Retrometabolic Drug Design and Targeting E-Book

Nicholas Bodor

• Herausgeber: John Wiley & Sons
• Kategorie: Wissenschaft und neue Technologien
• Sprache: Englisch

Seitenzahl: 775

Veröffentlichungsjahr: 2012

Beschreibung

Innovative approach to drug design that's more likely to result in an approvable drug product Retrometabolic drug design incorporates two distinct drug design approaches to obtain soft drugs and chemical delivery systems, respectively. Combining fundamentals with practical step-by-step examples, Retrometabolic Drug Design and Targeting gives readers the tools they need to take full advantage of retrometabolic approaches in order to develop safe and effective targeted drug therapies. The authors, both pioneers in the fields of soft drugs and retrometabolic drug design, offer valuable ideas, approaches, and solutions to a broad range of challenges in drug design, optimization, stability, side effects, and toxicity. Retrometabolic Drug Design and Targeting begins with an introductory chapter that explores new drugs and medical progress as well as the challenges of today's drug discovery. Next, it discusses: * Basic concepts of the mechanisms of drug action * Drug discovery and development processes * Retrometabolic drug design * Soft drugs * Chemical delivery systems Inside the book, readers will find examples from different pharmacological areas detailing the rationale for each drug design. These examples set forth the relevant pharmacokinetic and pharmacodynamic properties of the new therapeutic agents, comparing these properties to those of other compounds used for the same therapeutic purpose. In addition, the authors review dedicated computer programs that are available to support and streamline retrometabolic drug design efforts. Retrometabolic Drug Design and Targeting is recommended for all drug researchers interested in employing this newly tested and proven approach to developing safe and effective drugs.

Leseprobe

Contents

Cover

Title Page

Copyright

Preface

ACKNOWLEDGMENTS

Chapter 1: Introduction

1.1 NEW DRUGS AND MEDICAL PROGRESS

1.2 THE CHALLENGE OF NEW DRUG DISCOVERY

REFERENCES

Chapter 2: Mechanism of Drug Action: Basic Concepts

2.1 PHARMACODYNAMIC PHASE: DRUG–RECEPTOR INTERACTIONS

2.2 PHARMACOKINETIC PHASE: ADME

2.3 STRUCTURAL REQUIREMENTS: KEEPING IT “DRUG-LIKE”

REFERENCES

Chapter 3: The Drug Discovery and Development Process

3.1 DISCOVERY RESEARCH

3.2 PRECLINICAL DEVELOPMENT

3.3 CLINICAL DEVELOPMENT

3.4 REGULATORY APPROVAL AND POSTMARKETING DEVELOPMENT

3.5 PROBLEMS WITH THE CURRENT PARADIGM

REFERENCES

Chapter 4: Retrometabolic Drug Design

4.1 DESIGN PRINCIPLES

4.2 Terminology

REFERENCES

Chapter 5: Soft Drugs

5.1 ENZYMATIC HYDROLYSIS

5.2 SOFT DRUG APPROACHES

5.3 INACTIVE METABOLITE–BASED SOFT DRUGS

5.4 SOFT ANALOGS

5.5 ACTIVE METABOLITE–BASED SOFT DRUGS

5.6 ACTIVATED SOFT DRUGS

5.7 PRO-SOFT DRUGS

5.8 COMPUTER-AIDED DESIGN

5.9 SOFT DRUGS: SUMMARY

REFERENCES

Chapter 6: Chemical Delivery Systems

6.1 ENZYMATIC PHYSICOCHEMICAL-BASED (BRAIN-TARGETING) CDSs

6.2 SITE-SPECIFIC ENZYME-ACTIVATED (EYE-TARGETING) CDSS

6.3 RECEPTOR-BASED TRANSIENT ANCHOR-TYPE CDSS

REFERENCE

Conclusions

Index

Copyright © 2012 by John Wiley & Sons, Inc. All rights reserved.

Published by John Wiley & Sons, Inc., Hoboken, New Jersey. Published simultaneously in Canada.

