title: Pharmacologic properties, metabolism, and disposition of linaclotide, a novel therapeutic peptide approved for the treatment of irritable bowel syndrome with constipation and chronic idiopathic constipation.
abstract: Linaclotide, a potent guanylate cyclase C agonist, is a therapeutic peptide approved in the United States for the treatment of irritable bowel syndrome with constipation and chronic idiopathic constipation. We present for the first time the metabolism, degradation, and disposition of linaclotide in animals and humans. We examined the metabolic stability of linaclotide in conditions that mimic the gastrointestinal tract and characterized the metabolite MM-419447 (CCEYCCNPACTGC), which contributes to the pharmacologic effects of linaclotide. Systemic exposure to these active peptides is low in rats and humans, and the low systemic and portal vein concentrations of linaclotide and MM-419447 observed in the rat confirmed both peptides are minimally absorbed after oral administration. Linaclotide is stable in the acidic environment of the stomach and is converted to MM-419447 in the small intestine. The disulfide bonds of both peptides are reduced in the small intestine, where they are subsequently proteolyzed and degraded. After oral administration of linaclotide, <1% of the dose was excreted as active peptide in rat feces and a mean of 3-5% in human feces; in both cases MM-419447 was the predominant peptide recovered. MM-419447 exhibits high-affinity binding in vitro to T84 cells, resulting in a significant, concentration-dependent accumulation of intracellular cyclic guanosine-3',5'-monophosphate (cGMP). In rat models of gastrointestinal function, orally dosed MM-419447 significantly increased fluid secretion into small intestinal loops, increased intraluminal cGMP, and caused a dose-dependent acceleration in gastrointestinal transit. These results demonstrate the importance of the active metabolite in contributing to linaclotide's pharmacology.
authors.affiliation: Ironwood Pharmaceuticals, Inc., 301 Binney Street, Cambridge, MA 02142, USA. rbusby@ironwoodpharma.com
authors.forename: Robert W
authors.initials: RW
authors.lastname: Busby
authors.forename: Marco M
authors.initials: MM
authors.lastname: Kessler
authors.forename: Wilmin P
authors.initials: WP
authors.lastname: Bartolini
authors.forename: Alexander P
authors.initials: AP
authors.lastname: Bryant
authors.forename: Gerhard
authors.initials: G
authors.lastname: Hannig
authors.forename: Carolyn S
authors.initials: CS
authors.lastname: Higgins
authors.forename: Robert M
authors.initials: RM
authors.lastname: Solinga
authors.forename: Jenny V
authors.initials: JV
authors.lastname: Tobin
authors.forename: James D
authors.initials: JD
authors.lastname: Wakefield
authors.forename: Caroline B
authors.initials: CB
authors.lastname: Kurtz
authors.forename: Mark G
authors.initials: MG
authors.lastname: Currie
mesh_terms: D000478:Alkylation; D000818:Animals; D019540:Area Under Curve; D001682:Biological Availability; D001711:Biotransformation; D003248:Constipation / Q000150:complications / Q000188:drug therapy*; D000242:Cyclic AMP / Q000378:metabolism; D005243:Feces / Q000737:chemistry; D005260:Female; D005772:Gastrointestinal Transit / Q000187:drug effects; D006801:Humans; D006863:Hydrogen-Ion Concentration; D066298:In Vitro Techniques; D007413:Intestinal Mucosa / Q000378:metabolism; D007422:Intestines / Q000187:drug effects; D043183:Irritable Bowel Syndrome / Q000150:complications / Q000188:drug therapy*; D008297:Male; D010447:Peptide Hydrolases / Q000737:chemistry; D010455:Peptides / Q000493:pharmacokinetics / Q000494:pharmacology* / Q000627:therapeutic use; D011869:Radioligand Assay; D051381:Rats; D017207:Rats, Sprague-Dawley
chemical_list: D010455:Peptides; D000242:Cyclic AMP; D010447:Peptide Hydrolases; C523483:linaclotide