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Review
. 2019 Mar 23;8(3):280.
doi: 10.3390/cells8030280.

2,4 Dinitrophenol as Medicine

Affiliations
Review

2,4 Dinitrophenol as Medicine

John G Geisler. Cells. .

Abstract

In the sanctity of pure drug discovery, objective reasoning can become clouded when pursuing ideas that appear unorthodox, but are spot on physiologically. To put this into historical perspective, it was an unorthodox idea in the 1950's to suggest that warfarin, a rat poison, could be repositioned into a breakthrough drug in humans to protect against strokes as a blood thinner. Yet it was approved in 1954 as Coumadin® and has been prescribed to billions of patients as a standard of care. Similarly, no one can forget the horrific effects of thalidomide, prescribed or available without a prescription, as both a sleeping pill and "morning sickness" anti-nausea medication targeting pregnant women in the 1950's. The "thalidomide babies" became the case-in-point for the need of strict guidelines by the U.S. Food & Drug Administration (FDA) or full multi-species teratogenicity testing before drug approval. More recently it was found that thalidomide is useful in graft versus host disease, leprosy and resistant tuberculosis treatment, and as an anti-angiogenesis agent as a breakthrough drug for multiple myeloma (except for pregnant female patients). Decades of diabetes drug discovery research has historically focused on every possible angle, except, the energy-out side of the equation, namely, raising mitochondrial energy expenditure with chemical uncouplers. The idea of "social responsibility" allowed energy-in agents to be explored and the portfolio is robust with medicines of insulin sensitizers, insulin analogues, secretagogues, SGLT2 inhibitors, etc., but not energy-out medicines. The primary reason? It appeared unorthodox, to return to exploring a drug platform used in the 1930s in over 100,000 obese patients used for weight loss. This is over 80-years ago and prior to Dr Peter Mitchell explaining the mechanism of how mitochondrial uncouplers, like 2,4-dinitrophenol (DNP) even worked by three decades later in 1961. Although there is a clear application for metabolic disease, it was not until recently that this platform was explored for its merit at very low, weight-neutral doses, for treating insidious human illnesses and completely unrelated to weight reduction. It is known that mitochondrial uncouplers specifically target the entire organelle's physiology non-genomically. It has been known for years that many neuromuscular and neurodegenerative diseases are associated with overt production of reactive oxygen species (ROSs), a rise in isoprostanes (biomarker of mitochondrial ROSs in urine or blood) and poor calcium (Ca2+) handing. It has also been known that mitochondrial uncouplers lower ROS production and Ca2+ overload. There is evidence that elevation of isoprostanes precedes disease onset, in Alzheimer's Disease (AD). It is also curious, why so many neurodegenerative diseases of known and unknown etiology start at mid-life or later, such as Multiple Sclerosis (MS), Huntington Disease (HD), AD, Parkinson Disease, and Amyotrophic Lateral Sclerosis (ALS). Is there a relationship to a buildup of mutations that are sequestered over time due to ROSs exceeding the rate of repair? If ROS production were managed, could disease onset due to aging be delayed or prevented? Is it possible that most, if not all neurodegenerative diseases are manifested through mitochondrial dysfunction? Although DNP, a historic mitochondrial uncoupler, was used in the 1930s at high doses for obesity in well over 100,000 humans, and so far, it has never been an FDA-approved drug. This review will focus on the application of using DNP, but now, repositioned as a potential disease-modifying drug for a legion of insidious diseases at much lower and paradoxically, weight neutral doses. DNP will be addressed as a treatment for "metabesity", an emerging term related to the global comorbidities associated with the over-nutritional phenotype; obesity, diabetes, nonalcoholic steatohepatitis (NASH), metabolic syndrome, cardiovascular disease, but including neurodegenerative disorders and accelerated aging. Some unexpected drug findings will be discussed, such as DNP's induction of neurotrophic growth factors involved in neuronal heath, learning and cognition. For the first time in 80's years, the FDA has granted (to Mitochon Pharmaceutical, Inc., Blue Bell, PA, USA) an open Investigational New Drug (IND) approval to begin rigorous clinical testing of DNP for safety and tolerability, including for the first ever, pharmacokinetic profiling in humans. Successful completion of Phase I clinical trial will open the door to explore the merits of DNP as a possible treatment of people with many truly unmet medical needs, including those suffering from HD, MS, PD, AD, ALS, Duchenne Muscular Dystrophy (DMD), and Traumatic Brain Injury (TBI).

