Discovery of a Potent and Orally Bioavailable Hypoxia-Inducible Factor 2α (HIF-2α) Agonist and Its Synergistic Therapy with Prolyl Hydroxylase Inhibitors for the Treatment of Renal Anemia

J Med Chem. 2021 Dec 9;64(23):17384-17402. doi: 10.1021/acs.jmedchem.1c01479. Epub 2021 Oct 28.

Abstract

Activation of hypoxia-inducible factor 2 (HIF-2) has emerged as a potent renal anemia treatment strategy. Here, the benzisothiazole derivative 26 was discovered as a novel HIF-2α agonist, which first demonstrated nanomolar activity (EC50 = 490 nM, Emax = 349.2%) in the luciferase reporter gene assay. Molecular dynamics simulations indicated that 26 could allosterically enhance HIF-2 dimerization. Furthermore, compound 26 had a good pharmacokinetic profile (the oral bioavailability in rats was 41.38%) and an in vivo safety profile (the LD50 in mice was greater than 708 mg·kg-1). In the in vivo efficacy assays, the combination of 26 and the prolyl hydroxylase inhibitor, AKB-6548, was confirmed for the first time to synergistically increase the plasma erythropoietin level in mice (from 260 to 2296 pg·mL-1) and alleviate zebrafish anemia induced by doxorubicin. These results provide new insights for HIF-2α agonists and the treatment of renal anemia.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Oral
  • Anemia / drug therapy*
  • Animals
  • Basic Helix-Loop-Helix Transcription Factors / agonists*
  • Biological Availability
  • Drug Discovery*
  • Humans
  • Mice
  • Prolyl-Hydroxylase Inhibitors / chemistry*
  • Prolyl-Hydroxylase Inhibitors / pharmacology
  • Prolyl-Hydroxylase Inhibitors / therapeutic use*
  • Rats
  • Rats, Sprague-Dawley
  • Renal Insufficiency, Chronic / drug therapy*
  • Structure-Activity Relationship
  • Zebrafish

Substances

  • Basic Helix-Loop-Helix Transcription Factors
  • Prolyl-Hydroxylase Inhibitors
  • endothelial PAS domain-containing protein 1