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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5319_Библиотеки_им_академика_М_И_Перельмана.pdf
X
- •Preface and Acknowledgement
- •Chemical Structures of Amino Acids,Molecular Graphics and Introduction
- •Introduction
- •Literature
- •Chapter Abstract Videos
- •Contents
- •About the author
- •1.10 Synopsis
- •1.3 The Battle Against Infectious Disease
- •1.4 Biological Concepts in Drug Research
- •Bibliography and Further Reading
- •2.8 A Long List of Accidents
- •2.10 Synopsis
- •Bibliography and Further Reading
- •3. Classical Drug Research
- •3.2 Malaria: Success and Failure
- •3.6 Synopsis
- •Bibliography and Further Reading
- •4.1 The Lock-and-Key Principle
- •4.2 The Essential Role of the Membrane
- •4.6 Blame It All on Water!
- •4.11 Lessons for Drug Design
- •4.12 Synopsis
- •Bibliography and Further Reading
- •5.1 Louis Pasteur Sorts Crystals
- •5.2 Structural Basis of Optical Activity
- •5.4 Lipases Separate Racemates
- •5.8 Synopsis
- •Bibliography and Further Reading
- •6.2 Lead Structures from Plants
- •6.9 Synopsis
- •Bibliography and Further Reading
- •7.2 Color Change Demonstrates Activity
- •7.7 Biophysics Supports Screening
- •7.11 Synopsis
- •Bibliography and Further Reading
- •8.1 Strategies for Drug Optimization
- •8.5 From Agonists to Antagonists
- •8.9 Synopsis
- •Bibliography and Further Reading
- •9. Designing Prodrugs
- •9.1 Foundations of Drug Metabolism
- •9.2 Esters Are Ideal Prodrugs
- •9.6 Synopsis
- •Bibliography and Further Reading
- •10. Peptidomimetics
- •10.1 Therapeutic Relevance of Peptides
- •10.2 Designing Peptidomimetics
- •Bibliography and Further Reading
- •11.4 What Is Contained in Chemical Space?
- •Bibliography and Further Reading
- •12.7 Silencing Genes by RNA Interference
- •12.9 Proteomics and Metabolomics
- •Bibliography and Further Reading
- •13.3 Crystal Lattices Diffract X-Rays
- •Bibliography and Further Reading
- •Bibliography and further reading
- •15. Molecular Modeling
- •15.2 Strategies in Molecular Modeling
- •15.3 Knowledge-Based Approaches
- •15.4 Force Field Methods
- •15.5 Quantum Chemical Methods
- •Bibliography and further reading
- •16. Conformational Analysis
- •16.8 Synopsis
- •Bibliography and Further Reading
- •Bibliography and Further Reading
- •18.4 Lipophilicity and Biological Activity
- •Bibliography and Further Reading
- •19.3 The Role of Hydrogen Bonds
- •19.5 Absorption Profiles of Acids and Bases
- •19.8 From In Vitro to In Vivo Activity
- •Bibliography and Further Reading
- •Bibliography and Further Reading
- •21.5 LUDI Discovers the First Leads
- •Bibliography and Original Papers
- •22.1 The Druggable Genome
- •22.4 Enzymes and Their Inhibitors
- •22.9 Resistance and Its Origin
- •Bibliography and Further Reading
- •23.1 Serine-Dependent Hydrolases
- •23.10 Synopsis
- •Bibliography and Further Reading
- •24. Aspartic Protease Inhibitors
- •24.2 Design of Renin Inhibitors
- •24.8 Synopsis
- •Bibliography and Further Reading
- •25.1 Structure of Zinc Metalloproteases
- •25.9 What Zinc Can Do, Iron Can Too
- •25.11 Synopsis
- •Bibliography and Further Reading
- •26. Transferase Inhibitors
- •26.1 The Kinase “Gold Rush”
- •Bibliography and Further Reading
- •27. Oxidoreductase Inhibitors

9
Chapter • Designing Prodrugs
After optimization of a lead structure, there may still
be problems. Many substances lack important characteristics that are required for therapy in humans, for instance, adequate bioavailability, duration of action and
metabolic stability, the ability to penetrate the blood–
brain barrier, selectivity, or good tolerability. Often it
proves impossible to address or improve these properties
through structural variations. Asolution to this problem
can be found through special preparations, for instance,
to be used for poorly water soluble substances, or via
aderivatization to aprodrug. This term refers to anonac-
tive or poorly active precursor or derivative of an active
molecule. In the organism, this form is converted to the
actual active substance. In most cases, this is achieved by
enzymatic reactions; in afew cases, it happens by spontaneous chemical decomposition.
