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Discovery and development of 5α-reductase inhibitors

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65:. The receptor is known to consist of two hydrogen bond donors, where the C3 and 17β-side chain of the ligands connect, as well as three hydrophobic groups distributed over the steroidal structure. The best receptor inhibitors comply with these factors. Azasteroids are a type of steroid derivatives which have nitrogen atoms replaced at various positions for one of the carbon atoms in the steroid ring system. Two 4-azasteroids, finasteride and dutasteride are marketed as 5-ARIs. Finasteride (Proscar or Propecia) was the first steroidal 5α-reductase inhibitor approved by the U.S. 136: 240: 148: 204: 171: 199:
Benzo(f)quinolonone are also tricyclic compounds, but derivatives of the 4-azasteroid structure. The compounds that have been designed can be divided into two categories, hexahydro derivatives and octahydro derivatives. The octahydro derivatives have been proven to be more potent. Compound LY 191704,
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Benzo(c)quinolizinones are tricyclic derivatives of 10-azasteroids. The D-ring has been removed and the C-ring substituted for an aromatic one. The first compounds developed were selective 5-alpha reductase type 1 inhibitors, but the most potent one inhibits both type 1 and 2. The fluorine atom is an
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Many steroidal 5-ARIs have been researched but only 3 are marketed. Two of them are 4-azasteroids and will be covered here. As mentioned above, the third one, epristeride is only marketed in China and will not be covered here. The basic SAR of 4-azasteroids is shown below. For competitive inhibiting
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Dutasteride (Avodart) was the second steroidal 5α-reductase approved after finasteride. It is a competitive inhibitor of all three 5α-reductase isoenzymes and it inhibits types 1 and 2 better than finasteride, leading to it causing further reduction in DHT, with >90% recuded DHT levels following
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Dutasteride, however, is a so-called dual inhibitor with both 5α-R1 and 5α-R2 inhibition. IC50 for 5α-R1 is 7 nM but 6 nM for 5α-R2. As mentioned above, it reduces DHT > 90% overall, or precisely 94.7% and for intraprostatic DHT the reduction is 97-99%. Dutasteride has also been found to inhibit
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The 5α-reductase isozymes possess a similar steroidal catalytic site. The only available information about the 5α-reductase isozymes is their primary sequence estimated from c-DNAs and that affects the design of the novel inhibitors. The crystal structure of the 5α-reductase isozymes is not known
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The common factor in nonsteroidal 5-ARI discovery is that the first compounds were all selective inhibitors to 5α-reductase type 1 only, but were then developed in order to get dual inhibition on both type 1 and 2, since inhibition of the type 2 isozyme is a more important factor in treating the
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Piperidones are also 4-azasteroid derivatives but both B- and D-ring have been removed. The original compounds designed were type 1 selective, especially the ones containing a chlorine atom connected to the aromatic ring. By inserting a styryl group to the piperidones type 2 inhibitory activity
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Various pharmaceutical and academic groups have conducted the synthesis of nonsteroidal compounds that inhibit human 5α-reductases due to the unwanted hormonal side effects of steroidal compounds. Nonsteroidal inhibitors can be categorized due to their structure. Many have been obtained from
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designed to resemble steroidal carboxylic acids such as episteride. As with the other nonsteroidal inhibitors, they have been designed by removing steroid ring systems. As with the piperidones, addition of a styryl group provides good dual inhibition on isozyme 1 and 2, but the nonsteroidal
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Chen, Grace Shiahuy; Chang, Chih-Shiang; Kan, Wai Ming; Chang, Chih-Long; Wang, K. C.; Chern, Ji-Wang (2001-11-01). "Novel Lead Generation through Hypothetical Pharmacophore Three-Dimensional Database Searching: Discovery of Isoflavonoids as Nonsteroidal Inhibitors of Rat 5α-Reductase".
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Finasteride is considered similar to the transition state of reduced testosterone and is thus a slow-offset, irreversible inhibitor. The similarity to the transition state is a formation of an enzyme-NADP-dihydrofinasteride adduct by rearrangement on the A-ring of the compound.
