An oral substrate-like DPP-4 inhibitor used for treating diabetes. dpp4 inhibitor, galvus, glavumet, antidiabetic drug

Vildagliptin

Description

Oral anti-diabetic drug

Target(s)

Dipeptidyl peptidase-4 (DPP-4)

Generic

Vildagliptin

Commercial Name

Galvus (United States, United Kingdom); EQUA (Japan); Jalra (Mexico)

Combination Drug(s)

Galvumet, Galvan Plus, Eucreas (vildagliptin & metformin; United Kingdom)

Other Synonyms

LAF-327, Xiliarx

IUPAC Name

(2S)-1-{N-[(1R,3S,5R,7S)-3-hydroxytricyclo[3.3.1.1~3,7~]dec-1-yl]glycyl}pyrrolidine-2-carbonitrile

Ligand Code in PDB

LF7

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

PDB entry 3w2t 

Table 1. Basic profile of vildagliptin

Figure 1. 2D Structure of Vildagliptin

2D and 3D structure of vildagliptin.

Drug Information: 

Chemical Formula

C17H25N3O2

Molecular Weight

303.40 g/mol

Calculated Predicted Partition Coefficient: cLogP

1.12

Calculated Predicted Aqueous Solubility: cLogS

-2.2

Solubility (in water)

1.75 mg/mL (sparingly soluble)

Predicted Topological Polar Surface Area (TPSA)

76.36 Å2

Table 2. Chemical and physical properties (DrugBank).

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

Drug Target: 

Vildagliptin is an orally active, substrate-like DPP-4 inhibitor. Dipeptidyl peptidase-4 (DPP-4) is responsible for cleaving the gut incretin hormones glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide 1 (GLP-1) that are secreted in response to postprandial increase in blood glucose levels. Vildagliptin is an enzyme blocker that inhibits the enzymatic activity of DPP-4 by binding to its active site, and thus delaying incretin degradation (DrugBank). Consequently, the incretin hormones have a prolonged half-life and are able to extend the action of insulin while simultaneously suppressing the release of glucagon. Ultimately, this leads to a reduction in elevated blood glucose levels, restoring glucose homeostasis.

Drug-Target Complex: 

Dipeptidyl peptidase-4 (DPP-4)

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). Vildagliptin is shown as a ball-and-stick representation (PDB ID: 3w2t; Nabeno et al., 2013).

Vildagliptin, like other substrate-like inhibitors of DPP-4, inhibits DPP-4 through the formation of a covalent complex with the enzyme. The nitrile group from the cyanopyrrolidine ring forms the covalent imidate adduct with the hydroxyl of Ser630 in the catalytic triad, and the cyanopyrrolidine ring itself is buried in the S1 subsite of DPP-4 active site.

Figure 3. X-ray crystal structure of the DPP-4 dimer (ribbons) with bound vildagliptin (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: 3w2t; Nabeno et al., 2013). Vildagliptin 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 vildagliptin is shown on the left of Figure 3 (PDB entry 3BJM). The black box denotes the location of the active site. The figure at the bottom right shows a close-up view of vildagliptin in the active site.


 
Figure 4. Hydrogen bonding interactions (green lines) between vildagliptin (ball-and-stick) and active site residues (sticks) (PDB ID: 3w2t; Nabeno et al., 2013). 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 vildagliptin (Nabeno et al., 2013) reveals multiple interactions of the drug with its pharmacological target, DPP-4 (Figure 4). The major difference between the interactions of vildagliptin and the non-substrate like inhibitors (sitagliptin) of DPP-4, is the formation of a covalent bond between the drug and the hydroxyl group of the active-site serine, S630. The cyanopyrrolidine binds to the S1 subsite; the carbonyl oxygen of vildagliptin forms a hydrogen bond with Asn710, and the amino group of the drug participates in hydrogen-bonding with Glu205 and Glu206; the nitrogen of the cyanopyrrolidine rings interacts with the side-chain hydroxyl of Tyr547 (Nabeno et al., 2013). A comparison of the co-crystal structures of DPP-4 with vildagliptin (PDB ID 3w2t, Figure 4) and DPP-4 with its substrate, Diprotin A (Ile-Pro-Ile), (PDB ID 1nu8, Figure 5) reveals that vildagliptin acts by occluding the DPP-4 active site and prevents binding of incretin hormones.

Pharmacologic Properties and Safety: 

Features

Comment(s)

Source

Bioavailability (%)

85%

(Capuano et al., 2013)

IC50 (nM)

3.5 nM

(BindingDB)

Ki (nM)

10 nM

(Thomas et al., 2008)

Half-life (hrs)

2-3 hours

(Capuano et al., 2013)

Duration of Action

N/A

N/A

Absorption

Human intestinal absorption

(DrugBank)

Transporter(s)

P-glycoprotein (P-gp)

(DrugBank)

Metabolism

Cytochrome p450 3A4

(DrugBank)

Excretion

~85% urine; ~4.5% feces

(Capuano et al., 2013)

AMES Test (Carcinogenic Effect)

0.7053 (non AMES toxic)

(DrugBank)

hERG Safety Test (Cardiac Effect)

0.853 (weak inhibitor)

(DrugBank)

Liver Toxicity

No instances have been reported yet.*

(Ligueros-Saylan et al., 2010)

Table 3. Pharmacokinetics: ADMET of vildagliptin

*Interestingly, while vildagliptin-induced hepatotoxicity is uncommon in patients, studies in rats indicate that vildagliptin may protect the liver from cyclosporine-induced hepatotoxicity via reduction of DPP-4 activity and oxidative stress (El-Sherbeeny et al., 2015).

