Abstract
Prodrug design for brain delivery of small- and medium-sized neuropeptides was reviewed, focusing on thyrotropin-releasing hormone and structurally related peptides as examples. We have summarized our most important advances in methodology, as well as assessed the benefits and limitations of bioreversible chemical manipulation techniques to achieve targeting of the parent molecules into the central nervous system. The value of prodrug-amenable analogues as potential drug-like central nervous systems agents was highlighted.
1. Introduction
Drugs face a formidable obstacle in reaching the central nervous systems (CNS) due to the existence and specific properties of the blood-brain barrier (BBB) that is a vital element in the regulation of the delicate environment of the brain and the spinal cord [1]. Capillary endothelial cells display tight junctions in the brain, which eliminates any paracellular pathways into the inner milieu of the brain. To most solutes, the BBB essentially behaves like a continuous lipid bilayer and, thus, exhibits low permeability to hydrophilic substances (ions and polar compounds) that do not have specific transport mechanisms. Consequently, hydrophilic molecules such as peptides potentially useful as CNS-agents cannot cross the BBB in pharmacologically significant amounts. On the other hand, lipophilic substances are generally transferred across the BBB by passive transport. Highly active enzymes also represent a metabolic component that contributes to the homeostatic balance regulated by the BBB [2]. Most peptides are metabolically unstable because they are degraded by peptidases, e.g., in the cytosolic endothelial space, the luminal surface of the endothelial cells, cerebral pericytes, and/or synaptic regions juxtaposed to the brain microvessels, even if they have certain permeability. The transmembrane glycoprotein known as P-glycoprotein (P-gp) is also expressed in the BBB [3]. P-gp has been shown to operate as an active efflux system, and it generally transports back into the blood a variety of lipophilic molecules that enter the endothelial cells. P-gp should be considered a significant and functional part of the BBB [4], as it has been shown that P-gp knock-out mice show enhanced sensitivity to circulating drugs and toxins. Several other transporters may also contribute to the exclusion of certain drugs from the CNS, because they work in the direction of interstitial fluid to endothelial cell and/or endothelial cell to blood [5].
To overcome the BBB as an obstacle for the pharmacotherapy of the CNS, drug delivery via both invasive and non-invasive methods has been a longstanding and actively pursued endeavor [6]. Invasive strategies go around the BBB or alter/modify it to provide entry into the interstitial fluid of the brain or spinal cord (e.g., via lumbar punctures or by reversible BBB disruption) [7]. These types of procedures are only justified for life-threatening CNS maladies such as brain cancer; however, these costly surgical routes are not preferred for less dramatic illnesses. Non-invasive techniques exploit various transport processes that exist in the brain capillary endothelium to ferry therapeutic agents into the CNS after systemic administration. However, the plausible method of designing drugs that exploit carrier-mediated uptake mechanisms present in the endothelial cells of the CNS vasculature for specific biomolecules suffers from a critical kinetic feature of these systems, since they are often of low capacity, although of high affinity [8]. Additionally, current knowledge about the structural requirement of a drug capable of fully utilizing these specific transporters is limited. Efforts to exploit biological carriers have, therefore, concentrated on auxiliary transport systems with various degrees of success [9,10,11,12,13].
For CNS-delivery of small- to medium-sized neuropeptides and their analogues/mimetics, we advocate the prodrug approach. This versatile, non-invasive chemical manipulation technique relies on the bioreversible alteration of the target peptide to produce its inactive (bio)precursor (i.e., without intrinsic activity) having improved physicochemical characteristics to CNS-transport compared to those of the parent agent. The term ”prodrug” was first introduced by Albert in the late 1950’s [14] to define pharmacologically inactive chemical derivatives that could be used to alter the physicochemical properties of drugs in a transient manner to increase their usefulness and/or to decrease associated toxicity. In the classical sense, prodrugs are aimed at reaching the CNS by diffusion (passive transport), although pro-moieties that rely on carrier-mediated (active) transport have also been reported [15]. Passive transport through the BBB is controlled by several physicochemical parameters such as size (more exactly molecular volume), charge and hydrogen-bonding (donor or acceptor) capacity [16,17,18]; nevertheless, lipophilicity (expressed as the logarithm of the n-octanol/water partition coefficient, logP) is generally considered the most important indicator for BBB penetration [19,20]. A logP of around 2 (i.e., 100-times higher affinity to the lipid-mimicking n-octanol than to water) is believed to be an optimal value for CNS-delivery [21]. However, as mentioned above, efflux mechanisms [22] operating in the BBB must be also considered in prodrug design, because they can remove the prodrug from the brain even in case of a robust influx [23,24] resulting in poor CNS-retention and short biological half-life. Once the prodrug crossed the BBB, conversion by “post barrier” enzyme(s) [25] is utilized to regenerate the parent peptide.
