Selective non-steroidal inhibitors of 5 alpha-reductase type 1

The enzyme 5alpha-reductase (5alphaR) catalyses the reduction of testosterone (T) into the more potent androgen dihydrotestosterone (DHT). The abnormal production of DHT is associated to pathologies of the main target organs of this hormone: the prostate and the skin. Benign prostatic hyperplasia (BPH), prostate cancer, acne, androgenetic alopecia in men, and hirsutism in women appear related to the DHT production. Two isozymes of 5alpha-reductase have been cloned, expressed and characterized (5alphaR-1 and 5alphaR-2). They share a poor homology, have different chromosomal localization, enzyme kinetic parameters, and tissue expression patterns. Since 5alphaR-1 and 5alphaR-2 are differently distributed in the androgen target organs, a different involvement of the two isozymes in the pathogenesis of prostate and skin disorders can be hypothesized. High interest has been paid to the synthesis of inhibitors of 5alpha-reductase for the treatment of DHT related pathologies, and the selective inhibition of any single isozyme represents a great challenge for medical and pharmaceutical research in order to have more specific drugs. At present, no 5alphaR-1 inhibitor is marketed for the treatment of 5alphaR-1 related pathologies but pharmaceutical research is very active in this field. This paper will review the major classes of 5alphaR inhibitors focusing in particular on non-steroidal inhibitors and on structural features that enhance the selectivity versus the type I isozyme. Biological tests to assess the inhibitory activity towards the two 5alphaR isozymes will be also discussed. (C) 2004 Elsevier Ltd. All rights reserved.