Pleiotropic prodrugs for both symptomatic and disease-modifying treatment of Alzheimer’s disease

Meden, Anže (author), Žnidaršič, Neža (author), Knez, Damijan (author), Wang, Yuanyuan (author), Xu, Ziwei (author), Yang, Huajing (author), Zhang, Weiting (author), Pišlar, Anja (author), Perdih, Andrej (author), Kranjc Brezar, Simona (author), Grgurevič, Neža (author), Pajk, Stane (author), Sun, Haopeng (author), Gobec, Stanislav (author)

The inherent complexity of Alzheimer’s disease (AD) and failed clinical trials have spiked the interest in multifunctional ligands that target at least two key disease-associated macromolecules in AD pathology. Here we present a focused series of pleiotropic N-carbamoylazole prodrugs with dual mechanism of action. Pseudo-irreversible inhibition of the first therapeutic target, human butyrylcholinesterase (hBChE), enhances cholinergic transmission, and thereby provides symptomatic treatment, same as the standard therapeutics in use for AD. Simultaneously, this step also functions as a metabolic activation that liberates a nanomolar selective α2-adrenergic antagonist atipamezole, which blocks pathological amyloid β (Aβ)-induced and noradrenaline-dependent activation of GSK3β that ultimately leads to hyperphosphorylation of tau, thus achieving a disease-modifying effect. Lead compound 8 demonstrated long-term pseudo-irreversible hBChE inhibition, metabolic activation in human plasma, blood–brain barrier permeability, and p.o. bioavailability in mice. Multi-day in vivo treatment with 8 in an Aβ-induced AD murine model revealed a significant alleviation of cognitive deficit that was comparable to rivastigmine, the current drug of choice for AD therapy. Furthermore, decreased GSK3β activation and lowered tau phosphorylation were observed in APP/PS1 mice. This surpasses the symptomatic-only treatment with cholinesterase inhibitors, as it directly blocks an essential pathological cascade in AD. Therefore, these multifunctional α2-adrenergic antagonists–butyrylcholinesterase inhibitors, exemplified by lead compound 8, present an innovative, small molecule-based, disease-modifying approach to treatment of AD.

• Language: English
• Keywords: pleiotropic prodrug, Alzheimer’s disease, butyrylcholinesterase, α2A adrenoreceptor, disease-modifying treatment, N-heterocyclic ureas, carbamates, neurodegenerative diseases
• Work type: Article
• Typology: 1.01 - Original Scientific Article
• Organization: FFA - Faculty of Pharmacy; VF - Veterinary Faculty
• Publication status: Published
• Publication version: Version of Record
• Year: 2025
• Number of pages: Str. 4807-4828
• Numbering: Vol. 15, no. 9
• PID: 20.500.12556/RUL-179131
• UDC: 615:616.89
• ISSN on article: 2211-3843
• DOI: 10.1016/j.apsb.2025.07.005
• COBISS.SI-ID: 249943299
• Publication date in RUL: 06.02.2026

Record is a part of a journal

• Title: Acta pharmaceutica sinica B
• Publisher: Elsevier
• ISSN: 2211-3843
• COBISS.SI-ID: 524560409

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• License: CC BY 4.0, Creative Commons Attribution 4.0 International
• Link: http://creativecommons.org/licenses/by/4.0/
• Description: This is the standard Creative Commons license that gives others maximum freedom to do what they want with the work as long as they credit the author.