March 12, 2011

Levamisole: Was the “Wrong” Model the Right Model?

Many helminths (parasitic worms) of clinical and commercial importance are nematodes (roundworms). They parasitize humans and other mammals, so it is hardly surprising that candidate anthelmintic drugs are usually tested in small laboratory mammals.

Scientists at the Janssen company in Belgium, however, “screened” compounds for their potential anthelmintic activity against worms in chickens (Raeymaekers et al. 1966). They found a chemical compound (thiazothienol) that was active against the worms, but when they put it into worm-infected rats and mice, it was inactive.

Because roundworms of mammals were the primary target, the investigators might have been expected to ignore this lead. Instead, they performed experiments that showed that the feces of the treated chickens contained a substance that was active against worms in rats and mice.

Interestingly, it was not the original substance but was instead its metabolic product! That excreted substance (thiazothielite) was chemically modified to improve its efficacy and was developed as the veterinary drug tetramisole. The levo-isomer of tetramisole, named levamisole, was later found to have an improved safety margin, and was developed into an enormously successful anthelmintic agent for use in livestock and, to a lesser extent, in humans.

Here we have the “happy accident” so characteristic of serendipity. The compound that led to the discovery of levamisole was not synthesized by the scientists; it was synthesized by the chickens! That result was totally unexpected.

It was the scientists, however, who had the insight to recognize, from the “failed” rodent tests, that the secret to the previously observed anthelmintic efficacy lay not in what went into the chickens but in what came out! From this insight, an important drug was developed.

Obviously, the lesson to be drawn from this episode is not that we should deliberately select the wrong animal model. If there is a lesson to be learned, surely it is two-fold: we should be ever alert to the unexpected, and there is no such thing as a “failed” experiment.


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March 9, 2011

Discovery of Lyrica (pregabalin)

It’s a rare example of a compound that came right out of academia to become a drug, but the rest of its story is both unusual and (in an odd way) typical.

The drug is a very close analog of the neurotransmitter GABA. Silverman’s lab made a series of compounds in the 1980s to try to inhibit the aminotransferase enzyme (GABA-AT) that breaks GABA down in the brain, as a means of increasing its levels to prevent epileptic seizures.

They gradually realized, though, that their compounds were also hitting another enzyme, glutamic acid decarboxylase (GAD), which actually synthesizes GABA.


Shutting down the neurotransmitter’s breakdown was a good idea, but shutting down its production at the same time clearly wasn’t going to work out.

So in 1988 a visiting Polish post-doc (Ryszard Andruszkiewicz) made a series of 3-alkyl GABA and glutamate analogs as another crack at a selective compound. None of them were particularly good inhibitors of GABA- AT. But (most weirdly) they actually turned out to activate GAD, which would also work just fine to raise GABA levels.

Based on this discovery, Parke-Davis acquired the license for these molecules. One enantiomer of the 3-isobutyl GABA analog turned out to be a star performer in the company’s rodent assay for seizure prevention. Further testing resulted in the IND filing in 1995 and clinical trials continued until 2003. The FDA approved the drug in 2004.

And there you’d think the story ends – basic science from the university is translated into a big-selling drug, with the unusual feature of an actual compound from the academic labs going all the way.

But friends the twist comes here!!!

As Silverman makes clear, there’s a lot more to the story. As it turned out, the drug’s efficacy had nothing to do with its GABA-AT substrate behavior. But further investigation showed that it’s not even correlated with its activation of the other enzyme, GAD. None of the reasons behind the compound’s sale to Parke-Davis held up, except the biggest one: it worked well in the company’s animal models.

The biologists at P-D eventually figured out what was going on, up to a point. The compound also binds to a particular site on voltage-gated calcium channels. That turns out to block the release of glutamate, whose actions would be opposed to those of GABA.


So they ended up in the same place (potentiation of GABA effects) but through a mechanism that no one suspected until after the compound had been recommended for human trials!

There were more lucky surprises:Lyrica has excellent blood levels and penetration into the brain, while none of the other analogs came close. As it happened, and as the Parke-Davis folks figured out, the compound was taken up by active transport into the brain (via the System L transporter), which also helps account for its activity.


And Silverman goes on to show that while the compound was originally designed as a GABA analog, it doesn’t even perform that function. It has no binding to any GABA receptor, and doesn’t affect GABA levels in any way.

So on one level, this is indeed an academic compound that went to industry and became a drug. But looked at from another perspective, it was an extremely lucky shot indeed, for several unrelated reasons, and the underlying biology was only worked out once the compound went into industrial development.

And from any angle, it’s an object lesson in how little we know, and how many surprises are waiting for us!!


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March 6, 2011

Genzyme acquired by Sanofi Aventis: A blockbuster Deal


French drugmaker Sanofi-Aventis SA clinched its long-sought deal for Genzyme Corp with a sweetened $20.1 billion cash offer, plus payments tied to the success of the U.S. biotech group's drugs.

The deal's announcement, marks the second-biggest acquisition in biotech history after Roche's $46.8 billion purchase of Genentech in 2009.(as per Reuters)



Sanofi will pay $74 a share in cash and offer a tradable contingent value right, or CVR, whose value will depend on Genzyme's experimental multiple sclerosis drug Lemtrada and production of two other medicines.

According to Bloomberg, the CVR payouts are these:

  • $1 if the MS hopeful Lemtrada wins FDA approval;
  • $2 if Lemtrada sales surpass $400 million by certain deadlines
  • $3 if sales top $1.8 billion;
  • $4 for $2.3 billion-plus;
  • $3 for more than $2.8 billion.

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