Loren D Walensky1, Gregory H Bird. 1. Department of Pediatric Oncology, Dana-Farber Cancer Institute , Boston, Massachusetts 02215, United States.
Abstract
Protein structure underlies essential biological processes and provides a blueprint for molecular mimicry that drives drug discovery. Although small molecules represent the lion's share of agents that target proteins for therapeutic benefit, there remains no substitute for the natural properties of proteins and their peptide subunits in the majority of biological contexts. The peptide α-helix represents a common structural motif that mediates communication between signaling proteins. Because peptides can lose their shape when taken out of context, developing chemical interventions to stabilize their bioactive structure remains an active area of research. The all-hydrocarbon staple has emerged as one such solution, conferring α-helical structure, protease resistance, cellular penetrance, and biological activity upon successful incorporation of a series of design and application principles. Here, we describe our more than decade-long experience in developing stapled peptides as biomedical research tools and prototype therapeutics, highlighting lessons learned, pitfalls to avoid, and keys to success.
Protein structure underlies essential biological processes and provides a blueprint for molecular mimicry that drives drug discovery. Although small molecules represent the lion's share of agents that target proteins for therapeutic benefit, there remains no substitute for the natural properties of proteins and their peptide subunits in the majority of biological contexts. The peptide α-helix represents a common structural motif that mediates communication between signaling proteins. Because peptides can lose their shape when taken out of context, developing chemical interventions to stabilize their bioactive structure remains an active area of research. The all-hydrocarbon staple has emerged as one such solution, conferring α-helical structure, protease resistance, cellular penetrance, and biological activity upon successful incorporation of a series of design and application principles. Here, we describe our more than decade-long experience in developing stapled peptides as biomedical research tools and prototype therapeutics, highlighting lessons learned, pitfalls to avoid, and keys to success.
Chemists and biologists have
long sought to recapitulate the shape and bioactivity of the peptide
α-helix for basic science and therapeutic applications. A diversity
of clever approaches to reinforcing α-helical structure, spanning
noncovalent and covalent strategies, have been advanced over the past
several decades.[1,2] For example, designs that include
helical caps between terminal side chains and the peptide backbone,[3] hydrogen bonding or electrostatic interactions
between side chains at select positions,[4] and introduction of α,α-disubstituted amino acids,[5,6] such as aminoisobutyric acid, have yielded peptides with improved
α-helical structure in solution. Covalent approaches based on
installing disulfide[7] and lactam[8−10] bridges into the peptide architecture have provided even further
enhancements. With proof-of-concept for chemical stabilization of
peptide helices in hand, a critical next step was to transform structured
peptides into reagents that could withstand the in vivo proteolytic
environment, target and penetrate intact cells, and ultimately
achieve clinically relevant biological activity. The purpose of this
review is to describe our practical experience to date with inserting
all-hydrocarbon cross-links into bioactive peptide motifs and how
this chemical intervention created a new class of structured peptides
for biological discovery and clinical translation.The all-hydrocarbon
cross-link for peptide α-helix stabilization
was first published in 2000 by Verdine and colleagues, who sampled
a large series of α,α-disubstituted non-natural amino
acids bearing olefin tethers to determine optimal length and stereochemistry
for ruthenium-catalyzed ring-closing metathesis (RCM) across one or
two α-helical turns.[11] This work
was an extension of the pioneering studies of Blackwell and Grubbs,
who created a cross-link between O-allylserine residues
on a peptide template to form a covalent bond using the Grubbs catalyst.[12] Importantly, Verdine and colleagues combined
the principles of RCM with α,α-disubstitution of the amino
acid chiral carbon and on-resin peptide synthesis to ultimately achieve
the goal of structural stabilization[11] (Figure 1). The resultant constructs were later dubbed stapled
peptides,[13] based on the prior use of the
term “staple” to reflect the organization conferred
by covalent linkage of two previously independent entities, such as
in stapled molecules[14] and disulfide bridge
stapling,[15] and as elegantly depicted on
a Blackwell and Grubbs journal cover.[16] A critically important consequence of α-helical stabilization
by all-hydrocarbon stapling was the observed protease resistance,[11] a direct result of sequestering the amide bonds
in the interior of the helix core and thus rendering them poor substrates
for enzymatic hydrolysis.
Figure 1
Application of ruthenium-catalyzed olefin metathesis
to install
macrocyclic cross-links into synthetic peptides. Blackwell and Grubbs
performed the metathesis reaction on a pair of O-allylserine
residues (top), whereas Schafmeister and Verdine employed α,α-disubstituted
non-natural amino acids bearing all-hydrocarbon tethers (bottom).
The latter approach yielded peptide constructs with marked α-helical
stabilization.
Application of ruthenium-catalyzed olefin metathesis
to install
macrocyclic cross-links into synthetic peptides. Blackwell and Grubbs
performed the metathesis reaction on a pair of O-allylserine
residues (top), whereas Schafmeister and Verdine employed α,α-disubstituted
non-natural amino acids bearing all-hydrocarbon tethers (bottom).
The latter approach yielded peptide constructs with marked α-helical
stabilization.At the same time, the
late Dr. Stanley Korsmeyer, a renowned apoptosis
investigator, was decoding the selective roles of BCL-2 homology 3
(BH3) domains in mediating the critical BCL-2 family protein interactions
that literally regulate cellular life and death at the level of the
mitochondrion. Although defined structurally as amphipathic α-helices,
we found that synthetic BH3 peptides in solution were mostly unfolded
but could still be categorized functionally as either inhibitors of
BCL-2 family survival proteins or direct activators of BCL-2 family
death proteins.[17] Dr. Korsmeyer envisioned
that if these unfolded peptides could be “snapped back into
shape”, perhaps they could be better research tools and even
become therapeutic prototypes. A postdoctoral fellow in pediatric
oncology previously trained in synthetic chemistry by Dr. Edward Taylor
at Princeton University and in signal transduction by Dr. Solomon
Snyder at Johns Hopkins, Dr. Loren Walensky became the chemistry and
biology bridge for a Korsmeyer–Verdine collaboration on generating
hydrocarbon-stapled BH3 peptide helices. We found that hydrocarbon
stapling reliably transformed unfolded BH3 peptides into α-helices,
as measured by circular dichroism (Figure 2), and that the constructs were remarkably protease resistant in
vitro and in vivo.[18] In addition, these
stabilized α-helices of BCL-2 domains or SAHBs bound to their
physiologic BCL-2 family targets in vitro with nanomolar affinity
and via the same binding mode as unmodified peptides, as documented
by NMR analysis.[18] We further observed
that cancer cells treated with fluorescently labeled stapled BH3 peptides
developed glowing cytoplasm, whereas the corresponding fluorescently
labeled unmodified peptides showed no such effect. An exciting but
unexpected result for Drs. Korsmeyer and Walensky, Dr. Verdine was
less surprised: “if you were an amphipathic α-helix bearing
an all-hydrocarbon staple, would you prefer to live in aqueous culture
medium or head to a lipid membrane?” Indeed, the cellular uptake
was dose-responsive, time-responsive, and energy-dependent and tracked
with dextran-labeled pinosomes.[18] Time-dependent
colocalization of FITC-SAHBs at the mitochondria correlated with induction
of cell death, which was BH3 sequence-dependent in vitro and in vivo.[18] Since this original work, hydrocarbon stapling
has been applied by us and independently by others to more than two
dozen published peptide templates, corresponding to both extracellular
and intracellular targets (Table 1). Through
this body of work, we and others have encountered and overcome challenges
in design, uptake, and activity and in doing so have amassed a wealth
of information about how to iterate stapled peptide compositions for
a host of biomedical applications. As with any new technology, we’ve
learned that an open mind, experimental rigor, and persistence are
key ingredients to making progress when applying the principles and
practice of peptide stapling.
