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CARDIOVASCULAR DRUGS
Punniyakoti VT
Lovastatin, Simvastatin, and Pravastatin
• One of the most significant natural product discoveries in the last 25 years has
been a fungal secondary metabolite called lovastatin.
• Heralded as a major breakthrough in the treatment of coronary heart disease,
lovastatin was introduced onto the market by Merck in 1987 for the treatment of
hypercholesterolemia.
• Lovastatin works by inhibiting 3-hydroxy-3-methyl glutaryl coenzyme A (HMG-
CoA) reductase, a key rate-limiting enzyme in the cholesterol biosynthetic
pathway.
Lovastatin
• However, the first specific inhibitors of this enzyme were discovered several years
earlier by Endo et al. at Sankyo.
• The compounds, which are structurally related to lovastatin, were isolated from
Penicillium citrinum and shown to block cholesterol synthesis in rats and lower
cholesterol levels in the blood.
• Development of the most active compound, designated ML-236B, is believed to
have been curtailed because of toxicity problems.
• Brown et al. at Beechams also reported the isolation of
(ML-236B), but as a metabolite from Penicillium
brevicompactum. The group, naming the compound
compactin, reported its antifungal activity but failed to
reveal its mode of action as an inhibitor of HMG-CoA
reductase.
Lovastatin, Simvastatin, and Pravastatin
compactin
• The search for naturally occurring inhibitors of HMG-CoA reductase gained pace and after
spending several years developing appropriate screens, Merck found during only the second
week of testing a culture of Aspergillus terreus that displayed interesting inhibitory activity.
• In February 1979 the active component, lovastatin (mevinolin), was isolated and characterized,
and in November the following year Merck was granted patent protection in the United States.
• The discovery of compactin and lovastatin prompted efforts to develop derivatives with improved
biological properties.
• Modification of the methylbutyryl side chain of lovastatin led to a series of new ester derivatives
with varying potency and, in particular, introduction of an additional methyl group to the carbonyl
gave a compound with 2.5 times the intrinsic enzyme activity of lovastatin.
• The new derivative, named simvastatin, was the second HMG-CoA reductase inhibitor to be
marketed by Merck.
lovastatin simvastatin
• Both lovastatin and simvastatin are prodrugs and are hydrolyzed to their active
open-chain dihydroxy acid forms in the liver.
• A third compound, pravastatin, launched by Sankyo and Squibb in 1989, is the
open hydroxyacid form of compactin that was first identified as a urinary
metabolite in dogs.
• Pravastatin is produced by microbial biotransformation of compactin.
compactin
Microbial biotransformation
Pravastatin
• The HMG-CoA reductase inhibitors described above bind to two active sites on
the enzyme: the hydroxymethylglutaryl binding domain and an adjacent
hydrophobic pocket to which the decalin moiety binds.
• The recognition that the ring-opened hydroxy acids resemble mevalonic acid and
that the decalin moiety could be replaced by 4-fluorophenyl-substituted
heterocycles led to the launch of several new products including fluvastatin, the
ill-fated cerivastatin, and the so-called turbostatin “atorvastatin”.
cerivastatinfluvastatin atorvastatin
• Although cerivastatin was withdrawn from the market in 2001 because of fatal
adverse drug-drug interactions, the "statins" remain one of the fastest growing
segments of the pharmaceutical industry.
• The latest member of this group of cholesterol-lowering drugs, AstraZeneca's
rosuvastatin.
rosuvastatin
• the significance of ACE in the pathogenesis of hypertension was not fully
appreciated until the 1970s after Ondetti et al. had first isolated and then
synthesized the naturally occurring nonapeptide, teprotide.
• The compound proved to be a specific potent inhibitor of ACE and showed
excellent antihypertensive properties in clinical trials, although its use was limited
by the lack of oral activity.
• The discovery of teprotide led to a search for new, specific, orally active ACE
inhibitors.
• Ondetti et al. proposed a hypothetical model of the active site of ACE, based on
analogy with pancreatic carboxypeptidase A, and used it to predict and design
compounds that would occupy the carboxy-terminal binding site of the enzyme.
Teprotide and Captopril
teprotide
• Carboxyalkanoyl and mercaptoalkanoyl derivatives of proline were found to act
as potent, specific inhibitors of ACE and 2-D-methyl-3-mercaptopropanoyl-L-
proline (captopril) was developed and launched in 1981 as an orally active
treatment for patients with severe or advanced hypertension.
