Professional Documents
Culture Documents
SECOND EDITION
BENJAMIN E. BLASS
Temple University School of Pharmacy, Department of Pharmaceutical Sciences,
Moulder Center for Drug Discovery Research, Philadelphia, PA, United States
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ISBN: 978-0-12-817214-8
Sir Isaac Newton, one of the greatest scientists of his time, wrote “If I
have seen further it is by standing on the shoulders of Giants.”
Although he was almost certainly referring to his scientific achieve-
ments, the underling concept of learning from our forbearer is true in
any endeavor. Indeed, this concept can be further extended to include
those who are there in the present day, supporting the activities of an
individual as he or she attempts to accomplish that which they view as
important. With this thought in mind, I have dedicated this book to the
scientists who came before me, those who mentored me, and those who
work with me on a daily basis. In addition, and perhaps more impor-
tantly, this text is dedicated to the loving and supportive family that
has helped me become the person that I am today. Special thanks are
offered to my mother, father, sister, brother, my three children, and of
course, my wife Kathleen. These are the giants on whose shoulders I
have stood upon.
Contents
Foreword xv
vii
viii CONTENTS
Distribution 324
Permeability 326
Transporters 328
Plasma protein binding 330
Elimination pathways 332
Metabolism 333
Excretion 345
In vitro ADME model systems 348
In Vivo pharmacokinetics 351
Volume of distribution 353
Clearance 355
Half-life 356
Bioavailability 359
Species selection 362
Questions 362
References 364
The last several decades have witnessed a revolution in the drug dis-
covery and development process. Medicinal chemistry and in vitro
screening that were once major bottlenecks in the process of identifying
novel therapeutics have been dramatically accelerated through the
incorporation of automation and the development of enabling technolo-
gies such as recombinant DNA and transfection technology. High-
throughput screening, parallel synthesis, and combinatorial chemistry
have facilitated the synthesis and biological evaluation of large numbers
of potentially useful compounds. These activities, in turn, have gener-
ated vast amounts of data that can be analyzed to develop structure
activity relationships and structure property relationships useful for the
optimization of lead compounds. At the same time, new techniques,
technological advances, and a greater understanding of the importance
of pharmacokinetics, animal models, and safety studies have dramati-
cally altered how new molecules are selected for clinical study. Clinical
trial design strategies, biomarkers, translational medicine, the regulatory
landscape, intellectual property rights, and the business environment
have also changed dramatically over the course of the last 40 years.
The complexities of the drug discovery and development process
cannot be overstated, nor can the wide range of expertise required for
the successful development of new, marketable therapeutics. In order to
thrive in this very changing landscape, individuals interested in a career
in the pharmaceutical industry or related fields must be more than sim-
ply experts in their chosen field of study. They must also have an
understanding of the numerous, overlapping fields of their colleagues.
Basic Principles in Drug Discovery and Development has captured the criti-
cal information on the disparate processes, technologies, and expertise
required for modern drug discovery and development and presents it
in a logical and concise manner for students, practicing scientists, and
nonscientist with an interest in the pharmaceutical industry. Dr.
Benjamin E. Blass, an experienced educator and scientist with founda-
tional knowledge in medicinal chemistry, drug design, biological tar-
gets, and over 25 years of experience in industrial and academic drug
discovery and development, provides a comprehensive account of the
many functions involved in drug discovery and development, from
xv
xvi Foreword
1
Drug discovery and
development: An overview of
modern methods and principles
Over the course of the last two centuries, modern medicines have
improved the lives of countless patients. Diseases and conditions that
were once deemed incurable or fatal have been conquered with thera-
peutic agent designed to extend and improve quality of life. The most
recent, and perhaps most notable of these accomplishments is the transi-
tion seen in the consequences of infection with human immuno-
deficiency virus (HIV), the virus known to cause acquired
immunodeficiency syndrome (AIDS).1 When the virus was first identi-
fied by two research groups in 1983,2 there were few antiviral agents
available, none provided effective treatment for HIV infection, and
infection progressed rapidly to AIDS and death by opportunistic infec-
