Living cells maintain a balance between oxidation and reduction, and
perturbations of this redox balance are thought to contribute to various
diseases. Recent attempts to regulate redox state have focused on electrophiles
(EPs), which activate potent cellular defense systems against oxidative stress.
One example of this approach is exemplified by carnosic acid (CA) and carnosol
(CS), compounds that are found in the herb rosemary (Rosmarinus officinalis).
Importantly, CA and CS themselves are not electrophilic, but in response to
oxidation, become electrophilic, and then activate the Keap1/Nrf2/ARE
(antioxidant response element) transcription pathway to synthesize endogenous
anti-oxidant ‘phase 2’ enzymes. As a result of our efforts to
develop these compounds as therapeutics for brain health, we have formulated two
innovative criteria for drug development: the first concept is the use of
Pro-Electrophilic Drugs (PEDs) that are innocuous in and of themselves; and the
second concept involves the use of compounds that are Pathologically-Activated
Therapeutics (PATs), i.e., these small molecules are chemically converted to
their active form by the very oxidative stress that they are designed to then
combat. The chemical basis for PED and PAT drugs is embodied in the
ortho- and para-hydroquinone electrophilic
cores of the molecules, which are oxidized by the Cu2+/Cu+
cycling system (or potentially by other transition metals). Importantly, this
cycling pathway is under stringent regulation by the cell redox state. We
propose that redox-dependent quinone-formation is the predominant mechanism for
formation of PED and PAT drugs from their precursor compounds. In fact,
redox-dependent generation of the active form of drug from the
“pro-form” distinguishes this therapeutic approach from
traditional EPs such as curcumin, and results in a decrease in clinical side
effects at therapeutic concentrations, e.g., lack of reaction with other thiols
such as glutathione (GSH), which can result in lowering GSH and inducing
oxidative stress in normal cells. We consider this pro-drug quality of PED/PAT
compounds to be a key factor for generating drugs to be used to combat
neurodegenerative diseases that will be clinically tolerated. Given the
contribution of oxidative stress to the pathology of multiple neurodegenerative
diseases, the Keap1/Nrf2/ARE pathway represents a promising drug target for
these PED/PAT agents.