Design, synthesis and evaluation of pH-dependent hydrolysable emetine analogs as treatment for prostate cancer
The N-2\xe2\x80\xb2 position of the natural product emetine has been derivatized to thiourea, urea, sulfonamide, dithiocarbamate, carbamate and pH responsive hydrolysable amide analogs. In-vitro studies of these analogs in PC3 and LNCaP prostate cancer cell lines showed that the analogs are generally less cytotoxic (average IC50 ranging from 0.079 \xce\xbcM to 10 \xce\xbcM) than emetine (IC50 ranging from 0.0237 to 0.0329 \xce\xbcM). The pH sensitive sodium dithiocarbamate salt 13 and the amide analogs 21, 22, 26 (obtained from maleic and citraconic anhydrides) showed the most promise as acid-activatable prodrugs under mildly acidic conditions found in the cancer micro-environment. These prodrugs released 12 \xe2\x80\x93 83% of emetine at pH 6.5 and 41 \xe2\x80\x93 95% emetine at pH 5.5. Compounds 13 and 26 were further shown to exhibit increased cytotoxicity in PC3 cell culture media that was already below pH 7.0 at the time of treatment.
INTRODUCTION<!>Evaluation of the anti-prostate cancer activity of emetine<!>Synthesis of emetine analogs 4-15 and 20-27<!>Initial in-vitro determination of the anti-prostate cancer potency of the emetine analogs<!>Evaluation of pH-responsiveness of compounds 13, 21, 22 and 25-27 by HPLC<!>In-vitro cytotoxic studies of compounds 13 and 26 in PC3 cell line under pre-established acidic cancer cell culture medium (pH < 7.0)<!>In-vivo toxicity study to establish the safety of emetine, 13 and 26 in mice<!>CONCLUSION
<p>Prostate cancer is the most commonly diagnosed cancer in men in the United States with approximately 240,000 cases annually.1,2 About 33,000 American men die of prostate cancer each year with African American men having the highest death rate in the world.2,3 Androgen ablation therapy has remained the gold standard first line treatment of metastastic prostate cancer since its discovery in the 1940's. While producing remarkable palliative benefit, androgen ablation is never curative and all men progress to a castration resistant state. Recently, several new agents have been approved for the treatment of castration resistant disease based on a few months median survival improvement over placebo. While these results are encouraging, there remains an urgent need to develop new therapies for castration resistant prostate cancer.</p><p>One method for identifying new treatments is to look for older therapies which may have unique mechanisms of action that could be effective in cancer treatment. Emetine (1) is one such older agent that is a natural product alkaloid found in the root of Psychotria ipecacuanha.4 It is the active ingredient in the ipecac root long used in traditional folk medicine as an emetic and expectorant.5 Ipecac remains a staple in most households where it is used to induce vomiting in the event of accidental ingestion of toxic agents. Direct subcutaneous injection of emetine was, for a long time, also the treatment of choice for amoebiasis, amebic dysentery, and trypanosomiasis.6</p><p>While emetine has been shown to inhibit a number of important cell processes, its major mechanism of action appears to be related to its ability to inhibit ribosomal protein synthesis as first reported by Grollman5 while Lietman later reported the same in the mitochondria.7 As a protein synthesis inhibitor, its anticancer activities were investigated in several phase I-II clinical trials in a number of solid tumors between 1969 and 1974.8-13 While clinical responses were observed in these studies, emetine was reported to have a very narrow therapeutic index, and dose dependent side effects such as muscle fatigue and cardiac toxicity were observed. These were the same side effects observed in the treatment of amoebiasis patients.14,15</p><p>Based on the toxicity observed in these clinical studies, development of emetine as an anti-cancer drug ceased.16 Since then, this natural product has been used as an important tool in cell biology and pharmacology for in-vitro studies that require inhibition of protein biosynthesis. These more recent studies have revealed the potency of emetine in modulating different biological pathways associated with cancer growth.6 However, to further develop emetine-based therapeutics, an analog must be developed that is only active upon reaching the tumor microenvironment while relatively inactive in the general circulation and in normal tissues. Thus, to achieve this goal it is important that we understand the impacts of its structure and functional moieties on its biological activities.