Potent and selective inhibition of human cathepsin K leads to inhibition of bone resorption in vivo in a nonhuman primate

Cathepsin K is a cysteine protease that plays an essential role in osteocla st-mediated degradation of the organic matrix of bone. Knockout of the enzy me in mice, as well as lack of functional enzyme in the human condition pyc nodysostosis, results in osteopetrosis. These results suggests that inhibit ion of the human enzyme may provide protection from bone loss in states of elevated bone turnover, such as postmenopausal osteoporosis. To test this t heory, we have produced a small molecule inhibitor of human cathepsin K, SB -357114, that potently and selectively inhibits this enzyme (K-i = 0.16 nM) . This compound potently inhibited cathepsin activity in situ, in human ost eoclasts (inhibitor concentration [IC](50) = 70 nM) as well as bone resorpt ion mediated by human osteoclasts in vitro (IC50 = 29 nM). Using SB-357114, we evaluated the effect of inhibition of cathepsin K on bone resorption in vivo using a nonhuman primate model of postmenopausal bone loss in which t he active form of cathepsin K is identical to the human orthologue. A gonad otropin-releasing hormone agonist (GnRHa) was used to render cynomolgus mon keys estrogen deficient, which led to an increase in bone turnover. Treatme nt with SB-357114 (12 mg/kg subcutaneously) resulted in a significant reduc tion in serum markers of bone resorption relative to untreated controls. Th e effect was observed 1.5 h after the first dose and was maintained for 24 h. After 5 days of dosing, the reductions in N-terminal telopeptides (NTx) and C-terminal telopeptides (CTx) of type I collagen were 61% and 67%, resp ectively. A decrease in serum osteocalcin of 22% was also observed. These d ata show that inhibition of cathepsin K results in a significant reduction of bone resorption in vivo and provide further evidence that this may be a viable approach to the treatment of postmenopausal osteoporosis.