Aldehyde oxidase (AO) catalyzes oxidations
of azaheterocycles and
aldehydes, amide hydrolysis, and diverse reductions. AO substrates
are rare among marketed drugs, and many candidates failed due to poor
pharmacokinetics, interspecies differences, and adverse effects. As
most issues arise from complex and poorly understood AO biology, an
effective solution is to stop or decrease AO metabolism. This perspective
focuses on rational drug design approaches to modulate AO‑mediated
metabolism in drug discovery. AO biological aspects are also covered,
as they are complementary to chemical design and important when selecting
the experimental system for risk assessment. The authors’ recommendation
is an early consideration of AO-mediated metabolism supported by computational
and in vitro experimental methods but not an automatic avoidance of
AO structural flags, many of which are versatile and valuable building
blocks. Preferably, consideration of AO‑mediated metabolism
should be part of the multiparametric drug optimization process, with
the goal to improve overall drug-like properties.