European Journal of Medicinal Chemistry 139 (2017) 519e530

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European Journal of Medicinal Chemistry

journal homepage: http://www.elsevier.com/locate/ejmech

Mini-review

An update on small molecules targeting CXCR4 as starting points for

the development of anti-cancer therapeutics
Fedora Grande a, *, Gilda Giancotti b, Giuseppina Ioele a, Maria A. Occhiuzzi a,
Antonio Garofalo a
a
Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Via P. Bucci, 87036 Rende (CS), Italy
b
School of Pharmacy and Pharmaceutical Sciences, Cardiff University, King Edward VII Avenue, Cardiff CF10 3NB, UK

a r t i c l e i n f o a b s t r a c t

Article history: CXCR4 (C-X-C Chemokine Receptor type 4) and its natural ligand SDF-1a (Stromal-Derived-Factor-1a) are
Received 26 June 2017 involved in a number of physiological and pathological processes including cancer spread and pro-
Received in revised form gression. Over the past few years, numerous CXCR4 antagonists have been identified and currently are in
9 August 2017
different development stages as potential agents for the treatment of several diseases involving the
Accepted 10 August 2017
CXCR4/SDF-1a axis. Herein, we focus on small molecules reported in literature between 2013 and 2017,
Available online 12 August 2017
claimed as CXCR4 antagonists and potentially useful in the treatment of cancer and other diseases where
this receptor is involved. Most of the compounds resulted from a chemical optimization of previously
Keywords:
CXCR4
identified molecules and some of them could represent suitable candidates for the development of
Small molecules advanced anticancer agents.
Antagonists © 2017 Elsevier Masson SAS. All rights reserved.
Cancer

1. Introduction hematopoietic and immune systems with a consequent implication

CXCR4 (C-X-C chemokine receptor type 4), also known as cluster
of differentiation 184 (CD184) or fusin, belongs to the rhodopsin-
like G-protein-coupled receptor family [1,2]. Its structure consists
of 352 amino acid residues including a C-terminal domain, seven
trans-membrane domains, three extra-cellular and three intra-
cellular loops and a N-terminal domain [3]. The response of
CXCR4 to the specific interaction with its natural ligand SDF-1a
(Stromal-Derived-Factor-1a, also known as CXCL12), regulates a
number of physiological processes. During normal embryogenesis,
cells mobility results under the control of several chemokine-
mediated signaling pathways, of which a pivotal role is played by
the SDF-1a/CXCR4 axis. Such a type of control is still operating in
adult pluripotent stem cells. Cancer cells invasiveness seems to be
modulated by the same migratory pathway.
At first CXCR4 was identified as one of the two co-receptors
required for Human Immunodeficiency Virus (HIV) cell entry as
its involvement is necessary for the fusion between the HIV enve-
lope and the host cell membrane [4e9].
Recent studies confirmed a wide expression of CXCR4 in the
* Corresponding author.
E-mail address: fedora.grande@unical.it (F. Grande).
of this receptor in a panel of pathological processes such as WHIM
(Warts, Hypogammaglobulinemia, Infections, and Myelokathexis)
syndrome, SLE (Systemic Lupus Erythematosus), rheumatoid
arthritis, pulmonary fibrosis and cancer emergence and progres-
sion (Fig. 1) [10e22].
The important roles recognized for the SDF-1a/CXCR4 axis in
numerous pathogenic pathways make the receptor an attractive
target for the development of small-molecule ligands as effective
therapeutic agents.
It has been ascertained that certain HIV inhibitors acting on the
CXCR4 were also effective on chemokine-mediated processes
involved in cancer progression. Thus, several known antagonists
have been assayed on both HIV and cancer models, giving rise to
converging results [23].
Taking into consideration the key role of SDF-1a/CXCR4 axis in
mediating breast and ovarian cancer cell invasion and metastasis,
the development of small molecules endowed with antagonistic
activity towards the receptor, could lead to effective tools able to
inhibit tumor progression, particularly during spreading of
aggressive forms of this type of cancer.
Targeted therapies based on small molecules antagonists have
produced significant progress in experimental models [24].
A potential role of CXCR4 inhibitors was also assessed by a
recent study on the PPAR (Peroxisome Proliferator Activated

