Discovery of Novel and Potent Prolyl Hydroxylase Domain-Containing Protein (PHD) Inhibitors for The Treatment of Anemia

J Med Chem. 2024 Jan 25;67(2):1393-1405. doi: 10.1021/acs.jmedchem.3c01932. Epub 2024 Jan 8.

Abstract

Stabilization of hypoxia-inducible factor (HIF) by inhibiting prolyl hydroxylase domain enzymes (PHDs) represents a breakthrough in treating anemia associated with chronic kidney disease. Here, we identified a novel scaffold for noncarboxylic PHD inhibitors by utilizing structure-based drug design (SBDD) and generative models. Iterative optimization of potency and solubility resulted in compound 15 which potently inhibits PHD thus stabilizing HIF-α in vitro. X-ray cocrystal structure confirmed the binding model was distinct from previously reported carboxylic acid PHD inhibitors by pushing away the R383 and Y303 residues resulting in a larger inner subpocket. Furthermore, compound 15 demonstrated a favorable in vitro/in vivo absorption, distribution, metabolism, and excretion (ADME) profile, low drug-drug interaction risk, and clean early safety profiling. Functionally, oral administration of compound 15 at 10 mg/kg every day (QD) mitigated anemia in a 5/6 nephrectomy rat disease model.

MeSH terms

  • Administration, Oral
  • Anemia* / drug therapy
  • Animals
  • Hypoxia-Inducible Factor 1, alpha Subunit
  • Hypoxia-Inducible Factor-Proline Dioxygenases / metabolism
  • Prolyl Hydroxylases
  • Prolyl-Hydroxylase Inhibitors* / pharmacology
  • Prolyl-Hydroxylase Inhibitors* / therapeutic use
  • Rats
  • Renal Insufficiency, Chronic* / drug therapy

Substances

  • Prolyl Hydroxylases
  • Prolyl-Hydroxylase Inhibitors
  • Hypoxia-Inducible Factor-Proline Dioxygenases
  • Hypoxia-Inducible Factor 1, alpha Subunit