Exploiting the 2-(1,3,4,9-tetrahydropyrano[3,4- b ]indol-1-yl)acetic Acid Scaffold to Generate COXTRANs: A New Class of Dual Cyclooxygenase Inhibitors-Thromboxane Receptor Antagonists

The use of traditional nonsteroidal anti-inflammatory drugs (NSAIDs) and coxibs is effective for the treatment of inflammatory pain and chronic inflammatory conditions. However, their use is associated with enhanced risk of cardiovascular toxicity and thrombotic events, particularly for the latter. The vascular side effects of these drugs could be mitigated by pharmacological inhibition of the thromboxane A2 receptor (TP). Here we describe the development of a new class of dual cyclooxygenase (COX) inhibitors/thromboxane receptor antagonists (COXTRANs) based on the 2-(1,3,4,9-tetrahydropyrano[3,4-b]indol-1-yl)acetic acid scaffold. The in vitro evaluation of 50 newly synthesized compounds resulted in a set of well-balanced compounds exhibiting nanomolar activity on both COX-2 and TP receptor. Further studies in human whole blood and physicochemical profiling allowed the prioritization of 51 (CXT29) as a suitable candidate for in vivo studies. Compound 51, after oral administration, was able to prevent TP receptor-mediated platelet aggregation and to reduce inflammatory pain in mice.