New Drug Development for Hepatic Insulin Resistance

Transcription

1 New Drug Development for Hepatic Insulin Resistance Innovative Drug Research Center for Metabolic and Inflammatory Disease College of Pharmacy Sang Geon Kim

2 AMPK as an energy sensor, (A novel drug target for metabolic disease) [AMP] /[ATP] Upstream kinase AMPK Energy demand e.g.switch off fatty acid synthesis Energy supply e.g.switch on fatty acid oxidation Fatty acid synthesis Cholesterol synthesis Energy expenditure Energy intake Liver

3 Upstream signals of AMPK activation PKCζ SIRT1 TAK1 Ca ++ LKB1 CaMKK [AMP]:[ATP] Stress (ROS) AMPK Activation

4 LKB1-independent AMPK activation

5 LKB1-independent AMPK activation A Oltipraz B [AMP]:[ATP] LKB1 AMPK distinct pathway CaMKK Stress (ROS) Bae et al., Hepatology, 2007 Oltipraz activates AMPK through a distinct pathway independent of LKB1 or CaMKK. Not a direct AMPK activator.

6 AMPK activation by oltipraz leads to S6K1 inhibition. A) B) AMPK S6K C) Insulin Resistance (Bae et al., Hepatology, 2006)

7 Inhibition of S6K1 by Oltipraz A) B) (Bae et al., Hepatology, 2006)

8 Inhibition of insulin signaling by S6K1 (Um et al., Nature., 2004)

9 S6K1 inhibition by oltipraz enhances insulin signaling. A) B) (Bae et al., Hepatology, 2006)

10 Inhibition of IRS Ser-307 phosphorylation by oltipraz (Bae et al., Hepatology, 2006)

11 Inhibition of LXRα-SREBP-1c Pathway by AMPK-activating Candidates? Bae et al., Hepatology (2007) Oltipraz DTTs AMPK S6K1 Insulin Resistance closely linked Hepatic lipogenesis through LXRα-SREBP-1c pathway FATTY LIVER

12 LXR-dependent Lipogenic Gene Induction T Insulin Lipogenic gene transactivation (FAS, ACC, SCD-1) Cytosol Endogenous LXR ligand Nuclear translocation LXR RXR Target gene transactivation SREBP-1c expression (tethered in ER membrane) LXRE (e.g. SREBP-1c) Nucleus

13 Opposite Regulation of LXRα Activity by AMPK and S6K1 AMPK S6K1 LXRα SREBP-1c pathway

14 Inhibition of SREBP-1c Expression and Activation by Oltipraz (Hwahng et al., Hepatology, 2009)

15 Attenuation of SREBP-1c Target Gene Expression by Oltipraz SRE-containing FAS promoter SREBP-1c target gene FAS, ACC, SCD-1 (Hwahng et al., Hepatology, 2009)

16 Oltipraz AMPK S6K1 SREBP-1c Lipogenic Enzymes FAS ACC SCD-1

17 Repression of SREBP-1c by S6K1 Inhibition (Hwahng et al., Hepatology, 2009)

18 Role of AMPK in Inhibition of T090-stimulated SREBP-1c Induction (Hwahng et al., Hepatology, 2009)

19 Oltipraz? AMPK S6K1 LXRα SREBP-1c Lipogenic Enzymes FAS ACC SCD-1

20 Suppression of LXRα Activity by Oltipraz LXRE-containing reporter gene (Hwahng et al., Hepatology, 2009)

21 Direct Phosphorylations of LXRα by S6K1 and AMPK (Hwahng et al., Hepatology, 2009)

22 The Opposing Action of S6K1 and AMPK on LXRα Activity (Hwahng et al., Hepatology, 2009)

23 In case of LXR activation AMPK Inactive Thr p TSC2 LXR activity S6K1 Active Ser p

24 In case of LXR inhibition AMPK Inactive Thr p TSC2 LXR activity S6K1 Active Ser p

25 A summary on the LXRα SREBP-1c regulation Oltipraz DTTs AMPK Inactive Thr p TSC2 LXR activation Binding to LXRE SREBP-1c S6K1 Active Ser p FAS ACC SCD-1 Hepatic lipogenesis

26 In vivo Anti-steatotic Effect C57BL/6 mice (Hwahng et al., Hepatology, 2009)

27 Dithiolethiones C/EBPβ P RSK Drug Targets HIF-1α Degradation Insulin IR C/EBPβ TSC1/2 mtor- RAPTOR AMPK IRS1 PI3K Akt insulin resistance p70s6k1 Activating Phosphorylation Inhibitory Phosphorylation Nucleus ps pt LXR LXRE RXR SREBP-1c FAS, ACC, SCD-1 S6K1: insulin resistance, lipogenesis AMPK: insulin resistance, lipogenesis

28 IX. OVERALL SCHEME OF OLIPRAZ DEVELOPMENT Process development for large-scale production Set up specification & test method (raw material) Stability study (raw material) Preliminary Clinical Clinical marker setup Clinical trial protocol preparation Synthesis Mechanism study Prof. S.G. Kim Seoul National Univ. Efficacy Ph Phas Phas Toxicity Study IND ase e e I II III NDA PK Formulation Launch Preformulation study Formulation study PK study Prof. M.G. Lee Seoul National Univ. National Cancer Center (J.W. Park, M.D.) Samsung Medical Center (G.C. Koh, M.D.) Korea Cancer Center Hospital (C.J. Han, M.D.) Set up specification & test method (finished product) Stability study (finished product) 1st Year 2 nd Year 3 rd Year 4 th Year Launching ( 02) ( 03) ( 04) ( 05) ( 06)