http://dx.doi.org/10.1016/j.ejmech.2017.08.027
0223-5234/© 2017 Elsevier Masson SAS. All rights reserved.
520 F. Grande et al. / European Journal of Medicinal Chemistry 139 (2017) 519e530
Fig. 1. Diseases connected with SDF-1a/CXCR4 axis.
Receptor g, a member of the nuclear receptor superfamily) down-
regulation during breast cancer spread and progression [16].
A further possible application for CXCR4 antagonists was also
proposed for the treatment of pancreatic cancer, in which the
importance of the SDF-1a/CXCR4 axis was also demonstrated using
a gemcitabine-resistant tumor model. Matrigel invasion assays and
animal studies proved such agents as useful tools for a second-line
chemotherapy in pancreatic tumors [25].
Small cell lung carcinoma is known as one of the most aggres-
sive type of cancer with low prognosis success due to rapid meta-
static spread and quick emergence of resistance to chemo-agents.
The management of such a disease was achieved by the use of
AMD3100 (Plerixafor, Fig. 2), a widely studied CXCR4 antagonist,
demonstrating a relevant inhibitory activity in an orthotopic mouse
model [26].
In a recent study, this compound and TN14003 (Fig. 2) [27],
another known CXCR4 inhibitor, were tested against Herceptin-
sensitive and Herceptin-resistant HER2 breast cancers, proving a
certain differentiated activity in the two cancerous forms. In the
case of the Herceptin-resistant triple negative cancer, the CXCR4
inhibition did not cause reduction of tumor growth besides an
unexpected increase in metastatic spread, so limiting benefits of
such a therapeutic approach to Herceptin-sensitive form [28].
Fig. 2. Chemical structures of known antagonists of CXCR4.
In the last few years, the X-ray structure of CXCR4 co-
crystallized with various peptide and non-peptide ligands was
assessed and used for the development of pharmacophoric models.
In particular, the most used ligand for this purpose was IT1t, an
orally active isothiourea based compound (Figs. 2 and 3) [29].
Several libraries of compounds were accordingly screened and a
number of structural requirements have been deducted and taken
into consideration for the design of new effective ligands [30e35].
2. CXCR4 antagonists
The earlier identified CXCR4 antagonists were positively
charged peptides that have been gradually replaced by more
manageable downsized derivatives such as cyclic pentapeptides or
peptidomimetics. Among the non-peptide ligands, a useful lead
namely AMD3100, the first CXCR4 antagonist approved by the FDA,
was selected within the class of bicyclams (cyclam ¼ 1,4,8,11-
tetraazacyclotetradecane), where the two macrocyclic parts are
tethered by a p-xylylene fragment. The clinical applicability of this
compound is however limited by an inadequate bioavailability
[36e40]. To reduce the cationic nature as well as the large overall
size, one or both cyclam rings have been in turn replaced by smaller
moieties leading to still active compounds.
Successively, a tetrahydroquinoline derivative, AMD070 (Fig. 2),
was identified as an oral active CXCR4 antagonist with remarkable
activity, although its clinical investigation as anti-HIV agent has
been now discontinued [6,41,42].
Many others antagonists belonging to more than twenty
chemical classes have been so far discovered, even though only a
few of them demonstrated features compatible with a possible
clinical application.
Until 2012, in addition to the aforementioned bicyclams, the
most intriguing active compounds were cyclopentapeptide, indole,
tetrahydroquinoline, para-xylylenediamine and guanidine based
compounds [15].
All the classes of recently identified antagonists are herein
reviewed. However, the antagonists' classification based on a spe-
cific chemical feature could result ambiguous, due to the presence
of common fragments in the structure of members assigned to
 F. Grande et al. / European Journal of Medicinal Chemistry 139 (2017) 519e530
Fig. 3. Co-crystallized structure of CXCR4 with the known ligand IT1t.
distinct classes.
2.1. Cyclopentapeptides
Previous studies led to the discovery of a potent antagonist,
FC131 (cyclo(-Arg1-Arg2-2-Nal3-Gly4-D-Tyr5-), 2-Nal ¼ 3-(2-
naphthyl)alanine) (Fig. 4), the structure of which was deducted
from extensive SAR studies based on a pharmacophore model
containing the Arg2-Nal3-D-Tyr5-Arg14 sequence. More recently,
Fig. 4. Structures of FC131 and most active cyclopentapeptide analogues with relative EC50 calculated by a functional competitive assay against COS-7 cells.
521
FC131 has been adopted as a suitable lead for the design of novel
CXCR4 antagonists, in which various modifications of both the Nal
and Tyr residues were attempted. Moreover, the replacement of
Arg1 with the N-methyl-D-arginine led to the most potent deriva-
tive FC122 [43].
A small library of pentapeptide derivatives was accordingly
prepared and tested in a functional competitive assay that
measured inhibition of SDF-1a-induced activation of human
CXCR4. The chemical structures of the most active compounds are
reported in Fig. 4 (compounds 1e7). Further development of SAR
studies suggested that simpler peptidomimetics CXCR4 antagonists
could be designed starting from the Arg2-2-Nal3 fragment [44].
2.2. Tripeptidomimetics
Successively, in-depth SAR studies on cyclopentapeptide CXCR4
antagonists proved that the tripeptide motif L-/D-Arg1-Arg2-2-
Nal3 represents the minimal peptide sequence for the antago-
nistic activity. Thus, a systematic synthetic elaboration of the
sequence led to the identification of a series of constrained tri-
peptidomimetics, still endowed with CXCR4 antagonist activity.
These compounds were characterized by a dioxohexahydropyr-
azinothiazine bicyclic central core, bringing two tails ending with a
guanidine residue and a third tail containing a naphthyl system
(Fig. 5, compounds 8 and 9). Although the potency of such new
derivatives resulted lower than the cyclopeptides, as determined by
522 F. Grande et al. / European Journal of Medicinal Chemistry 139 (2017) 519e530