Aside from this, the metabolites of some drugs also
show favorable therapeutic properties. In some cases, this
has led to new and improved drugs; in other cases, the
original substance was retained as aprodrug.
9.1 Foundations of Drug Metabolism
Multiple factors are crucial for the absorption, bioavailability, and duration of action of an active substance.
The most important are the solubility and lipophilicity
of the drug, which are of nearly equal importance, followed by the molecular size and the metabolic stability.
The terms absorption and bioavailability have very different meanings. Absorption refers to the amount of active
substance that is taken up by the entire gastrointestinal
tract. The bioavailability refers to just the portion of the
active substance that is available in the circulation after
the rst pass through the liver.
After oral administration, the metabolism of the
substance by enzymes begins. Ester and amide bonds
are hydrolyzed, often already in the stomach and intestines, or by passage through the stomach and intestinal wall. The entire blood volume that ows through
the intestines goes rst to the liver via the portal vein
(. Fig.9.1). This passage is called “rst pass.” Because
of its rich spectrum of hydrolyzing, oxidizing, reducing,
and conjugating enzymes, the liver is the main site of
drug degradation, that is, metabolism. Adrug can have
poor bioavailability despite good absorption because of
fast and pronounced metabolism in the liver. For many
substances, the rst pass is already “the end of the road”
They are well absorbed, but are immediately metabolized or excreted in the bile. The “rst-pass effect” refers
to cases of successful and extensive metabolism in the
very rst passage. Lipophilic active substances and those
with amolecular weight of more than 500–600 daltons
(Da) are susceptible to particularly intense rst-pass effects. Of course, blood ows continuously through the
liver, and metabolism carries on. The substances are no
. Fig. 9.1 Schematic sketch of the “life cycle” of adrug after oral
administration. The drug is already metabolized during the passage
through the stomach or intestinal wall, and above all, during the rst
pass through the liver. Lipophilic drugs and substances with amolecular weight of more than 500–600 Da are excreted with the bile. Polar
substances and conjugated and/or metabolic products (metabolites)
are excreted by the kidneys
longer in the blood stream at as high aconcentration as
they were before the rst liver passage because they have
been distributed to the tissue. In general, the hydrolytic
cleavage of ester or amide groups leads to highly wa-
ter soluble metabolites that can be excreted by the kidneys. Conjugation, that is, the coupling of the substance
with native polar compounds, for instance, with sulfate
groups, the amino acid glycine, or the glucose oxidation
product glucuronic acid, leads to easily excreted products. In humans, conjugation is of great importance. It
is more critical if the substance has neither easily degradable functional groups nor conjugation positions.
Nonetheless, humans have enzymes that can metabolize
xenobiotics. Among these, the cytochrome P450 isoenzymes are particularly important because they are able
to chemically change amolecule oxidatively at various
positions (Sect.27.6). Usually this leads to better water solubility and therefore better-excretable substances.
Since it is not possible to predict what properties the
metabolites of these biotransformations will have, toxic
compounds with mutagenic or carcinogenic properties
may occasionally be formed.
Evolution has had time over millions of years to
hone the degradation and excretion of foreign substances. For some compounds, however, the system
can fail. Instead of detoxifying, the opposite happens,
i.e., “poisoning.” The carcinogenic effect of polycyclic
hydrocarbons is attributed to an oxidative assault, just
as are bone marrow damage and leukemia which are
caused by benzene9.1. The simplest alkyl homologue
of benzene, toluene9.2 is less toxic for the sole reason
that it can be oxidized to benzoic acid9.3, which, after
conjugation with the amino acid glycine, can be excreted
as hippuric acid9.4 (. Fig.9.2). There are even more
conjugation possibilities available for the benzoic acid
intermediate.

. • Esters Are Ideal Prodrugs
. Fig. 9.2 The oxidation of benzene9.1 leads to
areactive and toxic intermediate. In contrast, the
oxidation of toluene9.2 affords benzoic acid9.3, which
can be excreted by the kidney as its nontoxic glycine
conjugate9.4
One can speculate as to why no multienzyme complexes have evolved to immediately convert toxic intermediates into polar, nontoxic metabolites. In any case, it
is an almost unsolvable problem because the properties
of the metabolites would have to be predicted for each
xenobiotic. Amodication that leads to improved water
solubility in one compound can cause amutagenic effect
in another. For their own protection, humans have, in
fact, mechanisms for trapping reactive metabolites. Here
glutathione and glutathione transferase must be mentioned because they detoxify electrophiles particularly
well (Sect.27.7). Perhaps toxic or carcinogenic effects
were not aparticularly decisive theme for evolution until now. Tumors play asecondary role for most animals
because of their short lifespan. Up until just afew generations ago, war and infectious diseases were the primary
causes of death in humans. It has only been in recent
times that the average life expectancy has increased. In
the sense of evolution, aging individuals play only asecondary role. Once reproduction is complete, the parents
are only necessary for the care of their young until early
adulthood. One only needs to think of female spiders
that consider their mates to be nothing more than their
next prey immediately after copulation!
