Design and Structural Optimization of Dual FXR/PPARδ Activators.

Nonalcoholic steatohepatitis (NASH) is considered as severe hepatic manifestation of the metabolic syndrome and has alarming global prevalence. The ligand-activated transcription factors farnesoid X receptor (FXR) and peroxisome proliferator-activated receptor (PPAR) delta have been validated as molecular targets to counter NASH. To achieve robust therapeutic efficacy in this multifactorial pathology, combined peripheral PPAR delta-mediated activity and hepatic effects of FXR activation appear as a promising multitarget approach. We have designed a minimal dual FXR/PPAR delta activator scaffold by rational fusion of pharmacophores derived from selective agonists. Our dual agonist lead compound exhibited weak agonism on FXR and PPAR delta and was structurally refined to a potent and balanced FXR/PPAR delta activator in a computer-aided fashion. The resulting dual FXR/PPAR delta modulator comprises high selectivity over related nuclear receptors and activates the two target transcription factors in native cellular settings.