Deuterated drug explained

A deuterated drug is a small molecule medicinal product in which one or more of the hydrogen atoms in the drug molecule have been replaced by its heavier stable isotope deuterium. Because of the kinetic isotope effect, deuterium-containing drugs may have significantly lower rates of metabolism, and hence a longer half-life.^{[1] [2] [3]}

Mode of action

Hydrogen is a chemical element with an atomic number of 1. It has one proton and one electron. Deuterium is the heavier naturally-occurring stable isotope of hydrogen. Deuterium was discovered by Harold Urey in 1931, for which he received the Nobel Prize in 1934. The deuterium isotope effect has become an important tool in the elucidation of the mechanism of chemical reactions. Deuterium contains one proton, one electron, and a neutron, effectively doubling the mass of the deuterium isotope without changing its properties significantly. However, the C–D bond is a bit shorter,^[4] and it has reduced electronic polarizability and less hyperconjugative stabilization of adjacent bonds, including developing an anti-bonding orbital as part of the newly formed bond. This can potentially result in weaker van der Waals stabilization, and can produce other changes in properties that are difficult to predict, including changes in the intramolecular volume and the transition state volume.^[3] Substituting deuterium for hydrogen yields deuterated compounds that are similar in size and shape to hydrogen-based compounds.

History

The concept of replacing hydrogen with deuterium is an example of bioisosterism, whereby similar biological effects to a known drug are produced in an analog designed to confer superior properties.^[5] The first patent in the US granted for deuterated molecules was in the 1970s. Since then patents on deuterated drugs have become more common.^[6]

The applications of the deuterium isotope effect has increased over time, and it is now applied extensively in mechanistic studies of the metabolism of drugs as well as other studies focused on pharmacokinetics (PK), efficacy, tolerability, bioavailability, and safety.^[7] The introduction of deuterated drug candidates that began in the 1970s evolved from earlier work with deuterated metabolites. However, it took more than 40 years for the first deuterated drug, Austedo® (deutetrabenazine), to be approved by the FDA.^[8] Numerous publications have discussed the advantages and disadvantages of deuterated drugs.^{[9] [1] [2] [3]} A number of publications have discussed aspects of intellectual property of deuterated versions of drugs.^{[10] [11] [12]}

Examples

Deutetrabenazine is a deuterated version of tetrabenazine. It was developed by Auspex then acquired by Teva in 2015^[13] and approved by the FDA in 2017 as a treatment for chorea associated with Huntington's disease; it has a longer half life than the non-deuterated form of tetrabenazine, which had been approved earlier for the same use.^[14]

Deucravacitinib is a deuterated^[15] JAK inhibitor (specifically, TYK2 inhibitor)^[16] approved for the treatment of plaque psoriasis.^[17]

Concert Pharmaceuticals focuses on deuterated drugs for various conditions.^{[18] [19] [20]} Concert was acquired by Sun Pharma in March 2023.^[21]

The company Retrotope discovered and has been developing a deuterated fatty acid RT001 as a treatment for neurodegenerative diseases such as Friedreich's ataxia and infantile neuroaxonal dystrophy. Their premise is that fatty acids in cell membranes are a source of reactive oxygen species and deuterated versions will be less prone to generating them.^{[22] [23]}

Poxel SA, a French clinical-stage biopharmaceutical company focused on therapies for rare metabolic diseases, is developing PXL065 to target nonalcoholic steatohepatitis (NASH). The company acquired PXL065 (the deuterium-stabilized (R)-enantiomer of pioglitazone) and a portfolio of deuterated thiazolidinediones (TZDs) from DeuteRx, LLC, in 2018,^[24] and published positive results from the Phase 2 trial in March 2023.^[25]

