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			        		Wei GAO
			        		
			        		
			        		
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			        		Hongxiang HU
			        		
			        		
			        		
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			        		Lipeng DAI
			        		
			        		
			        		
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			        		Miao HE
			        		
			        		
			        		
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			        		Hebao YUAN
			        		
			        		
			        		
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			        		Huixia ZHANG
			        		
			        		
			        		
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			        		Jinhui LIAO
			        		
			        		
			        		
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			        		Bo WEN
			        		
			        		
			        		
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			        		Yan LI
			        		
			        		
			        		
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			        		Maria PALMISANO
			        		
			        		
			        		
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			        		Mohamed Dit Mady TRAORE
			        		
			        		
			        		
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			        		Simon ZHOU
			        		
			        		
			        		
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			        		Duxin SUN
			        		
			        		
			        		
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			        		Author Information
			        		
 - Publication Type:Journal Article
 - Keywords: Clinical efficacy/toxicity; Drug development; Drug optimization; Structure-tissue exposure/selectivity relationship (STR); Structure‒activity-relationship (SAR)
 - From: Acta Pharmaceutica Sinica B 2022;12(5):2462-2478
 - CountryChina
 - Language:English
 - Abstract: Drug optimization, which improves drug potency/specificity by structure‒activity relationship (SAR) and drug-like properties, is rigorously performed to select drug candidates for clinical trials. However, the current drug optimization may overlook the structure‒tissue exposure/selectivity-relationship (STR) in disease-targeted tissues vs. normal tissues, which may mislead the drug candidate selection and impact the balance of clinical efficacy/toxicity. In this study, we investigated the STR in correlation with observed clinical efficacy/toxicity using seven selective estrogen receptor modulators (SERMs) that have similar structures, same molecular target, and similar/different pharmacokinetics. The results showed that drug's plasma exposure was not correlated with drug's exposures in the target tissues (tumor, fat pad, bone, uterus), while tissue exposure/selectivity of SERMs was correlated with clinical efficacy/safety. Slight structure modifications of four SERMs did not change drug's plasma exposure but altered drug's tissue exposure/selectivity. Seven SERMs with high protein binding showed higher accumulation in tumors compared to surrounding normal tissues, which is likely due to tumor EPR effect of protein-bound drugs. These suggest that STR alters drug's tissue exposure/selectivity in disease-targeted tissues vs. normal tissues impacting clinical efficacy/toxicity. Drug optimization needs to balance the SAR and STR in selecting drug candidate for clinical trial to improve success of clinical drug development.
 
            