Fig. 5. Representative structures of tripeptidomimetics with relative EC50 calculated by a functional competitive assay against COS-7 cells.

a functional assay, they could represent suitable starting points for
the development of specific and less bulky CXCR4 ligands [45]. A
further development of this study focused on the length of the
three side chains of these compounds. It was demonstrated that the
optimal spacer between the central core and both the guanidine
moieties consists of a three-carbon atoms chain. On the other hand,
the distance between the naphthyl group and the bicyclic core must
kept in a two-carbon spacer, whereas a one-carbon spacer is
tolerated when a bromine atom was present on the aromatic sys-
tem, as calculated by functional antagonistic assay on a diastereo-
isomeric mixture of bromine derivative 10 (Fig. 5) [46].
In a recent study, the binding of a previously described
tripeptidomimetic antagonist KRH1636 to CXCR4 was assessed by
the combination of SAR, receptor mapping, and molecular docking
studies (Fig. 6). Accordingly, a small series of tripeptide analogues
has been synthesized and their antagonistic potency was calculated
in a functional inhibition assay measuring the SDF-1a mediated
activation of CXCR4. As a result, the identification of a binding
model resulted from the inspection of interactions with the re-
ceptor providing new insight for structure-based design of novel
small-molecule CXCR4 antagonists [34]. The chemical structures of
the most promising derivatives are depicted in Fig. 6 (compounds
11e15).

