Why drug discovery is so hard: Reason #25 — What if your drug target is really a pointer to the real target?

Any drug safely producing weight loss would be a big (or small) pharma blockbuster. Those finding it should get on the boat to Sweden. Finding a target to attack is the problem. Here’s one way to look. Take lots of fat people, lots of thin people and see what in their genomes differentiates them (assuming anything does). Actually what was done was to look at type II diabetics (non-insulin dependent) the vast majority overweight and controls. The first study involved the genomes of nearly 5,000 diabetics and controls. How did they interrogate the genomes? At the time of the work it was impossible to completely sequence this many genomes.

It’s time to speak of SNPs (single nucleotide polymorphisms). Our genome has 3.2 gigaBases of DNA. With sequencing being what it is, each position has a standard nucleotide at each position (one of A, T, G, or C). If 5% of the population have one of the other 3 at this position you have a SNP. Already 10 years ago, some 7 MILLION SNPs had been found and mapped to the human genome.

The first study found some SNPs associated with obesity in the diabetics. This tells where to look for the gene. A second study with nearly 9,000 diabetics and controls, replicated the first.

Then the monster study, with 39,000 people [ Science vol. 316 pp. 889 – 894 ’07 ] found FTO (FaT mass and Obesity associated gene) on chromosome #16. The 16% of Caucasian adults with two copies of the variant SNP in FTO were 1.67 times more likely to be obese. An intense flurry of work showed that the gene coded for an oxidase, using iron and 2 oxo-glutaric acid (alphaKG for you old timers). The enzyme removes methyl groups from the amino group at position #6 of adenine and the 3 position of thymine. Before this time, no one really paid much attention to them. Subsequently we’ve found 6 methyl adenine in a mere 7,676 mRNAs. Just what it does when it’s there, and why the cell wants to remove it is currently being worked out.

Clearly FTO is a great target for an obesity drug. Of course they knocked the gene out in the mouse. The animals were normal at birth, but at 6 weeks weighed 30 – 40% less than normal mice. FTO as a drug target looked even better after this.

It was somewhat surprising that the SNP was in an intron in the gene. This meant that even in the obese the protein product of the FTO gene was the same as in the skinny. Presumably this could mean more FTO, less FTO or a different splice variant. If some of this molecular biology is above your pay grade, the background you need is in 5 posts starting with https://luysii.wordpress.com/2010/07/07/molecular-biology-survival-guide-for-chemists-i-dna-and-protein-coding-gene-structure/.

It was somewhat surprising that FTO levels were the same in people with and without the fat SNP. That left splice variants as a possibility.

The denouement came this week [ Nature vol. 507 pp. 309 – 310, 371 – 375 ’14 ]. The intron containing the SNP in FTO produces obesity by controlling another gene called IRX3 which is a mere 500,000 nucleotides away. The intron of FTO binds to the promoter of IRX3 turning the gene on resulting in more IRX3. Mice lacking a functional copy of IRX3 have a 25 – 30% lower body mass. As any C programmer would say, FTO is the pointer not the data.

I don’t know if big or small pharma was at work finding inhibitors or enhancers of FTO function, but this paper should have brought them to a screeching halt. The FTO/IRX3 story just shows how many pitfalls there are to finding new drugs, and why the search has shown relatively little success recently. We are trying to alter the function of an incredibly complex system, whose workings we only dimly understand.

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