No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permitted under Section 107 or 108 of the 1976 United States Copyright Act, without either the prior written permission of the Publisher, or authorization through payment of the appropriate per-copy fee to the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, [phone], fax [phone], or on the web at www.copyright.com. Requests to the Publisher for permission should be addressed to the Permissions Department, John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, [phone], fax [phone], or online at http://www.wiley.com/go/permission.

Limit of Liability/Disclaimer of Warranty: While the publisher and author have used their best efforts in preparing this book, they make no representations or warranties with respect to the accuracy or completeness of the contents of this book and specifically disclaim any implied warranties of merchantability or fitness for a particular purpose. No warranty may be created or extended by sales representatives or written sales materials. The advice and strategies contained herein may not be suitable for your situation. You should consult with a professional where appropriate. Neither the publisher nor author shall be liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages.

For general information on our other products and services or for technical support, please contact our Customer Care Department within the United States at [phone], outside the United States at [phone] or fax [phone].

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic formats. For more information about Wiley products, visit our web site at www.wiley.com.

Library of Congress Cataloging-in-Publication

Bodor, Nicholas. Retrometabolic drug design and targeting / Nicholas Bodor, Peter Buchwald. p. ; cm. Includes bibliographical references and index. ISBN 978-0-470-94945-0 (cloth) I. Buchwald, Peter. II. Title. [DNLM: 1. Drug Design. 2. Drug Delivery Systems. 3. Drug Evaluation, Preclinical. 4. Pharmaceutical Preparations–metabolism. QV 745] 615.1′9–dc23 2012020183

PREFACE

The discovery and widespread introduction of new, highly effective drugs was probably one of the most important transformative forces of the twentieth century, as it dramatically altered the way of life in all industrialized nations. Nevertheless, rational drug design, which would allow the development of effective new pharmaceutical agents with minimal side effects on as rational a basis as possible, is still an elusive goal. Unfortunately, our understanding of biological systems and their complexities is far from sufficient, and a few success stories of rational designs on the basis of the molecular mechanism of action overshadow the many more unexpected failures of projects that were also initiated on the basis of similarly plausible rationales. Contrary to the quite predictable and steady rate of development of technological and engineering fields, the efficiency and rate of new drug introductions has been steadily declining since the 1950s. There are several reasons for this, including the increasing regulatory burden, the expectation that any new drug will outperform all existing ones (many of which are highly effective), the unprecedented need for highly multidisciplinary approaches, the inability of the increasingly few and increasingly large organizations left in the pharmaceutical/biotechnology field to carry out truly innovative research, or the fact that many new technical developments ultimately failed to materialize in an increased NCE (new chemical entity) output. For example, an analysis of drugs launched in 2000 revealed that not only did combinatorial chemistry and high-throughput screening have no significant impact, but most of the new drugs launched were, in fact, derived by modification of known drug structures or published lead molecules. It has even been suggested that the new techniques may be generating bigger haystacks as opposed to more needles.

During the drug discovery and development process, the identified leads generally have to undergo structural optimization to improve their activity and specificity. Typically, this process is focused on increasing the pharmacological potency, while side effect and toxicity issues are ignored at this stage. Consequently, large numbers of promising new drug candidates have to be discarded later in the development process when unacceptable toxicity or unavoidable side effects are encountered. Because side effects are often closely related to the intrinsic receptor affinity responsible for the desired activity, and because metabolism often generates multiple new structures that can have quantitatively or qualitatively different types of biological activity (including enhanced toxicity), rational drug design processes need to address all these issues from the beginning and need to integrate them thoroughly. The focus should not be on increasing activity, but on increasing the therapeutic index (TI), which is usually defined as the ratio between the median toxic dose (TD50) and the median effective dose (ED50) and reflects activity, selectivity, and margin of safety.

