improved design of TRβ-selective thyromimetics. We also address the early promise shown in human clinical trials and the current status of these drugs and other emerging compounds.
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Affiliation(s)
- Tomas Jakobsson
- Division of Clinical Chemistry, C1:74, Department of Laboratory Medicine, Karolinska University Hospital Huddinge, 141 86, Stockholm, Sweden
| | - Lise-Lotte Vedin
- Division of Clinical Chemistry, C1:74, Department of Laboratory Medicine, Karolinska University Hospital Huddinge, 141 86, Stockholm, Sweden
| | - Paolo Parini
- Division of Clinical Chemistry, C1:74, Department of Laboratory Medicine, Karolinska University Hospital Huddinge, 141 86, Stockholm, Sweden. .,Metabolism Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden. .,Inflammation and Infection Theme, Karolinska University Hospital, Stockholm, Sweden.
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Ferrara SJ, Bourdette D, Scanlan TS. Hypothalamic-Pituitary-Thyroid Axis Perturbations in Male Mice by CNS-Penetrating Thyromimetics. Endocrinology 2018; 159:2733-2740. [PMID: 29846550 PMCID: PMC6457038 DOI: 10.1210/en.2018-00065] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 05/22/2018] [Indexed: 02/08/2023]
Abstract
Thyromimetics represent a class of experimental drugs that can stimulate tissue-selective thyroid hormone action. As such, thyromimetics should have effects on the hypothalamic-pituitary-thyroid (HPT) axis, but details of this action and the subsequent effects on systemic thyroid hormone levels have not been reported to date. Here, we compare the HPT-axis effects of sobetirome, a well-studied thyromimetic, with Sob-AM2, a newly developed prodrug of sobetirome that targets sobetirome distribution to the central nervous system (CNS). Similar to endogenous thyroid hormone, administration of sobetirome and Sob-AM2 suppress HPT-axis gene transcript levels in a manner that correlates to their specific tissue distribution properties (periphery vs CNS, respectively). Dosing male C57BL/6 mice with sobetirome and Sob-AM2 at concentrations ≥10 μg/kg/d for 29 days induces a state similar to central hypothyroidism characterized by depleted circulating T4 and T3 and normal TSH levels. However, despite the systemic T4 and T3 depletion, the sobetirome- and Sob-AM2-treated mice do not show signs of hypothyroidism, which may result from the presence of the thyromimetic in the thyroid hormone-depleted background.
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Affiliation(s)
- Skylar J Ferrara
- Program in Chemical Biology, Department of Physiology & Pharmacology, Oregon Health and Science University, Portland, Oregon
| | - Dennis Bourdette
- Department of Neurology, Oregon Health and Science University, Portland, Oregon
| | - Thomas S Scanlan
- Program in Chemical Biology, Department of Physiology & Pharmacology, Oregon Health and Science University, Portland, Oregon
- Correspondence: Thomas S. Scanlan, PhD, Department of Physiology and Pharmacology, Program in Chemical Biology, Oregon Health and Science University, 3181 Southwest Sam Jackson Road, L334, Portland, Oregon 97206. E-mail:
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Columbano A, Chiellini G, Kowalik MA. GC-1: A Thyromimetic With Multiple Therapeutic Applications in Liver Disease. Gene Expr 2017; 17:265-275. [PMID: 28635586 PMCID: PMC5885148 DOI: 10.3727/105221617x14968563796227] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Thyroid hormones (THs), namely, 3,5,3'-triiodo-l-thyronine (T3) and 3,5,3',5'-tetraiodo-l-thyronine (thyroxine or T4), influence a variety of physiological processes that have important implications in fetal development, metabolism, cell growth, and proliferation. While THs elicit several beneficial effects on lipid metabolism and improve myocardial contractility, these therapeutically desirable effects are associated to a thyrotoxic state that severely limits the possible use of THs as therapeutic agents. Therefore, several efforts have been made to develop T3 analogs that could retain the beneficial actions (triglyceride, cholesterol, obesity, and body mass lowering) without the adverse TH-dependent side effects. This goal was achieved by the synthesis of TRβ-selective agonists. In this review, we summarize the current knowledge on the effects of one of the best characterized TH analogs, the TRβ1-selective thyromimetic, GC-1. In particular, we review some of the effects of GC-1 on different liver disorders, with reference to its possible clinical application. A brief comment on the possible therapeutic use of GC-1 in extrahepatic disorders is also included.
