An oral xanthine based DPP-4 inhibitor used for treating diabetes. dpp4 inhibitor, nesina, kazano, antidiabetic drug

Alogliptin

Description

Oral anti-diabetic drug

Target(s)

Dipeptidyl peptidase-4 (DPP-4)

Generic

Alogliptin

Commercial Name

Nesina (United States, Canada), Vipidia (United Kingdom)

Combination Drug(s)

Kazano (metformin & alogliptin; United States), Oseni (alogliptin & pioglitazone; United States)

Other Synonyms

Alogliptina, Alogliptine, Alogliptinum, SYR-322

IUPAC Name

2-({6-[(3R)-3-aminopiperidin-1-yl]-3-methyl-2,4-dioxo-3,4-dihydropyrimidin-1(2H)-yl}methyl)benzonitrile

Ligand Code in PDB

T22

3D Structure of Alogliptin bound to target protein DPP-4

PDB ID 3g0b

Table 1. Basic profile of alogliptin

Figure 1. 2D Structure of Alogliptin

2D and 3D structure of alogliptin. 

Drug Information: 

Chemical Formula

C18H21N5O2

Molecular Weight

339.39 g/mol

Calculated Predicted Partition Coefficient: cLogP

0.66

Calculated Predicted Aqueous Solubility: cLogS

-2.8

Solubility (in water)

0.58 mg/mL (sparingly soluble)

Predicted Topological Polar Surface Area (TPSA)

93.67 Å2

Table 2. Chemical and physical properties (DrugBank).

*Note: Predicted values may slightly vary from source to source. 

Drug Target: 

Like sitagliptin, alogliptin is an orally active, non-substrate-like inhibitor of DPP-4. Alogliptin improves the postprandial insulin level and lowers the amount of glucose produced by the body. It does this by blocking DPP-4's degradation of the incretin hormones, glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP) (Feng et al., 2007). These incretin hormones are responsible for stimulating insulin biosynthesis, inhibiting glucagon secretion, slowing gastric emptying, reducing appetite, and potentially stimulating the regeneration and differentiation of islet beta cells. However, the incretin hormones are rapidly inactivated by DPP-4. Hence, DPP-4 inhibitors, like alogliptin, increase the half life of the incretin hormones (Dineen et al., 2014). This allows patients with type II diabetes to synthesize postprandial insulin, reducing the need for constant insulin injections. 

Drug-Target Complex: 

DPP-4 is a transmembrane glycoprotein made up of 766 amino acids and consists of five regions: 

Figure 2. Overall structure of human DPP-4 monomer in ribbon representation showing the N- and C-termini and color-coded regions labeled, including cysteine-rich region (pink), the highly glycosylated region (cyan) and the catalytic domain (orange). Alogliptin is shown in a ball-and-stick representation (PDB ID: 3g0b; Zhang et al., 2011).

Alogliptin is a non-substrate-like inhibitor of DPP-4. This class of inhibitors binds non-covalently to the DPP-4 enzyme, and the S1 sub-pocket of the DPP-4 active site is occupied by an aromatic group versus a proline mimetic in substrate-like inhibitors.

Figure 3. X-ray crystal structure of the DPP-4 dimer (ribbons) with bound alogliptin (ball-and-stick). The DPP-4 monomer on the right is color-coded by region as in Figure 2 and the monomer on the left is shown as a grey ribbon (PDB ID: 3g0b; Zhang et al., 2011). The surface of the active site of DPP-4 is shown in the inset. Alogliptin is shown in a ball-and-stick representation, color-coded by atom type (C: gray; N: blue; O: red). Selected residues in the active sites are shown as sticks.

The X-ray structure of DPP-4 bound to alogliptin (PDB entry 3g0b) is shown in Figure 3. The black outlined box denotes the location of the active site. The figure at the bottom right shows a close-up view of alogliptin (ball-and-stick) in the active site (grey surface). The hydrophobic cyanobenzyl group of alogliptin occupies the S1 pocket of the enzyme, in accord with the pattern observed in non-substrate-like inhibitors of DPP4.