To overcome these problems, metabolic and targeting considerations should be integrated into the drug discovery and development process from the very beginning. One needs to be aware of the fact that for any given drug, metabolic conversion can generate multiple metabolites that will have various activity and toxicity levels and that will be present at the different sites together with the original drug at varying concentrations. Hence, the overall activity and toxicity of any drug are, in fact, a combination of the intrinsic activity and toxicity of the original drug with those of all the metabolites created but not yet eliminated. The importance of drug metabolism in causing toxicity via reactive metabolites is finally being recognized, and structural alerts are being used increasingly in an attempt to minimize possible adverse drug reactions caused by reactive metabolites. However, just as activity considerations are built into the molecular structure of new drug candidates, the route of metabolic inactivation should also be built into the structure to avoid the formation of potentially toxic metabolites by design.

Here we describe general drug design and targeting approaches developed during the past 40 or so years that represent systematic methodologies that thoroughly integrate structure–activity and structure–metabolism relationships and are aimed to design safe, locally active compounds with an improved therapeutic index. They are integrated under the retrometabolic drug design and targeting concept, a terminology selected in analogy to E. J. Corey's well-known retrosynthetic concept used to design synthetic routes for complex natural products. Retrometabolic drug design approaches include two distinct methods aimed at designing soft drugs (SDs) and chemical delivery systems (CDSs), respectively. It is important to note that whereas both SDs and CDSs require designed-in enzymatic reactions to fulfill their drug targeting roles, they are at somewhat opposing ends of the spectrum: SDs are active as administered and are designed to be predictably metabolized by design into inactive species, while CDSs are inactive as administered and sequential enzymatic reactions provide the differential distribution and the ultimate release of the active drug. The first public exposure of some of these ideas took place in an IUPAC–IUPHAR Symposium in 1981 in Noordwijkerhout, The Netherlands. In a half-day open forum featuring two opposing ideas, one by the outstanding Dutch scientist E. J. Ariëns, who advocated the design of nonmetabolizable drugs, which can be called hard drugs, and the other by N. Bodor, who advocated the design of predictably and safely metabolizable drugs, which are now designated as soft drugs; the pros and cons were presented and discussed. While it became evident that it is virtually impossible to design drugs that do not metabolize at all (unless going to pharmacokinetic extremes), it was demonstrated that the second approach is quite general and that it indeed can lead to an improved therapeutic index. Subsequently, specific methods were developed for both the design of safe soft drugs and for the design of different organ-targeting chemical delivery systems. The application of these principles has already resulted in several Food and Drug Administration–approved marketed drugs.

In the present work, following a brief overview of the basic concepts of the mechanism of drug action as well as of the main phases of the drug discovery and development process, the general classes of soft drugs are presented with specific examples. In many cases, the relevant medicinal chemistry, pharmacokinetic, and pharmacodynamics aspects are discussed in detail. The most successful concepts are the inactive metabolite, soft analog, and active metabolite approaches. Subsequently, various CDS approaches are discussed, including those designed to provide brain targeting via a 1,4-dihydrotrigonelline trigonelline (dihydropyridine pyridinium) redox targetor system using a sequential metabolism approach as well as those designed to provide eye targeting via an oxime-type targetor. As a truly rational drug design system, the structural transformation rules needed to design metabolites and virtual soft drug libraries, respectively, are well defined and specific; therefore, the design process can to a large extent be computerized, and virtually any lead compound can be converted into a corresponding virtual soft drug library. To assist in the selection of the best candidates for synthesis and activity testing, the virtual structures can subsequently be ranked using molecular properties and metabolic rates predicted based on molecular descriptors calculated from the structure alone using semiempirical (e.g., AM1) quantum chemical methods.