Figure 2
Enhanced α-helicity of all-hydrocarbon
stapled peptides.
Circular dichroism analyses of a series of BH3 peptides demonstrate
that stapling can convert unfolded BID (AA 81–101) (A), BAD
(aa 103–127) (B), BIM (aa 146–166) (C), and MCL-1 (208–226)
(D) peptides (14–20% α-helical content) into α-helices
(71–91% α-helical content) in solution (e.g., aqueous
potassium phosphate, pH 7).
Table 1
Applications of All-Hydrocarbon
Peptide
Stapling in a Diversity of Disciplines and Human Diseases, Spanning
Cancer, Infectious Diseases, Metabolism, and Neuroscience
helical ligand
protein target
target site
refs
Cancer
BID BH3
BCL-2 family proteins
intracellular
Walensky
et al. Science 2004; Mol. Cell 2006;
Leshchiner
et al. Proc. Natl. Acad. Sci. U.S.A. 2013
Moldoveanu
et al. Nat. Struct. Mol. Biol., 2013
BAD BH3
BCL-2 family proteins
intracellular
Walensky et al. Mol. Cell, 2006; Braun et
al. Chem. Biol. 2010
BIM
BH3
BCL-2 family proteins
intracellular
Walensky et al. Mol. Cell, 2006; Gavathiotis
et al. Nature 2008; Gavathiotis et al. Mol.
Cell 2010; LaBelle
et al. J. Clin. Invest. 2012; Okamoto et al. ACS Chem. Biol. 2012; Braun et al. Chem Biol. 2010; Bird et al. ACS Chem. Biol. 2014
MCL-1 BH3
MCL-1
intracellular
Stewart et al. Nat.
Chem. Biol. 2010; Joseph et al. PLoS One 2012
PUMA BH3
BCL-2 family
proteins
intracellular
Edwards et al. Chem.
Biol. 2013
p53
MDM2/MDMX
intracellular
Bernal et al. J.
Am. Chem. Soc. 2007; Bautista et al. J. Am. Chem.
Soc. 2009; Bernal et al. Cancer Cell 2010;
Guo et al. Chem. Biol. Drug. Des. 2010; Joseph et
al. Cell Cycle 2010; Baek et al. J. Am. Chem.
Soc. 2012; Gembarska et al. Nat. Med. 2012;
Brown et al. ACS Chem. Biol. 2012; Chang et al. Proc. Natl. Acad. Sci. U.S.A. 2013; Wei et al. PLoS
One 2013.
mastermind
notch
intracellular
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BCL9
β-catenin
intracellular
Takada
et al. Sci.
Transl. Med. 2012
axin
β-catenin
intracellular
Grossmann
et al. Proc. Natl. Acad. Sci. U.S.A. 2012; Cui et
al. Cell
Res. 2013
p110α
IRS1
intracellular
Hao et al. Cancer
Cell 2013
borealin
survivin
intracellular
Shi et al. Anal.
Chem. 2013
EZH2
EED
intracellular
Kim et al. Nat.
Chem. Biol. 2013
eIF4G
eIF4E
intracellular
Lama et al. Sci.
Rep. 2013
Infectious Disease
HIV-1 capsid
Gag
intracellular
Bhattacharya et al. J. Biol. Chem. 2008; Zhang
et al. J. Mol. Biol. 2008; Zhang et al. Retrovirology 2011; Zhang et
al. Retrovirology 2013
HIV-1
integrase
HIV-1 integrase
intracellular
Long et al. J. Med.
Chem. 2013
GP41 HR2 domain
GP41 six-helix bundle
extracellular
Bird et al. Proc.
Natl. Acad. Sci. U.S.A. 2010
lasioglossin
III
microbial membrane
extracellular
Chapuis et al. Amino
Acids 2012
melectin
microbial membrane
extracellular
Chapuis
et al. Amino
Acids 2012
CD81
HCV-E2
extracellular
Cui et al. Bioorg.
Med. Chem. 2013
esculentin-2EM
microbial membrane
extracellular
Pham et al. Bioorg.
Med. Chem. Lett. 2013
Metabolism/Endocrine
apolipoprotein A1
ABCA1 transporter
extracellular
Sviridov et al. Biochem.
Biophys. Res. Commun. 2011
phospho-BAD
BH3
glucokinase
intracellular
Danial et al. Nat.
Med. 2008; Szlyk et al. Nat. Struct. Mol. Biol. 2014
nuclear receptor coactivator peptide 2
estrogen receptor
intracellular
Phillips et al. J. Am.
Chem. Soc. 2011
Neurology
conantokins
NMDA receptor
extracellular
Platt et al. J.
Biol. Chem. 2012
galanin
galanin receptor
extracellular
Green et al. Bioorg.
Med. Chem. 2013
neuropeptide Y
neuropeptide Y receptor
extracellular
Green et al. Bioorg.
Med. Chem. 2013
Enhanced α-helicity of all-hydrocarbon
stapled peptides.
Circular dichroism analyses of a series of BH3 peptides demonstrate
that stapling can convert unfolded BID (AA 81–101) (A), BAD
(aa 103–127) (B), BIM (aa 146–166) (C), and MCL-1 (208–226)
(D) peptides (14–20% α-helical content) into α-helices
(71–91% α-helical content) in solution (e.g., aqueous
potassium phosphate, pH 7).