</p><p>An account of structure-activity relationship (SAR) studies on emetine and its biological activities done by various research groups has been recently reviewed.6 The available SAR data demonstrates that a secondary amine in the N-2′ position of emetine is critical for protein synthesis inhibition. A relatively significant loss of protein synthesis inhibitory activity was observed in both N-methylemetine (2) and O-methylpsychotrine (3); the hydrogen of the secondary amine might be involved in a crucial hydrogen bonding interaction of emetine to its targeted receptor.17 In addition, a more recent conformational study reported the critical need for the region between the tricyclic system (A,B,C rings) and the bicyclic isoquinoline (D,E) system to be unoccupied for emetine and its analogs to be active.18 Minimum energy conformational studies revealed that this region is occupied in inactive analogs, while unoccupied in active analogs.18</p><p>These studies document that modification of the N-2′ position of emetine results in reduced biological activity including protein synthesis inhibition and toxicity. Replacement of the N-2′ secondary amine hydrogen with a bulkier group may also lead to conformational changes that will affect the region S (Figure 3A and B) between the tricyclic and bicyclic systems. Consequently, an appropriate substituent in this position that could be selectively removed within the tumor microenvironment but remain stable in normal tissue could result in an emetine analog with improved therapeutic index that could be useful as cancer therapy. In our efforts to develop emetine into clinically useful anticancer agent we have thus focused on chemical modification of the N-2′ position to: (1) generate a functionally diverse library of emetine analogs with various hydrolysable moieties (such as sulphonamides, urea, thiourea, carbamates, dithiocarbamate, and amide) which are also known for incorporating bioactivities into small molecules;19-21 and (2) generate a set of prodrugs that will only be activated to release emetine in the cancer cells or tumor microenvironment. The prodrugs could be activated either at the cancer microenvironment by exploiting the lower extra-cellular pH (pH ≈ 6.4 – 6.9) of some tumor cells compared to that of normal tissue,22-24 or the mild acidic condition of the intracellular vesicles such as endosomes (pH ≈ 5.5 - 6) and lysosomes (pH ≈ 4.5 - 5).25</p><p>The present paper reports our initial studies on the synthesis and anticancer activities of novel bioactive emetine derivatives and acid-hydrolysable prodrugs by chemical modification of the N-2′ position. The cytotoxic activities of these compounds were evaluated on androgen receptor positive LNCaP and negative PC3 prostate cancer cell lines.</p><!><p>Due to lack of data on the cytotoxicity of emetine in prostate cancer cell lines, we began this study by first evaluating its anticancer potency in a representative androgen receptor positive LNCaP and androgen receptor negative metastatic PC3 and DU145 prostate cancer cell lines. Cell survival and proliferation was determined spectrophotometrically using the 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide (MTT) colorimetric assay (supplementary information). For the biological studies, emetine was used as the dihydrochloride salt. Time and concentration dependent potency of emetine in this study revealed that emetine could be a novel antineoplastic agent in prostate cancer drug development (Table 1) if the therapeutic index is somehow improved. Emetine is equally potent in both androgen receptor positive and negative prostate cancer cell lines. As shown from the IC50 values (concentration of drug that reduce the average growth value of the cancer cell lines by 50% relative to the average control growth value), cell death due to emetine relative to control was significant within the first 3 days of exposing the cells to emetine dihydrochloride hydrate with IC50 values in the nanomolar range. Encouraged by this initial screening result with emetine in prostate cancer cell lines, we designed and synthesized thiourea, urea, sulphonamide, carbamate, dithiocarbamate and amide derivatives of emetine via modification of the N-2′ position.</p><!><p>As depicted in Scheme 1a, efforts on the synthesis of thiourea analogs commenced with commercially available amines. Treatment of the appropriate amines with carbon disulfide in tetrahydrofuran in the presence of Et3N resulted in an in-situ generation of dithiocarbamic acid salt which on subsequent treatment with 4-toluenesulfonyl chloride as described by Wong and Dolman26 gave the corresponding isothiocyantes in 74 to 93% yields. Reaction of the isothiocyanate with emetine dihydrochloride in CH2Cl2 in the presence of pyridine furnished the appropriate thiourea derivatives 4-6 in 47 to 51% yield.