Fig. 6. Chemical structures of selected KRH1636 tripeptidomimetic analogues with relative EC50 calculated by a functional competitive assay against COS-7 cells.
 F. Grande et al. / European Journal of Medicinal Chemistry 139 (2017) 519e530
2.3. Indoles
A recent approach to identify CXCR4 antagonists was developed
using a minimal hybrid ligand/receptor-based pharmacophore
model. Such simple approach has been applied to screen a small
library of marine natural products. The search led to the identifi-
cation of Phidianidine A (PHIA, 16), an indole alkaloid isolated from
a mollusc, featuring at the same time a guanidine and an indole as
the molecules ends and an oxadiazole moiety as the core, resulting
in a very flexible structure (Fig. 7). It was demonstrated that this
compound selectively inhibits SDF-1a/CXCR4 mediated DNA syn-
thesis, cell migration, and ERK1/2 activation, using the CXCR4-
expressing/CXCR7-negative GH4C1 cell line. PHIA represents then
a new lead for the development of CXCR4 modulators [47].
A novel series of indole derivatives was designed by in silico
analysis of IT1t/CXCR4 complex. A few 2-(1H-indol-1-yl)benzohy-
drazide derivatives were synthesized and the biological testing
revealed their capability to block SDF-1a induced cancer cell
motility, proliferation and downstream signaling activation in
different experimental models, using MDA-MB-231 and MCF-7
breast cancer cells. A whole cell-based [125I]-SDF-1a ligand bind-
ing competition assay confirmed that the mode of action of these
compounds consists in a direct interaction with the active site of
the receptor. The most active derivative was showed to be com-
pound 17 (Fig. 8), with an IC50 of 11 nM in the binding assay, while
the cell migration inhibition was reached at a concentration lower
than 10 nM [48].
2.4. Tetrahydroquinolines
Among the previous classes of CXCR4 antagonists, a preeminent
position was occupied by derivatives based on a 1,2,3,4-
tetrahydroquinoline moiety. Recently, a new group of active ana-
logues containing also an additional isoquinoline nucleus was
described. These compounds were found to effectively inhibit the
receptor function either during CXCR4 mediated HIV attachment
(IC50 ¼ 5e40 nM, MAGI-HIV1 test) and calcium release
(IC50 ¼ 1e570 nM). The chemical structures of the most active
compounds are reported in Fig. 9 (compounds 18e26). Further-
more, the most promising compound (18) showed favourable
pharmacokinetics, oral bioavailability and the capability of mobi-
lizing white blood cells in a dose-dependent manner [49].
A second series of 1,2,3,4-tetrahydroquinolines, this time com-
bined with a piperazine nucleus, was designed and proved to be
active in the same tests above mentioned. One of the new de-
rivatives, compound 27 (Fig. 10), beside a pharmacokinetics and an
inhibitory potency comparable to the previous isoquinoline-
containing lead (IC50 ¼ 20 nM, MAGI-HIV1 test; IC50 ¼ 6 nM, cal-
cium release), showed an improved behaviour toward CYP450 and
hERG [50].
2.5. p-Xylylenediamine based derivatives
As already mentioned, to improve the pharmacokinetic profile
Fig. 7. Structure of phidianidine (PHIA).
523
Fig. 8. Structure of the most active indolbenzohydrazide derivative.
of AMD3100, characterized by a p-xylylenediamine tether between
two cyclams, intensive studies have been carried out in the search
of related simplified active structures. Accordingly, compounds
containing a single cyclam connected by a p-xylylenediamine linker
to an aromatic or heteroaromatic moiety have been developed and
exhibited high antagonistic activity due to their capability to
interact similarly to AMD3100 into the CXCR4 active site [15].
More recently, two monocyclams have been synthesized (Fig. 11,
compounds 28 and 29) and in turn linked through the primary
amino group to a long linear chain obtained by polymerization of
bis-acrilamide. A geometrically defined polymeric structure,
necessary for optimal receptor interaction, was obtained by inter-
calating the cyclams by pharmacologically inert butanol units along
the linear chain. Using a receptor redistribution assay based on
human osteosarcoma cell line U2OS, widely adopted for screening
CXCR4 ligands, it has been demonstrated that the antagonistic ac-
tivity was considerably improved turning from monomeric struc-
tures to polymer. Such macromolecules also showed a remarkable
capability to inhibit cancer cells migration and invasiveness at
similar concentration of the reference compound AMD3100.
Furthermore, due to their overall positive charge, such polymers
resulted able to interact with DNA mediating transfection. The
possibility to antagonize CXCR4 function and, at the same time, to
deliver nucleic acid makes these systems promising dual-function
polymeric drugs for an advanced approach to cancer treatment
[51].
More flexible and less bulky structures, with respect to previous
described bicyclams or cyclams, have been also taken into consid-
eration. Two series of compounds based on a p-xylylen central core,
but bearing different cyclic amines at various distances from the
phenyl ring on both sides of the molecule, have been prepared and
tested in anti-HIV and cytotoxic assays. The series were prepared
using a same amine at the same distance from the molecule core or
even different amines at variable distances, giving rise to unsym-
metrical derivatives. The compounds were tested in an antagonistic
assay against MT-4 cells The most active compounds were found to
belong to the symmetrical series and bear pyrrolidine, piperidine or
2-methylpiperidine as an amine to both ends of the molecule
(Fig. 12, compounds 30e38). The results obtained were confirmed
by molecular docking studies [52].
Starting from compound WZ811, a dipyridine derivative, which
showed an intriguing biological profile (Fig. 13) [53], a new class of
benzenesulfonamide analogues, retaining the central phenyl ring
was prepared and tested as CXCR4 antagonists. Some of these de-
rivatives were symmetrical compounds with respect to aromatic
central core, whilst some others were unsymmetrically substituted.
Chemical structure of all derivatives comprises a sulfonamide
moiety on one or both sides of the molecule. Two out of all syn-
thesized compounds, 39 and 40 (Fig. 13) resulted particularly active
exhibiting IC50 values lower than 10 nM in the binding affinity assay
and inhibition of invasion higher than 90% in the Matrigel assay.
However, authors hypothesized for these two molecules, lacking
the whole p-xylylene core, a different interaction mode with
CXCR4, with respect to the reference compound, as demonstrated
524 F. Grande et al. / European Journal of Medicinal Chemistry 139 (2017) 519e530