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Finasteride mainly inhibits the 5α-R2 (IC50=69 nM) and 5α-R3 (IC50=17.4 nM) with little inhibition of 5α-R1 (IC50=360 nM). As mentioned above, finasteride reduces prostatic DHT levels on a 70-90% range but the detailed reduction of DHT is 70.8% and 85% of intraprostatic DHT.
183:. There is no detailed data about the cause of hepatotoxicity in 4-MA regarding SAR, but a conclusion may be drawn that the R2 group is the cause as there are other 4-azasteroid compounds containing the same R1 group as 4-MA, or CH3, without showing hepatotoxicity. 937: 132:
functions there are two functions considered crucial, 4-en-3-one function and a lipophilic 17β-side chain with one or more oxygen atoms. The main problems for 4-azasteroids is the rapid conversion into inactive 4,5-dihydro form, which is done by the enzyme.
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because the nature of the 5α-reductase enzyme is so unstable during purification. The first 5-ARIs were designed by modifying the structure of natural substrates, including the substitution of one carbon atom of the rings of the steroids by a
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Finasteride is an unsaturated analogue of another 4-azasteroid, or 4-MA. 4-MA is known to have dual inhibiting features with good inhibition on 5α-R1 (IC50=1.7 nM) and 5α-R2 (IC50=1.9 nM). However, 4-MA was never marketed as it showed
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Yamana, Kazutoshi; Labrie, Fernand; Luu-The, Van (2010-08-01). "Human type 3 5α-reductase is expressed in peripheral tissues at higher levels than types 1 and 2 and its activity is potently inhibited by finasteride and dutasteride".
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family and has an important role in biological actions towards steroid metabolism. If the steroid 5α-reductase is overexpressed it causes overproduction of DHT that can lead to androgenic disorders in humans.
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later named bexlosteride, is the most potent octahydro derivative designed. It is a selective inhibitor to the type 1 isozyme, especially because of the chlorine atom and the amino-methyl group.
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falls into the category of benzo(f)quinolonones, and is probably the derivative that has come closest to being marketed. It functions as a 5-ARI1 inhibitor which inhibits testosterone stimulated
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Nonsteroidal inhibitors are thought to act as competitive inhibitors on the 5α-reductase isozymes, except for epristeride analogues (carboxylic acids), which are noncompetitive inhibitors.
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is the third marketed steroidal 5-ARI. It is a noncompetitive, specific inhibitor. It potency is not as significant as finasteride or dutasteride and thus it is only marketed in China.
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Karnsomwan, Wiranpat; Rungrotmongkol, Thanyada; De-Eknamkul, Wanchai; Chamni, Supakarn (2016-06-01). "In silico structural prediction of human steroid 5α-reductase type II".
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5α-R3, in vitro, with IC50=0.33 nM. The 2,5-difluorophenyl side chain on the D-ring of the compound shows significant lipophilic features and as increased
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Aggarwal, Saurabh; Thareja, Suresh; Verma, Abhilasha; Bhardwaj, Tilak Raj; Kumar, Manoj (2010). "An overview on 5α-reductase inhibitors".
2116: 2095: 1305: 292: 278:. It is also used under the brand name Permixon in Europe as a pharmaceutical drug for the treatment of benign prostatic hyperplasia. 1370: 1350: 1070: 1325: 1561: 652:
Kulig, Katarzyna., Malawska, Barbara (2006). "Trends in the Development of New Drugs for Treatment of Benign Hyperplasia".
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enhances the potency of the compounds binding at pocket site, its potency is much greater than of finasteride.
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cell growth but without testosterone the compound shows no effect and was therefore never marketed.
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azasteroid inhibitors by taking away one or more rings from the steroid structure.
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Trenbolone hexahydrobenzylcarbonate (trenbolone cyclohexylmethylcarbonate)
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Four main categories of nonsteroidal 5-ARIs have been described:
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Prostate Cancer: Basic Mechanisms and Therapeutic Approaches
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Steroid 5α-reductase is a membrane-associated enzyme in an
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Nucleoside and nucleotide reverse-transcriptase inhibitors
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Azzouni F, Godoy A, Li Y, Mohler J, et al. (2012).