Design and Synthesis
The building blocks for hydrocarbon
stapling are α,α-disubstituted non-natural
amino acids bearing terminal olefin tethers of varying length. For
single turn stapling, we typically employ S-pentenylalanine
at i, i + 4 positions, and for double
turn stapling, we use a combination of either R-octenylalanine/S-pentenylalanine or S-octenylalanine/R-pentenylalanine at i, i + 7 positions (Figure 3A). The same pairings
can be used to install more than one staple within a given peptide
template (Figure 3A). There are now multiple
synthetic routes to these non-natural amino acids, such as by use
of an oxazinone chiral auxiliary based on the method of Williams and
colleagues[19−21] or a benzylprolylaminobenzophenone
(BPB) based chiral auxiliary adapted from Belokon et al.[22] and Qiu et al.[23] (Figure 3B). We have successfully applied both synthetic
routes, as previously described in detail.[24,25] For the nonchemist, these building blocks are now readily available
for purchase from sources in the U.S. and abroad.
Figure 3
Building blocks of all-hydrocarbon
peptide stapling. (A) A series
of chiral non-natural amino acids are inserted at i, i + 4 or i, i + 7 positions and the terminal olefins cross-linked by RCM, yielding
cross-links that span one or two helical turns, respectively. For
example, S5–S5 pairs have been substituted at i, i + 4 positions, and S8–R5 or S5–R8
pairs have been substituted at i, i + 7 positions to generate single- or double-stapled peptides. (B)
Two synthetic approaches that we have used to generate the stapling
amino acids employ the oxazinone or BPB-Ni(II)-Ala chiral auxiliaries
to enforce the desired stereochemistry.
Building blocks of all-hydrocarbon
peptide stapling. (A) A series
of chiral non-natural amino acids are inserted at i, i + 4 or i, i + 7 positions and the terminal olefins cross-linked by RCM, yielding
cross-links that span one or two helical turns, respectively. For
example, S5–S5 pairs have been substituted at i, i + 4 positions, and S8–R5 or S5–R8
pairs have been substituted at i, i + 7 positions to generate single- or double-stapled peptides. (B)
Two synthetic approaches that we have used to generate the stapling
amino acids employ the oxazinone or BPB-Ni(II)-Ala chiral auxiliaries
to enforce the desired stereochemistry.In designing stapled peptide helices, the more structural
information
available the better. It is especially helpful to know that the intended
peptide for stapling is a bona fide α-helix in its natural context.
Without this natural propensity to fold, the installed olefin groups
may never juxtapose sufficiently to react. This is typically self-evident
based on RCM reactions that achieve complete conversion after a few
hours at room temperature compared to those that are sluggish even
after prolonged heating. Our early design approach was to substitute
the non-natural amino acid pair(s) on the nonbinding surface of the
α-helix in order to avoid disruption of the binding interface.[18] However, with increased access to the amino
acid building blocks and high throughput synthetic machinery (see
below), we have since adopted a more comprehensive “staple
scanning” approach, which essentially samples all staple positions
along the length of the peptide helix. A key benefit of this strategy
is the wealth of structure–activity relationship information
that emerges from mutating each residue of the template and probing
the various surfaces of the three-dimensional structure (Figure 4). As a result, optimally structured and biochemically
efficacious constructs can be readily identified, in addition to a
host of negative control compounds. However, if limited initially
to a small series of constructs due to financial or synthetic constraints,
structural information can guide the placement of staples away from
the binding surface for positive controls and directly at the interface
for negative controls.
Figure 4
Generating a library of stabilized α-helices by
staple scanning.
Ideally, the structure of a helix-in-groove interaction can help guide
the selection of staple insertion points to maximize α-helical
stabilization while avoiding interference with critical, native contact
points between the helix and groove. Sequential placement of staples
along the entire length of the peptide sequence yields a library of
constructs for structure–activity relationship analyses. We
have used this staple scanning approach to identify optimal staple
positions for structural stabilization, elucidate key residues and
contact surfaces for ligand–target interaction, and generate
negative control constructs for biological studies.
Generating a library of stabilized α-helices by
staple scanning.
Ideally, the structure of a helix-in-groove interaction can help guide
the selection of staple insertion points to maximize α-helical
stabilization while avoiding interference with critical, native contact
points between the helix and groove. Sequential placement of staples
along the entire length of the peptide sequence yields a library of
constructs for structure–activity relationship analyses. We
have used this staple scanning approach to identify optimal staple
positions for structural stabilization, elucidate key residues and
contact surfaces for ligand–target interaction, and generate
negative control constructs for biological studies.Once designed, stapled peptides are generated using
Fmoc-based
peptide synthesis chemistry, as described previously.[24,25] The most frequent complication of peptide synthesis is failure to
generate the full-length construct due to difficult amino acid couplings.
Because the amine of the non-natural amino acid is hindered, extended
deprotection and coupling times and/or double or triple couplings
with fresh reagent may be required, especially after naturally bulky
residues, such as arginine or β-branched amino acids (e.g.,
valine, isoleucine, and threonine). Other complications such as cross-reactions
or progressive inaccessibility of the N-terminus due to on-resin aggregation
can also occur. For example, Asp-Gly is the most likely amino acid
pair to undergo aspartimide formation; upon repeated exposure to piperidine,
the -NH- of Gly attacks the ester-protected side chain of Asp and
releases tert-butanol to form a five-membered ring.
