Repurposing antimalarial aminoquinolines and related compounds for treatment of retinal neovascularization

PLoS One. 2018 Sep 12;13(9):e0202436. doi: 10.1371/journal.pone.0202436. eCollection 2018.

Abstract

Neovascularization is the pathological driver of blinding eye diseases such as retinopathy of prematurity, proliferative diabetic retinopathy, and wet age-related macular degeneration. The loss of vision resulting from these diseases significantly impacts the productivity and quality of life of patients, and represents a substantial burden on the health care system. Current standard of care includes biologics that target vascular endothelial growth factor (VEGF), a key mediator of neovascularization. While anti-VGEF therapies have been successful, up to 30% of patients are non-responsive. Therefore, there is a need for new therapeutic targets, and small molecule inhibitors of angiogenesis to complement existing treatments. Apelin and its receptor have recently been shown to play a key role in both developmental and pathological angiogenesis in the eye. Through a cell-based high-throughput screen, we identified 4-aminoquinoline antimalarial drugs as potent selective antagonists of APJ. The prototypical 4-aminoquinoline, amodiaquine was found to be a selective, non-competitive APJ antagonist that inhibited apelin signaling in a concentration-dependent manner. Additionally, amodiaquine suppressed both apelin-and VGEF-induced endothelial tube formation. Intravitreal amodaiquine significantly reduced choroidal neovascularization (CNV) lesion volume in the laser-induced CNV mouse model, and showed no signs of ocular toxicity at the highest doses tested. This work firmly establishes APJ as a novel, chemically tractable therapeutic target for the treatment of ocular neovascularization, and that amodiaquine is a potential candidate for repurposing and further toxicological, and pharmacokinetic evaluation in the clinic.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aminoquinolines / chemistry
  • Aminoquinolines / pharmacokinetics
  • Aminoquinolines / therapeutic use*
  • Angiogenesis Inhibitors / chemistry
  • Angiogenesis Inhibitors / pharmacology
  • Angiogenesis Inhibitors / therapeutic use
  • Animals
  • Antimalarials / chemistry
  • Antimalarials / pharmacokinetics
  • Antimalarials / therapeutic use*
  • Apelin / metabolism
  • Apelin Receptors / antagonists & inhibitors
  • Apelin Receptors / metabolism
  • Cell Line
  • Cell Proliferation / drug effects
  • Choroidal Neovascularization / drug therapy
  • Choroidal Neovascularization / pathology
  • Disease Models, Animal
  • Drug Repositioning*
  • Female
  • Humans
  • Lasers
  • Mice
  • Mice, Inbred C57BL
  • Retinal Neovascularization / drug therapy*
  • Retinal Neovascularization / pathology
  • Small Molecule Libraries / chemistry
  • Small Molecule Libraries / therapeutic use
  • Tissue Distribution
  • Vascular Endothelial Growth Factor A / metabolism

Substances

  • Aminoquinolines
  • Angiogenesis Inhibitors
  • Antimalarials
  • Apelin
  • Apelin Receptors
  • Small Molecule Libraries
  • Vascular Endothelial Growth Factor A