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H2N H N H N N N COOH Sir Henry Dale, discovered histamine H i s - decarboxyl as iH2N His Histamine H N t N H2N 2-(1H-Imidazol-4-yl)-ethylamine H2N N N N H N p H2N Where is located Histamine: a)Neurons b)Mast cells and other cells Ruolo fisiologico dell’Istamina L’Istamina è un autacoide sintetizzato in un ristretto n° di neuroni localizzati prevalentementee nei nuclei tuberomamillari dell’ipotalamo posteriore. Nei tessuti periferici è particolarmente presente nei mastociti, eosinofili, basofili, cellule enterocromaffini. La eccessiva liberazione di questo autacoide induce effetti di tipo patofisiologico come: 1. contrazione della muscolatura liscia (bronchi, intestino, utero) 2. dilatazione dei piccoli vasi (arteriole, vene e capillari) 3. incremento della permeabilità dei capillari e rilascio di catecolamine dalla midollare del surrene. The function and evolution of mast cells Mast cells play a key role in the inflammatory process. When activated, a mast cell rapidly releases its characteristic granules and various hormonal mediators into the interstitium. Plasma cells, also called plasma B cells, plasmocytes, and effector B cells, are white blood cells which produce large volumes of antibodies. They are transported by the blood plasma and the lymphatic system. Like all blood cells, plasma cells ultimately originate in the bone marrow; however, these cells leave the bone marrow as B cells, before terminal differentiation into plasma cells, normally in lymph nodes. Mast cells can be stimulated to degranulate by direct injury (e.g. physical or chemical [such as opioids, alcohols, and certain antibiotics such as polymyxins]), cross-linking of Immunoglobulin E (IgE) receptors, or by activated complement proteins. The role of mast cells in the development of allergy. The substances of mast cells The molecules thus released into the extracellular environment include: 1. preformed mediators (from the granules): serine proteases, such as tryptase histamine (2-5 pg/cell) serotonin proteoglycans, mainly heparin (active as anticoagulant) 2. newly formed lipid mediators (eicosanoids): thromboxane prostaglandin D2 leukotriene C4 platelet-activating factor PAF 3. cytokines Eosinophil chemotactic factor Function of the enterochromaffin-like (ECL) cell of the stomach. Enterochromaffin-like cells or ECL cells are a type of neuroendocrine cells found in the gastric glands of the gastric mucosa beneath the epithelium, in particular in the vicinity of parietal cells. They are also considered a type of enteroendocrine cell. ECL cells synthesize and secrete histamine. ECL cells are stimulted by vagal nervous through the neurotransmitter Ach. The most important inhibitor of the ECL cell is somatostatin from oxyntic D cells. Gastrin is transferred from a specific type of G cell in the gastric epithelium to the PARITAL cells by blood. The post-ganglionic fibers of the vagus nerve that innervate the G cells of the stomach release gastrin release peptide (GRP), which stimulates the G cells to release gastrin. Histamine and Gastrin act synergistically as the most important stimulators of hydrochloric acid secretion from parietal cells and stimulators of secretion of pepsinogen from chief cells. Enterochromaffin-like cells also produce pancreastatin and probably other peptide hormones and growth factors. Histamine receptors system Histamine receptors play an important role in human disease, and drugs acting at these receptors are clinically important. Peripheral-selective H-1 antagonists are used in the treatment of allergies and allergic asthma and H-2 antagonists offer treatment for gastric distress due to hyperacidity. A third type of histamine receptor, the H-3 receptor, is a pharmacologically distinct histamine receptor located predominantly on