Bioreversible alteration of poorly CNS-available peptides involves chemical derivatization of the parent peptide by taking advantage of the inherently present functional group(s) of the peptide chain. Those chemical ‘handles” may be the amino- and carboxyl-termini or the side chain’s functional group (e.g., amino-, hydroxyl-, or carboxyl group). The appropriate transient masking of these polar groups will also decrease hydrogen-bonding capacity and render the prodrug neutral at physiological pH to promote passive transport through the BBB. Additionally, precise placement and choice of these cleavable “pro-moieties” can also provide protection against exo- and endopeptidases. In the blood, many small peptides with free N- and C-termini are degraded primarily by exopeptidases usually within a few minutes. Protection against peptidase recognition is, therefore, one of the critical aspects of peptide-based prodrug design, because even if these produgs can cross the BBB, they can only sustain adequate concentrations in the brain, if their blood concentration is maintained at sufficiently high levels by preventing their systemic degradation.
Brain-targeting prodrugs [26] are extensions of simple prodrugs in terms of having a specific pro-moiety whose major function is to promote access and retention in the brain. This may be achieved by in situ metabolic conversion of a non-ionic pro-moiety (e.g., 1,4-dihydropyridine) to an ionic (e.g. pyridinium) group as an intermediate before the release of the active agent [27]. In neuropeptide-based drug design, the real challenge often is, however, to meet the requirement of creating analogues/mimetics that preserve the intrinsic CNS effect(s) of the native peptide while abolishing its undesired systemic (e.g., endocrine) effects and metabolic susceptibility toward peptidases. In the most elegant approach, the analogue/mimetic is designed “prodrug amenable,” which permits transient chemical manipulation and allows for prodrug formation without the covalent attachment of any auxiliary pro-moiety (or pro-moieties) to facilitate transport across the BBB.
For the development of brain-targeting prodrug strategies involving neuropeptides we have studied most extensively thyrotropin-releasing hormone (TRH, pGlu-His-Pro-NH2) and its analogues (Figure 1) as models for neuropeptides with poor access to the CNS [28]. In this review, we summarize the most important developments our laboratory has achieved in this field in the last 10 years. TRH and structurally related endogenous peptides (Figure 1) have been considered lead compounds for developing useful CNS agents [29]. This small peptide was the first hypothalamic releasing factor characterized, establishing the fundamental proof for the existence of a neuroendocrine regulation of pituitary functions by hypothalamic neuronal structures [30,31]. A variety of behavioral effects are induced by its peripheral and central application [32]. Therefore, it has been implicated in the management of various neurological and neuropsychiatric disorders such as depression, epilepsy, brain injury, Alzheimer’s disease and schizophrenia, as well as stimulation of spinal-cord motorneurons. TRH has been successfully used for treating children with neurological disorders including epilepsy conditions intractable to anticonvulsants and adrenocorticotrophic hormone, mostly in Japan [33]. The best-known neuropharmacological effect of TRH is its analeptic action [34,35], which is frequently exploited for testing TRH-based compounds in early-phase development [29]. High doses administered peripherally and lower doses administered into specific brain regions, have been shown to significantly reduce pentobarbital-induced sleeping time in rats, rabbits and monkeys. The analeptic effects of TRH appear to be mediated by a cholinergic mechanism [36,37].
Figure 1.
Chemical structure of TRH and its analogues used in our studies.
Figure 1.
Chemical structure of TRH and its analogues used in our studies.

Studies in rodents and humans have shown that this tripeptide has a very short (6–10 min) half-life in plasma [38,39]. The rapid degradation in this medium is mainly due to the action of pyroglutamyl aminopeptidases [40]. Additionally, this highly hydrophilic molecule (logP = –2.46) also lacks its own active BBB transport system [41]; thus, high doses of the peptide unavoidably manifesting a profound and undesired hormonal (endocrine) effect would be required for CNS application. Therefore, dissociation of endocrine and CNS actions of TRH is a crucial issue in designing TRH analogues and mimetics for neuropharmacotherapy. Altogether, efforts have been focused on designing metabolically stable and centrally active analogues/mimetics.