</p><p>The urea analogs 7-9 were synthesized in two steps (Scheme 1b). First, the requisite isocyanates were prepared by treating an appropriate amine with trichloromethyl chloroformate in CH2Cl2 in the presence of non-nucleophilic amine base 1,8-bis(dimethylamino)naphthalene.27 A pre- determined quantity of emetine dihydrochloride was then added to each isocyanate in CH2Cl2 in the presence of 4-dimethylaminopyridine (DMAP) to produce compounds 7-9 in 74 to 85% yield. Unlike the thiourea synthesis, the urea analogs were isolated in a relatively high yield. The sulphonamide analogs 10-12 were obtained in 74 to 86% yield by treating emetine dihydrochloride with the appropriate sulfonyl chlorides in CH2Cl2 in the presence of 4-dimethyl aminopyridine (DMAP) (Scheme 1c). This reaction progressed well with DMAP but not with triethylamine as base.</p><p>The preparation of the dithiocarbamate analog 14 was achieved in two steps. Emetine dihydrochloride was reacted with carbon disulfide in ethanolic sodium hydroxide at -5 to +5 °C to produce the dithiocarbamic acid salt 13 which on treatment with benzyl bromide afforded 14 in 45% yield (Scheme 1d).</p><p>The carbamate analog 15 was synthesized in 46% yield by reacting emetine dihydrochloride with benzyl chloroformate in the presence of at least one molar equivalent of DMAP in excess triethyl amine using chloroform as solvent (Scheme 1e). Attempts to conduct this reaction in CH2Cl2, THF and a number of other solvents were not very successful.</p><p>As stated earlier, we desire to target emetine directly to the cancer region in the form of prodrugs that will be activated only at the cancer microenvironment either inter-cellularly or intra-cellularly. To achieve this goal, we also synthesized pH-responsive amide analogs of emetine (20-27) from cyclic anhydrides (Schemes 1f and 1g). These analogs were synthesized by reacting emetine with appropriate anhydride in CHCl3 in the presence of triethylamine to furnish the amide derivatives. Compounds 20-22 were isolated in 89 to 94% yield. To remove all the residual triethylamine from cis-aconityl amide analog (23), this analog was treated with 0.1 N aqueous NaOH. Thus, the dicarboxylic acid 23 was converted to its disodium salt 27 in about 79% overall yield. Similarly, compounds 20-22 were converted to the respective sodium salts 24-26 with overall yield of 78 to 88% from emetine. With the amide analogs obtained as the sodium salts, 24-27, it was possible to do a direct structure-activity relationship studies on the bioactivity and acid responsiveness of the four compounds.</p><!><p>First, to determine general effect of derivatizing emetine at the N-2′ on its cytotoxicity and to do structure-activity relationship studies on these synthetic analogs, we began by assaying their cytotoxicity in androgen receptor positive LNCaP and androgen receptor negative PC3 human prostate cancer cell lines. Six concentrations of each compound were tested on each of the two cell lines over a period of seven days. We utilized the colorimetric MTT assay to determine the viable cells after 3rd, 5th and 7th day of exposing the prostate cancer cell lines to the compounds. The anti-cancer potency of each compound on the 7th day measured as IC50 value is reported in Table 2.</p><p>This study further confirms that derivatizing emetine at the N-2′ position to produce a tertiary nitrogen results in reduction of its cytotoxicity. The extent of reduction depends not only on the functional groups bonded to this position but also on the structural features of the substituents attached. Thus the N-2′ position can serve as a tunable point where chemical modification can be carried out with the goal of generating emetine analogs and prodrugs that avoid the systemic toxicity associated with the parent compound. As observed for emetine, almost all the analogs have relatively potent cytotoxicity in both androgen receptor positive LNCaP and negative PC3 prostate cancer cells. The IC50 values are below 10 μM except for compounds 9 and 10 in PC3 cell lines. Among the thiourea analogs (4-6), compound 6 with electron withdrawing chlorine atom at the para position is the most active (Table 2). However, a distinct preference for electron withdrawing group over electron donating group is not too obvious as the IC50 values for compound 5 with electron donating methoxy group is slightly lower than that of compound 4 in PC3. A consistent observation is that these thiourea analogs have relatively lower IC50 values in LNCaP than in PC3 cell lines.