presynaptic nerve terminals, where it modulates the release of histamine and other neurotransmitters. Other etheroreceptors (M2, a2 and -opioid) have the same function to regulate the Histamine release. The H-3 receptor has recently gained attention for its potential role in modulating cognitive, psychiatric, appetitive, allergic, and other physiological processes, and there is much recent interest in finding potent and efficacious H-3 receptor antagonists to treat these diseases. Recently, a forth receptor H-4 was discovered and ligands were developed in order to charactherized its function. L-histidine Histamine neurone activity Nerve ending Histamine G protein H3/H4 Synaptical cleft Metabolism H3 homo/heteroreceptors: H, Ach, 5-HT, D, NA,…. Histamine H1 H2 Gq/G11 protein The signal transduction pathway used by the H3/H4 receptor appears to be via Gi and Go proteins. Gs-protein Effector cell IP3 DG + cAMP Histamine is also a neurotransmitter in the CNS with a role in sleep-wake cycles, appetite, learning and memory. It is produced in a subset of neurons in the tuberomammillary nucleus of the hypothalamus and its effects are transmitted widely to other regions of the brain. (A) Histaminergic neuron. H3 autoreceptor, endogenous histamine (HA), acts at presynaptic H3 autoreceptors to reduce HA synthesis and release (a negative feedback loop). (B) (B) Nonhistaminergic neuron. Blockade of the H3 heteroreceptors should modulate the release of other neurotransmitters. aa involved in the istamine receptor interaction Asp Thr, Asn Aspetti terapeutici mediati dal sistema istaminergico Dal prospetto fisiopatologico appare chiaro che con questo sistema bisogna contrastare piu’ che promuovere l’attivazione dell’Istamina liberata in base a certi stimoli. Tuttavia sono state evidenziate alcune attività terapeutiche istamino mediate: a) attraverso il sito H1 si puo’ determinare un’attività anticonvulsivante confermata dal dato farmacologico che gli antagonisti H1 inducono o incrementano il danno cerebrale in casi di epilessia, b) Si puo’ incrementare l’attività del muscolo cardiaco, in alternativa al sistema adrenergico, attraverso un’azione istamino simile mediata dal recettore H2. Patologia relativa al sistema istaminergico ISTAMINE is responsible of sudden, severe, potentially fatal, systemic allergic reaction that can involve various areas of the body (such as the skin, respiratory tract, gastrointestinal tract, and cardiovascular system). Common cause: food, insect stings, medicines. Terapia Dal prospetto patologico appare chiaro che bisogna contrastare piu’ che promuovere l’attivazione dell’Istamina liberata in base a certi stimoli. Histamine is released from preformed stores in mast cells and basophils Molecular models of H1 antagonists, first generation Ar 1 X Ar 2 H N N H2N R N R X = N, C, C-O, C-N and others The first generation of H1 antagonists is poor receptor selective and pass the BBB, they present more side effects. Molecular models of H1 antagonists, first generation X=N Thonzylamine N-(4-methoxybenzyl)-N',N'-dimethyl-N-pyrimidin-2-ylethane-1,2-diamine Also in association with NAPHAZOLINE, an a-agonist, in a formulation of eye drops. Molecular models of H1 antagonists, first generation Central activity of this H1 antagonist to treat emesis via cholinergic disactivation X = C-O O CH3 N CH3 O N O N O (2-Benzhydryloxy-ethyl)-dimethyl-amine Diphenydramine N H N N Cl 8-Chloro-1,3-dimethyl-3,7-dihydro-purine-2,6-dione or 8-chloro Theofilline. The salt is a Diphenidramine-theoclate Molecular models of H1 antagonists, first generation N X=C Cl CH3 N CH3 Chlorpheniramine +/-[3-(4-Chloro-phenyl)-3-pyridin-2-yl-propyl]-dimethyl-amine + isomer is POLARAMIN Molecular models of H1 antagonists, first generation X = C-N with cyclization of the spacer and the base Cyclizine 1-benzhydryl-4-methyl-piperazine