 
Figure 4. Hydrogen bonding interactions (green lines) between alogliptin (ball-and-stick) and active site residues (sticks) (PDB ID: 3g0b; Zhang et al., 2011). Figure 5. Hydrogen bonding interactions (green lines) between Diprotin A (ball-and-stick) and active site residues (sticks) (PDB ID: 1nu8; Thoma et al., 2003).
 

The co-crystal structure of DPP-4 and alogliptin (Zhang et al., 2011) reveals multiple interactions of the drug with its pharmacological target, DPP-4 (Figure 4). The uracil ring in alogliptin engages in π–π interactions with Tyr547; the aminopiperidine motif of the drug form salt bridges with residues Glu205 and Glu206; the cyanobenzyl group occupies the hydrophobic S1 pocket (Figure 3). The 2-position carbonyl of alogliptin participates in hydrogen bonding with the backbone NH of Tyr631. All of these interactions account for the tight binding of alogliptin with DPP-4 (Ic50 < 7 nm). A comparison of the co-crystal structures of DPP-4 with alogliptin (PDB ID 3g0b, Figure 4) and DPP-4 with its substrate, Diprotin A (Ile-Pro-Ile), (PDB ID 1nu8, Figure 5) reveals that alogliptin acts by occluding the DPP-4 active site and prevents binding of incretin hormones.

Pharmacologic Properties and Safety: 

Features

Comment(s)

Source

Bioavailability (%)

70%

(Capuano et al., 2013)

IC50 (nM)

1 - <10 nM

BindingDB

Ki (nM)

N/A

N/A

Half-life (hrs)

12.4-21.4 hours

(Capuano et al., 2013)

Duration of Action

24 hours

(Cada et al., 2013)

Absorption

Human intestinal absorption

(DrugBank)

Transporter(s)

P-glycoprotein (P-gp)

(DrugBank)

Metabolism

Cytochrome p450 2D6 & 3A4

(DrugBank)

Excretion

~76% urine; ~13% feces

(Capuano et al., 2013)

AMES Test (Carcinogenic Effect)

0.5595 (non AMES toxic)

(DrugBank)

hERG Safety Test (Cardiac Effect)

0.5507 (weak inhibitor)

(DrugBank)

Liver Toxicity

Liver injury due to alogliptin is rare

(LiverTox)

Table 3. Pharmacokinetics: ADMET of alogliptin

Drug Interactions and Side Effects: 

Alogliptin does not display any harmful effects on cardiac health nor is it carcinogenic (DrugBank). There have been post-marketing reports of both fatal and non-fatal hepatic failure in patients. However, some of these reports contain insufficient evidence necessary to establish a probable cause. No increase in QT was observed with alogliptin.

Features

Comment(s)

Source

Total Number of Drugs Interactions

634

(Drugs.com)

Major Drug Interactions

bexarotene and gatifloxacin

(Drugs.com)

Alcohol/Food Interaction(s)

moderate interaction with alcohol (ethanol)

(Drugs.com)

Disease Interaction(s)

pancreatitis (major), liver injury (moderate) and renal dysfunction (moderate)

 (Drugs.com)

On-target Side Effects

Liver problems, pancreatitis, hypoglycemia

(Drugs.com)

Off-target Side Effects

Nasophargyngitis, headache, upper respiratory tract infection, allergic reactions, cold symptoms

(Drugs.com)

CYP Interactions

Unknown

(Capuano et al., 2013)

Table 4. Drug interactions and side effects of alogliptin 

Regulatory Approvals/Commercial: 

Nesina (alogliptin) developed by Takeda was approved by the US FDA in 2013. Nesina (alogliptin) is prescribed as an oral medication in 6.25, 12.5 or 25 mg per day with or without food (DrugBank). Patients with mild to extreme renal impairment are suggested to take a reduced dosage. The cost of alogliptin is $309.96 per month. In April 2016, the FDA released a statement highlighting concerns that Nesina (alogliptin), Kazano (alogliptin and metformin), and Oseni (alogliptin and pioglitazone) increase risk of heart failure.

