RATIONAL DESIGN OF ALLOSTERIC MODULATORS OF HEMOGLOBIN AS DUAL ACTING ANTISICKLING AGENTS

Intracellular polymerization of deoxygenated sickle hemoglobin (Hb S) remains the principal cause of the pathophysiology associated with sickle cell disease (SCD). Naturally occurring and synthetic allosteric effectors of hemoglobin (AEH) have been investigated as potential therapeutic agents for the treatment of SCD. Several aromatic aldehydes, including vanillin, have been studied previously as AEHs for their antisickling activities. Specifically, these compounds form Schiff- base adduct with Hb to stabilize the oxygenated (R) state, increase Hb affinity for O2 and concomitantly prevent the hypoxia-induced primary pathophysiology of Hb S polymerization and RBC sickling, in turn, ameliorating several of the cascading secondary adverse effects. These compounds, however, undergo significant metabolism leading to suboptimal pharmacokinetic properties, e.g. short duration of pharmacologic action and low bioavailability. These drawbacks have severely hampered the use of aromatic aldehydes as AEHs to treat SCD. To counter these challenges, we designed and synthesized 14 novel compounds (PP- compounds) based on previously studied pyridyl derivative of vanillin. These modifications were expected to increase binding interactions with the protein and thus stabilize the Schiff-base adduct, as well as lead to perturbation of the surface-located F-helix that would stereospecifically destabilize polymer contacts. We investigated the in vitro pharmacokinetic/pharmacodynamic properties of these newly synthesized compounds to ascertain sustained binding and modification of normal human Hb. Subsequently, we conducted in vitro screening assays to test for inhibition of sickling, modification of Hb to the high-affinity form, as well as for a direct left-shift in oxygen equilibrium curves (OEC). Three selected compounds, PP6, PP10, and PP14, that demonstrated not only high antisickling activity but also showed sustained pharmacologic action were chosen for preliminary in vivo studies. Our results showed maximal levels of Hb modification, which were sustained for the entire 24 h experimental period. In contrast, TD-7 after reaching maximum effect at 1 h gradually decreased in potency and at 24 h has lost 45% of its activity, consistent with the low bioavailability of this compound. These findings suggested that our modifications appeared to successfully limit drug metabolism in red blood cells. Most of these compounds showed almost complete inhibition of sickling at 2 mM concentration; with significant modification of Hb to a higher affinity Hb as well as an increase in O2 affinity of Hb. Interestingly, while TD-7 demonstrated a clear linear correlation between its ability to increase Hb-O2 affinity and antisickling activity, PP2, PP3, PP6, PP9, PP10, and PP14, showed a weak correlation between these parameters. In fact, these compounds demonstrated high antisickling effect despite only marginally increasing Hb affinity for O2. This observation indicated that these compounds possibly exhibit the dual mechanism of antisickling activity. We hypothesize that their secondary mechanism of action is due to interactions with the surface located αF-helix that would lead to direct or stereospecific inhibition of polymer formation. To establish the mode of interaction with Hb, we further conducted x-ray crystallography studies and co-crystallized PP2, PP6, PP9 and PP11 with CO-liganded Hb. Our studies showed that these compounds bind in symmetry-related fashion at the α-cleft of Hb to form Schiff-base adducts with the N-terminal Val1 and showed direct interactions with the F-helix which overall enhanced interactions with Hb. PP6, PP10, and PP14 demonstrated significant in vivo modification of intracellular Hb in mice after IP administration, with increasing levels from 1 h to the 6 h experimental period. They also showed corresponding changes in O2 affinity observed at 3 h and 6 h, compared to 0 h pre-treatment samples in vivo. Thus, our results establish these compounds as a novel, promising group of potent anti-sickling agents, demonstrate their proposed mechanism of action and provide proof-of-concept justifications for our structure-based approach to developing potent therapeutics for SCD