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McCabe J, Zhang J, Yang F, Benn V. Pharmacokinetics of the Novel Nonsteroidal Mineralocorticoid Receptor Antagonist Ocedurenone (KBP-5074) in Individuals with Moderate Hepatic Impairment. Eur J Drug Metab Pharmacokinet 2024; 49:229-237. [PMID: 38329646 PMCID: PMC10904433 DOI: 10.1007/s13318-024-00879-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND AND OBJECTIVES Ocedurenone (KBP-5074) is a novel nonsteroidal mineralocorticoid receptor antagonist that has demonstrated safety and efficacy in clinical trials in patients with uncontrolled hypertension and stage 3b/4 chronic kidney disease. The aim of this study was to assess the pharmacokinetics, safety, and tolerability of ocedurenone in individuals with moderate hepatic impairment. METHODS This study was an open-label, nonrandomized, multi-center study investigating the pharmacokinetics, safety, and tolerability of a single dose of 0.5 mg ocedurenone administered orally in male and female subjects with moderate hepatic impairment (Child-Pugh B, score 7-9) compared with subjects with normal hepatic function. Serial blood samples were obtained from predose through 264 h postdose for analysis of ocedurenone concentrations using a validated liquid chromatography-tandem mass spectrometry method. Free ocedurenone concentrations in plasma were determined ex vivo using equilibrium dialysis. RESULTS Following a single oral dose of 0.5 mg ocedurenone administered to subjects with moderate hepatic impairment and subjects with normal hepatic function, ocedurenone was steadily absorbed with median time to peak drug concentration (Tmax) values of 4 and 3 h, respectively. After reaching maximum plasma concentration (Cmax), the disposition of ocedurenone appeared to be biphasic. The geometric mean t1/2 values for the moderate hepatic impairment group and normal hepatic function group were 75.6 and 65.7 h, respectively. Ocedurenone systemic exposure, as assessed by area under the plasma concentration-time curve (AUC) was 23.5-26.6% lower in subjects with moderate hepatic impairment versus subjects with normal hepatic function, whereas Cmax was 41.2% lower. Ocedurenone was determined to be > 99.7% bound to total protein in plasma. Hepatic impairment appeared not to change plasma protein binding or the unbound free fraction. Ocedurenone was safe and well-tolerated in all participants. CONCLUSIONS Considering the long half-life of ocedurenone and previously completed clinical studies using 0.25 mg and 0.5 mg doses demonstrating efficacy and safety, the observed decreases in AUC and Cmax do not warrant a dose adjustment in patients with moderate hepatic impairment. A single 0.5 mg dose of ocedurenone was safe and well-tolerated when administered to subjects with moderate hepatic impairment and subjects with normal hepatic function. CLINICAL TRIAL IDENTIFIER ( WWW. CLINICALTRIALS GOV ): NCT04534699.
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Affiliation(s)
- James McCabe
- KBP Biosciences USA Inc., 116 Village Blvd., Suite 210, Princeton, NJ, 08540, USA.
| | - Jay Zhang
- KBP Biosciences USA Inc., 116 Village Blvd., Suite 210, Princeton, NJ, 08540, USA
| | - Fred Yang
- KBP Biosciences USA Inc., 116 Village Blvd., Suite 210, Princeton, NJ, 08540, USA
| | - Vincent Benn
- KBP Biosciences USA Inc., 116 Village Blvd., Suite 210, Princeton, NJ, 08540, USA
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Spencer S, Wheeler‐Jones C, Elliott J. Aldosterone and the mineralocorticoid receptor in renal injury: A potential therapeutic target in feline chronic kidney disease. J Vet Pharmacol Ther 2020; 43:243-267. [PMID: 32128854 PMCID: PMC8614124 DOI: 10.1111/jvp.12848] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 01/20/2020] [Accepted: 02/09/2020] [Indexed: 12/24/2022]
Abstract
There is a growing body of experimental and clinical evidence supporting mineralocorticoid receptor (MR) activation as a powerful mediator of renal damage in laboratory animals and humans. Multiple pathophysiological mechanisms are proposed, with the strongest evidence supporting aldosterone-induced vasculopathy, exacerbation of oxidative stress and inflammation, and increased growth factor signalling promoting fibroblast proliferation and deranged extracellular matrix homeostasis. Further involvement of the MR is supported by extensive animal model experiments where MR antagonists (such as spironolactone and eplerenone) abrogate renal injury, including ischaemia-induced damage. Additionally, clinical trials have shown MR antagonists to be beneficial in human chronic kidney disease (CKD) in terms of reducing proteinuria and cardiovascular events, though current studies have not evaluated primary end points which allow conclusions to made about whether MR antagonists reduce mortality or slow CKD progression. Although differences between human and feline CKD exist, feline CKD shares many characteristics with human disease including tubulointerstitial fibrosis. This review evaluates the evidence for the role of the MR in renal injury and summarizes the literature concerning aldosterone in feline CKD. MR antagonists may represent a promising therapeutic strategy in feline CKD.
