Advancements in NMDA Receptor-Targeted Antidepressants: From d-Cycloserine Discovery to Preclinical Efficacy of Lu AF90103

J Med Chem. 2024 Nov 28;67(22):20135-20155. doi: 10.1021/acs.jmedchem.4c01477. Epub 2024 Nov 19.

Abstract

The discovery of d-cycloserine (DCS), a partial agonist of the NMDA receptor that exhibits antidepressant effects without the psychotomimetic effects of ketamine, has fueled interest in new NMDA-targeting antidepressants. Our objective was to identify potent partial agonists mirroring DCS, particularly tailored for the GluN2B subtype of the NMDA receptor. Through a structure-based drug design approach, we discovered compound 42d. This compound acts as a partial agonist of the GluN1/GluN2B complex, exhibiting 24% efficacy, and has an EC50 value of 78 nM. Subsequent investigations led us to 42e (Lu AF90103), a methyl ester prodrug of 42d capable of penetrating the blood-brain barrier, as confirmed by rat microdialysis studies. In different rat in vivo models relevant to neuropsychiatric diseases, administering 42e led to 42d demonstrating both acute effects, observed in a seizure model and EEG, and lasting effects in the stress-sensitive hippocampal pathway and an antidepressant-sensitive model.

MeSH terms

  • Animals
  • Antidepressive Agents* / chemistry
  • Antidepressive Agents* / pharmacology
  • Antidepressive Agents* / therapeutic use
  • Blood-Brain Barrier / drug effects
  • Blood-Brain Barrier / metabolism
  • Cycloserine* / chemistry
  • Cycloserine* / pharmacology
  • Drug Discovery
  • Humans
  • Male
  • Prodrugs / chemical synthesis
  • Prodrugs / chemistry
  • Prodrugs / pharmacology
  • Rats
  • Rats, Sprague-Dawley*
  • Receptors, N-Methyl-D-Aspartate* / metabolism
  • Seizures / drug therapy
  • Seizures / metabolism
  • Structure-Activity Relationship

Substances

  • Receptors, N-Methyl-D-Aspartate
  • Cycloserine
  • Antidepressive Agents
  • Prodrugs