title: A locally active antiinflammatory macrolide (MLD987) for inhalation therapy of asthma.
abstract: One of the characteristic features of asthma is a persistent pulmonary inflammation, with increased numbers of eosinophils and activated T-lymphocytes in the airways. T-helper cells of the Th2 phenotype play a pivotal role in the pathogenesis of asthma, and they are believed to orchestrate the asthmatic response by releasing a wide repertoire of cytokines. Herein, we describe the design, synthesis, and evaluation in models of allergic asthma of a locally active T-cell modulator, MLD987 (1). Compound 1 is a potent immunosuppressant that inhibits the activation, proliferation, and release of cytokines from T-cells with IC(50) values in the low nanomolar range. In a Brown-Norway rat model of allergic asthma, 1, when given into the airways by intratracheal administration (ED(50) = 1 mg/kg) or by inhalation (ED(50) = 0.4 mg/kg), potently reduced the influx of leukocytes into bronchoalveolar lavage fluid samples obtained from antigen-challenged animals. In contrast, 1 had an appreciably weaker activity in this model when given orally or intravenously. Pharmacokinetic evaluation in rat and rhesus monkey showed that 1 had both a low oral (2-4%) and a low pulmonary (7%, monkey) bioavailability. These findings are consistent with a local site of action of the compound and rule out that its antiinflammatory activity in the lung was caused by systemically absorbed material, which had been swallowed during inhalation or which had entered the circulation via the airways. Local administration and the metabolically soft structure of 1, which favors rapid systemic metabolism to less immunosuppressive metabolite 2, are the main reasons for the low exposure and weak systemic activity of the compound. Administration of a locally active compound such as 1, by inhalation, should reduce systemic side effects. Our results indicate that 1 has the potential to serve as an alternative to inhaled glucocorticosteroids for the long-term therapy of asthma of all grades of severity.
authors.affiliation: Novartis Institutes for BioMedical Research and Novartis Pharma Development, CH-4002 Basle, Switzerland. rene.hersperger@pharma.novartis.com
authors.forename: Rene
authors.initials: R
authors.lastname: Hersperger
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Buchheit
authors.forename: Salvatore
authors.initials: S
authors.lastname: Cammisuli
authors.forename: Albert
authors.initials: A
authors.lastname: Enz
authors.forename: Olivier
authors.initials: O
authors.lastname: Lohse
authors.forename: Monique
authors.initials: M
authors.lastname: Ponelle
authors.forename: Walter
authors.initials: W
authors.lastname: Schuler
authors.forename: Alain
authors.initials: A
authors.lastname: Schweitzer
authors.forename: Christoph
authors.initials: C
authors.lastname: Walker
authors.forename: Hartmut
authors.initials: H
authors.lastname: Zehender
authors.forename: Gerhard
authors.initials: G
authors.lastname: Zenke
authors.forename: Alfred G
authors.initials: AG
authors.lastname: Zimmerlin
authors.forename: Markus
authors.initials: M
authors.lastname: Zollinger
authors.forename: Lazzaro
authors.initials: L
authors.lastname: Mazzoni
authors.forename: John R
authors.initials: JR
authors.lastname: Fozard
mesh_terms: D000280:Administration, Inhalation; D000818:Animals; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000737:chemistry* / Q000494:pharmacology*; D019540:Area Under Curve; D001249:Asthma / Q000188:drug therapy*; D001671:Biochemistry / Q000379:methods; D002478:Cells, Cultured; D015195:Drug Design; D004804:Eosinophils / Q000187:drug effects; D006207:Half-Life; D006801:Humans; D008253:Macaca mulatta; D018942:Macrolides / Q000008:administration & dosage / Q000737:chemistry* / Q000494:pharmacology*; D051381:Rats; D011914:Rats, Inbred BN; D013329:Structure-Activity Relationship; D013601:T-Lymphocytes / Q000187:drug effects / Q000276:immunology; D016559:Tacrolimus / Q000031:analogs & derivatives* / Q000737:chemistry* / Q000494:pharmacology*
chemical_list: D000893:Anti-Inflammatory Agents; C492680:MLD 987; D018942:Macrolides; D016559:Tacrolimus