Modulators of the visual cycle have been developed for treatment of various
retinal disorders. These agents were designed to inhibit
retinoid isomerase [retinal pigment epithelium-specific 65 kDa
protein (RPE65)], the rate-limiting
enzyme of the visual cycle, based on the idea that attenuation of
visual pigment regeneration could reduce formation of toxic
retinal conjugates. Of these agents, certain ones that contain primary
amine groups can also reversibly form
retinaldehyde Schiff base adducts, which contributes to their
retinal protective activity. Direct inhibition of RPE65 as a therapeutic strategy is complicated by adverse effects resulting from slowed chromophore regeneration, whereas effective
retinal sequestration can require high
drug doses with potential off-target effects. We hypothesized that the RPE65-emixustat crystal structure could help guide the design of
retinaldehyde-
sequestering agents with varying degrees of RPE65 inhibitory activity. We found that addition of an isopropyl group to the central phenyl ring of
emixustat and related compounds resulted in agents effectively lacking in vitro
retinoid isomerase inhibitory activity, whereas substitution of the terminal 6-membered ring with branched moieties capable of stronger RPE65 interaction potentiated inhibition. The isopropyl derivative series produced discernible visual cycle suppression in vivo, albeit much less potently than compounds with a high affinity for the RPE65 active site. These agents were distributed into the retina and formed
Schiff base adducts with
retinaldehyde. Except for one compound [3-amino-1-(3-isopropyl-5-((2,6,6-trimethylcyclohex-1-en-1-yl)methoxy)phenyl)propan-1-ol (MB-007)], these agents conferred protection against
retinal phototoxicity, suggesting that both direct RPE65 inhibition and
retinal sequestration are mechanisms of potential therapeutic relevance.