</p><p>Similarly the urea analogs 7 and 9 exhibit more potency in LNCaP than PC3 as seen from the IC50 values, however, the urea analog 8 with the para electron donating methoxy group exhibited distinctly better potency (IC50, 3.669 μM) in the androgen receptor negative PC3 than androgen receptor positive LNCaP (IC50, 7.839 μM). Comparing the thiourea and urea analogs, it appears that without any substituent at the para position, replacement of the sulfur in thiourea by oxygen atom in the urea analog does not significantly affect the cytotoxicity in either cell lines as shown by the similar IC50 values obtained for thiourea derivative 4 (LNCap, 2.057 μM; PC3, 6.916 μM) and urea derivative 7 (LNCap, 2.115 μM; PC3, 7.613 μM).</p><p>All the sulphonamide analogs 10-12 also have higher potency (lower IC50 values) in LNCaP than in PC3 but the range is very narrow in LNCaP making it difficult to tell if the substituent at the para-position really affects the cytotoxicity. Compound 10 with no substituent on the sulphonamido-phenyl ring is the least active in PC3 cell lines (IC50 >10).</p><p>Interestingly, the dithiocarbamic acid salt 13 is significantly more potent in both LNCaP and PC3 than the emetine analogs 4-12 discussed above. The 7th day IC50 value is only about 3 fold higher than what we obtained for emetine. However, upon alkylation of 13 to the benzyl dithiocarbamate ester 14, a significant reduction in potency measured by a higher IC50 value of about 24 fold increase in LNCaP and 18 fold increase in PC3 (Table 2) was observed. The significance of this observation is further investigated in our prodrug development (Figures 4a, 4d & 6). We needed to know if 13 is acting by a different pharmacophore compare to emetine or it was hydrolysed in-vitro and served as a prodrug for emetine. The carbamate ester 15 has a slightly lower potency (higher IC50 value) relative to dithiocarbamate 14 in both cell lines (Table 2).</p><p>With the possibility that the better cytotoxicity of the dithiocarbamate salt 13 is due to its ease of hydrolysis thus serving as an emetine prodrug, the maleic acid monoamide derivatives 21, 22 and 25-27 were specifically designed as acid-activatable prodrugs of emetine; while succinic acid monoamide derivative 20 and 24 are not expected to be as easily hydrolysable. Maleic anhydride has been used for the reversible blocking or protection of amino groups of proteins and peptides in a reversible pH sensitive reaction.28-30 Hydrolysis of the protecting maleic acid monoamide is known to occur under mildly acidic condition by intramolecular acid catalyzed hydrolysis which initially revert to the amino group and maleic anhydride. 29-32 The maleic anhydride from the de-protection can then undergo further hydrolysis to maleic acid. A similar reversible blocking of amino groups of protein was reported for citraconic anhydride (a maleic anhydride derivative) and found to undergo faster hydrolysis than blocking with maleic anhydride.33 A number of studies have employed maleic acid amide derivatives as acid-activatable linkers for daunomycin- and doxorubicin- macromolecule conjugates in targeted drug delivery to tumor cells.34-36 The cis-aconitic monoamide derivative of daunomycin has been reported as a pH activated prodrug that releases daunomycin under acidic pH but more stable at neutral pH.34,37 Hence, the proposed maleic acid monoamide analogs (21,22,25-27) are expected to release emetine in the acidic cancer environment, while remaining stable at physiological pH range of 7.0-7.4.</p><p>Each amide with a carboxylic acid terminal (20-22) has a slightly higher cytotoxic activity (lower IC50 value) than the corresponding sodium salt, 24-26 (Table 2). The citraconyl derivative 22 with a vinylic methyl substituent is the most active in the acid category of the amides (20-22) and its corresponding sodium salt 26 is the most active among the sodium salts (24-27). Though not as active as the dithiocarbamate salt 13, compounds 22 and 26 are significantly more potent than emetine analogs 4-12 and 15. The remaining amide analogs, 20,21,24,25 and 27, show similar cytotoxicity level as the other emetine analogs 4-12 and 15 in this study. As mentioned above, the citraconyl moiety in compounds 22 and 26 had been previously employed in reversible blocking of amino groups in proteins and gave satisfactory result in the ease of de-blocking by hydrolysis of the amide bond in slightly acidic pH condition. It is therefore possible that the citraconyl group in compounds 22 and 26 was hydrolysed to emetine in the in-vitro cancer micro-environment of the tissue culture medium. In light of this possibility, we further evaluated the time-dependent cytotoxicity of some of these emetine analogs in prostate cancer cell lines and studied their pH-dependent hydrolysis to emetine.