Fig. 9. Structure of the most active tetrahydroquinoline based compounds with relative IC50 calculated by a calcium flux/release assay in Chem-1 cells.

by molecular docking studies [54].

In a separate study, structurally related p-xylylene derivatives,
still containing a sulfonamide moiety, were identified using a
computer-aided drug design screening, by a high throughput pro-
gram named FRESH workflow. From the first 30 prioritized struc-
tures, twelve compounds were selected and most of them showed
an excellent binding affinity to CXCR4. The amide-sulfamide
pharmacophore was confirmed to be a promising scaffold for the
development of CXCR4 antagonists.
The chemical structures of the most promising derivatives are
depicted in Fig. 14 (compounds 41e45) [55].
Fig. 10. Structure of tetrahydroquinoline 27. The same research group, very recently, published a study in

Fig. 11. Monocyclam structures included into polymeric system.

 F. Grande et al. / European Journal of Medicinal Chemistry 139 (2017) 519e530
Fig. 12. Structures of representative examples of symmetrical and unsymmetrical p-xylylenediamine based CXCR4 antagonists with relative EC50 calculated by a MTT assay against
MT-4 cells.
Fig. 13. Structures of WZ811 and sulfonamide analogues with relative IC50 calculated
by a seven-point assay against MDA-MB-231 cells.
which a new series of p-xylylene active unsymmetrical derivatives
were obtained. As the sulfonamide group was found to be neces-
sary for activity, in this new series a bioisostere amide group
replaced previous imine moiety on the second branch of the mol-
ecules, generating the novel amide-sulfamide series of compounds.
This new group of derivatives retains a potent CXCR4 antagonistic
activity. A number of selected derivatives showed noteworthy
525
activity in the Matrigel assay preventing invasion for more than
90% cells (Fig. 15, compounds 46e49) [56].
A further modification of previously reported p-xylylenedi-
amine derivatives was achieved by replacing the central 1,4-
disubstituted phenyl ring with a 2,6-disubstituted pyridine. The
resulting compounds were tested using an affinity binding test and
the Matrigel invasion assay. Most of the synthesized compounds
showed promising results in the binding affinity assay. In particular,
the derivative bearing a 3-fluorophenyl fragment on both sides of
the molecule and the 4-ethylphenyl analogue resulted as the most
interesting derivatives, with an EC value of 10 and 1 nM in the
binding affinity assay and 50% and 64% inhibition of invasion,
respectively using MDA-MB-231 breast cancer cells (Fig. 16, com-
pounds 50 and 51) [57].
In a successive study, several new derivatives substituted at
positions 2 and 6 or 2 and 5 of the pyridine central ring have been
synthesized and tested in a similar CXCR4 binding assay as well as
in an invasion inhibition test. Only two compounds, both belonging
to the 2,6-substituted series, showed interesting antagonistic
properties: the already known derivative 51 and a second one in
which the two substituents were replaced by a morpholine (Fig. 16,
compound 52). This compound showed an EC value of 10 nM in the
binding affinity and 63% inhibition of invasion [58].
Two new series of p-xylylenediamine derivatives were
described recently. A first series presents a variously substituted
526 F. Grande et al. / European Journal of Medicinal Chemistry 139 (2017) 519e530

Fig. 14. Structures of selected p-xylylene based CXCR4 antagonists with relative EC calculated by a rhodamine binding assay against MDA-MB-231 breast cancer cells.

Fig. 15. Structures of the most active sulfonamide derivatives with relative EC calculated by a rhodamine binding assay against MDA-MB-231 breast cancer cells.