Ring-opening by water or piperidine can yield a peptide bearing racemized
Asp or a piperamide, respectively. Suppression of this unwanted reaction
can be achieved by use of the commerically available side chain protected
dipeptide pair, Fmoc-Asp(OBu)-(Dmb)Gly-OH
(EMD Biosciences). Progressive hindrance of the reactive N-terminus
due to on-resin aggregation can also reduce synthetic yield; this
occurs when the growing peptides fold as β-sheets. This complication
can be avoided by lowering resin substitution, incorporating the α-helix-promoting
stapling amino acids themselves, and substituting pseudoprolineSer
and Thrdipeptides (EMD Biosciences) at X-Ser and X-Thr positions
to produce a kink that disrupts β-sheet formation. To improve
the synthetic success rate and yield of staple peptides, it is best
to identify difficult sequence patterns at the outset and then modify
the methodology accordingly. Peptide synthesizers that measure the
fulvene deprotection product by in-line UV monitoring allow for real-time
adjustments of the deprotection and subsequent coupling steps to optimize
the synthetic regimen.Originally, we synthesized stapled peptides
manually using a manifold
apparatus, a process that is certainly doable but time-consuming and
laborious.[24,26] We and others have since employed
a series of efficient peptide synthesis machines to produce large
quantities of stapled peptides with excellent yields and purity, including
equipment from Applied Biosystems, AAPPTec, Thuramed, CEM, and Protein
Technologies. When performing automated peptide synthesis for the
first time, we recommend optimizing the equipment and method using
the unmodified template peptide first. This ensures that the standard
protocol can produce the desired baseline peptide in high yield and
purity before advancing to stapled peptide synthesis. Once the peptide
containing the incorporated olefinic residues is complete, the RCM
reaction can be performed on-resin either before or after a variety
of N-terminal derivatizations (depending upon chemical compatibility)
and then cleaved and deprotected using standard cleavage cocktails,
as described.[24−26] In addition to N-terminal acetyl capping, we have
derivatized stapled peptides with fluorophores for binding analyses
and cellular imaging, biotin for affinity capture, MTSL for paramagnetic
relaxation enhancement NMR, and benzophenone for photo-cross-linking
and mass-spectrometry-based binding site identification (Figure 5).[18,27−29]
Figure 5
Design and derivatization
of stapled peptides for a diversity of
research applications. We have generated stapled peptides for (1)
cellular studies by optimizing α-helicity and adjusting overall
charge to the 0 to +2 range, (2) PRE NMR analyses by optimizing solubility
with overall negative charge and appending differentially localized
spin labels, (3) fluorescence polarization binding and cellular uptake
analyses by N-terminal derivatization with FITC, (4) in vivo PK and
extracellular targeting studies of lengthy α-helices by inserting
two staples, (5) protein interaction discovery and helix binding site
identification by inserting photoreactive non-natural amino acids
along the length of an N-terminally biotinylated stapled peptide followed
by affinity capture and mass spectrometry analysis.
Design and derivatization
of stapled peptides for a diversity of
research applications. We have generated stapled peptides for (1)
cellular studies by optimizing α-helicity and adjusting overall
charge to the 0 to +2 range, (2) PRE NMR analyses by optimizing solubility
with overall negative charge and appending differentially localized
spin labels, (3) fluorescence polarization binding and cellular uptake
analyses by N-terminal derivatization with FITC, (4) in vivo PK and
extracellular targeting studies of lengthy α-helices by inserting
two staples, (5) protein interaction discovery and helix binding site
identification by inserting photoreactive non-natural amino acids
along the length of an N-terminally biotinylated stapled peptide followed
by affinity capture and mass spectrometry analysis.Stapled peptides are purified to homogeneity by
HPLC/MS and then
quantified. We have long preferred quantitation by amino acid analysis
(AAA) because of its accuracy and consistency in assigning peptide
amounts across a diversity of peptides and between lots. Because AAA
can be costly and less accessible, quantitation by UV spectroscopy
is also an option. However, this approach depends upon the presence
of UV-active residues, which can differ significantly across a panel
of distinct peptides, leading to over- or underestimating the amount
of material present, which can directly impact reported EC50 values for biochemical and biological activity. Instead, we find
that performing AAA on duplicate samples of peptide prepared at two
different dilutions is the most reliable method for peptide quantitation.
Aliquoted peptide is then lyophilized and stored as a powder or in
100% DMSO at −20 °C, with integrity and activity retained
for years.Stapled peptide syntheses optimized according to
the above-described
principles can achieve purities and yields that match the corresponding
unmodified peptides. For example, a purity of 90% for the postcleavage
crude material is common and can be improved to >95% by HPLC, with
overall yields of 30% routinely obtained. In the absence of sequence-specific
coupling challenges, unanticipated side reactions, and/or on-bead
aggregation, we find that the majority of stapled peptides can be
successfully generated on the first attempt.
Solubility
Because
the primary goal of stapling peptides is to reinforce structure,
our first characterization step is to assess secondary structure in
solution by circular dichroism. However, in order to execute this
and other structural analyses, soluble peptide at high micromolar
concentrations is required. Therefore, it is essential to determine
and optimize as necessary the solubility of stapled peptide material.
Some constructs are soluble in water alone,[30] but others may need to be dissolved in 100% DMSO prior to stepwise
dilution into aqueous buffers.[31] The HPLC
elution profile is a useful barometer, as late-eluting, hydrophobic
peptides can be more challenging to solubilize. We determine the solubility
profile of newly developed stapled peptides by dissolving them in
a series of aqueous buffers, varying the pH and salt concentration.
Regardless of the ultimate solubilization protocol, such as dissolving
the powder for experimental use in 100% aqueous or serially diluting
it from a DMSO stock into aqueous buffers, it is essential to verify
that the peptide is actually in solution. For example, performing
a tabletop spin at maximum speed followed by inspection for the presence
of a pellet can alert the user to incomplete solubility. If the stapled
peptide is not fully dissolved in assay buffer or tissue culture medium,
rigorous evaluation of its activity will be compromised. For more
hydrophobic peptides, solubilization can often be achieved by iterative
dilution of the DMSO stock into aqueous buffer until the goal concentration
is reached. In the extreme case, insoluble peptides can be redesigned
to incorporate native flanking hydrophilic or charged residues, such
as Asp or Glu, to decrease overall hydrophobicity.Once solubilized,
we next turn to an assessment of the behavior
of the stapled peptide in solution. Like many chemical compounds,
peptides can aggregate depending upon the composition and concentration.
Stapled peptides are typically applied in biological studies within
a nanomolar to low micromolar dosing range, concentrations at which
self-association is rarely observed. However, to rule out self-association,
stapled peptide samples dissolved at various concentrations can be
evaluated by native gel electrophoresis[32] and/or gel filtration chromatography[29] for the presence of higher order species. If aggregation is observed
at a particular concentration, either the stapled peptide should be
employed below this concentration in biological studies or alternative
solubilization buffers explored. If all else fails, the peptide can
typically be redesigned to remedy its propensity to self-associate
by reducing overall hydrophobicity, as described above.