Keywords: 2,4-dinitrophenol (DNP); Brain-derived neurotrophic factor (BDNF); Duchenne Muscular Dystrophy; Huntington’s Disease; Multiple Sclerosis; Traumatic Brain Injury; anti-aging; metabesity; mitochondrial uncoupler; neurodegeneration.

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Conflict of interest statement

John G. Geisler is a founder and shareholder of Mitochon Pharmaceuticals, Inc. MP201 (DNP prodrug) has pending U.S. patent applications (15/451,938 and 62/693,142), as well as DNP/MP101 (15/002,531 and 15/357,412). The FDA has awarded Mitochon Pharmaceuticals Orphan Designation for DNP/MP101 for Huntington’s Disease.

Figures

Figure 1
Figure 1
Non-genomic to Genomic Effects of 2,4-Dinitrophenol (DNP). The early immediate effects of DNP lower the mitochondrial membrane potential, which abolishes overt reactive oxygen species (ROS) production and subsequently closes the uniporter involved in calcium influx [28,29,30]. This event is considered “non-genomic” since the target is a location, the mitochondrial matrix, vs. a protein, receptor or gene. However, this effect increases cyclic adenosine monophosphate (cAMP) (2nd messenger), likely through activation of adenylate cyclase. The production of cAMP transitions the non-genomic event into a genomic event and induction of expression of a host of genes, both up-regulated and down-regulated. In particular, the DNP → cAMP → cAMP response element binding (CREB) → Brain-derived neurotrophic factor (BDNF) cascade lends itself to the possibility of increased cognition [30,31,32]. Calcium graph was adapted from Liu, et al. 2015 [30].
Figure 2
Figure 2
Coupling vs. uncoupling. Maintaining the proton gradient across the mitochondrial matrix and cytosol involves the pumping of protons out of the matrix via cytochromes I, III and IV. (A) The coupling of a proton (hydrogen or H+) transfer to the synthesis of ATP is a result of H+ returning through ATP synthase, causing rotation and subsequent phosphorylation of ADP, thereby yielding an ATP molecule. (B) This mechanism is circumvented in the case of chemical uncoupling (i.e., entry of protons without phosphorylation to produce ATP). The proton transfer into the matrix is on a carrier, a weak acid molecule (i.e., 2,4-dinitrophenol) with a unique dissociable proton (H+) due to the two NO2 “electron withdrawing” groups. Outside of the mitochondria in the acidic environment of the cytosol, DNP is in the protonated neutral form, but attracted to the basic environment of the matrix. Upon entering the matrix, DNP releases the dissociable proton (H+). Now in the negatively charged anionic form, DNP is attracted to the acidic environment of the cytosolic space, therefore returning to the cytosol to become reprotonated and the cycle starts over again. All mitochondrial systems remain functional but are accelerated. Reprinted by permission from Springer, Diabetologia (2011) 54:237–244, Targeting Energy Expenditure via Fuel Switching and Beyond, J.G. Geisler [2].
Figure 3
Figure 3
Calcium overload and DNP. (A) The cytosolic Ca2+ under normal conditions is kept low and released from the mitochondria for signaling [1]. However, for conditions related to unfolded protein response (UPR) that lead to ER stress such as Huntington Disease [41,42] or mutations directly of ER function such as Wolfram Syndrome [43] or loss of dystrophin in the case of Duchenne Muscular Dystrophy [44], calcium levels rise in the cytosol and subsequently in the mitochondria. If the threshold for mitochondrial Ca2+ storage is exceeded, the mitochondrial permeability transition pore (mPTP) is formed and the mitochondria are destroyed setting up a cascade for neighboring mitochondrial destruction [16]. (B) Calcium overload of the mitochondria may be reduced, even in the presence of a sudden rise of cytosol Ca2+ from the ER, in TBI and other conditions of metabolic stress, in the presence of DNP by closing the calcium uniporter channel. Reduced intra-mitochondrial calcium removes the driving force toward apoptosis, thereby saving the neuron, myotube and other at-risk cell types.