2. TRH and Related Peptides as CNS Agents
2.1. [Leu2]TRH prodrugs
A centrally selective natural analogue of TRH is [Leu2]TRH (pGlu-Leu-Pro-NH2, Figure 1) [42], in which the central His of TRH is replaced with Leu. Compared to TRH, [Leu2]TRH shows an approximately 2.5-fold increase in typical TRH-associated analeptic effect and 50-fold decrease in promoting TSH release [43]. Therefore, we selected this tripeptide for substantiating our brain-targeting prodrug approach [25]. Nevertheless, [Leu2]TRH possesses a profound peptide character such as poor lipophilicity (logP = –1.67) that prohibits significant transport across the BBB. The amino- and carboxy-termini of [Leu2]TRH are not suitable for direct bioreversible derivatization to create a lipophilic prodrug by our approach; however, we envisioned that (by the analogy of TRH biosynthesis [44]) Gln-Leu-Pro-Gly would be a suitable progenitor sequence for [Leu2]TRH. Specifically, it was expected that peptidyl-a-hydroxy-glycine (PAM, [45]) would convert the carboxy-terminal Gly to Pro-NH2 and glutaminyl cyclase (QC [46]) would eventually produce pGlu from Gln by using this progenitor sequence. A “transport moiety” (1,4-dihydrotrigonellyl, Dht, residue) [26] for the prodrug creation was attached through strategically selected [47,48] scissile linkers (S) to the amino-terminus of the Gln-Leu-Pro-Gly progenitor sequence [25], as shown in Figure 2. Dht is expected to be oxidized to pyridinium (trigonellyl, Trig; the residue of N-methylnicotinic acid) in the brain analogously to that of NAD(P)H to NADP+ and, therefore, the resultant “oxidized prodrug” is captured inside the brain due to its ionic nature. To furnish lipophilicity to the prodrug for BBB transport, its carboxy-terminus was esterified with highly lipophilic alcohols such as cholesterol (Cho). The idea behind this design was that [Leu2]TRH is eventually formed in the brain after a well-orchestrated sequence of enzymatic processes (i to v, Figure 2).
Figure 2.
Schematic illustration of the prodrug concept developed for the brain delivery of [Leu2]TRH utilizing Gln-Leu-Pro-Gly progenitor sequence and enzymes (i to iv ) inherently present in the brain.
Figure 2.
Schematic illustration of the prodrug concept developed for the brain delivery of [Leu2]TRH utilizing Gln-Leu-Pro-Gly progenitor sequence and enzymes (i to iv ) inherently present in the brain.

A series of in vitro and in vivo experiments were employed in our proof-of-concept studies due to the complexity of the molecular architecture and the necessity of a multistep bioactivation process leading to the liberation of [Leu2]TRH [25]. We thoroughly investigated the cascade of enzymatic reactions responsible for the release of the core peptide by using appropriate putative metabolites. One of the most important steps is the Pro-NH2 formation on the carboxy-terminus. In vitro studies showed that this process was significant only in the brain. In blood and liver, the primary degradation produced an inactive metabolite having Pro-OH as the carboxy-terminal residue and moreover, the metabolism of the “oxidized” prodrug was much faster in the brain than in the blood and liver; thus, systemic formation of [Leu2]TRH was practically prevented. The peptidolytic cleavage catalyzed by enzymes such as dipeptidyl dipeptidases (EC 3.4.14.2 and/or EC 3.4.14.5) [47,49] for S=Pro/Ala, or proline oligopeptidase (POP, EC 3.4.21.26) [48] when S is a dipeptidyl moiety (e.g.: Ala-Pro, Table 1) to form Gln-Leu-Pro-NH2 (Figure 2) and the subsequent rapid formation of [Leu2]TRH by QC without significant side-reactions were also unequivocally detected in vitro [25].
Table 1.