ACKNOWLEDGMENTS

None of the accomplishments of the senior author's laboratory would have been possible without the contribution of some 150 graduate students, postdoctoral fellows, visiting scientists, and collaborators at the Center for Drug Discovery, University of Florida, whose work throughout the years is gratefully acknowledged. The work of the some 300 scientists, technicians, and staff employed by the Institute of Drug Research during the leadership of the senior author is also gratefully acknowledged. During all these years, collaborations and many invaluable discussions with mentors, co-workers, and friends also contributed significantly to the development and applications of all these concepts and ideas. The defining influences of Professors Michael J. S. Dewar, Takeru Higuchi, Michael Schwartz, Tsuneji Nagai, and Yuichi Sugiyama are acknowledged first. We are also grateful for the long-time help and support received from collaborators and co-workers such as Drs. Marcus E. Brewster, Thorsteinn Loftsson, James J. Kaminski, Efraim Shek, Emil Pop, John Howes, Hassan H. Farag, Hartmut Derendorf, Günther Hochhaus, Emy (Whei-Mei) Wu, Teruo Murakami, Gábor Somogyi, Sung-Hwa Yoon, Amy Buchwald, Fubao Ji, István Szelényi, Antal Simay, Katalin Horváth, István Kurucz, Zoltán Zubovics, Márta Pátfalusi, and many others. Daily lunch discussions through a six-year period with Phillip Frost, Chairman of Ivax Corporation and of Teva Pharmaceutical Industries, provided invaluable close insight into the working of the pharmaceutical industry and regulatory agencies. As always, all this work would not have been possible without the ongoing support and love of our families: Sheryl, Nicole, and Erik Bodor and Amy, Zoltan, and Zsuzsa Buchwald, respectively. Finally, let us note that most of the ideas, concepts, methods, and applications presented here are discussed regularly during a biannual Retrometabolic Drug Design and Targeting international scientific symposium series, which was started in 1997 and has its ninth conference scheduled for 2013 in Orlando, Florida.

NICHOLAS BODOR PETER BUCHWALD

1

Introduction

1.1 NEW DRUGS AND MEDICAL PROGRESS

The tremendous medical progress of the twentieth century, which has probably surpassed the progress during the rest of human history combined, was driven primarily by the progress in drug research and discovery [1–4]. Introduction of effective new drugs can provide enormous therapeutic benefits, and sometimes can even create entirely new therapeutic fields. Whereas even the best physician can help only a very limited number of patients during an entire lifetime—probably a few thousands at best—a new drug may help millions and in some cases may even help establish an entirely new therapeutic area. In today's developed industrial societies, we have already became so accustomed to many medical treatments which were real breakthroughs at their introduction that it is difficult to imagine what life could have been like before their introduction. Some of the more important ones include (Figure 1.1), for example (shown with their year of introduction in the United States) [5, 6]:

Morphine (1-1; ca.1806): the most abundant alkaloid in opium and a potent opiate analgesic isolated in the early nineteenth century and first marketed by Merck starting in 1827; still the gold standard analgesic used to relieve severe or agonizing pain and sufferingAspirin (1-2; ca.1899): prepared by Felix Hoffman and Arthur Eichengrün at Bayer in an attempt to find a salicylic acid derivative that causes less gastric irritation but maintains its anti-inflammatory properties;Arsphenamine (1-3; 1910): the first modern chemotherapeutic agent; also known as Salvarsan or 606; discovered by Sahachiro Hata and Paul Ehrlich in a rational and focused synthetic screening effort; used to treat syphilis and trypanosomiasisInsulin (1-4; 1922): the first lifesaving miracle drug; resulting from the work of Frederick Banting, Charles Best, John MacLeod, and others at the University of Toronto; completely altered the perspective of type 1 diabetes mellitus patientsSulfamidochrysoidine (1-5; ca.1935): the first effective sulfa drug (prontosil); resulting from the work of Gerhardt Domagk with azo dyes that became the first commercially available antibacterial and began the era of antimicrobial chemotherapyPenicillin (1-6; 1928–1948): the powerful antibacterial miracle drug; discovered accidentally by Alexander Fleming and then resurrected and produced in large quantities by Howard Florey and Boris Ernst Chain during World War IIMethotrexate (1-7; 1950): a folic acid analog and a dihydrofolate reductase inhibitor; resulting from the work of Sidney Farber at Harvard Medical School, Yellapragada Subbarao at Lederle, and others; one of the earliest successful anticancer agents and the mainstay of leukemia chemotherapyHydrocortisone (1-8; cortisol; 1952): a glucocorticoid steroid hormone synthesized by the adrenal glands that produces potent anti-inflammatory and immune-suppressive effects; discovered in the 1940s mainly by Philip Showalter Hench, Edward Calvin Kendall, and Tadeusz Reichstein during their work on hormones of the adrenal cortexChlorpromazine (1-9; 1953): synthesized by Paul Charpentier at Laboratoires Rhône-Poulenc as part of a search for new antihistamines and promoted for psychiatric use mainly by Henri Laborit, so that the entire field of today's psychopharmacology was, in fact, built on the foundation of a poor antihistamineNorethindrone (1-10; 1960): the first orally highly active progestin; synthesized by Carl Djerassi, George Rosenkranz, and co-workers at Syntex; ushered in the era of oral contraceptionDiazepam (1-11; 1963): a follow-up benzodiazepine to chlordiazepoxide; synthesized by Leo Sternbach at Hoffmann–La Roche; became a widely used anxiolytic and a top-selling drug during the 1970sFentanyl (1-12; 1968): a μ-opioid receptor agonist analgesic; synthesized by Paul Janssen; about two orders of magnitude more potent than morphine but of shorter duration of actionPropranolol (1-13; 1968): an antihypertensive, antianginal, and antiarrhythmic β-blocker; developed by James W. Black at Imperial Chemical Industries, UK from the earlier β-adrenergic antagonists dichloroisoprenaline and pronethalolCimetidine (1-14; 1979): an antiulcerative histamine H2-receptor antagonist; resulting from the work of James W. Black, C. Robin Ganellin, and others at Smith, Kline and FrenchCyclosporine (cyclosporin A, 1-15; 1983): a fungal metabolite; isolated at Sandoz while screening for antibiotics; revolutionalized organ transplantation when it turned out to be a potent immunosuppressant capable of preventing rejectionLovastatin (1-16; 1987): a fungal metabolite and the first of the statin class of drugs (HMG-CoA reductase inhibitor); discovered by Akira Endo and Masao Kuroda; received approval for the treatment of high cholesterol levels (hypercholesterolemia)Fluoxetine (1-17; 1987): a widely used specific serotonin reuptake inhibitor type of antidepressant; discovered by David Wong, Jong-Sir Horng, and others at Eli LillySildenafil (1-18; 1998): a cGMP-specific phosphodiesterase type 5 inhibitor; developed at Pfizer originally for use in hypertension and angina pectoris, but now in wide use for erectile dysfunctionRituximab (1-19; 1997): a chimeric monoclonal antibody against CD20 (a B-cell marker); used in the treatment of many lymphomas and leukemias, in transplant rejection, and for some autoimmune disorders; one of the first successful biotechnology drugs

FIGURE 1.1 Some of the important drugs that provided significant therapeutic improvements at the time of their introduction (shown in approximate chronological order). For each drug, its year of U.S. market approval (or an equivalent estimate) and its main therapeutic category are also shown. During the twentieth century, these drugs completely altered the way of life in all industrialized nations.

These structures, all shown in Figure 1.1, obviously represent a somewhat subjective selection. Nevertheless, as the result of these developments, many previously deadly infectious diseases, such as cholera, diphtheria, measles, pertussis, plague, scarlet fever, smallpox, tuberculosis, and typhoid fever, are now curable or avoidable. Even if there are still many serious diseases that represent a therapeutic challenge (e.g., Alzheimer's disease, cancer, influenza, multiple sclerosis, Parkinson's disease), many others were alleviated and are now manageable for the long term (e.g., asthma, diabetes mellitus, schizophrenia). The mortality associated with syphilis and other sexually transmittable diseases has also been eliminated and even AIDS has become a disease manageable for the long term. All this progress, achieved mostly within the last 100 years, is especially astonishing if we look at it in the light of W. C. Bowman's comment that “generally speaking, until really quite recently—well into the 20th century in fact—treatment by most available medicines was at best only marginally beneficial and at worst positively harmful” [7]. For a long period of human history, Voltaire (François-Marie Arouet, 1694–1778) was probably right when he noted that “doctors are men who prescribe medicines of which they know little, to cure diseases of which they know less, in human beings of whom they know nothing.” For example, substances that at some point have been used by doctors to treat illnesses include, among many others: snake skin, spider's web, crocodile dung, frog sperm, and eunuch fat, not to mention mercury and the sexual organs of a variety of animals. For a short period of time during the early twentieth century, Bayer, one of the earliest pharmaceutical companies, was proudly marketing aspirin (1-2) (acetylsalicylic acid—the acetylated derivative of salicylic acid that causes less digestive upset than pure salicylic acid, its active ingredient) together with diacetylmorphine synthesized on the basis of somewhat similar considerations as a safe alternative to morphine (1-1) and even coined the name heroin for it (see Figure 6–4) [6]. The same heroin, of course, is now well recognized as one of our most addictive and socially harmful substances [8], and Bayer quickly stopped marketing it when the problems became obvious.

