Steroids an Overview on 5-Reductase Inhibitors
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Steroids 75 (2010) 109–153 Contents lists available at ScienceDirect Steroids journal homepage: www.elsevier.com/locate/steroids Review An overview on 5␣-reductase inhibitors Saurabh Aggarwal a, Suresh Thareja a, Abhilasha Verma a, Tilak Raj Bhardwaj a,b, Manoj Kumar a,∗ a University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh 160014, India b I. S. F College of Pharmacy, Ferozepur Road, Moga, Punjab 142001, India article info abstract Article history: Benign prostatic hyperplasia (BPH) is the noncancerous proliferation of the prostate gland associated Received 13 July 2009 with benign prostatic obstruction and lower urinary tract symptoms (LUTS) such as frequency, hesitancy, Received in revised form 9 October 2009 urgency, etc. Its prevalence increases with age affecting around 70% by the age of 70 years. High activity of Accepted 20 October 2009 5␣-reductase enzyme in humans results in excessive dihydrotestosterone levels in peripheral tissues and Available online 30 October 2009 hence suppression of androgen action by 5␣-reductase inhibitors is a logical treatment for BPH as they inhibit the conversion of testosterone to dihydrotestosterone. Finasteride (13) was the first steroidal 5␣- Keywords: reductase inhibitor approved by U.S. Food and Drug Administration (USFDA). In human it decreases the 5␣-Reductase inhibitors Androgens prostatic DHT level by 70–90% and reduces the prostatic size. Dutasteride (27) another related analogue ␣ Azasteroids has been approved in 2002. Unlike Finasteride, Dutasteride is a competitive inhibitor of both 5 -reductase Testosterone type I and type II isozymes, reduced DHT levels >90% following 1 year of oral administration. A number BPH of classes of non-steroidal inhibitors of 5␣-reductase have also been synthesized generally by removing 5␣-Dihydrotestosterone one or more rings from the azasteroidal structure or by an early non-steroidal lead (ONO-3805) (261). In this review all categories of inhibitors of 5␣-reductase have been covered. © 2009 Elsevier Inc. All rights reserved. Contents 1. Introduction .......................................................................................................................................... 110 2. Enzyme 5␣-reductase ................................................................................................................................ 110 3. Steroidal 5␣-reductase inhibitors ................................................................................................................... 111 4. 2- and 3-Azasteroids ................................................................................................................................. 111 5. 4-Azasteroids......................................................................................................................................... 112 6. 6-Azasteroids......................................................................................................................................... 121 7. 7-Azasteroids......................................................................................................................................... 124 8. 8-Azasteroids......................................................................................................................................... 124 9. 9-Azasteroids......................................................................................................................................... 124 10. 19-Nor-10-azasteroids ............................................................................................................................. 124 11. 11-, 12a-, 13-Azasteroids ........................................................................................................................... 125 12. 15- and 16-Azasteroids ............................................................................................................................. 125 13. 17- and 17a-Aza-D-homosteroids .................................................................................................................. 125 14. Diazasteroids ....................................................................................................................................... 125 15. 11,13,15-Triazasteroids............................................................................................................................. 126 16. B,D-Dihomo-azasteroids............................................................................................................................ 126 17. Des-AB-azasteroids ................................................................................................................................. 126 18. Steroidal 3-carboxylic/phosphonic/phosphinic acids .............................................................................................. 127 19. Diazoketone steroids ............................................................................................................................... 128 20. 4-Substituted steroids .............................................................................................................................. 128 21. Steroidal oximes .................................................................................................................................... 129 22. Steroidal tetrahydrooxazin-2-ones................................................................................................................. 129 ∗ Corresponding author. Tel.: +91 172 2534115; fax: +91 172 2534112. E-mail addresses: [email protected] (S. Aggarwal), manoj [email protected] (M. Kumar). 0039-128X/$ – see front matter © 2009 Elsevier Inc. All rights reserved. doi:10.1016/j.steroids.2009.10.005 110 S. Aggarwal et al. / Steroids 75 (2010) 109–153 23. 16-Substituted steroids ............................................................................................................................. 130 24. 6-Methylene steroidal derivatives ................................................................................................................. 130 25. Seco steroids ........................................................................................................................................ 131 26. Derivatives of natural substrate: pregnane ........................................................................................................ 131 27. Non-steroidal 5␣-reductase inhibitors ............................................................................................................. 135 28. Mimics of 4-azasteroids: benzo[f]quinolinones.................................................................................................... 135 29. Pyridones, quinolinones and piperidines .......................................................................................................... 136 30. Mimics of 6-azasteroids: benzo[c] quinolinones................................................................................................... 139 31. Mimics of 10-azasteroids: benzo[c] quinolizinones ............................................................................................... 139 32. Non-steroidal aryl acids ............................................................................................................................ 141 33. Bisubstrate inhibitors ............................................................................................................................... 146 34. Miscellaneous non-steroidal inhibitors ............................................................................................................ 147 35. Conclusion and future ahead ....................................................................................................................... 149 Acknowledgements .................................................................................................................................. 149 References ........................................................................................................................................... 149 1. Introduction values for relevant compounds have been compared according to the molecular class. The values given are not comparable across Benign prostatic hyperplasia (BPH) is the noncancerous growth the studies and in each comparison a standard taken in the study of the prostate gland resulting due to over-proliferation of the is mentioned. stromal and glandular elements of the prostate [1]. It is caused due to the augmented levels of the androgen dihydrotestosterone 2. Enzyme 5␣-reductase (DHT). In BPH, microscopic foci within specific regions of the prostate grows to form macroscopic nodules which eventually dis- A significant correlation between the androgens and prostate is place the normal prostatic tissue and results into the uretheral well known. Testicular androgens constitute the most important compression. This compression resulting due to increased cell pro- mitogenic factor in vivo for the prostate [11]. Normal circulating liferation and/or impaired apoptosis causes physical enlargement levels of androgens are required for the maintenance of structural of the prostate gland and is referred to as static component. In function, growth and integrity of the prostate tissue. However, addition dynamic component involves sympathetic nerve stim- androgens have no direct effect on prostatic epithelial cells in ulation causing contraction of prostatic and uretheral smooth culture [12].