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2017 ; 234
(1
): T125-T140
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30 YEARS OF THE MINERALOCORTICOID RECEPTOR: Mineralocorticoid receptor
antagonists: 60 years of research and development
#MMPMID28634268
Kolkhof P
; Bärfacker L
J Endocrinol
2017[Jul]; 234
(1
): T125-T140
PMID28634268
show ga
The cDNA of the mineralocorticoid receptor (MR) was cloned 30 years ago, in 1987.
At that time, spirolactone, the first generation of synthetic steroid-based MR
antagonists (MRAs), which was identified in preclinical in vivo models, had
already been in clinical use for 30 years. Subsequent decades of research and
development by Searle & Co., Ciba-Geigy, Roussel Uclaf and Schering AG toward
identifying a second generation of much more specific steroidal MRAs were all
based on the initial 17-spirolactone construct. The salient example is
eplerenone, first described in 1987, coincidentally with the cloning of MR cDNA.
Its launch on the market in 2003 paralleled intensive drug discovery programs for
a new generation of non-steroidal MRAs. Now, 30 years after the cDNA cloning of
MR and 60 years of clinical use of steroidal MRAs, novel non-steroidal MRAs such
as apararenone, esaxerenone and finerenone are in late-stage clinical trials in
patients with heart failure, chronic kidney disease (CKD), hypertension and liver
disease. Finerenone has already been studied in over 2000 patients with heart
failure plus chronic kidney disease and/or diabetes, and in patients with
diabetic kidney disease, in five phase II clinical trials. Here, we reflect on
the history of the various generations of MRAs and review characteristics of the
most important steroidal and non-steroidal MRAs.