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Integration of Pharmaceutical Discovery and Development
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This article is about the discovery and development of
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Dual serotonin and norepinephrine reuptake inhibitors
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Androstanolone (stanolone, dihydrotestosterone, DHT)
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Hormone Molecular Biology and Clinical Investigation
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Carboxylic acid derivative and piperidone derivative
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Normethandrone (methylestrenolone, normethisterone)
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Drostanolone propionate (dromostanolone propionate)
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(2006). 288:Discovery and development of antiandrogens 1614: 1296:Oxabolone cipionate (oxabolone cypionate) 1140:Prasterone (dehydroepiandrosterone, DHEA) 1086: 582: 572: 1247:Metenolone acetate (methenolone acetate) 1313:17α-Alkylated testosterone derivatives: 888:Selective serotonin reuptake inhibitors 304: 1326:Chlorodehydromethyltestosterone (CDMT) 679: 28:Development of 5α-reductase inhibitors 1466:Norvinisterone (vinylnortestosterone) 1145:Prasterone enanthate (DHEA enanthate) 550: 548: 546: 544: 542: 540: 538: 536: 7: 1590:Tooltip human chorionic gonadotropin 1473:17α-Ethynyltestosterone derivatives: 647: 645: 643: 641: 639: 637: 635: 458: 456: 366: 364: 320: 318: 316: 314: 312: 310: 308: 83:Nonsteroidal 5α-reductase inhibitors 2096:List of androgens/anabolic steroids 1076:Tooltip anabolic–androgenic steroid 2025:Androvax (androstenedione albumin) 1463:17α-Vinyltestosterone derivatives: 1346:Methandriol (methylandrostenediol) 978:Bcr-Abl tyrosine-kinase inhibitors 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1356:Methandriol dipropionate 1181:testosterone undecanoate 923:Neuraminidase inhibitors 20:(5-ARIs), also known as 2117:5α-Reductase inhibitors 1756:Topilutamide (fluridil) 1177:testosterone propionate 898:HIV-protease inhibitors 819:5α-Reductase inhibitors 18:5α-reductase inhibitors 1361:Methandriol propionate 1267:Bolandiol dipropionate 1173:testosterone enanthate 1169:testosterone cypionate 1110:Boldenone undecylenate 948:Proton pump inhibitors 478:10.1515/hmbci.2010.035 249: 231: 211: 175: 155: 140: 95:Benzo(c)quinolizinones 1985:chlormadinone acetate 1646:Chlormadinone acetate 1217:Androstanolone esters 242: 229: 206: 173: 150: 138: 1997:gestonorone caproate 1805:Saw palmetto extract 1696:Potassium canrenoate 1291:Norclostebol acetate 1276:nandrolone decanoate 1130:Clostebol propionate 903:Integrase inhibitors 878:Direct Xa inhibitors 269:saw palmetto extract 253:Saw palmetto extract 1989:cyproterone acetate 1897:prolactin releasers 1839:Cyproterone acetate 1821:Abiraterone acetate 1681:Nomegestrol acetate 1656:Delmadinone acetate 1651:Cyproterone acetate 1633:Abiraterone