</p><p>To obtain an understanding of the time-dependent cytotoxicty of some of the compounds and use the information to gain insight into a possible pH activated prodrug development for emetine, we studied the progress of the in-vitro cytotoxicity of these emetine analogs over a seven day period by comparing the IC50 values obtained on 3rd, 5th and 7th day after exposing the cells to the drugs. We wanted to know how long it took to reach the optimum cytotoxic activity for each drug compared to that for emetine, and also to see if there is a progressive cytotoxicity common to each group of compounds over the seven day period. For each compound, a similar progression in cytotoxicity is observed in both LNCaP and PC3. So, we present the data obtained in PC3 cell lines in Figures 4a to 4f. Based on this data, it is clear that the cytotoxicity of emetine reached an optimum by the 3rd day of exposing the prostate cancer cells to emetine dihydrochloride. The 5th and 7th day studies gave very close results to that of day 3 (Figure 4a). Almost similar pattern was observed for the cytotoxic activity of thiourea analog 6, and urea analogs 7 & 9 (Figures 4b and c). For these compounds, the IC50 values appear to also reach an optimum by day 3 and the potency did not change much from day 3 to day 7. However, for compounds 5 (a thiourea, Figure 4b), 12 (a sulphonamide, Figure 4e), 13 (dithiocarbamate salt, Figure 4a), 26 (amide derivative, Figure 4a) and 24 (amide derivative, Figure 4f), an optimum IC50 value was obtained by day 5 after exposure. The IC50 value for each of these compounds on day 7 is similar to that of day 5. For urea analog 8 (Figure 4c), dithiocarbamate ester 14 (Figure 4d) and carbamate ester 15 (Figure 4d), there appear to be a progressive decrease in IC50 values (increase in cytotoxicity) from day 3 to day 7. The remaining analogs, 4, 11, 25, and 27, appear to show very close IC50 values for day 3, day 5 and day 7.</p><p>It should be pointed out here that no consistent pattern is observed in each class of compounds, and we believe that in addition to functional moieties, the conformation of each analog most likely affected its potency. A study on the effect of conformation of these analogs, its implication on the size of space "S" between the tricyclic ABC rings and bicyclic DE rings (Figure 3), and correlation of these to anticancer activities in emetine analogs is currently being planned. Of much interest in the study presented here, however, is the big increase in cytotoxicity observed for compound 13 between day 3 and day 5. In line with our design of an emetine prodrug, we were interested in understanding if this compound was acting as a prodrug, and thus, not as potent by day 3. And if so, was compound 13 hydrolysed to emetine by day 5 such that the potency observed after day 5 resulted from emetine? To have an insight into this possibility, we used HPLC to study the acid-catalyzed release of emetine from this compound and some of the other potentially pH-activatable analogs (21, 22, 25, 26 and 27). It is important to mention at this point that all the synthetic emetine analogs presented in Scheme 1 are hydrolysable with different degree of responsiveness to pH change and the time required. However, compounds 13, 21, 22, 25, 26 and 27 are expected to be more easily hydrolysable under mildly acidic environment as discussed above. The result of the evaluation of the pH-responsiveness of 13, 21, 22, 25, 26 and 27 by HPLC is thus presented in the following section and in Figure 5.</p><!><p>Relative rates of hydrolysis of these compounds over a 48 hour period were evaluated using the percent emetine released from the acid catalyzed hydrolysis of 13, 21, 22 and 25-27. The compounds were incubated in aqueous phosphate buffer at pH 5.5, 6.5 and 7.4 at 37 °C over a 48 h period. High performance liquid chromatography (HPLC) was employed to analyse the samples and quantify how much emetine was released. The data is summarized in Figures 5A and 5B. The compounds whose hydrolysis to emetine is shown in Figures 5A and 5B are all 100% stable at the physiological pH 7.4 up to a 5 day exposure. All the compounds studied here (13, 21, 22, 25, 26 and 27) were activated to emetine at pH 5.5 over a 48 h period, although to different extents. Percent hydrolysis to emetine was found to drop at the less acidic pH 6.5. These results are consistent with earlier reports of the hydrolysis of the monoamides of maleic anhydride derivatives outlined above.29-34,37 Hence, amide analogues synthesized from maleic anhydride and its derivatives in this study showed great promise as seen particularly in 21, 22 and 26 which release about 50%, 80% and 50% emetine, respectively, within 48 hours at pH 6.5. In addition, the free acid analogs 21 and 22 appear to be more pH-responsive and sensitive than the corresponding sodium carboxylate salts 25 and 26. The pH responsiveness of the sodium dithiocarbamate salt 13 is higher at pH 5.5 than at 6.5 producing about 94.5% hydrolysis within 48 hours at pH 5.5, but only 13.2% over