• Captopril, modeled on the biologically active peptides found in the venom of the
pit viper, made an important contribution to the understanding of hypertension
and paved the way for other ACE inhibitors, such as enalapril and lisinopril, which
have had a major impact on the treatment of cardiovascular disease.
Captopril Enalapril Lisinopril
• The compound was identified as 3,3'-methylenebis(4-hydroxycoumarin), an
oxidative degradation metabolite of coumarin, itself a common component of
Melilotus sp.
• Soon after the compound had been identified, trials were initiated that confirmed
the oral anticoagulant activity in humans and in 1942 it was marketed under the
name dicoumarol.
Dicoumarol and Warfarin
3,3'-methylenebis(4-hydroxycoumarin)
Dicoumarol
coumarin Warfarin
• The compound had a slow, erratic onset of action and efforts were initiated to
prepare synthetic analogs that acted faster and had longer duration of action.
• A 4-hydroqcoumarin residue, substituted at the 3-position, proved essential for
biological activity and
• In 1948, after synthesizing over 150 compounds, a 4-hydroxycoumarin
derivative that was longer acting and more potent than dicoumarol was
selected not for clinical use, but as a rodenticide.
• The compound named warfarin, became a household name for rat poison.
Concern over the use of oral anticoagulants and the inherent risk of
hemorrhage inhibited the development of warfarin as a therapeutic agent.
• However, in 1951, a U.S. Army cadet unsuccessfully attempted to commit
suicide by taking massive doses of the compound.
• The incident prompted further clinical trials that resulted in warfarin being
used as the anticoagulant of choice for prevention of thromboembolic
disease.
• The mode of action of the coumarin anticoagulants involves blocking the
regeneration of reduced vitamin K and induces a state of functional vitamin
K deficiency, thus interfering with the blood-clotting mechanism.
• Warfarin decreases blood clotting by blocking an enzyme called vitamin K
epoxide reductase that reactivates vitamin K1. Without sufficient active
vitamin K1, clotting factors II, VII, IX, and X have decreased clotting ability.

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Cardiovascular drugs

  • 2. Lovastatin, Simvastatin, and Pravastatin • One of the most significant natural product discoveries in the last 25 years has been a fungal secondary metabolite called lovastatin. • Heralded as a major breakthrough in the treatment of coronary heart disease, lovastatin was introduced onto the market by Merck in 1987 for the treatment of hypercholesterolemia. • Lovastatin works by inhibiting 3-hydroxy-3-methyl glutaryl coenzyme A (HMG- CoA) reductase, a key rate-limiting enzyme in the cholesterol biosynthetic pathway. Lovastatin
  • 3. • However, the first specific inhibitors of this enzyme were discovered several years earlier by Endo et al. at Sankyo. • The compounds, which are structurally related to lovastatin, were isolated from Penicillium citrinum and shown to block cholesterol synthesis in rats and lower cholesterol levels in the blood. • Development of the most active compound, designated ML-236B, is believed to have been curtailed because of toxicity problems. • Brown et al. at Beechams also reported the isolation of (ML-236B), but as a metabolite from Penicillium brevicompactum. The group, naming the compound compactin, reported its antifungal activity but failed to reveal its mode of action as an inhibitor of HMG-CoA reductase. Lovastatin, Simvastatin, and Pravastatin compactin
  • 4. • The search for naturally occurring inhibitors of HMG-CoA reductase gained pace and after spending several years developing appropriate screens, Merck found during only the second week of testing a culture of Aspergillus terreus that displayed interesting inhibitory activity. • In February 1979 the active component, lovastatin (mevinolin), was isolated and characterized, and in November the following year Merck was granted patent protection in the United States. • The discovery of compactin and lovastatin prompted efforts to develop derivatives with improved biological properties. • Modification of the methylbutyryl side chain of lovastatin led to a series of new ester derivatives with varying potency and, in particular, introduction of an additional methyl group to the carbonyl gave a compound with 2.5 times the intrinsic enzyme activity of lovastatin. • The new derivative, named simvastatin, was the second HMG-CoA reductase inhibitor to be marketed by Merck. lovastatin simvastatin