Compared to most of the twentieth century, during the last few decades, progress in identifying true breakthrough drugs may have slowed for a number of possible reasons, which are discussed briefly later, such as increasing focus on safety and regulation, the increasing difficulty of finding new effective targets (i.e., the possibility that all the “low-hanging fruit” has already been picked), the need to outperform all existing drugs (many of which are highly effective), the pursuit of speculative unproven targets, the inherent inefficiency of the very large organizations that are left in the pharmaceutical industry, and others ([9, 10] and references therein). Nevertheless, new drug launches continue to contribute significantly to improving health care by increasing the quality of life as well as longevity. Life expectancy at birth has been rising continuously in both developed industrialized nations and in less developed regions (Figure 1.2A), due to increasing access to medication and to the introduction of new therapeutic agents. Obviously, it is difficult to estimate exactly how much newly introduced drugs, called new chemical entities, contribute to the continuous worldwide increase in average life expectancy, but according to an estimate on the basis of a complex algorithm, this contribution is close to about half of the total increase seen even since the late 1980s, despite no real lifesaving medical breakthroughs discovered since then (Figure 1.2B) [11]. Even if drugs sometimes seem very expensive, they can be quite cost-effective. An example quoted in a recent book on drug discovery is illustrative [12]: While still a new, proprietary compound, the cost per unit weight of omeprazole was around $200,000 a pound, roughly 500 times more than the corresponding cost of $400 a pound of an F-18 Hornet aircraft, not exactly a cheap technology itself. Even if the cumulative sales of this heartburn medicine were about $40 billion, a large cost at first sight, the use of this drug was estimated to result ultimately in savings to society of about $85 billion, because its use reduced by 75% the gastric surgeries resulting from gastric ulcer complications.

FIGURE 1.2 Life expectancy at birth is increasing continuously in both developed industrialized nations and in the less developed regions of the world (A). A good portion of this is estimated to be due to the introduction of new drugs, even after mid-1980 (B), despite no real breakthrough medical therapies discovered since then. (Prepared using data from [11].)

1.2 THE CHALLENGE OF NEW DRUG DISCOVERY

Unfortunately, the discovery and development of a new chemical entity (NCE) that can reach the market as an effective new drug is a long, arduous, and expensive process. The odds of finding a new compound with the right combination of activity, selectivity, stability, and safety are very unfavorable, especially if one considers that the possible (or “allowable”) chemical space is incomprehensibly large [13]. Whereas the simplest living organisms can function with just a few hundreds of molecules (with less than 100 types accounting for nearly the entire molecular pool), and even human bodies might not contain more than a few thousand different types of small molecules at any given time [13], the chemically possible molecular structures represent a very large number. Even if we restrict ourselves to stable and reasonably small compounds (molecular mass <500) that contain only building blocks common in medicinal chemistry (C, H, N, O, S, P, F, Cl, and Br), the number of possibilities is astronomically high; it has been estimated to be around 1062 to 1063 [14]. Hence, accidentally hitting upon a right structure by a purely empirical trial-and-error process is highly unlikely, and performing the exhaustive syntheses and efficacy tests of all possible structures is completely impossible.