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Affiliation(s)
- Amedeo Columbano
- *Department of Biomedical Sciences, Unit of Oncology and Molecular Pathology, University of Cagliari, Cagliari, Italy
| | - Grazia Chiellini
- †Department of Surgical, Medical and Molecular Pathology, University of Pisa, Pisa, Italy
| | - Marta Anna Kowalik
- *Department of Biomedical Sciences, Unit of Oncology and Molecular Pathology, University of Cagliari, Cagliari, Italy
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Meinig JM, Ferrara SJ, Banerji T, Banerji T, Sanford-Crane HS, Bourdette D, Scanlan TS. Targeting Fatty-Acid Amide Hydrolase with Prodrugs for CNS-Selective Therapy. ACS Chem Neurosci 2017; 8:2468-2476. [PMID: 28756656 PMCID: PMC6342467 DOI: 10.1021/acschemneuro.7b00239] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The blood-brain barrier (BBB) can be a substantial impediment to achieving therapeutic levels of drugs in the CNS. Certain chemical functionality such as the carboxylic acid is a general liability for BBB permeability preventing significant CNS distribution of a drug from a systemic dose. Here, we report a strategy for CNS-selective distribution of the carboxylic acid containing thyromimetic sobetirome using prodrugs targeted to fatty-acid amide hydrolase (FAAH), which is expressed in the brain. Two amide prodrugs of sobetirome were shown to be efficient substrates of FAAH with Vmax/KM values comparable to the natural endocannabinoid FAAH substrate anandamide. In mice, a systemic dose of sobetirome prodrug leads to a substantial ∼60-fold increase in brain distribution (Kp) of sobetirome compared to an equimolar systemic dose of the parent drug. The increased delivery of sobetirome to the brain from the prodrug was diminished by both pharmacological inhibition and genetic deletion of FAAH in vivo. The increased brain exposure of sobetirome arising from the prodrug corresponds to ∼30-fold increased potency in brain target engagement compared to the parent drug. These results suggest that FAAH-targeted prodrugs can considerably increase drug exposure to the CNS with a concomitant decrease in systemic drug levels generating a desirable distribution profile for CNS acting drugs.
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Affiliation(s)
- J. Matthew Meinig
- Department of Physiology & Pharmacology, and ‡Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, Oregon 97239, United States
| | - Skylar J. Ferrara
- Department of Physiology & Pharmacology, and ‡Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, Oregon 97239, United States
| | - Tania Banerji
- Department of Physiology & Pharmacology, and ‡Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, Oregon 97239, United States
| | - Tapasree Banerji
- Department of Physiology & Pharmacology, and ‡Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, Oregon 97239, United States
| | - Hannah S. Sanford-Crane
- Department of Physiology & Pharmacology, and ‡Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, Oregon 97239, United States
| | - Dennis Bourdette
- Department of Physiology & Pharmacology, and ‡Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, Oregon 97239, United States
| | - Thomas S. Scanlan
- Department of Physiology & Pharmacology, and ‡Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, Oregon 97239, United States
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Delitala AP, Delitala G, Sioni P, Fanciulli G. Thyroid hormone analogs for the treatment of dyslipidemia: past, present, and future. Curr Med Res Opin 2017; 33:1985-1993. [PMID: 28498022 DOI: 10.1080/03007995.2017.1330259] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Treatment of dyslipidemia is a major burden for public health. Thyroid hormone regulates lipid metabolism by binding the thyroid hormone receptor (TR), but the use of thyroid hormone to treat dyslipidemia is not indicated due to its deleterious effects on heart, bone, and muscle. Thyroid hormone analogs have been conceived to selectively activate TR in the liver, thus reducing potential side-effects. METHODS The authors searched the PubMed database to review TR and the action of thyromimetics in vitro and in animal models. Then, all double-blind, placebo controlled trials that analyzed the use of thyroid hormone analog for the treatment of dyslipidemia in humans were included. Finally, the ongoing research on the use of TR agonists was searched, searching the US National Institutes of Health Registry and the WHO International Clinical Trial Registry Platform (ICTRP). RESULTS Thyromimetics were tested in humans for the treatment of dyslipidemia, as a single therapeutic agent or as an add-on therapy to the traditional lipid-lowering drugs. In most trials, thyromimetics lowered total cholesterol, low-density lipoprotein cholesterol, and triglycerides, but their use has been associated with adverse side-effects, both in pre-clinical studies and in humans. CONCLUSIONS The use of thyromimetics for the treatment of dyslipidemia is not presently recommended. Future possible clinical applications might include their use to promote weight reduction. Thyromimetics might also represent an interesting alternative, both for the treatment of non-alcoholic steatohepatitis, and type 2 diabetes due to their positive effects on insulin sensitivity. Finally, additional experimental and clinical studies are needed for a better comprehension of the effect(s) of a long-term therapy.