Barbiturate-induced sleeping times in mice after the administration of [Leu2]TRH and its produgs having various spacers (S). Sleeping time decrease is expressed as percent of sleeping time for vehicle administration only (54.9 ±3.8 min). Ten min after i.v. injection of the test compounds at a dose of 15 µmol/kg body weight, pentobarbital (60 mg/kg, i.p.) was injected. Sleeping time was recorded from the onset of the loss of the righting reflex until the reflex was regained. The statistical significance of differences between groups was determined using analysis of variance (ANOVA) followed by post hoc Fisher’s PLSD test for multiple comparisons: *P < 0.05 vs vehicle control, **P <0.05 vs both [Leu2]TRH and vehicle.
| Compound | % Decrease in Sleeping Time |
|---|---|
| [Leu2]TRH | 17 ± 7* |
| Prodrug, S= Ala | 30 ± 3* |
| Prodrug, S= Pro | 47 ± 6** |
| Prodrug, S= Ala-Ala | 32 ± 4* |
| Prodrug, S= Pro-Ala | 56 ± 4** |
| Prodrug, S= Pro-Pro | 55 ± 7** |
In vivo substantiation of the design was done by monitoring the CNS-mediated analeptic effect, a convenient pharmacological paradigm for the evaluation of TRH-related peptides, to assess the increase in the access of the prodrugs to the CNS upon i.v. injection of the prodrugs having various S moieties attached to the amino-terminal Gln of the progenitor sequence. Antagonism on the barbiturate-induced anesthesia indicates the extent of the activation of cholinergic neurons [37] and, thus, the successful central delivery of [Leu2]TRH by the prodrugs. As shown by the results summarized in Table 1, the unmodified parent peptide, [Leu2]TRH, decreased the sleeping time only by 17 ± 7% compared to the vehicle control (propylene glycol/DMSO 2:1 v/v; sleeping time 54.9 ± 3.8 min), while the most significant (p< 0.05) analeptic effect was achieved with prodrugs having Pro residue in their S function. The data in Table 1 also highlight the critical influence of the peptidase-catalyzed S-Gln cleavage on the observed pharmacological effect. The crucial role of the scissile peptide linkers (S) in successful peptide delivery in to the brain by analogous prodrug design was also confirmed for a Leu-enkaphalin analogue [50,51].
2.2. [Glu2]TRH Prodrugs
The TRH-like tripeptide [Glu2]TRH (pGlu-Glu-Pro-NH2, Figure 1), although originally identified from rabbit prostate [52], has been shown to occur in the human brain [53]. Many pharmacological activities of this peptide are similar to those of TRH [54]; however, the beneficial effects after treatment with [Glu2]TRH are reportedly more robust or prolonged. These advantages are probably due to the increased resistance of this peptide to enzymes principally responsible for the rapid degradation of TRH in vivo [40]. In addition, [Glu2]TRH practically does not bind to TRH receptors and does not elevate triiodothyronine (T3) levels which has indicated that the peptide probably exerts pharmacological effects through binding to its own receptor in the CNS.
Figure 3.
Structure of [Glu2]TRH prodrugs as potential CNS agents.
Figure 3.
Structure of [Glu2]TRH prodrugs as potential CNS agents.

Due to the presence of the central Glu, this peptide is, however, predominantly ionized at physiological pH at the γ-carboxyl group of Glu, which would prevent pharmacologically significant amounts of peptide entering the brain by passive transport. Therefore, we carried out a bioreversible modification to afford prodrugs on this γ-COOH of the Glu residue to render the molecule neutral (non-ionizable) and, hence, amenable for diffusion across the BBB [55]. The synthesized esters (R = methyl: Me; Hex: n-hexyl; c-Hex: cyclohexyl; t-Bu: tert-butyl; Bz: benzyl) were first evaluated for their potential to interact with biological membranes by immobilized artificial membrane chromatography (IAMC) [56,57,58]. IAMC measures partitioning into monolayers of cell membrane-like phospholipids immobilized by covalent binding on silica particles and therefore, mimics membrane interactions better than partitioning in the isotropic n-octanol/water system (logP). The chromatographic capacity factor (k’IAM) for a compound obtained by the method is directly related to its partition coefficient between the aqueous phase and the chemically bonded membrane phase and, ultimately, to the Km value representing its fluid-membrane partition coefficient.