S Also, cyclic structures in the first generation of H1 antagonists N H3C N CH3 Prometazine Dimethyl-(1-methyl-2-phenothiazin-10-yl-ethyl)-amine Only local therapy N H3C Ciproeptadine 4-(5H-Dibenzo[a,d]cyclohepten-5-ylidene)-1-methyl-piperidine Reorganization of H1 antagonists with poor side effects From cyclizine and hydroxyzine to CETIRIZINE Hydroxyzine cyclizine Cl N N O COOH Cetirizine (2-{4-[(4-Chloro-phenyl)-phenyl-methyl]-piperazin-1-yl}-ethoxy)-acetic acid Levocetirizine is a third-generation non-sedative antihistamine, developed from the second-generation antihistamine cetirizine. From chlorpheniramine to the second generation of H1 antagonists, more receptor selective and with poor side effects. Loratadine N Cl Cl N CH3 N CH3 N Chlorpheniramine +/-[3-(4-Chloro-phenyl)-3-pyridin-2-yl-propyl]-dimethyl-amine + isomer is POLARAMIN O O 4-(8-Chloro-5,6-dihydro-benzo[5,6]cyclohepta[1,2-b]pyridin-11-ylidene)-piperidine-1-carboxylic acid ethyl ester Cl N N H N O Cl N O Des-Loratadine, CLARINEX 8-Chloro-11-piperidin-4-ylidene-6,11-dihydro-5H-benzo[5,6]cyclohepta[1,2-b]pyridine Desloratadine (a major metabolite of loratadine) is extensively metabolized to 3-hydroxydesloratadine, an active metabolite, which is subsequently glucuronidated. HO Cl N N H Cyclic structure and chemical function for 2° antihistamine generation Olopatadine hydrochloride Olopatadine is an antihistamine (as well as anticholinergic) and mast cell stabilizer, sold as a prescription eye drop (0.2% solution, Pataday (or Patanol S in some countries), manufactured by Alcon). It is used to treat itching associated with allergic conjunctivitis (eye allergies). Olopatadine hydrochloride 0.1% is sold as Patanol (or Opatanol in some countries). A nasal spray formulation is sold as Patanase, which was approved by the FDA on April 15, 2008. It is also available as an oral tablet in Japan under the tradename Allelock, {(11Z)-11-[3-(dimethylamino)propylidene]-6,11-dihydrodibenzo[b,e]oxepin-2-yl}acetic acid Another cyclic structure and chemical function for 2° antihistamine generation Ketotifen 4-(1-Methylpiperidin-4-ylidene)-4,9-dihydro-10H-benzo[4,5]cyclohepta[1,2-b]thiophen-10-one Ketotifen is a second-generation H1-antihistamine used to treat allergic conjunctivitis or the itchy red eyes caused by allergies. In its oral form, it is used to prevent asthma attacks. Other antisthamine design Terfenadine COOH HO HO N N OH OH *Fexofenadine 2-(4-{1-Hydroxy-4-[4-(hydroxy-diphenyl-methyl)-piperidin-1-yl]-butyl}-phenyl)-2-methyl-propionic acid From haloperidol to terfenadine *Fexofenadine is a metabolite of Terfenadine, it has a better pharmacological profile and in praticular less interacts with the K+ channels O HO N F Cl Mast cell stabilizer Antagonists of the H1 receptor of Histamine are the more abundant drugs to prevent the action of the lignad in pathlogical conditions. We can aslo stabilizing the cell and thereby preventing the release of the ligand and related mediators comprehensive of histamine. It seems that these drugs (cromone medications) can block a calcium channels essentially for mast cell degranulation. Nedocromil is classified as a cromone, a derivative of benzopyran with a substituted keto group on the pyran ring. Nedocromil 9-ethyl-4,6-dioxo-10-propyl-6,9-dihydro-4H-pyrano[3,2-g]quinoline-2,8-dicarboxylic acid Nedocromil acts as a mast cell stabilizer, inhibits the degranulation of mast cells, prevents release of histamine and tryptase, so preventing the synthesis of prostaglandins and leukotrienes. Lumen of the stomac HCl H+ Cl- K+ K+ H+/K+ ATPase I principali interlocutori della cellula secretoria Protein kinases + H2 blockers cAMP Ca++ - + + IP3 and DG Proglumide M3 Histamine PGE2 Histamine M1 containing cell atropine Ach Gastrin Plesso del nervo vago con fibre colinergiche enterochromaffin-like