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Affiliation(s)
| | - Giuseppe Delitala
- b Department of Clinical and Experimental Medicine , University of Sassari , Sassari , Italy
| | - Paolo Sioni
- a Azienda Ospedaliero-Universitaria di Sassari , Sassari , Italy
| | - Giuseppe Fanciulli
- a Azienda Ospedaliero-Universitaria di Sassari , Sassari , Italy
- b Department of Clinical and Experimental Medicine , University of Sassari , Sassari , Italy
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13
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Hartley MD, Kirkemo LL, Banerji T, Scanlan TS. A Thyroid Hormone-Based Strategy for Correcting the Biochemical Abnormality in X-Linked Adrenoleukodystrophy. Endocrinology 2017; 158:1328-1338. [PMID: 28200172 PMCID: PMC5460829 DOI: 10.1210/en.2016-1842] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 02/09/2017] [Indexed: 02/05/2023]
Abstract
X-linked adrenoleukodystrophy (X-ALD) is a rare, genetic disorder characterized by adrenal insufficiency and central nervous system (CNS) demyelination. All patients with X-ALD have the biochemical abnormality of elevated blood and tissue levels of very long chain fatty acids (VLCFAs), saturated fatty acids with 24 to 26 carbons. X-ALD results from loss of function mutations in the gene encoding the peroxisomal transporter ABCD1, which is responsible for uptake of VLCFAs into peroxisomes for degradation by oxidation. One proposed therapeutic strategy for genetic complementation of ABCD1 is pharmacologic upregulation of ABCD2, a gene encoding a homologous peroxisomal transporter. Here, we show that thyroid hormone or sobetirome, a clinical-stage selective thyroid hormone receptor agonist, increases cerebral Abcd2 and lowers VLCFAs in blood, peripheral organs, and brains of mice with defective Abcd1. These results support an approach to treating X-ALD that involves a thyromimetic agent that reactivates VLCFA disposal both in the periphery and the CNS.
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Affiliation(s)
- Meredith D. Hartley
- Department of Physiology and Pharmacology and Program in Chemical Biology, Oregon Health & Science University, Portland, Oregon 92739
| | - Lisa L. Kirkemo
- Department of Physiology and Pharmacology and Program in Chemical Biology, Oregon Health & Science University, Portland, Oregon 92739
| | - Tapasree Banerji
- Department of Physiology and Pharmacology and Program in Chemical Biology, Oregon Health & Science University, Portland, Oregon 92739
| | - Thomas S. Scanlan
- Department of Physiology and Pharmacology and Program in Chemical Biology, Oregon Health & Science University, Portland, Oregon 92739
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14
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Ferrara SJ, Meinig JM, Placzek AT, Banerji T, McTigue P, Hartley MD, Sanford-Crane HS, Banerji T, Bourdette D, Scanlan TS. Ester-to-amide rearrangement of ethanolamine-derived prodrugs of sobetirome with increased blood-brain barrier penetration. Bioorg Med Chem 2017; 25:2743-2753. [PMID: 28385597 DOI: 10.1016/j.bmc.2017.03.047] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 03/17/2017] [Accepted: 03/21/2017] [Indexed: 02/05/2023]
Abstract
Current therapeutic options for treating demyelinating disorders such as multiple sclerosis (MS) do not stimulate myelin repair, thus creating a clinical need for therapeutic agents that address axonal remyelination. Thyroid hormone is known to play an important role in promoting developmental myelination and repair, and CNS permeable thyromimetic agents could offer an increased therapeutic index compared to endogenous thyroid hormone. Sobetirome is a clinical stage thyromimetic that has been shown to have promising activity in preclinical models related to MS and X-linked adrenoleukodystrophy (X-ALD), a genetic disease that involves demyelination. Here we report a new series of sobetirome prodrugs containing ethanolamine-based promoieties that were found to undergo an intramolecular O,N acyl migration to form the pharmacologically relevant amide species. Several of these systemically administered prodrugs deliver more sobetirome to the brain compared to unmodified sobetirome. Pharmacokinetic properties of the parent drug sobetirome and amidoalcohol prodrug 3 are described and prodrug 3 was found to be more potent than sobetirome in target engagement in the brain from systemic dosing.
