The ratio TD
50
/ED
50
is defined as a drug’s therapeutic
index, the ratio of the dose of the drug that produces toxi-
city to that which produces the desired effect. It is, of
course, preferable that a drug have a high therapeutic in-
dex, but this is not always possible.
b. Cathepsin K Is a Drug Target for Osteoporosis
The development of genomic sequencing techniques
(Section 7-2B) and hence the characterization of tens of
thousands of previously unknown genes is providing an
enormous number of potential drug targets. For example,
osteoporosis (Greek: osteon, bone poros, porous), a con-
dition that afflicts mostly postmenopausal women, is char-
acterized by the progressive loss of bone mass leading to a
greatly increased frequency of bone fracture, most often of
the hip, spine, and wrist. Bones consist of a protein matrix
that is 90% type I collagen (Section 8-2B), in which
spindle- or plate-shaped crystals of hydroxyapatite,
Ca
5
(PO
4
)
3
OH, are embedded. Bones are by no means
static structures. They undergo continuous remodeling
through the countervailing action of two types of bone
cells: osteoblasts (Greek:blast, germ cell),which synthesize
bone’s protein matrix in which its mineral component is
laid down; and osteoclasts (Greek: clast, broken), which
solubilize mineralized bone matrix through the secretion
of proteolytic enzymes into an extracellular bone resorp-
tion pit, which is maintained at pH 4.5. The acidic solution
dissolves the bone’s mineral component, thereby exposing
its protein matrix to proteolytic degradation. Osteoporosis
arises when bone resorption outstrips bone formation.
In the search for a drug target for osteoporosis, a cDNA
library (Sections 5-5E and 5-5Fa) was prepared from an
osteoclastoma (a cancer derived from osteoclasts; normally
osteoclasts are very rare cells). Around 4% of these cDNAs
encode a heretofore unknown protease, which was named
cathepsin K (cathepsins are proteases that occur in the lyso-
some). Further studies, both at the cDNA and protein levels,
indicated that cathepsin K is only expressed at high levels in
osteoclasts. Microscopic examination of osteoclasts that had
been stained with antibodies directed against cathepsin K
revealed that this enzyme is localized at the contact site be-
tween osteoclasts and the bone resorption pit. Subsequently,
it was shown that mutations in the gene encoding cathepsin
K are the cause of pycnodysostosis, a rare hereditary disease
which is characterized by hardened and fragile bones, short
stature, skull deformities, and osteoclasts that demineralize
bone normally but do not degrade its protein matrix. Evi-
dently, cathepsin K functions to degrade the protein matrix
of bone and hence is an attractive drug target for the treat-
ment of osteoporosis. Indeed, several cathepsin K inhibitors
are in clinical trials (Section 15-4Bb).
c. SARs and QSARs Are Useful Tools for
Drug Discovery
A lead compound is used as a point of departure to design
more efficacious compounds. Experience has shown that
even minor modifications to a drug candidate can result in
major changes in its pharmacological properties. Thus, one
might place methyl, chloro, hydroxyl, or benzyl groups at
various places on a lead compound in an effort to improve
its pharmacodynamics. For most drugs in use today, 5 to 10
thousand related compounds were typically synthesized in
generating the medicinally useful drug.These were not ran-
dom procedures but were guided by experience as medici-
nal chemists tested various derivatives of a lead compound:
For those compounds that had improved efficacy, deriva-
tives were made and tested; etc. This process has been sys-
tematized through the use of structure–activity relation-
ships (SARs): the determination, via synthesis and
screening, of which groups on a lead compound are impor-
tant for its drug function and which are not. For example, if
a phenyl group on a lead compound interacts hydrophobi-
cally with a flat region of its receptor, then hydrogenating
the phenyl ring to form a nonplanar cyclohexane ring will
yield a compound with reduced affinity for the receptor.
A logical extension of the SAR concept is to quantify it,
that is, to determine a quantitative structure–activity rela-
tionship (QSAR). This idea is based on the premise that
there is a relatively simple mathematical relationship be-
tween the biological activity of a drug and its physicochem-
ical properties. For instance, if the hydrophobicity of a drug
is important for its biological activity, then changing the
substituents on the drug so as to alter its hydrophobicity
will affect its activity. A measure of the substance’s hy-
drophobicity is its partition coefficient, P, between the two
immiscible solvents, octanol and water, at equilibrium:
[15.15]
Biological activity may be expressed as 1/C, where C is the
drug concentration required to achieve a specified level of
biological function (e.g., IC
50
).Then a plot of log 1/C versus
log P (the use of logarithms keeps the plot on a manage-
able scale) for a series of derivatives of the lead compound
having a relatively small range of log P values often indi-
cates a linear relationship (Fig. 15-29a), which can there-
fore be expressed:
[15.16]
Here k
1
and k
2
are constants, whose optimum values in this
QSAR can be determined by computerized curve-fitting
methods. For compounds with a larger range of log P val-
ues, it is likely that a plot of log 1/C versus log P will have a
maximum value (Fig. 15-29b) and hence be better de-
scribed by a quadratic equation:
[15.17]
Of course, the biological activities of few substances de-
pend only on their hydrophobicities. A QSAR can there-
fore simultaneously take into account several physico-
chemical properties of substituents such as their pK values,
van der Waals radii, hydrogen bonding energy, and confor-
mation.The values of the constants for each of the terms in
a QSAR is indicative of the contribution of that term to the
drug’s activity. The use of QSARs to optimize the biologi-
cal activity of a lead compound has proven to be a valuable
tool in drug discovery.
log
a
1
C
b k
1
(log P)
2
k
2
log P k
3
log a
1
C
b k
1
log P k
2
P
concentration of drug in octanol
concentration of drug in water
540 Chapter 15. Enzymatic Catalysis
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