Figure 4
Figure 4
Comparative Oral PK in Rats of MP101 (DNP) vs. MP201 (prodrug of DNP). Male Sprague-Dawley rats (weighing 250–300 g) were housed three per cage with ad libitum access to food and water in the Division of Laboratory Animal Resources, UAMS. Femoral vein-catheterized rats, were treated with MP201 at a single oral dose (N = 4/dose) of 8, 40 and 80 mg/kg (equivalent to 5, 25 and 50 mg/kg of MP101, respectively due to the extra molecular weight) or DNP at 5 mg/kg. Blood samples (0.15 mL) were collected at 0, 5, 15, 30, 45, 60, 120, 240 and 480 min. Plasma samples were prepared and analysis was run using LC/MS/MS spectrometry. (A) MP101 (DNP) at 5 mg/kg shows a quick rise and a high Cmax relative the same equivalent dose at 5 mg/kg of MP201 (adjusting for additional molecular weight). Data shown is MP201’s release of DNP upon cleavage of prodrug linker to an active form (MP101/DNP) with a ~20× suppression of Cmax compared to MP101. In addition, MP201 has a dose linear AUC going from 5 to 25 mg/kg. (B) In compensation for the lower Cmax relative to MP101, MP201 has a much longer elimination phase (~3×) extending the AUC significantly for a “trickle-like” effect delivering DNP (unpublished). *Below the limits of detection at 24-h time-point of 10 ng/mL.
Figure 5
Figure 5
MP101 (DNP) tissue concentrations (ng/g) in mice. Six-month aged male C57/bl6 mice were fasted for 4-h and then provided MP101 at a dose of 0.5, 1, 5 and 10 mg/kg (Mitochon sponsored study conducted at Melior Discovery (Exton, PA, USA)). Four hours later, the cortex, liver and skeletal muscles were harvested to determine tissue penetration levels by LC/MS at Keystone Bioanalytical (North Wales, PA, USA). The brain levels were generally slightly lower than muscle, which was less than the liver (unpublished).
Figure 6
Figure 6
MP101 and MP201 are protective for hearing loss due to noise trauma. The compound action potential (CAP) amplitude is plotted on a logarithmic on the y-axis with the intensity of noise (decibels) on the x-axis. The CAP input/output functions are shown at (a) 12, (b) 16, (c) 20 and (d) 24 kHz. The data indicate that the CAP amplitudes were larger (better) in the noise-exposed groups that received MP201, versus the Noise alone group and statistically significant at 16, 20 and 24 kHz (p-value < 0.0001), but not 12 kHz (unpublished). Repeat measures by ANOVA.
Figure 7
Figure 7
DNP as a Broad-Spectrum Treatment. DNP (MP101) or the prodrug of DNP (MP201) has been tested in disease models of acute and chronic studies with a known and unknown genetic cause that representing pediatric, adult and elderly indications with statistically positive outcomes. The indications also present diseases of neuromuscular disorders, development, neurodegeneration, autoimmune, metabolic and trauma. The future will help to determine the limitations of the pharmacology, but given the findings, it appears that DNP may be a broad-spectrum treatment to many disorders.
Figure 8
Figure 8
Paradigm shift from weight loss program to a wellness program. Extrapolating the human published data from the 1930s to doses that are significantly lower and likely within the hormetic range of inducing BDNF to gain synergy, while simultaneously partitioning lipids out of insulin-sensitive tissues at weight neutral doses. Human equivalent dose (HED) within this range offers the possibility to significantly improve whole body flux at safe doses using time as the primary variable.

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