A year into the COVID-19 pandemic more than 2.3 million people have died, with deaths in the US approaching 500,000. These are staggering numbers, and the scientific community has rapidly responded. Amidst this disaster, it is easy to lose sight of longstanding, even more deadly threats, such as heart disease.
A leading cause of metabolic disease is overconsumption of fructose. Because it is sweeter than other natural sugars and cheap to produce, fructose is widely used in processed foods. Fructose is not subject to the negative feedback regulation of other sugars, and overconsumption has been linked to nonalcoholic fatty liver disease (NAFLD), insulin resistance, and cardiovascular disease. The first step in fructose metabolism is mediated by the enzyme ketohexokinase (KHK), so blocking it seems like a reasonable approach.
More than three years ago we highlighted a paper from Pfizer describing the fragment-based effort which led to compound 1, an inhibitor of KHK. That post ended by noting that there was “still some way to go” to reach a drug. A paper published late last year in J. Med. Chem. by Kentaro Futatsugi and colleagues from Pfizer describes the journey to the clinic.
Compound 1 was well-suited to SAR by parallel synthesis, and a variety of replacements for the methylpyrrolidine (on top) led to compound 3. Although this molecule had similar affinity as compound 1, a crystal structure revealed that it had shifted its binding mode such that the other pyrrolidine ring was pointing towards an important arginine residue. Exploring a diverse range of replacements led to compound 4, with improved affinity driven in part due to interactions between the hydroxyl and the arginine side chain. Replacing this hydroxyl with a carboxylic acid led at last to a low nanomolar lead.
Compound 6 was unstable when incubated with human hepatocytes, and various studies revealed that glucuronidation at the remaining hydroxyl was responsible. Removing the hydroxyl and lowering lipophilicity by removing the nitrile ultimately led to PF-06835919. This compound is potent, orally bioavailable, and clean in a variety of off-target assays.
This is a beautiful example of lead optimization guided by structure with a keen focus on molecular and pharmaceutical properties. The initial fragments are difficult to discern in the final molecule, which is not a bad thing: the whole point of fragment-based discovery is giving multiple options for creative medicinal chemistry. In contrast to last week’s post, crystallography was essential for the program; it also benefited from the applied serendipity of parallel synthesis.
Often these sorts of publications are the valediction of a halted program, but not here: PF-06835919 is moving forward in three clinical trials, including a phase 2 trial for NAFLD. Interestingly, the compound was first dosed in humans in 2016 – a year before the initial paper. This gap between clinical efforts and publications is a reminder that our list of fragment-derived clinical compounds will always be incomplete. I look forward to watching PF-06835919 advance.