Using the Quantum Theory of Atoms in Molecules, the average electron density (AED) tool was developed and employed to quantitatively evaluate the similarities between bioisosteric moieties in drug design. Bioisosteric replacements are valuable in drug molecules to fine-tune their pharmacokinetic and pharmacodynamic properties while maintaining their biological activity. This study was performed on non-classical bioisosteres of carboxylic acid. It was found that the AED of a given bioisostere is generally transferable, within less than 5% difference, irrespective of its environment. It was shown that the AED tool succeeds at depicting not only the similarities of bioisosteric groups but also at highlighting, as counter examples, the differences in non-bioisosteric groups. For the first time, the AED was used to evaluate bioisosterism in an FDA-approved drug molecule, furosemide, and in five analogues of this medicine. In one of the analogues, non-bioisosteric moieties were exchanged, and in four of the analogues, carboxylic acid was replaced with either furan or sulfonamide, and vice versa. It was also found that irrespective of the pH, the AED tool consistently reproduced experimental predictions. The distinct power of the AED tool in quantitatively and precisely measuring the similarity among bioisosteric groups is contrasted with the relatively ambiguous bioisosteric evaluations through the classical qualitative electrostatic potential (ESP) maps. The ESP maps were demonstrated to fail, even qualitatively, in depicting the similarities, in some cases.
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