Medicinal chemistry, pharmacology, molecular biology, and related fields have certainly witnessed significant changes due to advances in the elucidation of the molecular–biochemical mechanisms of drug action and to other technical developments; nevertheless, rational drug design, which would allow the development of effective pharmaceutical agents with minimal side effects on as rational a basis as possible, is still an elusive goal. In fact, the situation seems to have worsened as a result of increasing regulation and the increased complexity of drug research, which has arguably hampered true innovation. There is increasing evidence for a slowdown as the number of NCEs launched per year has essentially stagnated around 15 to 25 per year since the mid-1960s, despite exponentially increasing research and development (R&D) expenditures (Figure 1.3) [10,15–21]. To understand the problems and to be able to discuss them in a meaningful manner, it is probably useful first to review the main basic concepts behind the mechanism of drug action and then the current drug discovery and drug development process in general, which we do in Chapter 2.

FIGURE 1.3 Number of small-molecule new chemical entities (NCEs) and biologics launched annually in the United States with FDA approval (heavy and light solid lines, respectively; scale on the left vertical axis) has been essentially stagnating since the mid-1960s, whereas research and development costs (shown here calculated per NCE launched in millions of U.S. dollars, dashed line; scale on the right vertical axis) grew exponentially. (Prepared based on data from [15,20,21].)

REFERENCES

[1] Le Fanu, J. The Rise and Fall of Modern Medicine, Carrol & Graf: New York, 1999.

[2] Drews, J. Drug discovery: a historical perspective. Science, 2000, 287, 1960–1964.

[3] Corey, E. J.; Czakó, B.; Kürti, L. Molecules and Medicine, Wiley: Hoboken, NJ, 2007.

[4] Nicolaou, K. C.; Montagnon, T. Molecules That Changed the World, Wiley-VCH: Weinheim, Germany, 2008.

[5] Sneader, W. Drug Discovery: A History, Wiley: Hoboken, NJ, 2005.

[6] Chast, F. A history of drug discovery. In The Practice of Medicinal Chemistry; Wermuth, C. G., Ed.; Academic Press: London, 2008; pp. 3–62.

[7] Prüll, C. R.; Maehle, A. H.; Halliwell, R. F. A Short History of the Drug Receptor Complex, Palgrave Macmillan: New York, 2009.

[8] Nutt, D.; King, L. A.; Saulsbury, W.; Blakemore, C. Development of a rational scale to assess the harm of drugs of potential misuse. Lancet, 2007, 369, 1047–1053.

[9] Walters, W. P.; Green, J.; Weiss, J. R.; Murcko, M. A. What do medicinal chemists actually make? A 50-year retrospective. J. Med. Chem., 2011, 54, 6405–6415.

[10] Scannell, J. W.; Blanckley, A.; Boldon, H.; Warrington, B. Diagnosing the decline in pharmaceutical R&D efficiency. Nat. Rev. Drug Discov., 2012, 11, 191–200.

[11] Lichtenberg, F. R. The impact of new drug launches on longevity: evidence from longitudinal, disease-level data from 52 countries, 1982–2001. Int. J. Health Care Finance Econ., 2005, 5, 47–73.

[12] Bartfai, T.; Lees, G. V. Drug Discovery: From Bedside to Wall Street, Academic Press: San Diego, CA, 2005.

[13] Dobson, C. M. Chemical space and biology. Nature, 2004, 432, 824–828.

[14] Bohacek, R. S.; McMartin, C.; Guida, W. C. The art and practice of structure-based drug design: a molecular modeling perspective. Med. Res. Rev., 1996, 16, 3–50.

[15] Reuben, B. G. The consumption and production of pharmaceuticals. In The Practice of Medicinal Chemistry; Wermuth, C. G., Ed.; Academic Press: London, 1996; pp. 903–938.

[16] Reuben, B. G. The consumption and production of pharmaceuticals. In The Practice of Medicinal Chemistry; Wermuth, C. G., Ed.; Academic Press: London, 2008; pp. 894–921.

[17] Buchwald, P.; Bodor, N. Computer-aided drug design: the role of quantitative structure–property, structure–activity, and structure-metabolism relationships (QSPR, QSAR, QSMR). Drugs Future, 2002, 27, 577–588.

[18] Tufts Center for the Study of Drug Development. Outlook 2007; Tufts: Boston, MA, 2007; pp. 1–6.

