New analogs of vitamin D-3

Calcitriol, the most active metabolite of vitamin D, controls parathyroid g land growth and suppresses the synthesis and secretion of parathyroid hormo ne (PTH). However, because of its potent effects on intestinal calcium abso rption and bone mobilization, calcitriol treatment can induce hypercalcemia , often precluding its use at therapeutic doses. Hyperphosphatemia is also a persistent problem among patients undergoing chronic hemodialysis and can be aggravated by therapeutic doses of calcitriol. Several pharmaceutical c ompanies were able to modify the side-chain of the 1,25(OH)(2)D-3, allowing some of these new analogs to retain the action on the parathyroid glands w hile decreasing their hypercalcemic and hyperphosphatemic effects. The stru cture-activity relationship for ligand-mediated transcriptional regulation has been studied in detail. In some analogs the serum binding protein (DBP) plays a key role in determining the pharmacokinetics of the vitamin D comp ound. The affinity to DBP for 22-oxacalcitriol (OCT), an analog of calcitri ol for the treatment of secondary hyperparathryoidism, is approximately 300 -400 times lower than that of calcitriol and the analog is rapidly cleared from the circulation. The mechanisms for the selectivity of 19-nor-1,25(OH) (2)D-2 (paricalcitol) (Zemplar(R)) another analog of calcitriol, is clearly different from OCT. Although the mechanisms of action is not completely kn own, it does appear that paricalcitol down-regulates the VDR in the intesti ne. It is likely that the unique biological profiles of vitamin D analogs i n vivo are due to multiple mechanisms. Understanding the molecular basis of the analog selectivity will not only provide an explanation for their uniq ue actions but allow intelligent design of more effective analogs in the fu ture.