From the above-described examples of toxic chemicals, the wrong conclusion should not be drawn that
only human-made substances can cause cancer. This is
true for afew natural products as well, for instance, af
latoxins. These microbial secondary metabolites, which
form in spoiled nuts and other foodstuffs, are potent
carcinogens. Certain alkaloids, for example, from the
Spurge family (Euphorbiaceae) are also strongly cancer-promoting substances; they are so-called tumor
promoters.
The principle of nil nocere (Lat. do not harm) is
strictly applied to medicines, and only slowly have these
standards been applied to other materials in our environment. For the testing and development of active compounds, this means that particularly rigorous tests for
carcinogenic, mutagenic, and teratogenic effects must be
conducted. The well-founded suspicion alone that acompound or one of its possible metabolites displays such
effects leads to the consequence that the compound is
not further developed.
9.2 Esters Are Ideal Prodrugs
Establishing sufcient water solubility in substances that
are simultaneously suitable for passive transport across
membranes is aspecial challenge in pharmaceutical optimization. Nowadays attention is paid to the correct balance of these parameters already in the early phase of
development (Chap.19). If it is not possible to achieve this
optimum with the actual active substance, esters will often
be produced as suitable prodrugs. Esters are easily cleaved
by ubiquitously occurring esterases. The improved lipophilicity helps with the passive transport through diffusion
over membrane barriers, as found in the intestines and,
above all, the blood–brain barrier. One prodrug that has
sadly achieved infamy is heroin9.5 (. Fig.9.3), the diace-
tyl ester of morphine (Sect.3.3). Because of its markedly
increased lipophilicity, heroin penetrates the blood–brain
barrier quickly. The pharmacologist Heinrich Dreser, who
tested acetylsalicylic acid at Bayer, introduced heroin to
therapy in 1898 as apain and cough medicine because
of its minimal respiratory depression. But heroin belongs
to the substances with the highest addictive potential. Its
abuse is an enormous social problem in many countries.
It is used therapeutically in exceptional cases, for instance,
for pain therapy in cancer patients, particularly those, who
have exhausted other therapeutic options.
Many other prodrugs are also esters. The transfor
-
mation from an acid or alcohol group to an ester usually
leads to abetter-absorbable product. The formerly used
antilipidemic clobrate9.6 (Sect. 28.6) is just such an
example of abioavailable ester of abiologically active
free acid9.7. The angiotensin-converting enzyme inhibitor enalapril9.8 (Sect.25.4) and its analogues are also
prodrugs. The free acid9.9 is not absorbed, but it is the
active form in vitro (. Fig.9.3). The diester is chemically
unstable and quickly forms the inactive diketopiperazine
9.10. It is essential that only one of the acid groups is
esteried to prevent the formation of this side product.
The monoester9.8 is “interpreted” as adipeptide and is
transported through the cell membrane by an oligopeptide transporter. The β-lactam antibiotics (Sect.23.7) are
also taken up by this transporter.
Hydroxymethylglutaryl coenzyme A 9.11 (HMG-
CoA) is enzymatically reduced to mevalonic acid 9.12 in
-

Chapter • Designing Prodrugs
9
the biosynthesis of cholesterol (. Fig.9.4). The antilipidemic lovastatin 9.13 (Sect.27.3) prevents this reaction
by inhibiting HMG-CoA reductase. It contains alactone
ring, which is transformed to its active form 9.14 by hy drolysis. This form is structurally very similar to the product of the enzymatic reaction, mevalonic acid 9.12.
Other ester prodrugs were developed for depot formulations to achieve alonger duration of action after
subcutaneous or intramuscular administration.
The phenolic hydroxyl group of bambuterol 9.15 is
masked as acarbamate. Terbutaline 9.16 (. Fig.9.5) is
formed from this prodrug after hydrolysis by unspecic
cholinesterases (Sect.23.7). By using this prodrug strategy, it was possible to make along-acting bronchospasmolytic that only needs to be administered once daily in
contrast to the actual active substance, which must be
administered three times daily.
Occasionally, aprodrug can be used to improve the
taste, for instance, in the case of the extremely bitter
chloramphenicol 9.17. By converting it to the palmitate
9.18 (. Fig.9.5), there is amarked reduction in the water
solubility, but the substance no longer tastes bitter. The
concomitant reduction in the absorption is of no consequence. The substance is hydrolyzed to the highly soluble
and easily absorbed chloramphenicol in the duodenum
by the pancreatic lipase enzymes.