Fig. 16. Selected active pyridine derivatives.

 F. Grande et al. / European Journal of Medicinal Chemistry 139 (2017) 519e530
quinazoline system as one side chain, while in the second series the
quinazoline was replaced by a substituted purine. The other side of
the molecule contains a cyclohexylamine propyl fragment in all the
derivatives (Fig. 17, compounds 53e58).
The most active analogue 58, belonging to the purine series,
showed a remarkable CXCR4 binding affinity with an IC50 value of
4.2 nM, thus representing a promising starting point for the
development of potent CXCR4 antagonists [59].
The same research group designed and synthesized a series of
novel symmetrical compounds characterized by a p-xylylene or a
2,6-pyridil central core bearing, as a structural novelty, a tertiary
amine on both sides of the molecule. The significant CXCR4
antagonistic effect was successfully retained, since ten derivatives
showed potent binding affinity with EC50 values from 1 to 100 nM.
Some of the synthesized compounds were also found to be able to
significantly limit tumor cell invasion, with inhibitory rates ranging
from 65% to 100%. These results clearly showed that tertiary amines
linked to the central core play a crucial role for the interaction with
the receptor and thus leading to an improved antagonistic activity.
The chemical structures of the most promising derivatives are
depicted in Fig. 18 (compounds 59e64) [60].
2.6. Trisubstituted amines
Some trisubstituted amine derivatives were known to be
capable of inhibiting the SDF-1a/CXCR4 axis provoking different
effects on haematopoiesis, stem cells mobilization and cancer. The
potent previously mentioned tetrahydroquinoline derivative
AMD070 (Fig. 2) is also referable to this class of compounds.
Recently, tris-[2-(dimethylamino)ethyl] amine (Me6TREN, Fig. 19),
Fig. 17. Quinazoline or purine containing p-xylylene derivatives with relative IC50 calculated by a cytotoxic assay against CEM cells.
527
a commercially available compound, has been proved as an effec-
tive agent able to mobilize hematopoietic stem/progenitor cells by
a mechanism involving the inhibition of the SDF-1a/CXCR4 axis.
Me6TREN promoted a significant inhibition of SDF-1aeinduced
chemotaxis in cells based assay (Fig. 19) [61].
A trisubstituted amine derivative, 3-((((1-cyclopentylpiperidin-
3-yl)methyl)(2-(piperidin-1-yl)ethyl)amino)methyl)phenol (CX6),
was selected after a computational search throughout a library as
an ideal small molecule CXCR4 antagonist (Fig. 20). The search was
conducted on the base of the shape of the known IT1t CXCR4 in-
hibitor (Fig. 2) as a reference and employing various algorithms
against the IT1t/CXCR4 complex crystal structure. A number of
molecules has been accordingly synthesized and tested against
U373-MAGI cells leading to compound CX6 as the most promising
candidate. In fact, CX6 showed to be able to inhibit Ca2þ flux elicited
by SDF-1a with an IC50 value of 92 nM [62].
2.7. Oxadiazolepyrimidine
A new class of small molecule CXCR4 antagonists based on the
use of computational modelling studies combined with in vitro
evaluation of SDF-1a -induced intracellular calcium mobilization,
proliferation and chemotaxis was discovered. The lead compound,
ICT5040, a 2-(pyridin-3-yl)-1,3,4-oxadiazole derivative, was shown
to inhibit SDF-1a induced intracellular calcium mobilization, with
an IC50 value of 3.8 mM, and was opportunely used for chemical
optimization. A series of analogues with improved anti-migratory
potency was then obtained and the most representative deriva-
tive was identified as the soluble analogue 65, which resulted very
potent in inhibiting SDF-1a induced intracellular calcium
528 F. Grande et al. / European Journal of Medicinal Chemistry 139 (2017) 519e530