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Affiliation(s)
- Sarah Spencer
- Comparative Biomedical SciencesThe Royal Veterinary CollegeLondonUK
| | | | - Jonathan Elliott
- Comparative Biomedical SciencesThe Royal Veterinary CollegeLondonUK
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Zhou X, Zhang J, Haimbach R, Zhu W, Mayer-Ezell R, Garcia-Calvo M, Smith E, Price O, Kan Y, Zycband E, Zhu Y, Hoek M, Cox JM, Ma L, Kelley DE, Pinto S. An integrin antagonist (MK-0429) decreases proteinuria and renal fibrosis in the ZSF1 rat diabetic nephropathy model. Pharmacol Res Perspect 2018; 5. [PMID: 28971604 PMCID: PMC5625158 DOI: 10.1002/prp2.354] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 07/13/2017] [Accepted: 07/19/2017] [Indexed: 01/24/2023] Open
Abstract
Multiple integrins have been implicated in modulating renal function. Modulation of integrin function can lead to pathophysiological processes associated with diabetic nephropathy such as alterations in the glomerular filtration barrier and kidney fibrosis. The complexity of these pathophysiological changes implies that multiple integrin subtypes might need to be targeted to ameliorate the progression of renal disease. To address this hypothesis, we investigated the effects of MK‐0429, a compound that was originally developed as an αvβ3 inhibitor for the treatment of osteoporosis, on renal function and fibrosis. We demonstrated that MK‐0429 is an equipotent pan‐inhibitor of multiple av integrins. MK‐0429 dose‐dependently inhibited podocyte motility and also suppressed TGF‐β‐induced fibrosis marker gene expression in kidney fibroblasts. Moreover, in the obese ZSF1 rat model of diabetic nephropathy, chronic treatment with MK‐0429 resulted in significant reduction in proteinuria, kidney fibrosis, and collagen accumulation. In summary, our results suggest that inhibition of multiple integrin subtypes might lead to meaningful impact on proteinuria and renal fibrosis in diabetic nephropathy.
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Affiliation(s)
- Xiaoyan Zhou
- Department of Pharmacology, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, New Jersey, 07033
| | - Ji Zhang
- Department of Cardiometabolic Diseases, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, New Jersey, 07033
| | - Robin Haimbach
- Department of Cardiometabolic Diseases, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, New Jersey, 07033
| | - Wei Zhu
- Department of Cardiometabolic Diseases, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, New Jersey, 07033
| | - Rosemary Mayer-Ezell
- Department of Pharmacology, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, New Jersey, 07033
| | - Margarita Garcia-Calvo
- Department of Pharmacology, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, New Jersey, 07033
| | - Elizabeth Smith
- Department of Pharmacology, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, New Jersey, 07033
| | - Olga Price
- Department of Pharmacology, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, New Jersey, 07033
| | - Yanqing Kan
- Department of Cardiometabolic Diseases, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, New Jersey, 07033
| | - Emanuel Zycband
- Department of Cardiometabolic Diseases, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, New Jersey, 07033
| | - Yonghua Zhu
- Department of Cardiometabolic Diseases, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, New Jersey, 07033
| | - Maarten Hoek
- Department of Cardiometabolic Diseases, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, New Jersey, 07033
| | - Jason M Cox
- Department of Medicinal Chemistry, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, New Jersey, 07033
| | - Lijun Ma
- Department of Cardiometabolic Diseases, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, New Jersey, 07033
| | - David E Kelley
- Department of Cardiometabolic Diseases, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, New Jersey, 07033
| | - Shirly Pinto
- Department of Cardiometabolic Diseases, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, New Jersey, 07033
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Systems pharmacology exploration of botanic drug pairs reveals the mechanism for treating different diseases. Sci Rep 2016; 6:36985. [PMID: 27841365 PMCID: PMC5107896 DOI: 10.1038/srep36985] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 10/24/2016] [Indexed: 11/30/2022] Open
Abstract
Multi-herb therapy has been widely used in Traditional Chinese medicine and tailored to meet the specific needs of each individual. However, the potential molecular or systems mechanisms of them to treat various diseases have not been fully elucidated. To address this question, a systems pharmacology approach, integrating pharmacokinetics, pharmacology and systems biology, is used to comprehensively identify the drug-target and drug-disease networks, exemplified by three representative Radix Salviae Miltiorrhizae herb pairs for treating various diseases (coronary heart disease, dysmenorrheal and nephrotic syndrome). First, the compounds evaluation and the multiple targeting technology screen the active ingredients and identify the specific targets for each herb of three pairs. Second, the herb feature mapping reveals the differences in chemistry and pharmacological synergy between pairs. Third, the constructed compound-target-disease network explains the mechanisms of treatment for various diseases from a systematic level. Finally, experimental verification is taken to confirm our strategy. Our work provides an integrated strategy for revealing the mechanism of synergistic herb pairs, and also a rational way for developing novel drug combinations for treatments of complex diseases.