The glucoside salicin (Sect.3.1) represents atrue prodrug that after hydrolysis and oxidation is converted to
the anti-inammatory salicylic acid. In contrast, acetylsalicylic acid (ASA) is amixed type, as part of it reacts
covalently with the enzyme and the remaining part occupies the active site non-covalently. It has its own activity
through the irreversible inhibition of cyclooxygenase,
above all as acoagulation-inhibiting substance. On the
other hand, ASA has aprodrug character because the
metabolic release of salicylic acid contributes asmall part
to the anti-inammatory effect (Sect.27.9). Furthermore,
ASA is less irritating to the mucous membranes and tastes
less unpleasant than salicylic acid. For adrug with amolecular weight of 180 Da, this combination of favorable
characteristic in one structure is aproud achievement.
Esterication can also help with inadequate water
solubility of an active substance. For this, esters with
phosphoric acid or hemiesters with dicarboxylic acids
such as succinic acid are formed. The added groups carry
acharge and increase the water solubility of the active
substance. In the organism, the esters are easily hydrolyzed again. The anticonvulsive compound phenytoin
could be converted to amore hydrophilic phosphate prodrug 9.19 (. Fig.9.5), which is easily hydrolyzed by phos-
phatases (Sect.26.7). If aterminal sulfonamide group, as
found in the prodrug of celecoxib (9.20, 9.21 . Fig.9.5),
is acylated, water soluble salts are more easily formed.
The acyl group is also easily hydrolyzed in the intestines.
Esterication with polyethylene glycol (PEG) can also
be used to enhance solubility. This very water soluble
polymer has been coupled through an ester group to the
natural product paclitaxel (Sect.6.2, 6.5). As PEG–paclitaxel, this compound can be used as an intravenous
chemotherapeutic.
. Fig. 9.3 Heroin9.5, the diacetyl derivative of morphine acts reli-
ably and quickly, “heroically.” Like morphine, it is slowly and inefciently absorbed, but after intravenous administration it crosses the
blood–brain barrier 100 times faster than morphine. There, the ester
is converted by the enzyme pseudocholinesterase to morphine, which
can no longer leave the brain because of its higher polarity. The cholesterol-lowering drug clobrate9.6 is aprodrug of the actual active
compound, the free acid9.7. The antihypertensive enalapril9.8 is also
aprodrug of the active compound9.9. Here, the high lipophilicity is
not responsible nor the absorption, rather it is actively transported by
binding to adipeptide transporter. The diester of enalapril is unsuitable as adrug because it spontaneously forms the inactive diketopiperazine9.10
. Fig. 9.4 The enzymatic reduction of hydroxymethylglutaryl co-
enzyme A 9.11 (HMG-CoA) to mevalonic acid 9.12 is inhibited by
the lactone-ring-opened active metabolite 9.14 of lovastatin 9.13
(Sect.27.3)

. • Chemically Well Wrapped: Multiple Prodrug Strategies
. Fig. 9.5 Bambuterol 9.15 is acarba-
mate-masked prodrug of the bronchospasmolytic terbutaline 9.16. It is transformed to the
active compound slowly via hydrolysis. The
prodrug 9.18 of chloramphenicol 9.17 masks
only its extremely bitter taste. Phenytoin can
be converted to aphosphoric acid ester 9.19,
which is signicantly more water soluble. The
cyclooxygenase inhibitor celecoxib can be converted to prodrugs (9.20 and 9.21) by adding
acyl groups; these have markedly improved
water solubility. The antimalarial cycloguanil
9.23 is formed by ametabolic cyclization of
the inactive precursor proguanil 9.22. The
water solubility of the anti-inammatory
sulindac 9.24 is 100 times greater than its actual active form, the sulde 9.25. In addition
to this reversible enzymatic reduction, an irreversible enzymatic oxidation to abiologically
inactive sulfone also occurs
9.3 Chemically Well Wrapped: Multiple
Prodrug Strategies
The antibacterial sulfonamide sulfamidochrysoidine
(Sect.2.3) is aprodrug. It is only after cleavage of the azo
bond that the metabolic product, sulfanilamide, acts as an
antimetabolite of p-aminobenzoic acid, which is critical
for microorganisms. Additional prodrugs are proguanil
9.22, which is converted to cycloguanil 9.23 (Sect.27.2),
and the anti-inammatory sulindac 9.24, which is metabolically converted to the active sulde 9.25 (. Fig.9.5).
Amidines are used as building blocks in thrombin in-
hibitors and antagonists of the integrin receptor
(Sect.31.2). These strongly basic groups are detrimental
for good bioavailability. Through oxidation to the corresponding amidoximes, aless basic group is formed
that is not protonated under physiological conditions.
