Journal
MINI-REVIEWS IN MEDICINAL CHEMISTRY
Volume 13, Issue 5, Pages 720-729Publisher
BENTHAM SCIENCE PUBL LTD
DOI: 10.2174/1389557511313050009
Keywords
Reactive metabolite; drug safety; hepatotoxicity; idiosyncratic adverse drug reaction; web application; structural alerts; bioactivation
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Idiosyncratic adverse drug reactions (IADRs) cause a broad range of clinically severe conditions of which drug induced liver injury (DILI) in particular is one of the most frequent causes of safety-related drug withdrawals. The underlying cause is almost invariably formation of reactive metabolites (RM) which by attacking macromolecules induce organ injuries. Attempts are being made in the pharmaceutical industry to lower the risk of selecting unfit compounds as clinical candidates. Approaches vary but do not seem to be overly successful at the initial design/synthesis stage. We review here the most frequent categories of mechanisms for RM formation and propose that many cases of RMs encountered within early ADME screening can be foreseen by applying chemical and metabolic knowledge. We also mention a web tool, SpotRM, which can be used for efficient look-up and learning about drugs that have recognized IADRs likely caused by RM formation.
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