Structural Analysis
Circular dichroism provides a rapid assessment of average α-helical
content of stapled peptides in solution. The relative benefit of installing
a particular hydrocarbon staple is determined by comparison with the
corresponding unmodified peptide. Screening a library of differentially
stapled peptides often identifies the optimal staple position(s) for
maximizing α-helical stabilization (Figure 6A and Figure 6B). The degree of staple-induced
structural stabilization can also be comparatively assessed by NMR,
as previously described.[33] It is important
to note that (1) inserting a staple at any given position does not
guarantee structural reinforcement[33] and
(2) maximizing α-helicity does not guarantee optimal biochemical
or biological activity. For example, in the case of hydrocarbon-stapled
gp41 HR2 domains, constructs of intermediate helicity were optimal
for biological activity, with excessive helicity from a single C-terminal
constraint actually reducing antiviral activity.[32] Ultimately, the topography and plasticity of the receptor
surface will select for the optimally structured stapled peptide ligand.
Thus, advancing a spectrum of structurally stabilized peptide α-helices
to biochemical and biological testing is advised in order to determine
which construct is best for a given target.
Figure 6
Structural analysis of
stapled peptide helices. (A, B) Examination
of a series of differentially stapled MCL-1 BH3 (aa 208–226)
(A) and p53 transactivation domain (aa 14–29) (B) peptides
by circular dichroism demonstrates the importance of staple position
in optimizing α-helical stabilization. Whereas the majority
of MCL-1 SAHB constructs manifest substantial structural stabilization
compared to the unmodified MCL-1 BH3 peptide (A), only one of the
sampled positions in the p53 sequence yielded a peptide with marked α-helicity.
These data demonstrate that installing a hydrocarbon staple at any
one location does not guarantee structural enhancement, but sampling
a series of positions can typically yield a construct or a panel of
constructs with the desired properties. (C, D) X-ray structures of
the stapled peptide/target protein complexes MCL-1 SAHB/MCL-1 (C)
and SAH-p53-8/HDM2 (D) demonstrate the reinforced α-helical
structure of the peptide ligands and the capacity of the staple itself
to engage the protein surface, resulting in enhancement of binding
activity without compromising specificity.
Structural analysis of
stapled peptide helices. (A, B) Examination
of a series of differentially stapled MCL-1BH3 (aa 208–226)
(A) and p53 transactivation domain (aa 14–29) (B) peptides
by circular dichroism demonstrates the importance of staple position
in optimizing α-helical stabilization. Whereas the majority
of MCL-1SAHB constructs manifest substantial structural stabilization
compared to the unmodified MCL-1BH3 peptide (A), only one of the
sampled positions in the p53 sequence yielded a peptide with marked α-helicity.
These data demonstrate that installing a hydrocarbon staple at any
one location does not guarantee structural enhancement, but sampling
a series of positions can typically yield a construct or a panel of
constructs with the desired properties. (C, D) X-ray structures of
the stapled peptide/target protein complexes MCL-1SAHB/MCL-1 (C)
and SAH-p53-8/HDM2 (D) demonstrate the reinforced α-helical
structure of the peptide ligands and the capacity of the staple itself
to engage the protein surface, resulting in enhancement of binding
activity without compromising specificity.A variety of stapled peptides in complex with their biological
targets have now been visualized by computer simulation,[34,35] NMR,[28,36−38] and X-ray crystallography.[30,39−41] In each case and as anticipated, the peptide is observed
in α-helical conformation. Whereas the staple is typically oriented
away from the binding interface,[34,35,37] staples inserted at the amphipathic border can engage
in complementary hydrophobic interactions with the binding surface
itself[30,39,41] (Figure 6C and Figure 6D). In the
case of a stapled MCL-1BH3 helix bound to antiapoptotic MCL-1, the
specific residues engaged by the hydrocarbon staple are actually employed
in physiologic interactions with other natural BH3 domain residues.[30] A similar phenomenon was observed for the SAH-p53-8/hDM2
interaction.[39] Importantly, the binding
specificities of such staple-interacting constructs were not disturbed
by these fortuitous interactions,[30,33,39,41,42] which instead enhanced affinity and showcase the opportunity to
actually harness the staple for medicinal-chemistry-based optimization
of target binding.
Protease Resistance
One of the most
striking features of hydrocarbon-stapled peptides
is their proteolytic resistance,[11,18,33] which correlates with both the degree of α-helical
stabilization and the number of inserted staples.[32] To assess the relative contribution of the staple itself
to the observed protease resistance, we previously compared the induced
α-helicity and in vitro protease resistance of a 36 amino acid
long peptide containing single staples, double staples, or substituted
but not stapled non-natural amino acids. Importantly, each of the
peptides had the same number of chymotrypsin sites. The most telling
comparison was between the double stapled and tetrasubstituted-but-unstapled
constructs, which showed similar average α-helical stabilization
in solution but a 9-fold difference in half-life (Figure 7A and Figure 7B). From a
mechanistic standpoint, the double staples not only slowed the kinetics
of proteolytic digestion but completely eliminated cleavage of two
chymotryptic sites that either localized within the protective umbrella
of the staple or was immediately adjacent to it (Figure 7C). In an acidic environment, the double stapled peptide manifested
further enhancement of α-helical structure and a 192-fold prolongation
in half-life compared to the corresponding unmodified peptide (Figure 7D). Strikingly, the construct was detected in full-length
form in blood withdrawn from mice 30 min after oral gavage treatment,[32] demonstrating the capacity of this doubly stapled
peptide to withstand the acidic environment of the stomach and achieve
intestinal absorption into the blood in full-length form (Figure 7E). Importantly, even though insertion of α,α-disubstituted
non-natural amino acids without olefin metathesis can achieve α-helical
induction,[32] and for some templates even
cellular uptake,[33] closure of the staple
is essential for developing protease-resistant constructs for in vivo
application.
Figure 7
Protease resistance of hydrocarbon-stapled peptides. (A,
B) A mechanistic
analysis of peptide fortification by hydrocarbon stapling revealed
that the average α-helicity in solution of a doubly stapled
lengthy peptide SAH-gp41(A,B) vs the corresponding tetrasubstituted
but unstapled analogue UAH-gp41(A,B) was the same (A), yet the proteolytic
half-life of the doubly stapled construct was prolonged by 24-fold
compared to the unmodified peptide, whereas the tetrasubstituted but
unstapled analogue showed only a 3-fold difference (B). (C) Proteomic
analysis of the digestion products revealed that peptide double stapling
slowed the kinetics of proteolysis at sites distal to the staple and
completely prevented hydrolysis at sites flanked by or immediately
adjacent to the staple. Notably, the tetrasubstituted but unstapled
analogue was unable to achieve this degree of protection. (D) The
dramatic antiproteolysis effect of hydrocarbon double stapling was
reflected by a 192-fold enhancement in half-life of SAH-gp41(A,B)
compared to the corresponding unmodified peptide in the presence of
pepsin at pH 2. (E) The striking in vitro proteolytic stability of
SAH-gp41(A,B) at acidic pH prompted us to explore its oral bioavailability
after administration to mice by oral gavage. SAH-gp41(A,B) achieved
measurable and dose-dependent plasma concentrations, in fully intact
form, within 30 min of oral administration, whereas the corresponding
unmodified construct was not detectable (ND).