α
IIbβ3
Reductases, which are present in the liver, kidney, lung,
and brain, release the original amidine structure. This
concept, together with the esterication of the terminal
acid function, was applied in adouble-prodrug strategy
for the thrombin inhibitor ximelagatran 9.26 (Sect.23.4)
and the receptor antagonist sibraban 9.27 (Sect.31.3,
. Fig.9.6).
The bombing of an allied ship that was docked in an
Italian harbor in 1943 with 100 tonnes of mustard gas
9.28 (bis-β-chloroethylsulde, . Fig.9.7) led to the ob-
servation that many of those who were poisoned experienced asevere reduction in their white blood cell counts.
This severe toxicity for cells that quickly divide could be
used for killing tumor cells. The cytotoxic effect arises
from multiple alkylations of DNA. Consequently, replication and subsequent cell division are affected. Apurposeful search for analogues of mustard gas with less

9
Chapter • Designing Prodrugs
. Fig. 9.6 Ximelagatran 9.26 and sibraban 9.27 were developed to
improve oral bioavailability and contain both an uncharged amidoxime group and an ester function as adouble prodrug
gas) might be suitable for atumor-specic therapy. The
most interesting compound was cyclophosphamide 9.31,
asubstance that can cause the complete disappearance
of tumors in animal experiments. The originally assumed
mechanism was not correct because the substance is inactive in vitro in cell cultures of tumors. The metabolic
activation occurs outside the tumor in the liver through
oxidation (. Fig.9.7).
In the case of the cancer therapeutic 5-uorouracil
9.33, activation occurs through tumor-specic enzymes.
The triple-prodrug capecitabin 9.34 is initially activated to
9.35 by acarboxylesterase in the liver (. Fig.9.8). Then
cytidine deaminase cleaves an amino group to give 9.36 in
the liver as well as in the tumor. Finally, thymidine phosphorylase releases the active substance 9.33 in the tumor
cell. There, the compound unleashes its effect by blocking
thymidylate synthase, an enzyme that plays an important
role in thymine biosynthesis (Sect.27.2) in that it delivers
building blocks for DNA synthesis. Because cancer cells
divide more quickly than healthy cells, they are more de
pendent on the activity of thymidylate synthase.
-
. Fig. 9.7 The cytostatic N-methyl and N-aryl compounds 9.29 and
9.30 are derived from mustard gas 9.28. The rst step in the activation
of the prodrug cyclophosphamide 9.31 is ametabolic hydroxylation
of the carbon next to the nitrogen atom. The biologically active agent
9.32 and the toxic side product acrolein come from alabile intermediate that is formed by enzymatic degradation and spontaneous decomposition
toxicity led via N-derivative 9.29 to the aromatic-substi-
tuted derivative 9.30, which still had inadequate tolerability and tumor specicity. Tumor cells are especially rich
in phosphatases. Because of this, H.Arnold at the German company Chemie Grünenthal reasoned that phosphoric acid derviatives (9.29 or 9.30) of N-lost (mustard
9.4 l-DOPA Therapy: AClever Prodrug
Concept
The neurotransmitters dopamine and acetylcholine fulll
different tasks in particular parts of the central nervous
system. Parkinson’s disease, also called “shaking palsy,”
is aresult of the degeneration of dopamine-producing
cells in the Substantia nigra in the midbrain. The ensuing
disproportion between the dopaminergic and cholinergic
nerve impulses leads to episodic chronic movement disorders such as rigidity, tremor, shaking, and an inability
to move normally. Similar side effects are caused by substances that block the dopamine receptors, for instance,
the tricyclic neuroleptics (Sect.1.6). Intravenous administration of dopamine 9.37 (. Fig.9.9) does not lead to
the desired effect because the substance cannot penetrate
the blood–brain barrier. Because of its purely peripheral
effect, undesirable cardiovascular and circulatory side effects are observed, for example, an increase in heart rate
and blood pressure.
The desired equilibrium in the brain should also be
established by suppressing the cholinergic system. This
route is also taken by giving anticholinergics, that is,
antagonists to the cholinergic receptors. The administration of the amino acid l-DOPA 9.38 (. Fig.9.9) is
amore elegant possibility for dopamine substitutions.
This metabolic precursor of dopamine is an orally
bioavailable, central nervous system (CNS)-effective
medicine. It is even more polar than dopamine and can
neither be absorbed from the gastrointestinal tract nor
can it cross the blood–brain barrier just by passive diffusion. Because it is an amino acid, it uses an amino
acid transporter.