tion. By 1987, AZTs (Retrovirs and Azidothymidine; Fig. 1.1), the first
nucleoside reverse transcriptase inhibitor (NRTI), was approved for
clinical application for the treatment of HIV infection,3 and additional
treatment options were developed through the next three decades. New
NRTIs such as Vireads (Tenofovir)4 and Zeffixs (Lamivudine)5
(Fig. 1.1) that shared AZT’s mechanism of action (phosphorylation,
incorporation into a growing DNA chain, and chain termination)
expanded this class of HIV drugs. The development of non-NRTIs such
as Viramunes (Nevirapine)6 and Doravirines (Pifeltro)7 (Fig. 1.1) fur-
ther advanced HIV therapy and demonstrated that reversible, allosteric
inhibition (enzyme inhibition accomplished through drug binding at a
site other than the catalytic site, see Chapter 3) of reverse transcriptase
was a viable approach. HIV protease inhibitors such as Viracepts
(Nelfinavir),8 Norvirs (Ritonavir),9 and Crixivans (Indinavir)10 entered
the market at the beginning in the mid-1990s, adding a new dimension
to HIV therapy. At the same time, multidrug cocktail treatment
NH2 O
OH O
H HN
N N S N O CN
O H N NH2 N
HO OH HN
N O N P O N N
N N
N3 NH O O O N N CF3
O OH O
Cl
® ®
AZT Viread® Zeffix Viramune® Doravirine®
(Retrovir) (Tenofovir) (Lamivudine) (Nevirapine) (Pifeltro)
O
O
N N OH HN O
S HN O H O
O HO NH
O S
N N N
N N O N H
H H N OH N
OH H
S
H
OH
Viracept® Norvir® Crixivan® N
FIGURE 1.1 Reverse transcriptase was the first enzyme successfully targeted in a drug
discovery program that focused on developing treatment options for HIV infection and
AIDS. AZTs (Retrovir), Vireads (Tenofovir), and Zeffixs (Lamivudine) are nucleoside
inhibitors of this important enzyme that terminate DNA chain growth, while Doravirines
(Pifeltro) is a non-nucleoside inhibitor of reverse transcriptase that reversibly binds to an
allosteric site of the target. HIV protease, another enzyme critical to the progression of
HIV and AIDS, has also been the subject of intense study. The antiviral agents Viracepts
(Nelfinavir), Norvirs (Ritonavir), and Crixivans (Indinavir) are HIV protease inhibitors
that were developed for the treatment of HIV infection and AIDS. HIV integrase inhibitors
such as Raltegravirs (Isentress), Dolutegravirs (Tivicay), and Bictegravirs (GS-9883) were
also developed for the treatment of HIV. AIDS, Acquired immunodeficiency syndrome;
HIV, human immunodeficiency virus.
O H2N O
P
H H
N N N N
N
N
N O Cl NH
N
Alunbrig® Zejula®
N (Niraparib)
(Brigatinib)
F
HN Cl
H
N
N N
O
O N
Vizimpro® Keytruda®
(Dacomitinib) (Pembrolizumab)
FIGURE 1.3 Vizimpros (Dacomitinib) was approved in 2018 for the treatment of meta-
static non-small cell lung cancer. Zejulas (Niraparib) was approved in 2017 for the treatment
of epithelial ovarian, fallopian tube, and primary peritoneal cancers. Alunbrigs (Brigatinib)
was approved in 2017 for the treatment of metastatic non-small cell lung cancer. Keytrudas
(Pembrolizumab) was approved in 2014 for the treatment of advanced melanoma.
H2N Cl OH
O N H OH
O H O N H
H2N NH2 N O O N
S N
N N H2N
O O H2N
H2N Cl
Midamor® Lozol® Tenoretic® Inderal®
(Amiloride) (Indapamide) (Atenolol) (Propranolol)
HO
HO O
O O O OH
O HO
HS O O
O
O N O N
N H O F
N H
OH OH
O
® ® ®
Capoten Vasotec Zocor Lipitor®
(Captopril) (Enalapril) (Simvastatin) (Atorvastatin)
FIGURE 1.4 The diuretics Midamors (Amiloride) and Lozols (Indapamide), the
β-blockers Tenoretics (Atenolol) and Inderals (Propranolol), the ACE inhibitors Capotens
(Captopril), Vasotecs (Enalapril), and the HMGCoA reductase inhibitors Lipitors
(Atorvastatin) and Zocors (Simvastatin) have significantly improved the treatment of car-
diovascular disease. ACE, Angiotensin-converting enzyme.
F O
O
OH O
N NH2 N H
N N N
H N N
N N N H
F S H2N O O
O2
O O OH O O OH OH HO N
O OH OH
F N
H H HO H2N HO
S N HO O
N N O O O
N O O H H
O NH N OH
O O O O
OH
Staphcillin® Cipro® Vibramycin® Zithromax® O
OH
(Methicillin) (Ciprofloxacin ) (Doxycycline) (Azithromycin)
O O
F OH
H N HO Cl NH OH
OH N
N N O
H H O HO
F Cl OH
N OH O
S O
N ®
O Merrem NH2 NH2 Cl O Cl
OH (Meropenem) F O O
O HO O
®
Baxdela O OH
OH O O
H (Delafloxacin) O H H H
S N B N N N
O N N
O O N N N N
O N H H H
O HN O O
OH N H2N
HO
Vaborbactam O N
F O O
F O
OH
F
F S
HO
N O
F
Cl N
OH N O
H Singulair®
O Prozac® (Montelukast) HO
HO
Lipitor® (Fluoxetine)
(Atorvastatin)
O
NH F F
O O N
N
N N Humira® (Adalimumab)
N H N
H O FAB Fragment
Ledipasvir
HN
O O
O
NH
O
H
N O N O
P
O
O
O O Sofosbuvir
OH F Lantus®
Insulin glargine
Harvoni®
FIGURE 1.8 An analysis of the various stages of the drug discovery and development
process provides an indication of the success rate of each stage of the process. Based on
these estimates, only 1 out of every 24 early stage programs (target-to-hit stage) will pro-
duce a marketed therapy. The cost to develop a single new drug must also account for the
costs associated with all of the programs that are unsuccessful. The total cost is estimated
to be $2.875 billion.