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Nariai T, Fujita K, Kawane K, Mori M, Nakayama R, Matsuda K, Katayama S, Fukuda N, Hori S, Iwata M, Hasegawa F, Suzuki K, Kato H. DSR-71167, a novel mineralocorticoid receptor antagonist with carbonic anhydrase inhibitory activity, separates urinary sodium excretion and serum potassium elevation in rats. J Pharmacol Exp Ther 2015; 354:2-9. [PMID: 25922341 DOI: 10.1124/jpet.114.221341] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 04/24/2015] [Indexed: 01/22/2023] Open
Abstract
Mineralocorticoid receptor (MR) antagonists, such as spironolactone (SPI) and eplerenone (EPL), are useful for treating hypertension and heart failure. However, these two agents have the serious side effect of hyperkalemia. We hypothesized that adding the ability to inhibit carbonic anhydrase (CA) would reduce the risk of hyperkalemia associated with MR antagonists. We investigated the profiles of DSR-71167 [2-([(2,2-difluoroethyl)amino]methyl)-2'-fluoro-N-(3-methoxy-4-sulfamoylphenyl)biphenyl-4-carboxamide hydrochloride; an MR antagonist with weak CA inhibitory activity] with regard to antimineralocorticoid actions by examining relationships between the urinary excretion of sodium (index of antimineralocorticoid action) in deoxycorticosterone acetate-treated rats and elevation of serum levels of potassium in potassium-loaded rats compared with a DSR-71167 derivative without CA inhibition (2-(hydroxymethyl)-N-[4-(methylsulfonyl)phenyl]-2'-(trifluoromethyl)biphenyl-4-carboxamide), SPI, and EPL. DSR-71167 dose-dependently increased urinary excretion of sodium in deoxycorticosterone acetate-treated rats without elevating serum levels of potassium in potassium-loaded rats. 2-(Hydroxymethyl)-N-[4-(methylsulfonyl)phenyl]-2'-(trifluoromethyl)biphenyl-4-carboxamide, SPI, and EPL elevated serum levels of potassium significantly in potassium-loaded rats at doses that increased MR inhibitory activity. We confirmed that DSR-71167 significantly increases urinary bicarbonate and decreases blood bicarbonate, as pharmacodynamic markers of CA inhibition, in intact rats. Chronic DSR-71167 administration showed antihypertensive effects in high salt-loaded Dahl hypertensive rats. These results demonstrate that DSR-71167 is a novel type of MR antagonist, with CA inhibitory activity, which is expected to become a safer MR antagonist with a low potential risk for hyperkalemia.