. • Drug Targeting, Trojan Horses, and Pro-prodrugs
. Fig. 9.8 The triple-prodrug capecitabin 9.34 is activated to 9.35 by
acarboxylesterase in the liver, then it is transformed into 9.36 by acyt-
With this, the rst goal, CNS activity, is achieved.
Oral l-DOPA administration however, still presents too
many side effects in the peripheral nervous system. Fur-
thermore, l-DOPA is very short acting as dopamine is
quickly metabolized in the brain. Therefore, one must try
to prevent the metabolism of the substance, while simultaneously reducing its concentration in the periphery. The
combination of l-DOPA with the peripheral decarboxylase inhibitor benserazide 9.39 and the CNS-effective
monoamine oxidase inhibitor selegilin 9.40 (Sect.27.8)
. Fig. 9.9 Because dopamine 9.37 cannot enter the central nervous
system, the metabolic precursor l-DOPA 9.38 is used. To reduce the
cardiovascular effects of dopamine, l-DOPA is combined with a peripherally active decarboxylase inhibitor benserazide 9.39. The administration of amonoamine oxidase inhibitor, for example, selegilin 9.40,
prevents the rapid degradation of dopamine
. Fig. 9.10 Because it is a lipophilic neutral molecule, progabide
9.41 can cross the blood–brain barrier. It is transformed into the neurotransmitter γ-aminobutyric acid (GABA) 9.42 upon metabolic re-
lease of the amino and carboxyl groups
idine deaminase in the tumor, and athymidine phosphorylase produces the cancer therapeutic 5-uorouracil9.33
largely solves this problem. The peripheral side effects are
reduced and the CNS effects are extended (. Fig.9.9).
Despite this masterpiece of drug design, which has led
to signicant therapeutic progress, the metabolically
produced dopamine still acts in too many places. Aside
from the residual peripheral side effects, sudden changes
between excessive movement, normal movement, and
rigidity, insomnia, agitation, and hallucinations are all
manifestations of the generalized CNS activity.
It has been speculated in conjunction with this observation whether, in addition to endogenous and genetic
factors, environmental factors, for example, the metabolic transformation of structurally analogous foreign
substances, might be responsible for triggering Parkinson’s disease.
9.5 Drug Targeting, Trojan Horses,
and Pro-prodrugs
The design of active substances that exert their effect only
in, or overwhelmingly in, one particular organ is called
drug targeting. Aside from general principles, for example optimal lipophilicity as aprerequisite for crossing the
blood–brain barrier, specic metabolic transformations
are used. The Parkinson’s disease drug l-DOPA, which
was introduced in the previous section, is such aprodrug.
The anticonvulsive medicine progabide 9.41 is adouble
prodrug because both functional groups of the neurotransmitter are masked. After crossing the blood–brain
barrier and release of the amino and carboxyl groups, the
actual active compound, γ-aminobutyric acid (GABA,
. Fig.9.10), is formed.
The ability of the blood–brain barrier to exclude polar substances can also be used as aprodrug concept.
For this, an active compound with ametabolically labile
group can be coupled to adihydropyridine. The neutral
conjugate 9.43 can cross the blood–brain barrier. Oxidation leads to apermanently charged compound 9.44,
which can no longer leave the brain. Upon metabolic
cleavage, the free active compound is released in situ

9
Chapter • Designing Prodrugs
. Fig. 9.11 Drug targeting in the brain is accomplished
with a drug–dihydropyridine conjugate 9.43. This substance can easily enter the central nervous system. Metabolic oxidation leads to apermanently charged pyridine
9.44, which cannot cross the blood–brain barrier. The active compound is released in the brain, and the polar conjugate is quickly excreted from the periphery
. Fig. 9.12 Aciclovir 9.45 is aTrojan horse. An enzymatic phosphor-
ylation of its hydroxyl group by aviral kinase affords its monophosphorylated form in virus-infected cells only, which is then transformed
to the triphosphate derivative by the cellular kinases. Valaciclovir 9.46
is apro-prodrug because it is rst transformed to aciclovir by hydrolysis and subsequently activated
. Fig. 9.13 In acidic milieu, omeprazole 9.47 is rearranged to
asulfenic acid 9.48, which is in equilibrium with acyclic sulfenamide
9.49. This reacts irreversibly with the thiol group of acysteine on H+/
K+-ATPase, the so-called proton pump
(. Fig.9.11). If oxidation takes place in the periphery,
the highly water soluble complex is excreted before the
actual active substance is released. This example should
show how, in principle, targeting to aspecic tissue can
be achieved when the specically given chemical conditions are taken into account.