Molecular progression
FIGURE 1.9 The drug discovery and development process viewed from “20,000 Ft.”
success, as it is often difficult if not impossible to identify the lead series that
will contain the final lead candidate in the early phases of the drug discov-
ery process. Parallel operations of this type mitigate the risk of failure of any
one series of compounds. The lead discovery phase typically conclude with
the successful demonstration of in vivo efficacy in an appropriate animal
model employing a compound that possesses physical and chemical proper-
ties consistent with an eventual clinical study in the drug development
stage.
The second major stage, drug development, typically begins once a
single compound has been identified, which is then progressed through
various studies designed to support its approval for sale by the appro-
priate regulatory bodies. The first step in this process is the submission
of an investigational new drug application which requests permission
to move a clinical candidate into human study. This document provides
regulatory agencies with detailed preclinical data describing animal
pharmacology and toxicology studies, chemical manufacturing informa-
tion (including formulation, stability studies, and quality control mea-
sures), and of course, detailed clinical protocols that describe how the
clinical compounds will be studied in human populations if the studies
are approved.
While clinical trial design can vary substantially from one candidate to
another, the general goals of phase I, II, III, and IV are the same. Chapter 10
will provide a more detailed review of clinical trials, but the basic tenants of
clinical trials are as follows. In phase 1 clinical trials, safety and tolerability
of an investigational new drug is examined in a small number of healthy
individuals, typically 20100 people, with the goal of determining if safety
margins are suitable for further progression in the clinical trial process.
Pharmacokinetic (PK) and pharmacodynamic aspects of the candidate are
closely monitored, and the drug candidate is typically administered first in
a single ascending dose (SAD) study, followed by a multiple ascending dose
(MAD) study. In the SAD study, the drug is given to a group subjects once
and they are monitored to determine the impact of the drug. If there are no
adverse effects, then a second group is treated with a single higher dose of
the drug candidate and monitored as before. The cycle is repeated until
intolerable side effects appear in order to determine the maximum tolerated
dose (MTD). MAD studies are similar, but each group of subjects is pro-
vided with multiple low doses of a candidate compound over a set time. As
in the SAD studies, the manifestation of clinically intolerable side effects
defines the MTD for the MAD studies. The data developed through the
course of the phase I studies are used to determine the doses that will be
used in phases II and III clinical trials.
Phase II typically involves 100300 patients and is designed to deter-
mine whether or not the clinical candidate provides the desired biological
impact. Safety studies also continue through phase II trials. In the first part
of phase II trials, referred to as phase IIA, the goal is to determine the dose
required to provide the desired therapeutic impact or endpoint for the clin-
ical candidate. Once the proper dose levels are determined, phase IIB stud-
ies can be initiated. The goal of this portion of phase II studies is to
determine the overall efficacy of candidate compounds in a limited popu-
lation of subjects. The majority of clinical drug candidates fail in phase II
studies due to safety issues or lack of efficacy. As of 2011, only 34% of
phase II clinical candidates successfully reach phase III studies.
The effectiveness of new drug candidates in larger patient population is
determined in phase III clinical trial. These studies typically involve hun-
dreds to thousands of patients at multiple clinical trial sites, are typically
randomized, and are designed to determine the efficacy of the candidate
compound relative to the current standard of care. The cost and time associ-
ated with this phase of clinical study can vary dramatically depending on
the clinical endpoint under investigation. Clinical trials for new, acute treat-
ments, such as novel antibacterial agents, are shorter and involve far fewer
patients than clinical trials for chronic conditions such as osteoarthritis.
