Peptide
agonists of the glucagon-like peptide-1 receptor (GLP-1R)
have revolutionized diabetes therapy, but their use has been limited
because they require injection. Herein, we describe the discovery
of the orally bioavailable, small-molecule, GLP-1R agonist PF-06882961
(danuglipron). A sensitized high-throughput screen was used to identify
5-fluoropyrimidine-based GLP-1R agonists that were optimized to promote
endogenous GLP-1R signaling with nanomolar potency. Incorporation
of a carboxylic acid moiety provided considerable GLP-1R potency gains
with improved off-target pharmacology and reduced metabolic clearance,
ultimately resulting in the identification of danuglipron. Danuglipron
increased insulin levels in primates but not rodents, which was explained
by receptor mutagensis studies and a cryogenic electron microscope
structure that revealed a binding pocket requiring a primate-specific
tryptophan 33 residue. Oral administration of danuglipron to healthy
humans produced dose-proportional increases in systemic exposure (NCT03309241).
This opens an opportunity for oral small-molecule therapies that target
the well-validated GLP-1R for metabolic health.