acetate 1165:Testosterone esters 574:10.1155/2012/530121 220:tricyclic compounds 98:Benzo(f)quinolonone 22:dihydrotestosterone 2069:Never to phase III 1935:diethylstilbestrol 1562:GnRH (gonadorelin) 1366:Methyltestosterone 1301:Trenbolone acetate 1257:Stenbolone acetate 1222:Bolazine capronate 1125:Clostebol caproate 973:Tubulin inhibitors 276:dietary supplement 250: 232: 212: 176: 156: 141: 2104: 2103: 2038: 2037: 2005:megestrol acetate 1878:Antigonadotropins 1872: 1871: 1829:Aminoglutethimide 1686:Osaterone acetate 1676:Megestrol acetate 1599: 1598: 1272:Nandrolone esters 1120:Clostebol acetate 1020: 1019: 968:TRPV1 antagonists 908:Lipase inhibitors 709:www.ema.europa.eu 660:(28): 3395–2416. 625:978-981-256-067-4 526:978-0-306-47384-5 431:10.1021/jm010433s 425:(23): 3759–3763. 174:Structure of 4-MA 2129: 1971:GnRH antagonists 1947:ethinylestradiol 1943:estradiol esters 1773: 1620: 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835: 834:Antiandrogens 832: 830: 827: 825: 822: 820: 817: 816: 814: 808: 798: 795: 794: 793: 790: 788: 785: 784: 783: 780: 778: 775: 773: 770: 769: 767: 763: 759: 752: 747: 745: 740: 738: 733: 732: 729: 710: 703: 697: 694: 689: 683: 675: 671: 667: 663: 659: 655: 648: 646: 644: 642: 640: 638: 636: 632: 627: 621: 617: 612: 611: 602: 599: 594: 590: 585: 580: 575: 570: 566: 562: 558: 551: 549: 547: 545: 543: 541: 539: 537: 533: 528: 522: 518: 511: 508: 503: 499: 495: 491: 487: 483: 479: 475: 471: 467: 459: 457: 453: 448: 444: 440: 436: 432: 428: 424: 420: 412: 409: 404: 400: 396: 392: 388: 384: 380: 376: 375: 367: 365: 361: 356: 352: 348: 344: 340: 336: 332: 328: 321: 319: 317: 315: 313: 311: 309: 305: 298: 294: 291: 289: 286: 285: 281: 279: 277: 274: 270: 266: 265: 260: 252: 247: 246: 241: 234: 228: 224: 221: 216: 210: 207:Structure of 205: 201: 197: 193: 186: 184: 182: 172: 168: 166: 165:lipophilicity 160: 154: 151:Structure of 149: 145: 137: 133: 127:4-Azasteroids 126: 121: 119: 117: 113: 109: 103: 100: 97: 94: 93: 92: 89: 82: 80: 78: 74: 70: 68: 64: 60: 54: 51: 43: 41: 39: 35: 27: 25: 23: 19: 2021: 1981:Progestogens 1849:Ketoconazole 1777:5α-Reductase 1741:Ketoconazole 1731:Enzalutamide 1726:Darolutamide 1716:Bicalutamide 1707: 1671:Medrogestone 1666:Drospirenone 1629: 1522: 1472: 1462: 1432: 1421:Oxymetholone 1392: 1376:Oxymesterone 1312: 1286:Norclostebol 1263: 1237:Mepitiostane 1232:Epitiostanol 1208: 1160:Testosterone 1101: 818: 715:28 September 713:. Retrieved 708: 696: 682:cite journal 657: 653: 609: 601: 564: 560: 516: 510: 472:(3): 293–9. 469: 465: 422: 418: 411: 378: 372: 330: 326: 262: 256: 243: 217: 213: 209:bexlosteride 198: 194: 190: 187:Nonsteroidal 177: 161: 157: 142: 130: 112:Bexlosteride 110: 107: 90: 86: 75: 71: 55: 47: 38:nonsteroidal 31: 15: 2055:from market 1965:leuprorelin 1913:haloperidol 1909:risperidone 1901:domperidone 1893:antagonists 1859:Seviteronel 1800:Finasteride 1795:Epristeride 1790:Dutasteride 1785:Alfatradiol 1751:Seviteronel 1711:Apalutamide 1622:antagonists 1566:leuprorelin 1506:lynestrenol 1416:Oxandrolone 1411:Mestanolone 1381:Penmesterol 1336:Formebolone 1321:Calusterone 1316:Bolasterone 1242:Mesterolone 1189:Deposterona 1002:antagonists 787:Preclinical 777:Hit to lead 758:Drug design 215:increased. 