Repurposing antimalarial aminoquinolines and related compounds for treatment of retinal neovascularization

• Published in: PloS one Vol. 13; no. 9; p. e0202436
• Main Authors: McAnally, Danielle, Siddiquee, Khandaker, Gomaa, Ahmed, Szabo, Andras, Vasile, Stefan, Maloney, Patrick R, Divlianska, Daniela B, Peddibhotla, Satyamaheshwar, Morfa, Camilo J, Hershberger, Paul, Falter, Rebecca, Williamson, Robert, Terry, David B, Farjo, Rafal, Pinkerton, Anthony B, Qi, Xiaping, Quigley, Judith, Boulton, Michael E, Grant, Maria B, Smith, Layton H
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 12.09.2018; Public Library of Science (PLoS)
• Subjects: Age; Aminoquinolines; Aminoquinolines - chemistry; Aminoquinolines - pharmacokinetics; Aminoquinolines - therapeutic use; Amodiaquine; Angiogenesis; Angiogenesis inhibitors; Angiogenesis Inhibitors - chemistry; Angiogenesis Inhibitors - pharmacology; Angiogenesis Inhibitors - therapeutic use; Animals; Antagonists; Antimalarials - chemistry; Antimalarials - pharmacokinetics; Antimalarials - therapeutic use; Apelin - metabolism; Apelin Receptors - antagonists & inhibitors; Apelin Receptors - metabolism; Biology and Life Sciences; Cell Line; Cell Proliferation - drug effects; Choroidal Neovascularization - drug therapy; Choroidal Neovascularization - pathology; Complications and side effects; Creationism; Cytokines; Development and progression; Diabetes; Diabetes mellitus; Diabetic retinopathy; Disease Models, Animal; Dosage and administration; Drug development; Drug Repositioning; Drug therapy; Eye; Eye diseases; Female; Genomics; Growth factors; Health aspects; Health care; Humans; Lasers; Macular degeneration; Malaria; Medicine; Medicine and Health Sciences; Mice; Mice, Inbred C57BL; Neovascularization; Obesity; Organic chemistry; Patients; Pharmacology; Prevention; Proteins; Quality of life; Quinolines; Research and Analysis Methods; Retina; Retinal Neovascularization - drug therapy; Retinal Neovascularization - pathology; Retinopathy; Risk factors; Small Molecule Libraries - chemistry; Small Molecule Libraries - therapeutic use; Therapeutic applications; Tissue Distribution; Toxicity; Vascular endothelial growth factor; Vascular Endothelial Growth Factor A - metabolism; Vascularization; Vision disorders; Visual impairment; Indiana; Florida; Alabama; United States > US; Oklahoma; Indianapolis Indiana
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0202436

Neovascularization is the pathological driver of blinding eye diseases such as retinopathy of prematurity, proliferative diabetic retinopathy, and wet age-related macular degeneration. The loss of vision resulting from these diseases significantly impacts the productivity and quality of life of patients, and represents a substantial burden on the health care system. Current standard of care includes biologics that target vascular endothelial growth factor (VEGF), a key mediator of neovascularization. While anti-VGEF therapies have been successful, up to 30% of patients are non-responsive. Therefore, there is a need for new therapeutic targets, and small molecule inhibitors of angiogenesis to complement existing treatments. Apelin and its receptor have recently been shown to play a key role in both developmental and pathological angiogenesis in the eye. Through a cell-based high-throughput screen, we identified 4-aminoquinoline antimalarial drugs as potent selective antagonists of APJ. The prototypical 4-aminoquinoline, amodiaquine was found to be a selective, non-competitive APJ antagonist that inhibited apelin signaling in a concentration-dependent manner. Additionally, amodiaquine suppressed both apelin-and VGEF-induced endothelial tube formation. Intravitreal amodaiquine significantly reduced choroidal neovascularization (CNV) lesion volume in the laser-induced CNV mouse model, and showed no signs of ocular toxicity at the highest doses tested. This work firmly establishes APJ as a novel, chemically tractable therapeutic target for the treatment of ocular neovascularization, and that amodiaquine is a potential candidate for repurposing and further toxicological, and pharmacokinetic evaluation in the clinic.