Following oral administration of vildagliptin, approximately 85.4% of the drug is absorbed by the GI tract while roughly 70% of the administered dose is metabolized by the liver and is excreted via waste product. The remaining 20-30% remains unaltered and is processed by the kidney (He et al., 2009).  Less than 1.6% of the administered drug is metabolized by cytochrome p450. Approximately 85% of the dose is excreted through the urine while 15% the inactive metabolite is found in the feces (Novartis 2015).

Drug Interactions and Side Effects: 

Vildagliptin does not display any harmful effects on cardiac health nor is it carcinogenic (DrugBank).  Meta-analyses suggest that vildagliptin is not associated with in drug-caused liver injury, pancreatitis, infection, elevated hepatic enzyme levels, skin-related toxicity, and an increased risk of hepatic related injury (Ligueros-Saylan et al., 2010).

Features

Comment(s)

Source

Total Number of Drugs Interactions

111 drugs

(DrugBank)

Major Drug Interactions

N/A

N/A

Alcohol/Food Interaction(s)

N/A

N/A

Disease Interaction(s)

pancreatitis

 (Drugs.com)

On-target Side Effects

hypoglycemia, constipation, nausea, diarrhea, pancreatitis, abdominal pain

 

Off-target Side Effects

rash, dyspnea, nasopharyngitis, cephalalgia

 

CYP Interactions

Unknown

(Capuano et al., 2013)

Table 4. Drug interactions and side effects of vildagliptin

There is no known interaction between vildagliptin and cytochrome p450 3A4. In combination with metformin, sulfonylurea, thiazolidinedione, and rosiglitazone, the steady-state pharmacokinetics of vildagliptin were unaltered and no adverse side-effects of using vildagliptin in combination with other drugs including amlodipine, ramipril, valsartan and simvastatin (Novartis 2015). 

Regulatory Approvals/Commercial: 

Developed by Novartis, Galvus (vildagliptin), is currently approved for use (2008) and available in many countries. However, it has not been approved by the US FDA. Patients diagnosed with type 2 diabetes mellitus take Galvus once a day in 100 mg doses or twice daily in 50 mg doses (Novartis 2015).  Galvus tablets are to be administered orally with a glass of water and can be taken as monotherapy or as an add-on drug. 60 tablets sell for approximately $97.24, which comes out to roughly $1.62 per tablet (Novartis 2015).

Links: 

DrugBank

http://www.drugbank.ca/drugs/DB04876

Drugs.com

https://www.drugs.com/international/vildagliptin.html

Food and Drugs Administration

http://www.fda.gov/Drugs/DrugSafety/ucm459579.htm

National Center for Biotechnology Information (NCBI) 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2663430/

Table 5. Links to relevant resources

References: 

BindingDB: Vildagliptin. http://www.bindingdb.org/jsp/dbsearch/PrimarySearch_pdbids.jsp?pdbids_submit=Search&pdbids=3W2T

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

DrugBank: Vildagliptin.  http://www.drugbank.ca/drugs/DB04876.

El-Sherbeeny, N.A., Nader M.A. (2015). The Protective Effect of Vildagliptin in Chronic Experimental Cyclosporine A-induced Hepatotoxicity. Canadian Journal of Physiology and Pharmacology, 94(3): 251-256. doi: 10.1139/cjpp-2015-0336.

He, H., Tran, P., Yin, H., Smith, H., Flood, D., Kramp, R., Filipeck, R., Fischer, V., Howard, D. (2009). Disposition of Vildagliptin, a Novel Dipeptidyl Peptidase 4 Inhibitor, in Rats and Dogs. Drug Metabolism & Disposition, 37(3): 536-544. doi: 10.1124/dmd.108.023002.

Ligueros-Saylan, M., Foley, J.E., Schweizer, A., Couturier, A., Kothny, W. (2010). An Assessment of Adverse Effects of Vildagliptin versus Comparators on the Liver, the Pancreas, the Immune system, the Skin and in Patients with Impaired Renal Function from a Large Pooled Database of Phase II and III Clinical Trials. Diabetes, Obesity and Metabolism, 12: 495-509. doi: 10.1111/j.1463-1326.2010.01214.x.

Nabeno, M. Akahoshi, F., Kishida, H., Miyaguchi, I., Tanaka, Y., Ishii, S., Kadowaki, T. (2013). A Comparative Study of the Binding Modes of Recently Launched Dipeptidyl Peptidase IV Inhibitors in the Active Site. Biochemical and Biophysical Research Communications, 434 (2): 191-196. doi: 10.1016/j.bbrc. 2013.03.010.

Novartis (2015). Galvus [PDF File]. Web. 24 Apr. 2016. 

PubChem: Vildagliptin. https://pubchem.ncbi.nlm.nih.gov/compound/Vildagliptin#section=2D-Structure 

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.

Thomas, L., Eckhardt, M., Langkopf, E., Tadayyon, M., Himmelsbach, F., Mark, M. (2008). (R)-8-(3-Amino-Piperidin-1-Yl)-7-But-2-Ynyl-3-Methyl-1-(4-Methyl-Quinazolin-2-Ylmethyl)-3,7-Dihydro-Purine-2,6-Dione (BI 1356), a Novel Xanthine-Based Dipeptidyl Peptidase 4 Inhibitor, has a Superior Potency and Longer Duration of Action Compared with Other Dipeptidyl Peptidase-4 Inhibitors". Journal of Pharmacology and Experimental Therapeutics, 325(1): 175-82. doi: 10.1124/jpet.107.135723.



Summer 2016, Matthew M. Kim, Jennifer Jiang, Sutapa Ghosh; Reviewed by ***