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Affiliation(s)
- Skylar J Ferrara
- Program in Chemical Biology, Department of Physiology & Pharmacology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, United States
| | - J Matthew Meinig
- Program in Chemical Biology, Department of Physiology & Pharmacology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, United States
| | - Andrew T Placzek
- Program in Chemical Biology, Department of Physiology & Pharmacology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, United States
| | - Tapasree Banerji
- Program in Chemical Biology, Department of Physiology & Pharmacology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, United States
| | - Peter McTigue
- Program in Chemical Biology, Department of Physiology & Pharmacology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, United States
| | - Meredith D Hartley
- Program in Chemical Biology, Department of Physiology & Pharmacology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, United States
| | - Hannah S Sanford-Crane
- Program in Chemical Biology, Department of Physiology & Pharmacology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, United States
| | - Tania Banerji
- Program in Chemical Biology, Department of Physiology & Pharmacology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, United States
| | - Dennis Bourdette
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, United States
| | - Thomas S Scanlan
- Program in Chemical Biology, Department of Physiology & Pharmacology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, United States.
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15
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Devereaux J, Ferrara SJ, Banerji T, Placzek AT, Scanlan TS. Increasing Thyromimetic Potency through Halogen Substitution. ChemMedChem 2016; 11:2459-2465. [PMID: 27731931 PMCID: PMC5389920 DOI: 10.1002/cmdc.201600408] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Indexed: 12/17/2022]
Abstract
Sobetirome is one of the most studied thyroid hormone receptor β (TRβ)-selective thyromimetics in the field due to its excellent selectivity and potency. A small structural change-replacing the 3,5-dimethyl groups of sobetirome with either chlorine or bromine-produces significantly more potent compounds, both in vitro and in vivo. These halogenated compounds induce transactivation of a TRβ-mediated cell-based reporter with an EC50 value comparable to that of T3, access the central nervous system (CNS) at levels similar to their parent, and activate an endogenous TR-regulated gene in the brain with an EC50 value roughly five-fold lower than that of sobetirome. Previous studies suggest that this apparent increase in affinity can be explained by halogen bonding between the ligand and a backbone carbonyl group in the receptor. This makes the new analogues potential candidates for treating CNS disorders that may respond favorably to thyroid-hormone-stimulated pathways.
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Affiliation(s)
- Jordan Devereaux
- Department of Physiology & Pharmacology, Program in Chemical Biology, Oregon Health & Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Skylar J Ferrara
- Department of Physiology & Pharmacology, Program in Chemical Biology, Oregon Health & Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Tania Banerji
- Department of Physiology & Pharmacology, Program in Chemical Biology, Oregon Health & Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Andrew T Placzek
- Department of Physiology & Pharmacology, Program in Chemical Biology, Oregon Health & Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Thomas S Scanlan
- Department of Physiology & Pharmacology, Program in Chemical Biology, Oregon Health & Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
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16
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Sobetirome prodrug esters with enhanced blood-brain barrier permeability. Bioorg Med Chem 2016; 24:5842-5854. [PMID: 27707627 DOI: 10.1016/j.bmc.2016.09.038] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 09/13/2016] [Accepted: 09/15/2016] [Indexed: 12/15/2022]
Abstract
There is currently great interest in developing drugs that stimulate myelin repair for use in demyelinating diseases such as multiple sclerosis. Thyroid hormone plays a key role in stimulating myelination during development and also controls the expression of important genes involved in myelin repair in adults. Because endogenous thyroid hormone in excess lacks a generally useful therapeutic index, it is not used clinically for indications other than hormone replacement; however, selective thyromimetics such as sobetirome offer a therapeutic alternative. Sobetirome is the only clinical-stage thyromimetic that is known to cross the blood-brain-barrier (BBB) and we endeavored to increase the BBB permeability of sobetirome using a prodrug strategy. Ester prodrugs of sobetirome were prepared based on literature reports of improved BBB permeability with other carboxylic acid containing drugs and BBB permeability was assessed in vivo. One sobetirome prodrug, ethanolamine ester 11, was found to distribute more sobetirome to the brain compared to an equimolar peripheral dose of unmodified sobetirome. In addition to enhanced brain levels, prodrug 11 displayed lower sobetirome blood levels and a brain/serum ratio that was larger than that of unmodified sobetirome. Thus, these data indicate that an ester prodrug strategy applied to sobetirome can deliver increased concentrations of the active drug to the central nervous system (CNS), which may prove useful in the treatment of CNS disorders.
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Elbers LPB, Kastelein JJP, Sjouke B. Thyroid Hormone Mimetics: the Past, Current Status and Future Challenges. Curr Atheroscler Rep 2016; 18:14. [PMID: 26886134 PMCID: PMC4757599 DOI: 10.1007/s11883-016-0564-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The association between thyroid hormone status and plasma levels of low-density lipoprotein cholesterol has raised the awareness for the development of thyroid hormone mimetics as lipid-lowering agents. The discovery of the two main types of thyroid hormone receptors (α and β) as well as the development of novel combinatorial chemistry providing organ specificity has drastically improved the selectivity of these compounds. In the past decades, several thyroid hormone mimetics have been investigated with the purpose of lowering low-density lipoprotein cholesterol levels. However, until now, none of the thyromimetics reached the stage of completing a phase III clinical trial without deleterious side effects. Here, we review the currently available literature on thyromimetics investigated for the treatment of dyslipidemia, their rise, their downfall and the challenges for the development of novel agents.