153:finasteride 101:Piperidones 77:Epristeride 63:azasteroids 2111:Categories 1975:cetrorelix 1931:bifluranol 1854:Nilutamide 1834:Bifluranol 1824:+niraparib 1768:inhibitors 1746:Nilutamide 1721:Cimetidine 1691:Oxendolone 1636:+niraparib 1630:Steroidal: 1498:norgestrel 1486:Progestins 1481:Gestrinone 1441:Mibolerone 1426:Stanozolol 1155:Quinbolone 893:Gliflozins 567:: 530121. 299:References 59:heteroatom 2065:Phase III 2053:Withdrawn 1939:estradiol 1927:Estrogens 1921:sulpiride 1899:) (e.g., 1844:Flutamide 1736:Flutamide 1661:Dienogest 1641:Canrenone 1552:clomifene 1548:tamoxifen 1401:Furazabol 1115:Clostebol 1066:Androgens 1054:Androgens 561:Adv. Urol 486:1868-1891 439:0022-2623 395:1054-2523 34:steroidal 2077:See also 1983:(incl., 1890:receptor 1516:Tibolone 1197:Sustanon 1193:Omnadren 1094:agonists 963:Triptans 848:agonists 792:Clinical 674:17168713 593:22235201 502:28841145 494:25961201 447:11689062 403:12096090 355:44363501 347:19879888 327:Steroids 282:See also 40:5-ARIs. 1973:(e.g., 1963:(e.g., 1929:(e.g., 1574:(e.g., 1560:(e.g., 1546:(e.g., 1488:(e.g., 1476:Danazol 1274:(e.g., 1167:(e.g., 1069:(incl. 953:Statins 584:3253436 2048:WHO-EM 2015:Others 1814:Others 797:Phases 672:  622:  591:  581:  523:  500:  492:  484:  445:  437:  401:  393:  353:  345:  705:(PDF) 498:S2CID 399:S2CID 351:S2CID 116:LNCaP 1056:and 998:5-HT 844:Beta 717:2017 688:link 670:PMID 620:ISBN 589:PMID 565:2012 521:ISBN 490:PMID 482:ISSN 443:PMID 435:ISSN 391:ISSN 343:PMID 257:The 36:and 1586:hCG 1072:AAS 662:doi 616:250 579:PMC 569:doi 474:doi 427:doi 383:doi 335:doi 2113:: 2061:: 2003:, 1999:, 1995:, 1991:, 1987:, 1953:, 1949:, 1945:, 1941:, 1937:, 1933:, 1919:, 1915:, 1911:, 1907:, 1903:, 1615:AR 1583:, 1577:LH 1564:, 1550:, 1508:, 1504:, 1500:, 1496:, 1492:, 1278:, 1203:)) 1199:, 1195:, 1191:, 1183:, 1179:, 1175:, 1171:, 1087:AR 707:. 684:}} 680:{{ 668:. 658:13 656:. 634:^ 618:. 587:. 577:. 563:. 559:. 535:^ 496:. 488:. 480:. 468:. 455:^ 441:. 433:. 423:44 421:. 397:. 389:. 379:25 377:. 363:^ 349:. 341:. 331:75 329:. 307:^ 2007:) 1977:) 1967:) 1957:) 1923:) 1895:( 1888:2 1886:D 1592:) 1568:) 1554:) 1512:) 1282:) 1187:( 1078:) 1046:e 1039:t 1032:v 1000:3 846:2 750:e 743:t 736:v 719:. 690:) 676:. 664:: 628:. 595:. 571:: 529:. 504:. 476:: 470:2 449:. 429:: 405:. 385:: 357:. 337::

Index

5α-reductase inhibitors
dihydrotestosterone
steroidal
nonsteroidal
oxidoreductase
heteroatom
azasteroids
Food and Drug Administration
Epristeride
Bexlosteride
LNCaP
Basic SAR of 4-azasteroids
Finasteride
finasteride
lipophilicity

hepatotoxicity

bexlosteride
tricyclic compounds


Serenoa repens
European Medicines Agency
Serenoa repens
saw palmetto extract
over-the-counter
dietary supplement
Discovery and development of antiandrogens
List of 5α-reductase inhibitors

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