Structural and Clinical Characterization of CYP11B2 Inhibition by Dexfadrostat Phosphate.

Pignatti, Emanuele; Kollar, Jakub; Hafele, Evelyn; Schuster, Daniela; Steele, Ronald E; Vogt, Bruno; Schumacher, Christoph; Groessl, Michael (2023). Structural and Clinical Characterization of CYP11B2 Inhibition by Dexfadrostat Phosphate. The journal of steroid biochemistry and molecular biology, 235(106409), p. 106409. Elsevier 10.1016/j.jsbmb.2023.106409

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Aldosterone synthase (CYP11B2) represents a promising drug target because its genetic dysregulation is causally associated with cardiovascular disease, its autonomous activity leads to primary aldosteronism, and its deficiency leads to salt wasting syndromes. The serendipitous discovery that the dextro-rotatory stereoisomer of the racemic aromatase (CYP19A1) inhibitor CGS16949A mediates potent CYP11B2 inhibition led to the purification and clinical development of dexfadrostat phosphate. To characterize the pharmacophore of dexfadrostat phosphate, structure-based enzyme coordination with CYP11B2, CYP11B1 and CYP19A1 was combined with steroid turnover upon in vitro and clinical treatment. Dexfadrostat, but not its 5S-enantiomer (5S-fadrozole), precisely coordinates with the catalytic heme moiety in the space of the CYP11B2 substrate binding pocket forming a tight and stable complex. Conversely, neither rigid nor flexible docking led to a plausible coordination geometry for dexfadrostat in steroid 11β-hydroxylase (CYP11B1 - orthologue to CYP11B2) or in CYP19A1. The inhibitory preference of dexfadrostat was confirmed in vitro using an adrenal cortex-derived cell line. Dexfadrostat phosphate treatment of healthy subjects in the context of a clinical phase 1 study led to a dose-dependent decrease in urinary aldosterone secretion, accompanied by an increase in urinary corticosterone and deoxycorticosterone metabolites. Increased urinary corticosterone metabolites are indicative of CYP11B2 (18-oxidase) inhibition with clinical features reminiscent of patients with inborn corticosterone methyloxidase type II deficiency. An off-target effect on CYP19A1 was not observed as indicated by no clinical changes in testosterone and estradiol levels. Therefore, dexfadrostat exhibits the ideal structural features for binding and catalytic inhibition of CYP11B2 but not CYP11B1. Clinically, treatment with dexfadrostat phosphate leads to suppression of aldosterone levels by inhibiting predominantly one or both final CYP11B2-mediated reactions.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Paediatric Medicine
04 Faculty of Medicine > Department of Dermatology, Urology, Rheumatology, Nephrology, Osteoporosis (DURN) > Clinic of Nephrology and Hypertension
04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Paediatric Medicine > Endocrinology/Metabolic Disorders
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > Unit Childrens Hospital > Forschungsgruppe Nephrologie / Hypertonie

UniBE Contributor:

Pignatti, Emanuele (A), Vogt, Bruno, Grössl, Michael

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1879-1220

Publisher:

Elsevier

Language:

English

Submitter:

Pubmed Import

Date Deposited:

13 Oct 2023 13:35

Last Modified:

08 Jan 2024 14:57

Publisher DOI:

10.1016/j.jsbmb.2023.106409

PubMed ID:

37827219

Uncontrolled Keywords:

Aldosterone CYP11B2 dexfadrostat phosphate

BORIS DOI:

10.48350/187150

URI:

https://boris.unibe.ch/id/eprint/187150

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