Table 2 shows that all ester prodrugs had increased membrane affinity compared to the unmodified parent peptide, and the hexyl ester (R = n-Hex) yielded the highest k’IAM (16.0). In vitro stability studies in mouse brain homogenate (20%, w/v) revealed that the half-lives were around 20 min and 22 min for R = Me and Hex, respectively, 25 min for R = c-Hex, and 70 min for the sterically hindered ester (R = t-Bu). On the other hand, the aromatic benzyl ester (R = Bz) was quite stable in the tissue (t½ > 2 h) that rendered the compound practically useless as a prodrug. We utilized again the robust analeptic activity of [Glu2]TRH as an indicator of the CNS effect, although the potency of this compound as an analeptic agent is less than that of TRH [35]. When compared to an equimolar dose of the parent peptide (10 µmol/kg body weight, i.v), prodrugs having R=Me, Hex, c-Hex, respectively, showed a statistically significant (P<0.05) decrease in the sleeping time compared to that of unmodified parent peptide. The measured pharmacological effect appeared to correlate well with the in vitro metabolic stability of the prodrugs measured in mouse the brain homogenate.
A slight influence of the increase in membrane affinity was also revealed upon comparing the analeptic response of the aliphatic methyl- and n-hexyl esters (Table 2). In all, esterification of the COOH in the side chain of the Glu residue with primary alcohols (the more lipophilic the better) afforded the most promising prodrugs for an efficient central delivery of [Glu2]TRH. Dose-response studies with the “best-performing” prodrug (R=Hex) also revealed that ED50 was around 2 µmol/kg body weight—a significant (10-fold) improvement in efficacy compared to that of the unmodified parent peptide.
Table 2.
IAMC capacity factors (k’IAM), in vitro half-lives (in 20% w/v mouse brain homogenate) and analeptic effects of test compounds (i.v. in mice at equimolar dose of 10 µmol/kg body weight when pentobarbital (i.p., 60 mg/kg body weight) was administered 10 min after the injection of the saline vehicle or test compounds) [55]. The k’IAM value was calculated as (tR-t0)/t0, where tR is the retention time for the compound and t0 is retention time of [Glu2]TRH used as a marker for dead volume. Statistically significant differences (ANOVA followed by post hoc Tukey test, P<0.05) from the control group (vehicle) and from both control group and Glu2[TRH] were indicated by single and double asterisks, respectively.
| Compound | k’IAM | t1/2 (min) | Sleeping time (min) |
|---|---|---|---|
| Vehicle | N/A | N/A | 80±2 |
| [Glu2]TRH, R=H | 0 | N/A | 65±3* |
| R=Me | 0.13 | 20 | 54±1** |
| R=Hex | 16.0 | 22 | 50±2** |
| R=cHex | 6.02 | 55 | 55±2** |
| R=tBu | 1.67 | 70 | 58±1* |
| R=Bz | 5.48 | >120 | 72±2 |
4. Conclusions
The pleiotropic action of TRH in the CNS makes this neuropeptide an attractive template for drug design and discovery. However, several limitations of TRH-based neurotherapy need to be addressed, including metabolic instability, poor CNS bioavaibility and selectivity. Because TRH per se also is an endocrine hormone, drug discovery efforts involving the CNS have focused thus far on designing TRH analogues/mimetics that have diminished, if any, hormonal effect and show sufficient resistance against proteolytic degradation in the blood. However, delivery of these agents into the CNS has remained a crucial aspect of the drug discovery process. For this purpose, we promote the prodrug approach as a versatile and bioreversible chemical manipulation technique that furnishes the target agent with adequate lipophilicity necessary for passive transport through the BBB. When coordinated with the discovery and development of prodrug-amenable analogues, this approach may provide specific molecular probes by which the central action of TRH can be studied by using convenient systemic administration, and it also offers potential treatment for various CNS maladies.
Acknowledgements
This research has been supported by grants from the NIH (MH59360 and RR012023). The authors are grateful to Drs. A.D. Zharikova, V. Nguyen, M. Teixidó, H.S. Kim, A.C. Braddy, S.M. Stevens Jr., X. Wang. K. Kónya and P. Perjési for their invaluable contributions to the projects summarized in this review. Laszlo Prokai is the Robert A. Welch Professor of the University of North Texas Health Science Center (grant number BK-0031).
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- Sample Availability: Samples of the compounds presented in this review are available from the authors.
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