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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. Asolution to this problem can be found through special preparations, for instance, to be used for poorly water soluble substances, or via aderivatization to aprodrug. This term refers to anonac- 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 afew 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 aprodrug.

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. Adrug 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 amolecular 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 adrug 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 amolec­ular 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 aconcentration 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 amolecule 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 benzene9.1. The simplest alkyl homologue of benzene, toluene9.2 is less toxic for the sole reason that it can be oxidized to benzoic acid9.3, which, after conjugation with the amino acid glycine, can be excreted as hippuric acid9.4 (. 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 benzene9.1 leads to
areactive and toxic intermediate. In contrast, the oxidation of toluene9.2 affords benzoic acid9.3, which can be excreted by the kidney as its nontoxic glycine conjugate9.4

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. Amodication that leads to improved water solubility in one compound can cause amutagenic 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 aparticularly decisive theme for evolution un­til now. Tumors play asecondary role for most animals because of their short lifespan. Up until just afew 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 asec­ondary 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 afew 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 acom­pound 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 sufcient water solubility in substances that are simultaneously suitable for passive transport across membranes is aspecial 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 heroin9.5 (. 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 apain 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 abetter-absorbable product. The formerly used antilipidemic clobrate9.6 (Sect. 28.6) is just such an example of abioavailable ester of abiologically active free acid9.7. The angiotensin-converting enzyme inhib­itor enalapril9.8 (Sect.25.4) and its analogues are also prodrugs. The free acid9.9 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 esteried to prevent the formation of this side product. The monoester9.8 is “interpreted” as adipeptide 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 alactone 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 alonger duration of action after subcutaneous or intramuscular administration.
The phenolic hydroxyl group of bambuterol 9.15 is masked as acarbamate. Terbutaline 9.16 (. Fig.9.5) is
formed from this prodrug after hydrolysis by unspecic cholinesterases (Sect.23.7). By using this prodrug strat­egy, it was possible to make along-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, aprodrug 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 amarked 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 atrue pro­drug that after hydrolysis and oxidation is converted to the anti-inammatory salicylic acid. In contrast, acetyl­salicylic acid (ASA) is amixed 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 acoagulation-inhibiting substance. On the other hand, ASA has aprodrug character because the metabolic release of salicylic acid contributes asmall part to the anti-inammatory effect (Sect.27.9). Furthermore, ASA is less irritating to the mucous membranes and tastes less unpleasant than salicylic acid. For adrug with amo­lecular weight of 180 Da, this combination of favorable characteristic in one structure is aproud achievement.
Esterication 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 acharge 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 amore hydrophilic phosphate pro­drug 9.19 (. Fig.9.5), which is easily hydrolyzed by phos- phatases (Sect.26.7). If aterminal 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.
Esterication 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 Heroin9.5, the diacetyl derivative of morphine acts reli-
ably and quickly, “heroically.” Like morphine, it is slowly and inef­ciently 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 clobrate9.6 is aprodrug of the actual active compound, the free acid9.7. The antihypertensive enalapril9.8 is also aprodrug of the active compound9.9. Here, the high lipophilicity is not responsible nor the absorption, rather it is actively transported by binding to adipeptide transporter. The diester of enalapril is unsuit­able as adrug because it spontaneously forms the inactive diketopip­erazine9.10
. 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 acarba-
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 aphosphoric acid ester 9.19, which is signicantly 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 ametabolic cyclization of the inactive precursor proguanil 9.22. The water solubility of the anti-inammatory sulindac 9.24 is 100 times greater than its ac­tual active form, the sulde 9.25. In addition to this reversible enzymatic reduction, an irre­versible enzymatic oxidation to abiologically inactive sulfone also occurs