cells Istamine and H2 receptor Events leading to hydrochloric acid formation by the parietal cell Regulation of stomac secretion Paracrine comunication by cells in the stomac Function of the enterochromaffin-like (ECL) cell of the stomach. Enterochromaffin-like cells or ECL cells are a type of neuroendocrine cells found in the gastric glands of the gastric mucosa beneath the epithelium, in particular in the vicinity of parietal cells. They are also considered a type of enteroendocrine cell. ECL cells synthesize and secrete histamine. ECL cells are stimulted by vagal nervous through the neurotransmitter Ach. The most important inhibitor of the ECL cell is somatostatin from oxyntic D cells. Gastrin is transferred from a specific type of G cell in the gastric epithelium to the ECL cells by blood. The post-ganglionic fibers of the vagus nerve that innervate the G cells of the stomach release GRP, which stimulates the G cells to release gastrin. Histamine and gastrin act synergistically as the most important stimulators of hydrochloric acid secretion from parietal cells and stimulators of secretion of pepsinogen from chief cells. Enterochromaffin-like cells also produce pancreastatin and probably other peptide hormones and growth factors. Molecular models of H2 antagonists Imidazole ring replacement H2N Istamine H N H N N N H2N modification of the spacer modification of the amino function Design of H2 antagonists 1. modification of the amino function NH NH2 O O Amidine function H N H N H N R R NH S Ureic or thioureic function H N Guanidine function Amidine and guanidine functions are considered to more basic and NO2 and CN groups were used to modify the chemical properties, expecially in the last guanidine 2. modification of the spacer S In the modification of the spacer has been considered the distance between amino function and imidazole ring and the influence of the spacer into the chemical properties of the same imidazole ring 3. Imidazole ring or analog of this scaffold with similar properties N N H R Design of H2 antagonists Burimamide was the first compound to be described with selectivity for the H2 receptor. Burimamide has since been shown to be a more potent antagonist of the presynaptic H3 receptor present on nerve terminals within the central and peripheral nervous systems. The development of selective H3 receptor agonists (e.g. R- -methylhistamine, immetit) and antagonists (e.g. thioperamide, clobenpropit, iodoproxyfan and ciproxifan) was reported. There is growing evidence that both the H3 and H4 receptor are potentially exciting new therapeutic targets for neuropathological and immunological disorders, respectively, with compounds currently in Preclinical development or Phase I and II clinical trials Design of H2 antagonists H H N N S N NH2 N N-CN N H N H Cimetidine istamine N-cyanoN'-Methyl-N''-[2-(5-methyl-1H-imidazol-4-ylmethylsulfanyl)-ethyl]-guanidine S N H N H N N-NO2 N H N O S N S H N H NO2 H N CH-NO2 N H H N H N Ranitidine N-[2-(5-dimetilaminometil-furan-2-il-metilsulfanil)-etil]-N'-metil-2-nitro-1,1-etendiammina S N N S H N H N H NO2 Design of H2 antagonists Nizatidine N-[2-(5-dimetilaminometil-tiazol-4-il-metilsulfanil)-etil]-N'-metil-2-nitro-1,1-eten-diammina N NH2 N H2N N S SO2-NH2 NH2 S Famotidine 3-[[[2-[(aminoiminometil)amino]-tiazol-4-il]-metil]-sulfanil]-N-(aminosulfonil)-propan-imideamide NH2 N H2N N S S H N NHCH3 N CN Tiotidine N-cyanoN'-Methyl-N''-[[[2-(aminoiminomethyl)amino]-tiazol-4-yl]-methylsulfanylethyl]-guanidine Design of H2 antagonists O N O O N H O Roxatidine acetate Acetic acid [3-(3-piperidin-1-ylmethyl-phenoxy)-propylcarbamoyl]-methyl ester Roxatidine acetate is a specific and competitive H2 receptor antagonist. The antisecretory effect of roxatidine acetate is mediated by its main metabolite, roxatidine. O N O N H OH Gastric