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Affiliation(s)
- Tetsuro Nariai
- Drug Research Division, Sumitomo Dainippon Pharma., Co., Ltd., Osaka, Japan
| | - Katsuya Fujita
- Drug Research Division, Sumitomo Dainippon Pharma., Co., Ltd., Osaka, Japan
| | - Kenji Kawane
- Drug Research Division, Sumitomo Dainippon Pharma., Co., Ltd., Osaka, Japan
| | - Masaya Mori
- Drug Research Division, Sumitomo Dainippon Pharma., Co., Ltd., Osaka, Japan
| | - Ryo Nakayama
- Drug Research Division, Sumitomo Dainippon Pharma., Co., Ltd., Osaka, Japan
| | - Koichi Matsuda
- Drug Research Division, Sumitomo Dainippon Pharma., Co., Ltd., Osaka, Japan
| | - Seiji Katayama
- Drug Research Division, Sumitomo Dainippon Pharma., Co., Ltd., Osaka, Japan
| | - Nobuhisa Fukuda
- Drug Research Division, Sumitomo Dainippon Pharma., Co., Ltd., Osaka, Japan
| | - Seiji Hori
- Drug Research Division, Sumitomo Dainippon Pharma., Co., Ltd., Osaka, Japan
| | - Masato Iwata
- Drug Research Division, Sumitomo Dainippon Pharma., Co., Ltd., Osaka, Japan
| | - Futoshi Hasegawa
- Drug Research Division, Sumitomo Dainippon Pharma., Co., Ltd., Osaka, Japan
| | - Kuniko Suzuki
- Drug Research Division, Sumitomo Dainippon Pharma., Co., Ltd., Osaka, Japan
| | - Hiroshi Kato
- Drug Research Division, Sumitomo Dainippon Pharma., Co., Ltd., Osaka, Japan
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Sun QL, Li M, Rui HL, Chen YP. Inhibition of local aldosterone by eplerenone reduces renal structural damage in a novel model of chronic cyclosporine A nephrotoxicity. J Renin Angiotensin Aldosterone Syst 2014; 16:301-10. [PMID: 25500744 DOI: 10.1177/1470320314561248] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Accepted: 10/14/2014] [Indexed: 11/16/2022] Open
Affiliation(s)
- Qiao-Ling Sun
- Department of Nephrology, Qilu Hospital, Shandong University, China
| | - Meng Li
- Department of Neurosurgery, Qianfoshan Hospital, Shandong University, China
| | - Hong-Liang Rui
- Department of Nephrology, Beijing An Zhen Hospital, Capital Medical University, China
| | - Yi-Pu Chen
- Department of Nephrology, Beijing An Zhen Hospital, Capital Medical University, China
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McGraw AP, McCurley A, Preston IR, Jaffe IZ. Mineralocorticoid receptors in vascular disease: connecting molecular pathways to clinical implications. Curr Atheroscler Rep 2014; 15:340. [PMID: 23719923 DOI: 10.1007/s11883-013-0340-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The mineralocorticoid receptor (MR), a steroid-hormone-activated transcription factor, plays a substantial role in cardiovascular diseases. MR antagonists (MRAs) have long been appreciated as effective treatments for heart failure and hypertension; however, recent research suggests that additional patient populations may also benefit from MRA therapy. Experimental evidence demonstrates that in addition to its classic role in the regulating sodium handling in the kidney, functional MR is expressed in the blood vessels and contributes to hypertension, vascular inflammation and remodeling, and atherogenesis. MR activation drives pathological phenotypes in smooth muscle cells, endothelial cells, and inflammatory cells, whereas MRAs inhibit these effects. Collectively, these studies demonstrate a new role for extrarenal MR in cardiovascular disease. This review summarizes these new lines of evidence and how they contribute to the mechanisms of atherosclerosis, pulmonary and systemic hypertension, and vein graft failure, and describes new patient populations that may benefit from MRA therapy.
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Affiliation(s)
- Adam P McGraw
- Molecular Cardiology Research Institute, Tufts Medical Center, 800 Washington Street, Boston, MA, USA.
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Smooth muscle cell mineralocorticoid receptors: role in vascular function and contribution to cardiovascular disease. Pflugers Arch 2013; 465:1661-70. [PMID: 23636772 DOI: 10.1007/s00424-013-1282-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 04/11/2013] [Indexed: 02/07/2023]
Abstract
The mineralocorticoid receptor (MR), a member of the steroid receptor family, regulates blood pressure by mediating the effects of the hormone aldosterone on renal sodium handling. In recent years, it has become clear that MR is expressed in vascular smooth muscle cells (SMCs), and interest has grown in understanding the direct role of SMC MR in regulating vascular function. This interest stems from multiple clinical studies where MR inhibitor treatment reduced the incidence of cardiovascular events and mortality. This review summarizes the most recent advances in our understanding of SMC MR in regulating normal vascular function and in promoting vascular disease. Many new studies suggest a role for SMC MR activation in stimulating vascular contraction and contributing to vessel inflammation, fibrosis, and remodeling. These detrimental vascular effects of MR activation appear to be independent of changes in blood pressure and are synergistic with the presence of endothelial dysfunction or damage. Thus, in humans with underlying cardiovascular disease or cardiovascular risk factors, SMC MR activation may promote hypertension, atherosclerosis, and vascular aging. Further exploration of the molecular mechanisms for the effects of SMC MR activation has the potential to identify novel therapeutic targets to prevent or treat common cardiovascular disorders.
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