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Science 2024, 385 (6715), eado1868

DOI: 10.1126/science.ado1868

Liu F.; Wu C. G.; Tu C. L.; Glenn I.; Meyerowitz J.; Kaplan A. L.; Lyu J.; Cheng Z.; Tarkhanova O. O.; Moroz Y. S.; Irwin J. J.; Chang W.; Shoichet B. K.; Skiniotis G.

Positive allosteric modulator (PAM) drugs enhance the activation of the calcium-sensing receptor (CaSR) and suppress parathyroid hormone (PTH) secretion. Unfortunately, these hyperparathyroidism-treating drugs can induce hypocalcemia and arrhythmias. Seeking improved modulators, we docked libraries of 2.7 million and 1.2 billion molecules against the CaSR structure. The billion-molecule docking found PAMs with a 2.7-fold higher hit rate than the million-molecule library, with hits up to 37-fold more potent. Structure-based optimization led to nanomolar leads. In ex vivo organ assays, one of these PAMs was 100-fold more potent than the standard of care, cinacalcet, and reduced serum PTH levels in mice without the hypocalcemia typical of CaSR drugs. As determined from cryo-electron microscopy structures, the PAMs identified here promote CaSR conformations that more closely resemble the activated state than those induced by the established drugs.

 

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