A primary source of attrition during drug discovery stems from poor
in vivo efficacy [
1]. An important factor that contributes to this problem is the major disconnect that exists between
in vitro data and our ability to predict efficacy in humans. A detailed understanding of drug mechanism of action is important for improving the success of drug discovery, and we posit that a critical contributor to this understanding, and to modulating
in vivo drug activity, is the lifetime of the drug-target complex. To provide this information the target must be known and assays must be available to assess both the thermodynamics
and kinetics of drug-target interactions.
In order to appreciate how kinetic parameters can modulate drug activity, it is useful to consider the fundamental difference between drug behavior in a closed (
in vitro) system and that in an open (
in vivo) system [
2••]. In a closed system drug, target and substrate are at equilibrium, and thus thermodynamic equilibrium constants such as K
d or K
i values, or more commonly IC
50 values, accurately reflect the concentration of the drug-target complex and are appropriate metrics for differentiating potency. A similar argument can be made for whole cell assays, such as standard minimum inhibitory concentration (MIC) measurements of antibacterial activity, where activity is measured at fixed drug concentrations. However,
in vivo systems are open systems in which drug concentration fluctuates with time, and in which the concentrations of both the endogenous substrate (ligand) for the target and the target itself can vary during normal function or in the presence of the drug. Clearly, if drug and target are not at equilibrium, measurements of
in vitro potency based only on thermodynamic parameters are unlikely to reflect potency
in vivo, and thus prioritizing compounds based on K
d, K
i or IC
50 values is unlikely to be successful. Instead, in open systems it is more appropriate to consider the lifetime of the drug-target complex, since a drug will only exert its effect when it is bound to the target. In this case residence time (
tR), which is the reciprocal of the rate constant for dissociation of the drug-target complex (
koff), can be conveniently used to quantify the lifetime of the drug-target interaction [
3••].
The importance of residence time in controlling the pharmacodynamics of drug action is illustrated in (see also [
3••] [
4••] [
5]: for example, see Figure 2 in [
3••]). Key considerations include (i) the concentration of drug at the target site (i.e. the pharmacokinetics), (ii) the thermodynamic dissociation constant of the drug-target complex and (iii) the rate constant for dissociation of the drug-target complex (
koff). In our analysis we have chosen a hypothetical situation in which the concentration of drug at the target site decreases exponentially with a half life of 1 h from a C
max value of 500 nM. For pimelic diphenylamide 106, which has a dissociation constant of 14 nM for histone deacetylase [
6–
7], the C
max is sufficient to inhibit 97 % of the target, assuming that the concentration of target is
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500 nM and that no substrate is present. The percent inhibition of histone deacetylase has then been plotted as a function of time assuming that the drug does not rebind to the target and using the
koff value of 0.086 h
−1 for this system [
6–
7], which corresponds to a half life for the drug-target complex of 8 h (
tR = 11.6 h). Thus after 12 h the enzyme target is still 37 % inhibited even though the free drug concentration has decreased by more than 2,000-fold and is now well below K
d. Also shown in is a similar analysis for two other hypothetical drugs that also have dissociation constants of 14 nM for their targets. For a drug that has a half-life of 72 h on its target (
tR = 104 h), the percent target occupancy is 87 % after 12 h. Conversely, for a rapid reversible drug the percent target occupancy is given simply by the dissociation constant of the drug-target complex and only 2 % of the target is occupied after 12 h. It can thus clearly be seen that residence time has a dramatic effect on percent target occupancy (i.e. on drug pharmacodynamics) in situations where the drug concentration fluctuates over the K
d for the target. In the case of a rapid reversible drug, the percent target occupancy is entirely dependent on the drug concentration at the target site. Drugs with elimination half-lives that are shorter than 1 h will cause the percent target occupancy to fall more rapidly than shown in , while the percent target occupancy will fall more slowly for drugs with elimination half-lives that are longer than 1 h. As has been noted before, the analysis in also demonstrates how the difference in residence time of a drug on its target and on an off-target protein responsible for unwanted (toxic) side-effects will dictate how the therapeutic index of the drug varies with time [
3••] [
4••] [
5]. For example, if the rapid reversible interaction depicted in represents the interaction of pimelic diphenylamide 106 with an off-target protein, then in our analysis this drug will have almost completely dissociated from the off-target protein after 12 h whereas the occupancy of the therapeutic target will still be 37 %.
The significance of drug-target residence time is highlighted by the large number of current drugs that have long residence times, stretching from minutes to days, on their targets [
2••] [
3••] [
4••] [
5] [
8] [
9•]. For example, investigation of 85 New Molecular Entities approved by the FDA between 2001 and 2004 showed that, for the 72 drugs for which the molecular target is known, 19 (26 %) are slow binding inhibitors [
10•]. Furthermore, a survey of 50 drugs demonstrated that, in general, those compounds with longer residence time have better biological efficacy [
11••]. In this review we add an additional 25 compounds (), most of which have been reported in the past 2 years, to the growing list of long residence time drugs, and present two specific examples in which there is a direct correlation between residence time and
in vivo efficacy, and where thermodynamic assessments of potency are poor predictors of
in vivo activity. We then comment on the significant hurdle to using mechanistic information for predicting and modulating residence time.
| Table 1Long residence time in drugs and inhibitors reported in the past two years. |