Fig. 18. Representative examples of active symmetrical CXCR4 antagonists with relative EC calculated by a rhodamine binding assay in MDA-MB-231 breast cancer cells.

mobilization, as well as cell proliferation and migration. The

chemical structures of the most promising derivatives are depicted
in Fig. 21 (compounds 65e68) [63].

3. Conclusion

Fig. 19. Structure of Me6TREN.

The role of the SDF-1a/CXCR4 axis has been definitively clarified
as crucial during several physio-pathological events, including
spread and mobility of different types of cancer. In particular,
hormones sensitive breast and ovarian cancer morbidity seems
strictly related to the effects springing from the interaction of SDF-
1a with its receptor. Moreover, reduced survival in breast and
ovarian cancer patients was shown to be dependent to an altered
SDF-1a expression. Thus, agents able to impair the SDF-1a/CXCR4
axis could represent valuable tools for alternative anti-neoplastic
therapies. To date only one CXCR4 antagonist has reached the
advanced phases of the clinical trials. As several compounds
belonging to distinct chemical classes have been identified as
promising antagonists for this process, it seems likely that new
Fig. 20. Structure of CX6. small molecules could be shortly developed as therapeutic agents.

Fig. 21. Representative examples of oxadiazolepyrimidine CXCR4 antagonists with relative IC50 calculated by MTT assay against U87-MG cells.
 F. Grande et al. / European Journal of Medicinal Chemistry 139 (2017) 519e530
Amongst the described compounds, cyclopentapeptides and
bicyclams seem the most promising classes to be investigated in
order to select potent candidates for clinical application. Both
classes of compounds, considered small molecules, show unfavor-
able pharmacokinetic profiles, which greatly limit a possible use in
therapy. p-Xylylenediamine and tetrahydroquinoline derivatives
are presently widely investigated, even though none of the other
described chemical classes has been so far completely abandoned.
Herein, the most recent findings in this field have been reviewed.
Although most of the active compounds have been at first recog-
nized as feasible anti-HIV agents, all identified antagonists could
even act as effective anticancer agents. However, all the examined
classes are worth to be in depth investigated in order to generate
candidates for a clinical development. In fact, a major goal for
medicinal chemists could reside in the identification of orally active
and safe CXCR4 antagonists after a comprehensive characterization
of long-term toxicity and off-target effects of the most promising
candidates. Finally, the possibility to obtain radiolabelled de-
rivatives as potential biomarkers in cancer diagnosis, prevention
and drug response, may represent a further applicative develop-
ment of CXCR4 antagonists.
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