Several analogues of nucleobases and nucleosides
are Trojan horses. The antiherpes medicine aciclovir 9.45
enters the cell as its inactive form. The rst monophosphorylation occurs only in virus-infected cells by avirus-specic thymidine kinase. Next cellular kinases carry
out the formation of the triphosphate, the actual active
substance. Because of this aciclovir acts as atargeted antiviral. The compound is, however, poorly absorbed. The
more suitable valaciclovir 9.46 (. Fig.9.12) can be con-
sidered to be apro-prodrug. In the organism, it is initially
hydrolyzed to aciclovir and then transformed into the
active form by the viral enzyme. Valaciclovir is more lipophilic than aciclovir, but despite this, it is more soluble
in water and has abioavailability of approximately 55%.
Omeprazole 9.47 is the prodrug of an irreversible inhibitor of the H+/K+-ATPase, the so-called proton pump
(Sect.30.9). Only under strongly acidic conditions, in the
acid-producing cells of the stomach, is it transformed
into the sulfenic acid 9.48, which is in equilibrium with
the cyclic sulfenamide 9.49 (. Fig.9.13). This reacts irreversibly with an SH group of acysteine residue of the
enzyme to form adisulde. Omeprazole is more effective
than the H2-antagonists (Sect.3.5) because it blocks not
only the histamine-induced acid secretions but rather all
forms of acid secretions.

. • Synopsis
. Fig. 9.14 The metabolic peculiarities of the eye
are exploited for drug targeting in glaucoma therapy. After penetrating the cornea, the bis-pivaloyl
ester, dipivefrine 9.50 of adrenaline 9.51 is hydrolyzed 20times faster than it is in the periphery. The
oxime ether of timolol 9.52 is metabolized through
the ketone to the active form, timolol 9.53, only in
the eye
The different metabolic activity in different tissues
can be used to achieve aselective effect in one specic
organ. In principle, adrenaline (Sect.1.4) as well as some
β
-blockers are suitable for the treatment of glaucoma,
because they can normalize elevated intraocular pressure. However, they have substantial undesirable side
effects on the heart function and circulation. This can
be avoided by the administration of prodrugs that are
metabolized more quickly in the eye, or only in the eye,
for example, aparticularly robust ester 9.50 of adrenaline 9.51, or aketone–oxime ether 9.52 of timolol 9.53
(. Fig.9.14).
The area of drug targeting has developed into an
exciting eld in recent years. Aside from the above-described prodrugs that release active compounds in the
target area, the concept of antibody–conjugate drugs has
been pursued especially for the development of novel
cancer therapeutics. Another approach is the coupling
of drugs to acell-specic recognition sequence. The goal
of this work is to trick the membrane transporters of
very specic cells so that the drug–conjugate gains entry. Tumor therapeutics that were derived from N-lost
were introduced in Sect.9.3. These cytotoxic alkylating
compounds, however, are very reactive and should only
be activated in the desired target tissue. For this, the following strategies were developed. Aromatic N-lost derivative 9.55 (. Fig.9.15) is released from prodrug 9.54
by specic peptide cleavage with carboxypeptidase G2,
an enzyme that only exists in bacteria. This enzyme was
coupled to amonoclonal antibody (Sect.32.3) that spe-
cically recognizes human colorectal cancer cells. With
this, the bacterial enzyme that “arms” the cancer drug is
brought in the immediate vicinity of the cancer cell. In
the future, this antibody-guided enzyme-activated prodrug therapy could make cancer therapy more tolerable
and less toxic by releasing the active substance locally
and in adistinctly more targeted way (see antibody–drug
conjugates, Sect.32.3).
. Fig. 9.15 The highly reactive cancer therapeutic derivative 9.55 is
released from prodrug 9.54, which is activated by aspecic carboxypeptidase. The carboxypeptidase is bound to an antibody that is targeted to the cancer cell
9.6 Synopsis
If it is impossible to achieve sufcient bioavailability,
-
duration of action, membrane penetration, or metabolic stability by chemical modications, aprodrug
can be developed that corresponds to anonactive or
poorly active precursor or derivative that is converted
in the organism to its active form.
After absorption, adrug is transported to the liver
-
and exposed to degrading enzymes that make it more
water soluble for excretion. The amount of the drug
that survives this rst liver pass is referred to as the
bioavailable portion and can be distributed in the organism.
Esters are often used as prodrugs to mask polar acid
-
groups; they are cleaved by ubiquitously present esterases.
Alarge variety of chemical modications have been
-
applied to modulate the physicochemical properties
of drug molecules; however, they require special enzymes in the targeted cells or organs for metabolic
activation.

Chapter • Designing Prodrugs
9
l-DOPA, an amino acid analogue of dopamine, is
-
delivered to the brain via an amino acid transporter
and rapidly decarboxylated. To avoid side effects in
the periphery, acombination with polar decarboxy-
lase inhibitors is advisable.