Protease resistance of hydrocarbon-stapled peptides. (A,
B) A mechanistic
analysis of peptide fortification by hydrocarbon stapling revealed
that the average α-helicity in solution of a doubly stapled
lengthy peptide SAH-gp41(A,B) vs the corresponding tetrasubstituted
but unstapled analogue UAH-gp41(A,B) was the same (A), yet the proteolytic
half-life of the doubly stapled construct was prolonged by 24-fold
compared to the unmodified peptide, whereas the tetrasubstituted but
unstapled analogue showed only a 3-fold difference (B). (C) Proteomic
analysis of the digestion products revealed that peptide double stapling
slowed the kinetics of proteolysis at sites distal to the staple and
completely prevented hydrolysis at sites flanked by or immediately
adjacent to the staple. Notably, the tetrasubstituted but unstapled
analogue was unable to achieve this degree of protection. (D) The
dramatic antiproteolysis effect of hydrocarbon double stapling was
reflected by a 192-fold enhancement in half-life of SAH-gp41(A,B)
compared to the corresponding unmodified peptide in the presence of
pepsin at pH 2. (E) The striking in vitro proteolytic stability of
SAH-gp41(A,B) at acidic pH prompted us to explore its oral bioavailability
after administration to mice by oral gavage. SAH-gp41(A,B) achieved
measurable and dose-dependent plasma concentrations, in fully intact
form, within 30 min of oral administration, whereas the corresponding
unmodified construct was not detectable (ND).In addition to the remarkable difference between stapled
and unstapled/unmodified
peptides upon exposure to proteolytic enzymes in vitro and in vivo,
we also found that stapled peptides have greater intracellular stability.
We recently compared the intracellular levels of a stapled BCL-9 peptide
with the corresponding unmodified version bearing a cell-penetrating
TAT sequence at the N-terminus.[43] Whereas
equivalent uptake kinetics was observed for the two fluorescently
labeled peptides, the TAT-BCL-9 peptide exhibited time-dependent elimination
and was undetectable by 12 h, while the stapled BCL-9 construct maintained
similar, high level peptide throughout the time course. Taken together,
these data highlight that hydrocarbon stapling can remedy a major
liability of peptide therapeutics, namely, susceptibility to rapid
proteolytic degradation in vivo. What’s more, awareness of
specific sequence vulnerabilities to extra- or intracellular proteases
can guide the placement of staples and thereby potentially eliminate
key sites of proteolysis.
Biochemical Testing
To carefully
establish the structure–activity relationship
for a pilot panel of stapled peptides, it is ideal to have both a
direct target binding assay and an in vitro biochemical assay to link
binding with functional consequences. Fluorescence polarization, surface
plasmon resonance, ELISA, FRET, BRET, isothermal calorimetry, and
other measures of ligand–protein interaction allow for calculation
of binding constants and assessment of comparative binding efficacy
for both positive and negative control stapled peptides. With lead
constructs in hand, including mutant controls, optimal binders can
then be advanced to functional testing. For example, we have studied
the comparative binding activity of SAHBs for a series of recombinant
BCL-2 family member proteins and examined their biochemical activity
in modulating death channel formation in liposomal and mitochondrial
release assays.[29−31] The capacity of specific, high affinity SAHBs to
disrupt the corresponding protein–protein interactions, for
example, can be assessed further by co-immunoprecipitation of native
complexes from cellular lysates. Such biochemical assays are routinely
used to vet iterative panels of stapled peptides, optimized based
on sequence composition, staple composition and placement, measured
α-helicity, overall charge, and compound solubility (Figure 8A). In advance of cellular application, protein
targeting in cellular lysates can also be examined by stapled peptide
pull-down assays that employ FITC-tagged, biotinylated, and/or photoreactive
constructs, followed by protein detection by Western blotting and/or
proteomic analyses.[27,31,42] In our view, in vitro biochemical testing of stapled peptides is
an essential step toward their development for cellular and in vivo
application. Advancing stapled peptides directly from synthesis to
cellular testing is a treacherous path because without validating
and optimizing constructs for specific, high affinity biochemical
activity first, we believe there is little chance that cellular work
will succeed. Instead, we strongly endorse a stepwise approach that
starts with SAR-driven biochemical optimization of stapled peptide
design, followed by direct measurement of cellular uptake and synthetic
adjustment as needed to maximize penetrance, all before advancing
lead constructs to cellular and in vivo analyses.
Figure 8
Deploying stapled peptides
for biological investigation. Workflows
for using stapled peptides in (A) in vitro biochemical, structural,
and functional studies and (B) cellular and in vivo analyses.
Deploying stapled peptides
for biological investigation. Workflows
for using stapled peptides in (A) in vitro biochemical, structural,
and functional studies and (B) cellular and in vivo analyses.
Cellular Uptake
Designing peptides
for cellular delivery is one of the most exciting
yet challenging frontiers of peptide therapeutics. Traditionally,
unfolded and polar peptides have shown little propensity for cellular
uptake except when cell penetrating tags such as TAT, antennapedia,
and poly-Arg are appended. The explicit mechanisms of uptake remain
active areas of investigation but appear to involve energy-dependent
pinocytosis[44] and perhaps in some circumstances
direct penetration.[45] We have observed
cellular uptake of stapled peptides in a time-, temperature-, and
ATP-dependent manner, consistent with a pinocytotic mechanism.[18] Egress from pinosomes to intracellular sites
of biological activity (e.g., mitochondria, nucleus, cytosol) has
been observed by live confocal microscopy performed over time;[18,29,46] the explicit mechanism(s) of
pinosomal export and opportunities to facilitate this process are
active areas of investigation. We have also found that, depending
on their sequence, some (but not all) stapled peptides manifest reduced
cellular uptake in the presence of serum. For those constructs impeded
by serum, dose-responsive reduction of cellular uptake by serum has
been observed, with consequent impairment in biological activity.[46] This could derive from either direct serum component
binding, which we have measured for albumin,[27] or other mechanisms, such as competing with natural serum-containing
substrates for pinocytosis.[47]To
eliminate the potential for variable, serum-based reduction
of cellular uptake for specific constructs, we have traditionally
initiated our uptake analyses using serum-free medium (e.g., Opti-MEM)
or by treating cells in the absence of serum for a 1–4 h period
followed by serum replacement.[18] We evaluate
cellular uptake of FITC-stapled peptides by live confocal microscopy,
FACS analysis of treated cells, and fluorescence scan of electrophoresed
lysates from treated cells[18,29,33,46] (Figure 8B). Before analysis, the cells are washed to remove stapled peptide-containing
medium. For the FACS and cell lysate evaluations, cells are also treated
with trypsin to digest surface protein and thus eliminate any nonspecifically
bound peptide. On the basis of our development and analysis of many
series of stapled peptides, we find that their capacity for cellular
penetrance depends on a combination of factors that include charge,
hydrophobicity, and α-helical structure, with negatively charged
and less structured constructs often requiring sequence modification
to achieve cellular uptake.[24,25] For example, substituting
Asn for Asp and/or Gln for Glu, or adding native or non-native charged
residues at the N- or C-termini to adjust the overall charge to 0
to +2, can often enhance the cell permeability of stapled peptides.