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Affiliation(s)
- L P B Elbers
- Department of Vascular Medicine, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Department of Internal Medicine, Medical Center Slotervaart, Amsterdam, The Netherlands
| | - J J P Kastelein
- Department of Vascular Medicine, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - B Sjouke
- Department of Vascular Medicine, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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Lammel Lindemann J, Webb P. Sobetirome: the past, present and questions about the future. Expert Opin Ther Targets 2015; 20:145-9. [PMID: 26565124 DOI: 10.1517/14728222.2016.1090429] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Sobetirome binds selectively to the main hepatic form of thyroid hormone (TH) receptor, TRβ1, compared to TRα1, which is principally responsible for thyrotoxic effects on heart, muscle and bone. Sobetirome also preferentially accumulates in liver. It was originally envisaged that sobetirome could be used to stimulate hepatic pathways that lower cholesterol without harmful side effects and might be used in conjunction with statins. Indeed, sobetirome progressed through preclinical animal studies and Phase I human clinical trials with excellent results and without obvious harmful side effects. Despite the fact that cardiovascular disease remains a major cause of mortality and that new therapies are desperately needed, it is unlikely that sobetirome will progress in further human clinical trials in the near future. The emergence of alternative cholesterol-lowering therapeutics may render selective thyromimetics redundant. Further, fears of thyrotoxic effects in the heart and emergence of cartilage defects in dogs after long-term use of eprotirome, a similar though not identical compound, has reduced enthusiasm for this strategy. We argue that it is nevertheless important to explore uses of sobetirome in humans; more treatment strategies would help patients with hard-to-treat dyslipidemias. Sobetirome may also have additional applications in orphan indications and short-term controlled weight loss.
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Affiliation(s)
- Jan Lammel Lindemann
- a Houston Methodist Research Institute, Genomic Medicine Program , 6565 Fannin Street, Fondren 8-060, Houston , TX 77030 , USA.,b Technological University of Monterrey, ITESM, Monterrey , Mexico
| | - Paul Webb
- a Houston Methodist Research Institute, Genomic Medicine Program , 6565 Fannin Street, Fondren 8-060, Houston , TX 77030 , USA.,b Technological University of Monterrey, ITESM, Monterrey , Mexico
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Takahashi N, Izuchi T. Characterisation of liver-specific distribution of a novel 1-benzyl-4-aminoindole-based thyroid hormone receptor β agonist, SKL-13784: comparison with GC-1. Xenobiotica 2015; 46:108-16. [PMID: 26075834 DOI: 10.3109/00498254.2015.1052862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
1. SKL-13784, a novel series of 1-benzyl-4-aminoindole-based thyroid hormone receptor β (TRβ)-selective agonists, showed higher liver selectivity than GC-1 and was poorly distributed in the heart and brain. We aimed to clarify the mechanism of liver selectivity of SKL-13784 through a comparative study with GC-1. 2. Media-loss assays using fresh rat hepatocytes showed that the Oatp family may have been involved in liver uptake for both compounds and that SKL-13784 was more efficiently taken up than GC-1. 3. In addition, the media-loss assay results showed that hepatic uptake was important in eliminating both compounds in rats. 4. The low passive permeability of SKL-13784 on the parallel artificial membrane permeability assay (PAMPA) contributed to the limited distribution of SKL-13784 into extrahepatocytes. 5. Biliary extraction was a major route of SKL-13784 and GC-1 disposition. SKL-13784 was excreted into bile unchanged and in its glucuronide form, whereas almost all GC-1 in bile was in its glucuronide form. In bile duct-cannulated rats, a 4.3-fold decrease in t1/2 of SKL-13784 was observed, implicating enterohepatic biliary recirculation. 6. The selective distribution of SKL-13784 in the liver was largely due to efficient uptake via hepatic transporters.
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Affiliation(s)
- Naoki Takahashi
- a Drug Discovery Laboratories , Sanwa Kagaku Kenkyusho, Co., Ltd. , Mie , Japan
| | - Tohru Izuchi
- a Drug Discovery Laboratories , Sanwa Kagaku Kenkyusho, Co., Ltd. , Mie , Japan
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