Alogliptin can be taken as a monotherapy or in conjunction with metformin (Kazano) or pioglitazone (Oseni). Kazano and Oseni were both manufactured by biopharmaceutical company Takeda Canada Inc. 

Links: 

DrugBank

http://www.drugbank.ca/drugs/DB06203

Drugs.com

https://www.drugs.com/mtm/alogliptin.html

Food and Drugs Administration

http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/EndocrinologicandMetabolicDrugsAdvisoryCommittee/UCM442063.pdf

National Institutes of Health (NIH)

https://livertox.nlm.nih.gov/Alogliptin.htm

Table 5. Links to relevant resources

References: 

BindingDB: Alogliptin. http://www.bindingdb.org/jsp/dbsearch/PrimarySearch_pdbids.jsp?pdbids_submit=Search&pdbids=3G0B

Cada, D.J., Levien, T.L., Baker, D.E. (2013).  Alogliptin. Hosp Pharm. Jul;48(7):580-92. doi: 10.1310/hpj4807-580
Capuano, A., Sportiello, L., Maiorino, M.I., Rossi, F., Giugliano, D., Esposito, K.. (2013). Dipeptidyl Peptidase-4 Inhibitors in Type 2 Diabetes Therapy – Focus on Alogliptin". Drug, Design, Development and Therapy, 213(7), 989-1001 doi: 10.2147/DDDT.S37647
Dineen, L., Law, C., Scher, R., & Pyon, E. (2014). Alogliptin (nesina) for adults with type-2 diabetes. Pharmacy and Therapeutics39(3), 186.
DrugBank: Alogliptin. (n.d.). Retrieved April 15, 2016, from http://www.drugbank.ca/drugs/DB06203
Feng, J., Zhang, Z., Wallace, M. B., Stafford, J. A., Kaldor, S. W., Kassel, D. B., Navre, M., Shi, L., Skene, R.J.,Asakawa, T., Takeuchi, K., Xu, R., Webb, D.R., Takeuchi, K. (2007). Discovery of alogliptin: a potent, selective, bioavailable, and efficacious inhibitor of dipeptidyl peptidase IV. Journal of Medicinal Chemistry, 50(10), 2297-2300.
Livertox. https://livertox.nlm.nih.gov/Alogliptin.htm
Nesina (alogliptin) Side effects, Cost, Prescribing Information. (n.d.). Retrieved April 15, 2016, from http://www.rxeconsult.com/healthcare-articles/-Nesina-alogliptin-Side-effects-Cost-Prescribing-Information-452/ 
PubChem: Alogliptin. https://pubchem.ncbi.nlm.nih.gov/compound/Alogliptin

Thoma, R., Loffler, B., Stihle, M., Huber, W., Ruf, A., Hennig, M. (2003). Structural basis of proline-specific exopeptidase activity as observed in human dipeptidyl peptidase-IV. Structure. 11(8), 947-959.  doi: 10.1016/S0969-2126(03)00160-6
U.S. Food and Drug Administration. (n.d.). Retrieved May 01, 2016, from http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm494252.htm
Zhang, Z., Wallace, M.B., Feng, J., Stafford, J.A., Skene, R.J., Shi, L., Lee, B., Aertgeerts, K., Jennings, A., Xu, R., Kassel, D.B., Kaldor, S.W., Navre, M., Webb, D.R., Gwaltney, S.L. (2011). Design and Synthesis of Pyrimidinone and Pyrimidinedione Inhibitors of Dipeptidyl Peptidase IV. Journal of Medicinal Chemistry, 54(2): 510-24. doi: 10.1021/jm101016w.


Summer 2016, Avina S. Rami, Jennifer Jiang, Sutapa Ghosh; Reviewed by ***