Producing constructs with greater α-helical content through
differential staple placement has also been a successful intervention.
Of the published stapled peptide constructs successfully applied in
cells to date, over one-third are efficacious in the presence of serum,[40,41,43,48−52] whereas the remainder benefit from at least a serum-free window
to facilitate cellular loading.[18,28−30,33,42,53−58] Increasing the dosing level for cellular and in vivo studies and/or
limited amino acid sequence adjustments can often overcome the effect
of serum, which is also offset by the striking proteolytic stability
of stapled peptides.[18,32]It is also important to
be aware that certain peptides, such as
cationic antimicrobial peptides,[59] can
perturb membranes as a result of their amino acid composition. Therefore,
in advance of treating cells (or purified organelles) with stapled
peptides, it is important to perform a maximally tolerated dose titration
to screen for constructs that disrupt membranes based on composition
or dose range. Monitoring cells by light microscopy (e.g., trypan
blue exclusion) and performing LDH release assays immediately after
treatment are facile approaches for identifying disruptive peptides
(Figure 8B). Stapled peptides should only be
applied at tolerated doses, and redesigned when necessary to eliminated
unwanted biophysical properties, so that on-target, sequence-dependent
biological activity can be achieved.Finally, it is important
to underscore that overlooking the above-described,
previously reported[24,25,60] design and characterization principles can lead to misapplication
of stapled peptides in cellular assays and, as a consequence, misleading
conclusions. A prominent example is a recently reported collaborative
Walter and Eliza Hall Institute (WEHI) and Genentech study[61] that examined the structural and biochemical
features and cellular activity of a stapled peptide modeled after
the death domain of the proapoptotic protein BIM. The authors analyzed
our weakened-by-design construct (developed to capture a transient
ligand–protein interaction by HSQC NMR)[28] that has suboptimal α-helical stabilization and overall
negative charge of −2, both of which limit cellular uptake,
and “unexpectedly” found that stapling BIMBH3 peptides
“does not necessarily enhance affinity or biological activity”.[61] Without performing any direct measure of cellular
uptake, the authors further concluded from their negative results,
which were predictable based on the prior literature,[18,28,29,31,62] that stapled BIMBH3 peptides are “not
inherently cell permeable”. Curiously, the WEHI/Genentech team
chose not to focus their study on our original stapled BIMBH3 construct,[31] which manifests robust α-helicity, nanomolar
binding affinity to the broad spectrum of BCL-2 family targets, and
most importantly, cell permeability and sequence-specific cellular
and in vivo activity[29,31] (Figure 9). In a single supplementary experiment, the authors apply the correct
construct for cellular work to demonstrate lack of activity in wild-type
mouse embryo fibroblasts (MEFs) and again point to a lack of cellular
penetrance (without analyzing cellular uptake).[61] However, we had already reported that this potent, cell
permeable analogue showed little to no activity in adherent wild-type
MEFs despite actually being cell penetrant (as measured directly)
but effectively activated the apoptotic pathway in resistant hematologic
cancer cells, indeed predicting a potential therapeutic window for
treating cancer.[29] In our view,[63] an important lesson from the WEHI/Genentech
study[61] is that lack of attention to sequence
composition and biophysical properties can lead to misapplication
of stapled peptides and faulty conclusions (Figure 9).
Figure 9
Stapling down the facts on BIM SAHBs. In order to accomplish a
challenging NMR analysis of the hit-and-run interaction between BIM
BH3 and BAX (left), we adjusted the sequence of our prototype high
α-helicity, high affinity, and cell permeable BIM SAHBA (146–166) peptide[29,31] (right) to enhance
its solubility and weaken (i.e., slow down) its BAX-activating capability[28] (left). Czabotar and colleagues from WEHI and
Genentech[61] also successfully applied this
refashioned BIM SAHBA (145–164) peptide for structural
determination (left) (“Yes” arrow). However, the authors
misapplied the weakened-by-design BIM SAHBA (145–164)
construct in binding and cellular studies (“No” arrow)
and predictably observed no cellular activity, yet broadly concluded
that stapling BIM BH3 does not enhance its binding affinity or biological
activity. In response to our recent correspondence,[63] Czabotar and co-authors have now tested the correct BIM
peptide (right) in leukemia cells and successfully reproduced our
published results.To facilitate the successful application of peptide
stapling, a rigorous and detail-oriented approach is required and
includes careful consideration of the sequence, biophysical, biochemical,
structural, cellular uptake, and biological properties of discrete
stapled peptide constructs[63] (“Yes”
arrows).
Stapling down the facts on BIMSAHBs. In order to accomplish a
challenging NMR analysis of the hit-and-run interaction between BIMBH3 and BAX (left), we adjusted the sequence of our prototype high
α-helicity, high affinity, and cell permeable BIMSAHBA (146–166) peptide[29,31] (right) to enhance
its solubility and weaken (i.e., slow down) its BAX-activating capability[28] (left). Czabotar and colleagues from WEHI and
Genentech[61] also successfully applied this
refashioned BIMSAHBA (145–164) peptide for structural
determination (left) (“Yes” arrow). However, the authors
misapplied the weakened-by-design BIMSAHBA (145–164)
construct in binding and cellular studies (“No” arrow)
and predictably observed no cellular activity, yet broadly concluded
that stapling BIMBH3 does not enhance its binding affinity or biological
activity. In response to our recent correspondence,[63] Czabotar and co-authors have now tested the correct BIM
peptide (right) in leukemia cells and successfully reproduced our
published results.To facilitate the successful application of peptide
stapling, a rigorous and detail-oriented approach is required and
includes careful consideration of the sequence, biophysical, biochemical,
structural, cellular uptake, and biological properties of discrete
stapled peptide constructs[63] (“Yes”
arrows).