acid secretion Gastric acid is secreted by parietal cells of the stomach in response to stimuli such as the presence of food in the stomach or intestine and the taste, smell, sight or tought of food. Such stimuli result in the activation of hystamine, acethycoline or gastrin receptor ( the H2 M3 and CCK2) located in the basolateral membrane of the parietal cell, which initiates signal trasduction patways that converge on the activation of H+/K+-ATPase, the final step of acid secretion. A proton-pump as a final step in the secretion of HCl Plasma CO2 HCO3- Gastric Parietal Cell Lumen of the Stomach carbonic anhydrase CO2 + H2CO3 H2O H+ H+ HCO3- K+ ATP Cl- Cl- ADP + Pi Cl- H+,K+-ATPase Figure 1. Production of gastric acid and its secretion H+,K+-ATPase Ion trasport is coupled to a cycle of phosphorylation and dephosphorylation of the enzyme. The enzyme is composed of two subunits, the big catalitic a-subunit consists of 1000 aa and it is responsible of the transport, and a smaller b-subunit perhaps 300 aa with a structural and membrane-targeting function. The a-catalytic subunit of the H+/K+ ATPase appears to have 10 membrane-spanning segments and the loop between M5-6 contains Cys813 that may have relevant for inhibition by drugs that are acid-activated thiol reagents. Other Cys residues to be considered in the contest of the drug-activity are 321 in the M3-4 and 892 in the M7-8 loop. H+ Proton pump inhibitors Omeprazole (Losec) Esomeprazole (Nexium) Lansoprazole (Zoton, Lansox) Pantoprazole (Protium) Rabeprazole sodium (Pariet) S N N CH3 N H N S N Chemical milestones in the development of proton-pump inhibitors Omeprazolo OCH3 N O S N OCH3 HN 5-Methoxy-2-(4-methoxy-3,5-dimethyl-pyridin-2-yl-methanesulfinyl)-1H-benzoimidazole Lansoprazolo CF3 O N O S N HN 2-[3-Methyl-4-(2,2,2-trifluoro-ethoxy)-pyridin-2-yl-methanesulfinyl]-1H-benzoimidazole Pantoprazolo O O N O S N HN O CHF2 5-Difluoromethoxy-2-(3,4-dimethoxy-pyridin-2-yl-methanesulfinyl)-1H-benzoimidazole Rabeprazolo O N O O S N HN 2-[4-(3-Methoxy-propoxy)-3-methyl-pyridin-2-yl-methanesulfinyl]-1H-benzoimidazole Proton-pump inhibitors such as omeprazole are prodrugs that are converted to their active form in acidic environments. Omeprazole is a weak base, and so specifically concentrates in the acidic secretory canaliculi of the parietal cell, where it is activated by a proton-catalysed process to generate a sulphenamide. The sulphenamide interacts covalently with the sulphydryl groups of cysteine residues in the extracellular domain of the H+K+/ATPase in particular Cys 813 thereby inhibiting its activity. Omeprazole sulphenamide active form H3C OCH3 CH3 H3C N N S S HN O + N H+ SOH N O NH H 3CO OCH3 CH3 H3C + N H+ (slow) NH H 3CO OCH3 CH3 NH H 3CO ossidazione H3C OCH3 CH3 H3C OCH3 CH3 N + N S N H 3CO - H2 O NH N H 3CO SH NH OCH3 CH3 H3C + N RS — N H3C SSR NH + N RSH ENZ-S H H 3CO OCH3 CH3 N N S H 3CO Sulphenamide intermediate Altri farmaci utili per le patologie gastriche Antiacidi: Al(OH)3, AlO(OH), Al2O3 The hydroxide reacts with excess acid in the stomach, reducing its acidity. This decrease of acidity of the contents of the stomach may in turn help to relieve the symptoms of ulcers, heartburn or dyspepsia. It can also cause constipation and is therefore often used with magnesium hydroxide or magnesium carbonate, which have counterbalancing laxative effects. Sucralfate is a cytoprotective agent, an oral gastrointestinal medication primarily indicated for the treatment of active duodenal ulcers. All alcholic functions are -C-O-SO2-O-Al(OH)2 Altri farmaci utili per le patologie gastriche Analoghi delle PGE2 che sulle cellule non parietali, epiteliali e della mucosa, inducono la sintesi di mucoproteine e bicarbonato per tamponare l’acidità. L’interazione della PGE2 con il recettore specifico delle cellule parietali è un messaggio