Cathepsin K inhibitors for osteoporosis and potential off-target effects

Abstract

Cathepsin K is a highly potent collagenase and the predominant papain-like cysteine protease expressed in osteoclasts. Cathepsin K deficiencies in humans and mice have underlined the central role of this protease in bone resorption and, thus, have rendered the enzyme as an attractive target for anti-resorptive osteoporosis therapy. In the past decade, a lot of efforts have been made in developing highly potent, selective and orally applicable cathepsin K inhibitors. Some of these inhibitors have passed preclinical studies and are presently in clinical trials at different stages of advancement. The development of the inhibitors and preliminary results of the clinical trials revealed problems and lessons concerning the in situ specificity of the compounds and their tissue targeting. In this review, we briefly summarize the history of cathepsin K research and discuss the current development of cathepsin K inhibitors as novel anti-resorptives for the treatment of osteoporosis. We also discuss potential off-target effects of cathepsin K inhibition and alternative applications of cathepsin K inhibitors in arthritis, atherosclerosis, blood pressure regulation, obesity and cancer.

Keywords::

• arthritis
• bone
• cartilage
• cathepsin K
• inhibitor
• osteoporosis

Acknowledgements

This work was supported in part by the National Institutes of Health Grant AR48669 (D Brömme), the Canadian Institutes of Health Award MOP89974 (D Brömme), and supported by Vaincre les Maladies Lysosomales and Vaincre la Mucoviscidose (France) (F Lecaille). Furthermore, D Brömme was supported by the Canada Research Chair Award.

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