Compound	Status	Beneficial deuterium effect
Fludalanine (MK-0641)	Discontinued	Reduce toxic metabolite, 3-fluorolactate
Austedo (deutetrabenazine) (SD-809)	Approved	Reduce formation of toxic metabolite by CYP2D6
ALK-001 (d3-vitamin A)	Phase 3	Slows the dimerization rate of vitamin A
AVP-786 (d6-dextromethorphan)	Phase 3	Reduce formation of toxic metabolite by CYP2D6
VX-561 (formerly CTP-656) (d9-ivacaftor)	Phase 2	Reduce rate of tert-Bu group oxidation and in vivo clearance by CYP3A4
VX-984 (Novel cancer agent)	Phase 1	Reduce aldehyde oxidase-driven metabolism
PXL065 (formerly DRX-065) (d1-(R)-pioglitazone)^[26]	Phase 2	Stabilize preferred R-enantiomer to obtain mitochondrial function modulation without peroxisome proliferator-activated receptor gamma (PPARγ) agonist activity (due to S-pioglitazone)^[27]
RT001 (d2-linoleic acid ethyl ester)	Phase 1/2	Limit lipid peroxidation
SP-3164 (formerly DRX-164^[28]) (d-(S)-avadomide)	Preclinical	Stabilize preferred S-enantiomer for increased cereblon (CRBN) binding affinity^[29]

See also

• Reinforced lipids

Further reading

Heavy drugs gaining momentum.