negativo per la sintesi di HCl. Prostaglandin E2 Misoprostol Fine presentazione Models for the cation binding domain of the wild-type enzyme (left panel) and the N792Q mutant (right panel) Ruolo terapeutico Istamina-Recettori Il ruolo fisiologico dell’Istamina non é del tutto chiaro (è presente nella maggior parte dei tessuti e in conc. elevata nei polmoni, nell’epidermide e nel tratto gastrointestinale e in alcune cellule del sangue come mastociti e basofili), mentre la eccessiva liberazione di questo autacoide induce effetti di tipo patofisiologico come: 1. contrazione della muscolatura liscia (bronchi, intestino, utero) 2. dilatazione dei piccoli vasi (arteriole, vene e capillari) 3. incremento della permeabilità dei capillari e rilascio di catecolamine dalla midollare del surrene. Dal prospetto fisiopatologico appare chiaro che bisogna contrastare l ’eccessiva attività dell’Istamina liberata in base a certi stimoli o impedire l’attvità di questa sostanza mediata dai rispettivi siti recettoriali. Tuttavia sono state evidenziate alcune attività terapeutiche istamino mediate, per esempio attraverso il sito H1 si puo’ determinare un’attività anticonvulsivante confermata dal dato farmacologico che gli antagonisti H1 inducono o incrementano il danno cerebrale in casi diepilessia, oppure incrementare l’attività del muscolo cardiaco, in alternativa al sistema adrenergico attraverso un’azione istamino simile mediata dal recettore H2. Hydroxyzine, ATARAX 2-[2-[4-(p-chlorobenzhydryl)-1-piperazinyl]ethoxy]ethanol dihydrochloride. Prostaglandins The development of agents active at prostaglandin (PG) E2 receptors has been an area of interest to the pharmaceutical industry for the past three decades, with both agonists and antagonists anticipated to have therapeutic utility in treating diverse conditions including asthma, inflammation, pain, ulcers, cancer, and osteoporosis. PGE2 has been shown to be the preferred prostanoid ligand for four of these receptor subtypes, the EP1, EP2, EP3, and EP4 (EP2 and EP4 receptors coupled to an increase in intracellular cAMP are smooth muscle relaxants. EP2 and/or EP4 antagonists play an important role in diminishing allergic and IgE-mediated asthmatic responses since EP2 and EP4 subtypes regulate activation and differentiation of mouse B lymphocytes to IgE-secreting cells. Other prostanoids interact with: PGD-2 for the DP receptor, PGF-2a for the FR receptor, PGI-2 for the IP receptor, and TXA-2 for the TP receptor. Prostaglandins and therapy Protective of gastric mucosa, O COOCH3 CH3 HO OH MISOPROSTOL, a PGE2 analogues (11a, 13E) 11,16-diidrossi-16-metil-9-oxo-prost-13-en-1-oico acido metil estere O HO CH3 OH HO RIOPROSTIL (11a, 13E) 1,11,16-triidrossi-16-metil-prost-13-en-9-one Cl H3C HO OH CH3 COOH NOCLOPROST (9R, 11R, 15R) 9-cloro-11,15diidrossi-16,16-dimetil-prosta-5Z,13E-dienoico acido Vasodilatant in perifery, O HO COOH OH CAVERJECT (11a, 13E) 11,15-diidrossi-9-oxo-prost-13-en-1-oico acido Stimulant of the uterus muscle O HO HO COOH OH PGE2 (11R, 15R) 9-oxo-11,15-diidrossi-prosta-5Z,13E-dienoico acido HO COOH OH PGF2a (9R,11R, 15R) 9,11,15-triidrossi-prosta-5Z,13E-dienoico acido Modificazioni molecolari dell’His/Istamina CF3 H N N H2N 2-(1H-Imidazol-4-yl)-2-(3-trifluoromethyl-phenyl)-ethylamine, agonista selettivo H1 More modifications N HN S H N H N H N N NH Impromidine N-[3-(1H-Imidazol-4-yl)-propyl]-N'-[2-(5-methyl-1H-imidazol-4-ylmethylsulfanyl)-ethyl]-guanidine, agonista selettivo H2 Modificazioni molecolari dell’His/Istamina H N N H2N 2-(1H-Imidazol-4-yl)-1-methyl-ethylamine, agonista H3 Gli agonisti del recettore H3 possono essere proposti nell’infiammazione neurogenica (vie aeree e vescica), migrain e nei disordini del sonno. H N H N N H N N S 4-(1H-Imidazol-4-yl)-piperidine-1-carbothioic acid cyclohexylamide, antagonista H3 N H N O O