the same period at pH 6.5. The hydrolysis of 13 appears to be slower at pH 6.5 and it is therefore conceivable that there is an increase in amount of emetine released between day 3 and day 5 in the in vitro study, thus making this compound to show optimum activity by day 5. A brief evaluation of the other emetine analogs 4-12, 14 and 15 show that they are stable at these slightly acidic pHs over the time period studied. Taken together, these data demonstrate that pH-responsiveness of 13, 22 and 26, resulting in release of emetine, may be playing a significant role in their increased cytotoxicity (lower IC50 values) observed after day 3 when the pH of growth medium has probably dropped to between 6.0 and 7.0 (Figures 4a, 5A and 5B and Table 1). These results encouraged further in-vitro studies of the activation of two of these potential prodrugs (13 and 26) in cell culture medium under slightly acidic pH (6.0 to 6.9).</p><!><p>Upon establishing the release of emetine from these compounds under mildly acidic condition, we rationalized that we could increase the potency of the pH-responsive analogs if we could adapt the cancer cell to an acidic medium, so that the pH of the cell culture is already below 7 at day 0. To investigate this we selected compounds 13 and 26 which are two of the three most cytotoxic pH-responsive analogs.</p><p>To accomplish our objective here, we first needed to establish the range of pH changes of the PC3 cell lines in our in vitro studies over a 7 day period. Hence, we investigated the effects of the metabolism of PC3 cell lines on change in pH of growth medium without any drugs and the result is presented in Figure 6. This study showed that the metabolic activities of the PC3 cancer cells caused a fall in the pH of the growth medium from 7.4 on day 0 to 7.05 on day 3 and 6.66 by day 7 (Figure 6).</p><p>In our initial in-vitro cytotoxic studies on these compounds, a gradual reduction in the pH of the growth medium was observed as the cancer cells metabolized over a seven day period (Figure 6). We therefore reasoned that it is possible to adapt the prostate cancer cells to low pH between 6.5 and 7.0. Hence, confluent PC3 cell lines were left incubated at 37 °C until the growth medium attained a low pH of 6.7-7.0. The cells were further passaged twice into RPMI-1640 medium (pH 6.7-7.0) to allow them adapt to this low pH environment. These cancer cells were then suspended in growth media buffered at pH 6.8 using KH2PO4, and plated in a 96 well plate. Cells from the same passage were also plated in normal RPMI-1640 growth medium of pH 7.4. The growth of PC3 cell lines under these two pH conditions was monitored over a 5-day incubation period. They both gave a comparable growth curve (Figure 7). Thus, this became our in-vitro model for performing a pH-responsive prodrug activation assay.</p><p>Prostate cancer cell lines already adapted to growth under this slightly acidic pH were thus plated at a higher density of 15000 to 20000 cells/well in growth medium of pH 6.8. Cells were incubated for 48 hours to give room for metabolism that might lead to further lowering of pH before drug treatment. Cells were then treated with six different concentrations of each drug (13 or 26) prepared in a growth medium of pH 6.8. Emetine dihydrochloride was used as a positive control. Due to cancer cell metabolism, the average pH gradually decreased further to as low as 6.4 by the 5th day of this study. As expected, the difference in the cytotoxicity of 13 and 26 compared to that of emetine reduced drastically (only about 2 fold difference from emetine) at pH < 7.0. On the other hand, there is more than 16 fold difference in the cytotoxicity of 13 and 26 relative to emetine at pH 7.4 (Table 3). The increased cytotoxicity of these prodrugs (13 and 26) at pH less than 7.0 is thus in agreement with their activation to emetine under slightly acidic environment. Hence, it appears that emetine is the major cytotoxic agent when these compounds are subject to pH < 7.0. In addition, the results at pH 7.4 compared to pH < 7.0 indicate that these compounds are far more activatable in the acidic cancer environment thus establishing these compounds as potential prodrugs of emetine. In order to carry out an initial assessment of the relative toxicity of the prodrugs 13 and 26 compared to emetine, we opted for an in-vivo toxicity studies in healthy mice.</p><!><p>The dose dependent side effects associated with the use of emetine usually culminates in lethality. To establish the safety of the N-2′ derived analogs developed in this study, we further evaluated the in-vivo toxicity of emetine and compounds 13 and 26 in healthy mice.