Cited by 86Drug Transport and Resistance MechanismsLiver Disease Diagnosis and TreatmentLiver Diseases and Immunity

Nonsteroidal FXR Ligands: Current Status and Clinical Applications

Gege, Christian, Hambruch, Eva, Hambruch, Nina, Kinzel, Olaf, Kremoser, Claus·2019·Handbook of Experimental Pharmacology

Abstract

FXR agonists have demonstrated very promising clinical results in the treatment of liver disorders such as primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC), and nonalcoholic steatohepatitis (NASH). NASH, in particular, is one of the last uncharted white territories in the pharma landscape, and there is a huge medical need and a large potential pharmaceutical market for a NASH pharmacotherapy. Clinical efficacy superior to most other treatment options was shown by FXR agonists such as obeticholic acid (OCA) as they improved various metabolic features including liver steatosis as well as liver inflammation and fibrosis. But OCA's clinical success comes with some major liabilities such as pruritus, high-density lipoprotein cholesterol (HDL c) lowering, low-density lipoprotein cholesterol (LDL c) increase, and a potential for drug-induced liver toxicity. Some of these effects can be attributed to on-target effects exerted by FXR, but with others it is not clear whether it is FXR- or OCA-related. Therefore a quest for novel, proprietary FXR agonists is ongoing with the aim to increase FXR potency and selectivity over other proteins and to overcome at least some of the OCA-associated clinical side effects through an improved pharmacology. In this chapter we will discuss the historical and ongoing efforts in the identification and development of nonsteroidal, which largely means non-bile acid-type, FXR agonists for clinical use.

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Crossref · 10.1007/164_2019_232

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147 of 147 references verified0 citation errors · 0 not checkable

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  • Non-steroidal FXR ligands have higher affinity for FXR, lack a BA structure, and may have different pharmacokinetic, efficacy and safety profiles.

    “several non-steroidal FXR ligands with even higher affinity for FXR have been developed.”

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Authors
Gege, C., Hambruch, E., Hambruch, N., Kinzel, O., & Kremoser, C.
Affiliations
Phenex Pharmaceuticals (Germany) (DE)
Corresponding author
Kremoser, Claus
Venue
Handbook of Experimental Pharmacology
Published
2019
Volume
256
Pages
167-205
ISSN
  • 0171-2004 (ISSN-L)
  • 1865-0325
OpenAlex
W2952800496
Cited by
83
References
147
Citations by year
2026: 4 · 2025: 9 · 2024: 10 · 2023: 7 · 2022: 20 · 2021: 21 · 2020: 11 · 2019: 1
FWCI
20.03
Type
book chapter
Language
en
Open access
closed
Locations
  • Handbook of experimental pharmacology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Oncology › Drug Transport and Resistance Mechanisms
  • Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
  • Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
Keywords
farnesoid X receptor, FXR agonists, obeticholic acid, nonalcoholic steatohepatitis, primary biliary cirrhosis, primary sclerosing cholangitis, liver fibrosis, drug-induced liver injury, pruritus, drug development
MeSH terms
Receptor, Farnesoid X-Activated, Chenodeoxycholic Acid, Humans, Ligands, Liver Diseases, Receptors, Cytoplasmic and Nuclear, Non-alcoholic Fatty Liver Disease

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