Notes and References

1. Sanderson K . Big interest in heavy drugs . Nature . 458 . 7236 . 269 . March 2009 . 19295573 . 10.1038/458269a . 4343676 .
2. Katsnelson A . Heavy drugs draw heavy interest from pharma backers . Nature Medicine . 19 . 6 . 656 . June 2013 . 23744136 . 10.1038/nm0613-656 . 29789127 . free .
3. Gant TG . Using deuterium in drug discovery: leaving the label in the drug . Journal of Medicinal Chemistry . 57 . 9 . 3595–3611 . May 2014 . 24294889 . 10.1021/jm4007998 .
4. Bartell LS, Roth EA, Hollowell CD, Kuchitsu K, Young Jr JE . Electron-Diffraction Study of the Structures of C₂H₄ and C₂D₄ . The Journal of Chemical Physics . April 1965 . 42 . 8 . 2683–6 . 10.1063/1.1703223 . 1965JChPh..42.2683B .
5. Meanwell NA . Synopsis of some recent tactical application of bioisosteres in drug design . Journal of Medicinal Chemistry . 54 . 8 . 2529–2591 . April 2011 . 21413808 . 10.1021/jm1013693 .
6. News: Drugs that live long will prosper. The Economist. 2015-09-18. 0013-0613.
7. Pirali T, Serafini M, Cargnin S, Genazzani AA . Applications of Deuterium in Medicinal Chemistry . Journal of Medicinal Chemistry . 62 . 11 . 5276–5297 . June 2019 . 30640460 . 10.1021/acs.jmedchem.8b01808 . 58610901 .
8. Book: 10.1016/bs.armc.2017.08.010 . A Decade of Deuteration in Medicinal Chemistry . Platform Technologies in Drug Discovery and Validation . 50 . 519–542 . Annual Reports in Medicinal Chemistry . 2017 . Liu JF, Harbeson SL, Brummel CL, Tung R, Silverman R, Doller D . 978-0-12-813069-8 .
9. Foster AB . Deuterium isotope effects in the metabolism of drugs and xenobiotics: implications for drug design . Advances in Drug Research . 1985 . 14 . 1–40 .
10. Timmins GS . Deuterated drugs; updates and obviousness analysis . Expert Opinion on Therapeutic Patents . 27 . 12 . 1353–1361 . December 2017 . 28885861 . 10.1080/13543776.2017.1378350 . 25694617 .
11. Timmins GS . Deuterated drugs: where are we now? . Expert Opinion on Therapeutic Patents . 24 . 10 . 1067–1075 . October 2014 . 25069517 . 4579527 . 10.1517/13543776.2014.943184 .
12. Buteau KC . Deuterated Drugs: Unexpectedly Nonobvious? . Journal of High Technology Law . 10 . 1 . 2009 . 22–73 .
13. Web site: 2015-05-05 . Teva Completes Acquisition of Auspex Pharmaceuticals . 2024-03-02 . www.tevapharm.com . en.
14. Schmidt C . First deuterated drug approved . Nature Biotechnology . 35 . 6 . 493–494 . June 2017 . 28591114 . 10.1038/nbt0617-493 . 205269152 .
15. Mullard . Asher . First de novo deuterated drug poised for approval . Nature Reviews Drug Discovery . September 2022 . 21 . 9 . 623–625 . 10.1038/d41573-022-00139-6. 35974147 . 251623586 .
16. Chimalakonda . A . Burke . J . Cheng . L . Catlett . I . Tagen . M . Zhao . Q . Patel . A . Shen . J . Girgis . IG . Banerjee . S . Throup . J . Selectivity Profile of the Tyrosine Kinase 2 Inhibitor Deucravacitinib Compared with Janus Kinase 1/2/3 Inhibitors. . Dermatology and Therapy . October 2021 . 11 . 5 . 1763–1776 . 10.1007/s13555-021-00596-8 . 34471993. 8484413 . free .
17. Web site: U.S. Food and Drug Administration Approves Sotyktu™ (deucravacitinib), Oral Treatment for Adults with Moderate-to-Severe Plaque Psoriasis . Business Wire . 10 September 2022 . en . 10 September 2022.
18. News: Interview with the Scientific Founder, President and CEO: Concert Pharmaceuticals, Inc. (CNCE). The Wall Street Transcript. 2 April 2015.
19. Web site: Deudextromethorphan. AdisInsight. 16 February 2017 .
20. News: Garde D . Biotech IPOs roll on with Concert's $84M aria. FierceBiotech. February 13, 2014 .
21. Web site: Pharma . Sun . Sun Pharma Completes Acquisition of Concert Pharmaceuticals . 2024-03-02 . www.prnewswire.com . en.
22. News: Hamzelou J . Pill of super-protective 'heavy' fat may be key to eternal youth . New Scientist. 13 May 2015.
23. Web site: RT 001. AdisInsight. 15 January 2018 .
24. Web site: 2018-08-30 . Poxel Expands Metabolic Pipeline Through Strategic Acquisition Agreement with DeuteRx for DRX-065, a Novel Clinical Stage Drug Candidate for NASH, and Other Programs . 2023-05-23 . Poxel SA . en-US.
25. Jacques . Vincent . Bolze . Sébastien . Hallakou-Bozec . Sophie . Czarnik . Anthony W. . Divakaruni . Ajit S. . Fouqueray . Pascale . Murphy . Anne N. . Van der Ploeg . Lex H. T. . DeWitt . Sheila . August 2021 . Deuterium-Stabilized (R)-Pioglitazone (PXL065) Is Responsible for Pioglitazone Efficacy in NASH yet Exhibits Little to No PPARγ Activity . Hepatology Communications . 5 . 8 . 1412–1425 . 10.1002/hep4.1723 . 2471-254X . 8369945 . 34430785.
26. Web site: Deuteropioglitazone dcl, (5R)-. pubchem.ncbi.nlm.nih.gov.
27. Web site: PXL065 (DEUTERIUM-STABILIZED R-ENANTIOMER OF PIOGLITAZONE) REDUCES LIVER FAT CONTENT AND IMPROVES LIVER HISTOLOGY WITHOUT PPARG -MEDIATED SIDE EFFECTS IN PATIENTS WITH NASH: ANALYSIS OF A 36 WEEK PLACEBO-CONTROLLED PHASE 2 TRIAL (DESTINY1) AASLD . 2023-05-23 . www.aasld.org.
28. 2022-01-13 . Salarius Pharmaceuticals Expands Oncology Pipeline Through Strategic Acquisition of Targeted Protein Degradation Portfolio from DeuteRx, LLC . 2023-05-23 . GlobeNewswire News Room . en.
29. Web site: SP-3164, a Novel Cereblon-Binding Protein Degrader, Shows Activity in Preclinical Lymphoma Models . 2023-05-23 . ashpublications.org.