  • 5. • Both lovastatin and simvastatin are prodrugs and are hydrolyzed to their active open-chain dihydroxy acid forms in the liver. • A third compound, pravastatin, launched by Sankyo and Squibb in 1989, is the open hydroxyacid form of compactin that was first identified as a urinary metabolite in dogs. • Pravastatin is produced by microbial biotransformation of compactin. compactin Microbial biotransformation Pravastatin
  • 6. • The HMG-CoA reductase inhibitors described above bind to two active sites on the enzyme: the hydroxymethylglutaryl binding domain and an adjacent hydrophobic pocket to which the decalin moiety binds. • The recognition that the ring-opened hydroxy acids resemble mevalonic acid and that the decalin moiety could be replaced by 4-fluorophenyl-substituted heterocycles led to the launch of several new products including fluvastatin, the ill-fated cerivastatin, and the so-called turbostatin “atorvastatin”. cerivastatinfluvastatin atorvastatin
  • 7. • Although cerivastatin was withdrawn from the market in 2001 because of fatal adverse drug-drug interactions, the "statins" remain one of the fastest growing segments of the pharmaceutical industry. • The latest member of this group of cholesterol-lowering drugs, AstraZeneca's rosuvastatin. rosuvastatin
  • 8. • the significance of ACE in the pathogenesis of hypertension was not fully appreciated until the 1970s after Ondetti et al. had first isolated and then synthesized the naturally occurring nonapeptide, teprotide. • The compound proved to be a specific potent inhibitor of ACE and showed excellent antihypertensive properties in clinical trials, although its use was limited by the lack of oral activity. • The discovery of teprotide led to a search for new, specific, orally active ACE inhibitors. • Ondetti et al. proposed a hypothetical model of the active site of ACE, based on analogy with pancreatic carboxypeptidase A, and used it to predict and design compounds that would occupy the carboxy-terminal binding site of the enzyme. Teprotide and Captopril teprotide
  • 9. • Carboxyalkanoyl and mercaptoalkanoyl derivatives of proline were found to act as potent, specific inhibitors of ACE and 2-D-methyl-3-mercaptopropanoyl-L- proline (captopril) was developed and launched in 1981 as an orally active treatment for patients with severe or advanced hypertension. • Captopril, modeled on the biologically active peptides found in the venom of the pit viper, made an important contribution to the understanding of hypertension and paved the way for other ACE inhibitors, such as enalapril and lisinopril, which have had a major impact on the treatment of cardiovascular disease. Captopril Enalapril Lisinopril
  • 10. • The compound was identified as 3,3'-methylenebis(4-hydroxycoumarin), an oxidative degradation metabolite of coumarin, itself a common component of Melilotus sp. • Soon after the compound had been identified, trials were initiated that confirmed the oral anticoagulant activity in humans and in 1942 it was marketed under the name dicoumarol. Dicoumarol and Warfarin 3,3'-methylenebis(4-hydroxycoumarin) Dicoumarol coumarin Warfarin
  • 11. • The compound had a slow, erratic onset of action and efforts were initiated to prepare synthetic analogs that acted faster and had longer duration of action. • A 4-hydroqcoumarin residue, substituted at the 3-position, proved essential for biological activity and • In 1948, after synthesizing over 150 compounds, a 4-hydroxycoumarin derivative that was longer acting and more potent than dicoumarol was selected not for clinical use, but as a rodenticide. • The compound named warfarin, became a household name for rat poison. Concern over the use of oral anticoagulants and the inherent risk of hemorrhage inhibited the development of warfarin as a therapeutic agent.
  • 12. • However, in 1951, a U.S. Army cadet unsuccessfully attempted to commit suicide by taking massive doses of the compound. • The incident prompted further clinical trials that resulted in warfarin being used as the anticoagulant of choice for prevention of thromboembolic disease. • The mode of action of the coumarin anticoagulants involves blocking the regeneration of reduced vitamin K and induces a state of functional vitamin K deficiency, thus interfering with the blood-clotting mechanism. • Warfarin decreases blood clotting by blocking an enzyme called vitamin K epoxide reductase that reactivates vitamin K1. Without sufficient active vitamin K1, clotting factors II, VII, IX, and X have decreased clotting ability.

Notas do Editor

  1. hypercholesterolemia, a condition marked by elevated levels of cholesterol in the blood.
  2. Lignans are a type of plant compound known as polyphenols.