29 Pharmacokinetic profiles of oltipraz in cirrhotic patients (Patients safety verified) 경구투여 (Parent) 경구투여 (Metabolite) Kim YM et al., Clin Pharmacol Ther. (2010)

30 LKB1-dependent AMPK activation

31 Sauchinone (Sau) A lignan in Saururus chinensis - frequently used medicinal plants - treat fever, jaundice, and inflammation. Anti-inflammation: Inhibits inos, COX-2 and TNF-α induction in macrophages. Br J Pharmacol, Lee et al., 2003 삼백초 ( 三白草 ) Liver protection: Attenuates liver toxicity in primary hepatocytes. Biol Pharm Bull, Sung et al., 2000 Sauchinone

32 AMPK activation by Sau Kim YW et al., FRBM (2009)

33 LKB1-dependent AMPK activation by Sau Kim YW et al., FRBM (2009)

34 Improvement of insulin sensitivity Kim YW et al., FRBM (2010)

35 Inhibition of LXRα activity by Sau Kim YW et al., FRBM (2010)

36 SREBP-1c repression by Sau Kim YW et al., FRBM (2010)

37 Inhibition of SREBP-1c target gene Kim YW et al., FRBM (2010)

38 Inhibition of lipogenesis in mice fed HFD Kim YW et al., FRBM (2010)

39 Sau treats LXRα-dependent lipogenesis by activating AMPK. Sau LKB1 AMPK S6K1 FATTY LIVER Hepatic lipogenesis through LXRα-SREBP-1c pathway

40 LKB1-dependent AMPK activation by resveratrol Resveratrol PAR LKB1 p-ampk Drug action Shin SM et al., Mol Pharm (2009)

41 Pharmacological modulations of AMPK activity AMPK Kim SG et al., Handbook of Type I DM (2009)

42 Cytoprotective, antioxidant, & mitochondrial protective effects of AMPK-activators

43 Inhibition of HFD-induced liver injury Kim YW et al., FRBM (2010)

44 Inhibition of HFD-induced oxidative stress Kim YW et al., FRBM (2010)

45 Mitochondrial permeability transition pore OMM VDAC Oxidative stress OMM VDAC IMM IMS Matrix PTP CypD ANT IMM IMS Matrix PTP CypD ANT (Miura and Miki, Circ J., 2009) Non-selective large conductance channel in the mitochondrial inner membrane ANT, CypD and VDAC regulatory factors Opening of mptp causes MMP transition and cytochrome c release apoptosis.

46 1) Mitochondrial protective; 2) H 2 O 2 scavenging effect A) B)

47 Mitochondrial protective and H 2 O 2 scavenging effects of Sau

48 Mitochondrial protective and H 2 O 2 scavenging effects of Res A) B)

49 Mitochondrial protective and H 2 O 2 scavenging effects of ILQ

50 AMPK and GSK3β AMPK GSK3β P AMPK activators p-gsk3β Mitochondrial protection

51 Increase in GSK3β phosphorylation by ILQ

52 Effect of GSK3β inhibition on mitochondrial protection GSK3β GSK3β P VDAC P ANT-CypD binding mptp opening Mitochondrial Membrane Permeability

53 AMPK activation alone by metformin is not sufficient to protect cells from severe oxidative stress!!! Kim YW et al., FRBM (2010) (Unpublished data) B) DCFH-DA No H 2 O 2 scavenging effect (Unpublished data)

54 Down-stream functions of AMPK AMPK Kim SG et al., Handbook of Type I DM (2009)

55 Clinical & Instestigational AMPK activators Kim SG et al., Handbook of Type I DM (2009)

56 Clinical & Instestigational AMPK activators (continued) Kim SG et al., Handbook of Type I DM (2009)

57 Collaborations Prof. Myung Gull Lee, Ph. D. (Seoul National Univ.) Prof. Chang Ho Lee, Ph.D. (Hanyang Univ.) Prof. Keon Wook Kang, Ph.D. (Chosun Unvi.) Prof. Min Kyung Cho, Ph. D. (Dongguk Univ.) Prof. Yoon Gyoon Kim, Ph. D. (DanKook Univ.) Prof. Seung Jin Lee, Ph. D. (Asan Hosp.) Prof. Soo Kyung Bae, Ph. D. (Inje Univ.) Prof. Il Je Cho, Ph. D. (Daegu Haany Univ.) Acknowledgements Ph.D. Students Won Dong Kim Young Woo Kim Young Mi Kim Woo Hyung Lee Yoon-Mee Yang Chang Yup Han Tae Hyun Kim Hee Yeon Kay M.S. Students Chan Gyu Lee Kyoung Noh Seul Ki Kang Jung Min Lee Hong Min Wu So Yeon Seo A-young Kim Ja Hyun Koo Jeong Sik Eom Ju Yeon Cho