</p><p>These compounds were administered to the mice intravenously (iv). A single dose of emetine at 100 mg/kg body weight killed all three mice within 48 hours. However, no sign of toxicity was shown in the mice that received 100 mg/kg body weight of compounds 13 and 26 daily for five days. To further investigate the safety of these compounds at 100 mg/kg, we determined the change in the body weight of these mice and that of the mice in the control group (mice that received just 1% DMSO in saline) within 48 hours (Figure 8). The percent weight change observed within 48 hours in the mice that received analogs 13 and 26 were very similar to that obtained for the control group (Figure 8). This indicates that this small weight change is not due to the toxicity effect of these drugs. The mice were further studied for three weeks, and no noticeable effect of toxicity was observed in them. To further establish the safety of one of the top pH-responsive prodrugs of emetine compared to emetine, we needed a dose of emetine that is not immediately lethal to the mice (i.e. does not result in death of the mice). To this end, we found a lower dose of 33 mg/kg body weight of emetine did not kill the mice within the period of study. Hence, each mice group was given 33 mg/kg of emetine and prodrug 13, respectively. Though mice that received 33 mg/kg of emetine did not die within 48 hours, these mice appeared slightly lethargic and weight loss was observed (Figure 9). A weight loss of 4.5%, 2.0% and 1.7% were observed in mice that received emetine, prodrug 13 and control (1% DMSO in saline), respectively, within 24 hours. Over a 48 hour period, mice that received emetine at 33 mg/kg showed an average weight loss of about 3.6% and appeared lethargic while those that received 33 mg/kg of 13 showed a weight loss of 0.67% but appeared healthy with no noticeable signs of toxicity (Figure 9). Within 48 hours of this daily dosing, the percent weight loss in mice that received emetine was about 4 times the weight loss in control mice, while there was no significant difference in weight loss between mice injected with prodrug 13 and the control group (Figure 9).</p><p>These results indicate that the toxicity associated with the use of emetine has been significantly reduced if not removed in these pH-responsive prodrugs. The drugs are therefore considered safe for further in-vivo efficacy studies.</p><p>In summary, these results suggest that an appropriately designed emetine analog could become a valuable cancer chemotherapy. The vital role of the N-2′ secondary amine is seen in the reduced cytotoxicity of all the N-2′ derived analogs. These analogs can be hydrolyzed to emetine at variable rates that depends on the substituent at the "tunable handle". It is also vital to note that these compounds are relatively stable at pH 7.4, indicating that emetine will most likely not be released in the blood or the environment of normal tissue as demonstrated in non-toxic nature of two of these prodrugs relative to emetine in healthy mice.</p><!><p>Overall, in an attempt to improve the therapeutic index of the natural product emetine, we have developed several N-2′ derived analogs of emetine and they were assayed in both androgen receptor positive and negative prostate cancer cell lines. The data obtained clearly confirmed that the secondary amine of the N-2′ position of emetine plays a crucial role in its cytotoxic activity. All chemical modifications of this position to thiourea, urea, dithiocarbamate, carbamate, sulfonamides and amides resulted in various analogs that are almost 5 to 400 times less potent than emetine. This is obviously a starting point for designing an emetine prodrug which will avert the systemic toxicity associated with its therapeutic use and thus improve its therapeutic index. The current study utilized synthetic analogues of emetine that are sensitive to pH change for their controlled activation. The water soluble sodium dithiocarbamate salt 13 and the amide analogs 21, 22, 26 (obtained from maleic and citraconic anhydrides) showed the most promise as potential pH-sensitive prodrug for activation by the slightly acidic cancer micro-environment with significant stability at physiological pH. The results obtained from the compounds investigated showed that the N-2′ position is "tunable" for controlled release of emetine. In-vitro model of slightly acidic prostate cancer micro-environment was also developed and employed in in-vitro activation of potential prodrug in this study. Further, the relative safety, in health mice, was demonstrated in-vivo for two of the prodrugs 13 and 26 compared to emetine. Our findings in this preliminary study are a significant foundation for further in-vivo efficacy and pharmacokinetic studies, as well as further efforts towards the design of new synthetic analogues of emetine in prodrug development.</p>