NOVEL AGENTS TO PREVENT KIDNEY DISEASE IN DIABETES

该项目的目标是开发一种具有抗糖基化特性的小分子，该小分子适合用于糖尿病肾病的治疗。已经完成的第一阶段的主要目标是：a)设计和合成EXO-226的结构类似物；以及b)测试新合成的化合物抑制白蛋白非酶糖基化的能力。这项工作的基本原理源于我们最近的研究表明：a)糖化白蛋白刺激细胞外基质蛋白(ECM)、转化生长因子-β1和信号转导的II型转化生长因子-β受体的表达，并激活肾小球细胞中的PKC；b)给糖尿病db/db小鼠注射经Amadori葡萄糖加合物修饰的白蛋白的小鼠单抗可减少尿蛋白排泄增加，抑制系膜基质的调节，并防止未治疗的糖尿病小鼠肾脏IV型胶原和纤维连接蛋白mRNA的过度表达；c)这些有益的作用与血浆糖化白蛋白浓度的降低有关(尽管显著的高血糖持续存在)；D)EXO-226在体外和体内抑制糖化白蛋白的形成，即使在db/db小鼠和人体内，即使血糖浓度保持在较高水平；以及e)使用EXO-226降低糖化白蛋白与减少人的尿白蛋白排泄有关，并与改善db/db小鼠糖尿病肾病的结构和功能变化有关(即，它减少了升高的尿蛋白排泄，增加了降低的内生肌酐清除率，并减少了肾小球系膜基质的积聚)。第二阶段的主要目标是在第一阶段结果的基础上选择临床条件日期(S)进行临床前、动物和毒理学研究，以证明所选化合物是安全有效的，从而启动新药物实体的人体临床试验。拟议的商业应用：这项研究和开发有望导致用于预防/治疗糖尿病肾脏疾病的新化学物质的临床引入。

The objective of this project is to develop a small molecule that possesses anti-glycation properties and that is appropriate for therapeutic use in diabetic nephropathy. The major goals in Phase I, which have been accomplished, were to: a) design and synthesize structural analogues of EXO-226; and b) test the newly synthesized compounds for their ability the inhibit the nonenzymatic glycation of albumin. The rationale for this work derives from our recent studies demonstrating that: a) glycated albumin stimulates the expression of extracellular matrix proteins (ECM), TGF-beta1 and the signaling Type II TGF-beta receptor, and activates PKC, in renal glomerular cells; b) administration of a murine monoclonal antibody that site- specifically reacts with albumin modified by Amadori glucose adducts to diabetic db/db mice reduces the elevated urinary protein excretion, inhibits the mesangial matrix accomulation, and prevents the overexpression of renal Type IV collagen and fibronectin mRNA that are observed in untreated diabetic mice; c) these salutary effects are associated with reduction of elevated plasma glycated albumin concentrations (even though marked hyperglycemia persists); d) EXO- 226 inhibits the formation of glycated albumin in vitro, and in vivo in the db/db mouse and in man, even though blood glucose concentrations remain elevated; and e) lowering glycated albumin with EXO-226 is associated with reduced urine albumin excretion in man, and with amelioration of the structural and functional changes of diabetic nephropathy in the db/db mouse (i.e. it reduces the elevated urine protein excretion, raises the decreased creatinine clearance, and attenuates the accumulation of glomerular mesangial matrix). The major goals in Phase II are to conduct, with the clinical condidate(s) selected on the basis of Phase I results, preclinical, animal and toxicology studies to show that the selected compound is safe and effective, leading to initiation of human clinical trials with the new drug entity. PROPOSED COMMERCIAL APPLICATION: This research and development is expected to lead to the clinical introduction of new chemical entities for the prevention/treatment of diabetic kidney disease.