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Anemia in patients with sickle cell disease (SCD) increases 2,3-diphosphoglycerate (2,3-DPG), decreasing hemoglobin-oxygen (HbO) affinity to improve oxygen offloading and promote hemoglobin polymerization (sickling) of red blood cells (RBCs). We report the discovery of FT-4202, an investigational, selective pyruvate kinase type-R (PKR) activator with a multimodal mechanism of action and potential to increase ATP and decrease 2,3-DPG, resulting in increased HbO affinity, decreased Hb polymerization, and improved RBC health. FT-4202 was identified via structure-enabled lead optimization medicinal chemistry using X-ray crystallography, molecular modeling, and thermal shift assays.

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Article Synopsis
  • The study explores the role of 2,3-bisphosphoglycerate mutase (BPGM) in the kidney, highlighting its upregulation during acute kidney injury in both mice and humans.
  • Using a specialized mouse model, researchers found that BPGM is mainly located in the distal nephron and its knockout led to rapid kidney injury and structural damage after just four days.
  • The absence of BPGM disrupts crucial metabolic processes, elevating oxidative stress and inflammation while linking stress responses between different parts of the nephron, underscoring its importance in kidney function.
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