Cellular and in Vivo Activity
With
potent and cell permeable stapled peptide constructs in hand,
a broad spectrum of cellular and in vivo studies are achievable, with
exemplary studies spanning the fields of cancer, infectious disease,
metabolism, and neuroscience (Table 1). Stapled
peptides modeled after the BH3 domains of BID and BIM have been applied
in cellular and in vivo studies to document therapeutic reactivation
of the apoptotic pathway in preclinical mouse models of humanleukemia.[18,29] The discovery that the stapled BH3 domain of antiapoptotic MCL-1
is an exquisitely selective inhibitor of MCL-1 revealed the utility
of this agent in sensitizing apoptotic responses to proapoptotic treatments
that are otherwise thwarted by MCL-1 expression.[30] Stapled p53peptides have been designed to target the p53
antagonists HDM2 and HDMX, reactivating the p53tumor suppressor pathway
in cells and in vivo.[33,42] Next-generation analogues have
recently been developed that are more effective in the presence of
serum[41,48] and are showing promising activity in mouse
models of solid tumors.[41] Pathologic β-catenin
signaling in cancer has been targeted by stapled peptides modeled
after the β-catenin-interacting domains of BCL-9[43] and axin.[40] Stapled
peptides corresponding to a mutant interaction domain of p110α
have been deployed to disrupt the oncogenic IRS1-p110α E545K
interaction and thereby inhibit tumor growth in a mouse xenograft
model of humancolorectal carcinoma.[50] Most
recently, EZH2-based stapled peptides have been shown to selectively
inhibit histone-3 Lys27 trimethylation by disrupting the EZH2-EED
complex, effectively suppressing PRC2-dependent cancer cell growth
by targeting this epigenetic “writer”.[52] In all cases, the stapled peptide-based modulation of signal
transduction and induction of cell death (or, for EZH2, growth arrest
and induced differentiation) was shown to be exquisitely dependent
on the bioactive peptide sequence.Outside the cancer field,
stapled peptides have been used to inhibit
HIV-1 infection by extracellular targeting of the gp41 fusion apparatus[32] and intracellular inhibition of capsid particle
assembly[37,57,58] and viral
DNA integration.[64] Proof-of-concept for
effective extracellular receptor targeting by stapled peptides has
been reported for the ABCA1 transporter,[65] NMDA receptor,[66] galanin receptor,[67] neuropeptide Y receptor,[67] and the HCV envelope glycoprotein 2.[68] Strikingly, a stapled peptide version of the PKA-phosphorylated
BAD BH3 helix selectively targets glucokinase in pancreatic β-cells
and restores glucose-stimulated insulin secretion in BAD-deficient
islets, suggesting a therapeutic application in diabetes.[49,69] Indeed, the growing diversity of cellular and in vivo studies published
by our group and independently by others showcases the potential broad
impact of stapled peptides in dissecting and targeting extra- and
intracellular proteins for therapeutic benefit (Figure 10).
Figure 10
Growth of stapled peptide applications for biomedical
discovery
and drug development. (A) Since the original reports of the all-hydrocarbon
cross-linked peptide helix[11] and its proof-of-concept
utility for signal transduction research, cellular delivery, and therapeutic
targeting,[18] there has been increased accessibility
to and successful application of the technology by us and many other
laboratories, as indicated by the growing number of yearly stapled
peptide publications. (B) Stapled peptides serve as versatile probes
for protein interaction research and as prototype therapeutics for
modulating extracellular and intracellular protein targets.
Growth of stapled peptide applications for biomedical
discovery
and drug development. (A) Since the original reports of the all-hydrocarbon
cross-linked peptide helix[11] and its proof-of-concept
utility for signal transduction research, cellular delivery, and therapeutic
targeting,[18] there has been increased accessibility
to and successful application of the technology by us and many other
laboratories, as indicated by the growing number of yearly stapled
peptide publications. (B) Stapled peptides serve as versatile probes
for protein interaction research and as prototype therapeutics for
modulating extracellular and intracellular protein targets.
Clinical Translation
In the context
of established drug modalities such as small molecules
and antibodies, the stapled peptide technology is relatively new.
Since the first all-hydrocarbon staple publication by Verdine and
colleagues in 2000, remarkable progress has been made in a relatively
short period of time and the number of reported studies employing
stapled peptides is accelerating (Figure 10A). Synthetic protocols have been optimized and advanced to GMP production
scale. Increased accessibility to the stapling amino acids and high
throughput peptide synthesis equipment has enabled many laboratories
in the U.S. and abroad to harness the stapled peptide technology for
their individual research needs. The structures of stapled peptides
in complex with their targets are being solved[30,37−41] and are revealing novel modes of interaction,[28,38,69] binding and specificity determinants,[30] and opportunities for affinity optimization.
The hard work of stapled peptide iteration and optimization for a
host of research and therapeutic needs is bearing fruit across disciplines
(Table 1). The design principles for enhancing
cellular uptake are being refined, and the explicit mechanisms of
cellular uptake, and how they can be harnessed to maximize stapled
peptide import, are subjects of intense investigation. The dual goals
of the biochemical, cellular, and in vivo work are to advance our
basic understanding of signaling pathways, both homeostatic and pathologic,
and unleash the therapeutic potential of peptides for treating human
disease (Figure 10B). With the first clinical
trial of a stapled peptide in man successfully completed by Aileron
Therapeutics in 2013 and additional trials already being planned,
the early indications regarding the clinical translational potential
of stapled peptides are now forthcoming. For example, ALRN-5281, a
long-acting growth hormone releasing hormone (GHRH) agonist indicated
for metabolic/endocrine disorders, showed no serious adverse events,
dose-limiting safety findings, or tolerability issues leading to study
withdrawal in a phase I study of 32 subjects. As with any new technology,
much remains to be learned, speed bumps are inevitable, and enthusiasts
and naysayers abound. Nevertheless, a focused, persistent, rigorous,
stepwise, and open-minded approach will ultimately provide the greatest
chance for stapled peptides to realize their full potential.
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