Drug targeting to particular organs or cells exploits
-
specic metabolic transformations only present in
these compartments of the body.
Antibody-conjugate drugs are specically delivered
-
to those compartments or organs that present the
antibody-specic recognition site on the surface of
disease-related cells. To trick membrane transport-
ers, drugs can be coupled to cell-specic recognition
sequences and, thus, gain entry to the cells.
Bibliography and Further Reading
General Literature
H. Bundgaard, Eds., Design of Prodrugs, Elsevier, Amsterdam (1985)
N. Bodor, Prodrugs and Site-Specic Chemical Delivery Systems, Ann.
Rep. Med. Chem., 22, 303–313 (1987)
H. Bundgaard, Design and Application of Prodrugs, in: A Textbook
of Drug Design and Development, P. Krogsgaard-Larsen and
H. Bundgaard, Eds., Harwood Academic Publishers, Chur, pp.
113–191 (1991)
G. G. Gibson, Introduction to Drug Metabolism, Blackie, London
(1994)
R. B. Silverman, M. W. Holladay, The Organic Chemistry of Drug De-
sign and Drug Action, 3rd edn., Academic Press, (2014), Chapter 8,
Drug Metabolism, and Chapter 9, Prodrugs and Drug Delivery
Systems
L. P. Balant and E. Doelker, Metabolic Considerations in Prodrug De-
sign, in: Burger’s Medicinal Chemistry, M. E. Wolff, Eds., 5th edn,
Vol. I, John Wiley & Sons, New York, pp. 949–982 (1995)
P. Ettmayer, G. L. Amidou, B. Clement and B. Testa, Lessons Learned
from Marketed and Investigational Prodrugs, J. Med. Chem., 47,
2394–2404 (2004)
B. Testa and J. M. Mayer, Hydrolysis in Drug and Prodrug Metabo-
lism—Chemistry, Biochemistry and Enzymology, Wiley-VHCA,
Zurich (2003)
K. Beaumont, R. Webster, I. Gardner and K. Dack, Design of ester
prodrugs to enhance oral absorption of poorly permeable com-
pounds: challenges to the discovery scientist, Curr. Drug Metab.,
4, 461–485 (2003)
B. Testa, Prodrug and Soft Drug Design, Comprehensive Medicinal
Chemistry II, J. B. Taylor and D. J. Triggle, Eds., vol. 5, Elsevier,
Oxford, pp. 1009–1041 (2007)
V. J. Stella, R. T. Borchardt, M. J. Hageman, R. Oliyai, H. Maag and
J. W. Tilley, Eds., Prodrugs: Challenges and Rewards. 2 vols.,
Springer, New York (2007)
J. Rautio, Prodrugs and targeted delivery—towards better ADME
properties. In: R. Mannhold, H. Kubinyi, G. Folkers, Eds., Meth-
ods and principles in medicinal chemistry, vol. 47, Wiley-VCH,
Weinheim (2012)
N. Bodor and P. Buchwald, Ophthalmic Drug Design Based on the
Metabolic Activity of the Eye: Soft Drugs and Chemical Delivery
Systems, The AAPS Journal, 7, E820–833 (2005)
M. P. Napier, S. K. Sharma et al Antibody-directed Enzyme Prodrug
Therapy: Efcacy and Mechanism of Action in Colorectal Carcinoma. Clin. Cancer Res., 6, 765–772 (2000)
Special Literature
M. E. Brewster, E. Pop and N. Bodor, Chemical Approaches to
Brain-Targeting of Biologically Active Compounds, in: Drug De-
sign for Neuroscience, A. P. Kozikowski, Eds., Raven Press, New
York (1993)

Peptidomimetics
Contents
10.1 Therapeutic Relevance of Peptides – 138
10.2 Designing Peptidomimetics – 139
10.3 First Step to Variation: Modifying Side Chains – 140
10.4 A More Courageous Step: Modifying the Main Chain – 140
10.5 Rigidifying the Backbone by Fixing Conformations – 141
10.6 Peptidomimetics to Interfere with Protein–
Protein Interactions – 143
10.7 Tracing Selective NK Receptor Antagonists by Ala Scan – 145
10.8 CAVEAT: Idea Generator for the Design
of Peptidomimetics – 147
10.9 Design of Peptidomimetics: Quo Vadis? – 148
10.10 Synopsis – 148
Bibliography and Further Reading – 149
© The Author(s), under exclusive license to Springer-Verlag GmbH, DE, part of Springer Nature 2024
G. Klebe, Drug Design, https://doi.org/10.1007/978-3-662-68998-1_10
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