Patients are also closely monitored for adverse side effects, as the larger
patient pools can identify safety issues that did not become apparent in
smaller phase II trials. The number of subjects, time requirements, and com-
plex design of phase III clinical trials (especially in chronic medical condi-
tions) dictate that they are the most expensive aspect of drug discovery and
development. Phase III clinical trials typically involve 10003000 patients,
multiple clinical sites, institutional review boards, and are multiyear endea-
vors (typically 2.55 years). Upon completion of phase III trials a new drug
application is submitted to the appropriate regulatory body. This document
typically contains comprehensive details of both animal and human studies,
all safety findings (adverse effect and side effects), manufacturing proce-
dures (including methods of analysis to ensure drug quality), detailed for-
mulation information for all dosing methods studied, and storage
conditions. Regulatory reviews can lead to requests for additional informa-
tion regarding the submission, or even additional clinical trials to further
establish either safety or efficacy. Ideally, these reviews lead to regulatory
approval, including labeling requirements, and approval to market the new
drug.71
Approval of regulatory bodies does not, however, signal the end of clin-
ical trials. In many cases, regulatory agencies will require additional
follow-up studies, often referred to as phase IV trials or postmarketing sur-
veillance. In general, these studies are designed to detect rare adverse
effect across a much larger population of patients than could be supported
in phase III trials or long-term adverse effects that might be outside of the
scope of phase III trial durations. The impact of phase IV studies can
include alterations to labeling based on safety results, contraindication for
use of the new drug in combination with other medications, or even the
O
S N
O
O Cl
O
Vioxx® Meridia®
(Rofecoxib) (Sibutramine)
O OH OH
HO O
Baycol®
(Cerivastatin) N
FIGURE 1.10 Vioxxs (Rofecoxib) and Meridias (Sibutramine) were removed from the
market as a result of an increased risk of ischemic events, while and Baycols (cerivastatin)
was withdrawn from the market based on increased occurrence of fatal rhabdomyolysis
versus similar drugs in its class.
[454]
[455]
[456]
[457]
Bull. Essex Inst. xxii. 1890, p. 24; also Amer. Natural. xxx. 1896, p.
591.
[458]
[459]
[460]
See Lindeman, Bull. Soc. Moscou, lxii. 1886, No. 2, p. 296, and
Uzel, Mon. 1895, pp. 397, 398.
[461]
[462]
[464]
[465]
[466]
[467]
[468]
[469]
[470]
[471]
Naturhist. Tidskr. (3) vi. 1896; translated in Ann. N. Hist. (4), vi.
1870, p. 225.
[472]
[474]
On this subject, see Reuter, Ann. Soc. ent. France (5) v. 1875, p.
225.
[475]
[476]
[477]
Künckel, Ann. Soc. ent. France (4) vii. 1867, p, 45, and C.R. Ac.
Paris, cxx. 1895, p. 1002.
[478]
[479]
[480]
[481]
[482]
A table of the families is given by Ashmead, but does not work out
quite satisfactorily, Entom. Americana, iv. 1888, p. 65; a brief table
of the characters of the British families is given by Saunders,
Hemiptera-Heteroptera of the British Islands, 1892, p. 12.
[483]
[484]
[485]
[486]
[487]
[488]
[489]
[490]
[491]
Ent. Zeit. Stettin, li. 1890, p. 281.
[492]
[493]
[494]
[495]
[496]
[497]
Acta Ac. German. li. 1887, p. 224, and Zeitschr. wiss. Zool. xliii.
1886, p. 537.
[498]
[499]
[500]
[501]
See remarks on pp. 543, 544.
[502]
[503]
[504]
It is unnecessary to say that the poet was not Sappho, but one of
the baser sex, named Xenarchus.
[505]
[506]
[507]
[508]
Riley, P. ent. Soc. Washington, iii. 1895, p. 88. For the younger
stages of Membracis foliata, see Tijdschr. Ent. (2) iv. 1869, pl. viii.
[509]
[510]
[511]
Cornell Univ. Agric. exp. station Bulletin, 44, 1892, and Bull. 108,
1896.
[512]
[513]
[514]
[515]
[516]
[517]
[518]
[519]
[520]
Balbiani, Ann. Sci. Nat. Zool. (5) xi. 1869, p. 29. For concise recent
remarks on the early embryonic states, see Lemoine, Bull. Soc.
ent. France, 1893, p. lxxxix.
[521]
[522]
[523]
[524]
[525]
[526]
Ent. Zeit. Stettin, xxxvi. 1875, p. 368.
[527]
[528]
Arb. Inst. Wien, iv. 1882, Heft iii. p. 397; see on this organ also
Mordwilko, Zool. Anz. xviii. 1895, p. 357.
[529]
[530]
See, inter alia, Webster, J. New York ent. Soc. i. 1893, p. 119.
[531]
[532]
[533]
[534]
[535]
[536]
[537]
[538]
[539]
[540]
[541]
[542]
[543]
[544]
Cf. Graber, Zeitschr. wiss. Zool. xxii. 1872, p. 165, and Landois in
the same Journal, xiv. 1864, p. 24.
[545]
[546]
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