[19] Yildirim, M. A.; Goh, K. I.; Cusick, M. E.; Barabasi, A. L.; Vidal, M. Drug–target network. Nat. Biotechnol., 2007, 25, 1119–1126.

[20] Pharmaceutical Research and Manufacturers of America. 2001Industry Profile, PhRMA: Washington, DC, 2001.

[21] Hughes, B. 2009 FDA drug approvals. Nat. Rev. Drug Discov., 2010, 9, 89–92.

2

Mechanism of Drug Action: Basic Concepts

According to our current understanding, the physiological effects generated by biologically active substances, including drugs, are a function of (1) the amount of active compound that actually reaches a receptor (or an effect compartment in general), which in a general picture can be an enzyme, an ion channel, a receptor protein, a nucleic acid (a gene sequence), or any other biological macromolecule, and (2) the strength of the interaction at this site (affinity) plus the relevance of the structural changes produced at this site (efficacy). A schematic summary of all the processes involved in a drug being able to exert its therapeutic effect is presented in Figure 2.1. In most cases, only a very small portion of the dose administered reaches the intended site of action (i.e., the receptor), which is ultimately responsible for the desired effect. Considerable fractions can be lost during sequential processes that involve, among others, dissolution, absorption, distribution, metabolism (which result in the formation of various metabolites Mk, including possible toxic intermediates In*), and excretion (ADME). Therefore, the therapeutic potential of a drug is a function of the various properties determining both the efficacy of the entire stimulus–response mechanism [1] and the overall ADME behavior. The four main phases required are usually categorized as follows (Figure 2.1) [2–4]: (1) the (bio)pharmaceutical phase, during which the drug has to get from its formulation into the biological system (e.g., for therapeutic purposes, into the patient); (2) the pharmacokinetic phase, during which the drug has to get to its site of action; (3) the pharmacodynamic phase, during which the required pharmacological effect is produced; and (4) the therapeutic phase, during which the pharmacological effect is translated into a therapeutic effect. There are many detailed and good reviews on the basic concepts of drug action, medicinal chemistry, and their implication on drug design and development [4–8], so these are covered here only to the extent of a brief overview, which is needed to understand the main concepts discussed later. We proceed in a sort of reverse order, starting with the receptor and proceeding backward.

FIGURE 2.1 Schematic summary showing the fate of drug molecules (D) during all the processes necessary to exert their final therapeutic effect following administration. In most cases, only a very small portion of the dose administered reaches the intended site of action (receptor), which is ultimately responsible for the beneficial therapeutic effect, as considerable fractions can be lost during sequential processes that involve, among others, dissolution, absorption, distribution, metabolism (which result in the formation of various metabolites Mk, including possible toxic intermediates In*), and excretion (ADME). The four main phases required are summarized in the text.

2.1 PHARMACODYNAMIC PHASE: DRUG–RECEPTOR INTERACTIONS

2.1.1 The Receptor Concept and Receptor Types

The receptor concept, which was heralded by the work of Langley [9,10] and elaborated by Ehrlich (corpora non agunt nisi fixata) [11–13] toward the end of the nineteenth century [14], followed by the quantitative work of Clark [15,16], lies at the core of today's pharmacology and mechanism of drug action theory. A receptor has to bind a ligand and must transduce this into some type of functional response. Typically, a receptor has to show structural specificity in binding its (natural) ligand (including stereospecific binding), and the binding should be saturable and limited. The pharmacological receptors, which are of obvious interest in characterizing drug action, are typically classified into four main classes [17]; from fast to slow mode of action, they are:

Ligand-gated ion channels (ionotropic receptors), which are involved primarily in fast synaptic transmissions so that ligand binding and channel opening occur on a millisecond time scale. There are several structural families, but most commonly they are heteromeric assemblies of four or five subunits with transmembrane helices arranged around a central aqueous channel. Some well-known examples include the nicotinic acetylcholine receptor, the γ-aminobutyric acid (GABA) type A (GABA) receptor, and the 5-hydroxytryptamine type 3 (5-HT) receptor.