9.3 Chemically Well Wrapped: Multiple
Prodrug Strategies
The antibacterial sulfonamide sulfamidochrysoidine (Sect.2.3) is aprodrug. 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-inammatory sulindac 9.24, which is meta­bolically converted to the active sulde 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, aless 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 esterication of the terminal acid function, was applied in adouble-prodrug strategy for the thrombin inhibitor ximelagatran 9.26 (Sect.23.4) and the receptor antagonist sibraban 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-chloroethylsulde, . Fig.9.7) led to the ob- servation that many of those who were poisoned experi­enced asevere 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. Apur­poseful search for analogues of mustard gas with less
9
Chapter  • Designing Prodrugs
. Fig. 9.6 Ximelagatran 9.26 and sibraban 9.27 were developed to
improve oral bioavailability and contain both an uncharged amidox­ime group and an ester function as adouble prodrug
gas) might be suitable for atumor-specic therapy. The most interesting compound was cyclophosphamide 9.31, asubstance 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-specic enzymes. The triple-prodrug capecitabin 9.34 is initially activated to
9.35 by acarboxylesterase 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 ametabolic hydroxylation of the carbon next to the nitrogen atom. The biologically active agent
9.32 and the toxic side product acrolein come from alabile 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 specicity. 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: AClever Prodrug
Concept
The neurotransmitters dopamine and acetylcholine fulll different tasks in particular parts of the central nervous system. Parkinson’s disease, also called “shaking palsy,” is aresult 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 amore 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
acarboxylesterase in the liver, then it is transformed into 9.36 by acyt-
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 amonoamine 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 athymidine phosphorylase produc­es the cancer therapeutic 5-uorouracil9.33
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 signicant 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 aprerequisite for crossing the blood–brain barrier, specic metabolic transformations are used. The Parkinson’s disease drug l-DOPA, which was introduced in the previous section, is such aprodrug. The anticonvulsive medicine progabide 9.41 is adouble 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 aprodrug concept. For this, an active compound with ametabolically labile group can be coupled to adihydropyridine. The neutral conjugate 9.43 can cross the blood–brain barrier. Oxi­dation leads to apermanently 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 apermanently 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 aTrojan horse. An enzymatic phosphor-
ylation of its hydroxyl group by aviral 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 apro-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
asulfenic acid 9.48, which is in equilibrium with acyclic sulfenamide
9.49. This reacts irreversibly with the thiol group of acysteine 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 aspecic tissue can be achieved when the specically 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 avi­rus-specic thymidine kinase. Next cellular kinases carry out the formation of the triphosphate, the actual active substance. Because of this aciclovir acts as atargeted an­tiviral. The compound is, however, poorly absorbed. The more suitable valaciclovir 9.46 (. Fig.9.12) can be con- sidered to be apro-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 abioavailability 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 acysteine residue of the enzyme to form adisulde. 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 20times 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 aselective effect in one specic 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, aparticularly robust ester 9.50 of adrena­line 9.51, or aketone–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 acell-specic recognition sequence. The goal of this work is to trick the membrane transporters of very specic 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 specic peptide cleavage with carboxypeptidase G2, an enzyme that only exists in bacteria. This enzyme was coupled to amonoclonal antibody (Sect.32.3) that spe- cically 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 adistinctly 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 aspecic carboxy­peptidase. The carboxypeptidase is bound to an antibody that is tar­geted to the cancer cell

9.6 Synopsis

If it is impossible to achieve sufcient bioavailability,
-
duration of action, membrane penetration, or meta­bolic stability by chemical modications, aprodrug can be developed that corresponds to anonactive or poorly active precursor or derivative that is converted in the organism to its active form.
After absorption, adrug 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.
Alarge variety of chemical modications 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, acombination with polar decarboxy-
lase inhibitors is advisable.
Drug targeting to particular organs or cells exploits
-
specic metabolic transformations only present in
these compartments of the body.
Antibody-conjugate drugs are specically delivered
-
to those compartments or organs that present the
antibody-specic recognition site on the surface of
disease-related cells. To trick membrane transport-
ers, drugs can be coupled to cell-specic 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-Specic 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: Efcacy 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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