Direct and Sequential Bioactivation of Pemigatinib to a Reactive Iminium Ion Intermediate Culminates in Mechanism-Based Inactivation of Cytochrome P450 3A.

Mechanism-based inactivation (MBI) is a unique phenomenon in drug metabolism that arises when an enzyme metabolically activates a drug to a chemically reactive intermediate and primes it for irreversible binding, leading to an irrevocable loss of catalytic activity that is only restored upon de novo synthesis of the implicated enzyme. Our laboratory recently established the MBI of cytochrome P450 3A (CYP3A) by the fibroblast growth factor receptor (FGFR) inhibitors erdafitinib and infigratinib. Serendipitously, our preliminary data has also revealed that pemigatinib (PEM) - another clinically approved FGFR1-3 inhibitor - similarly elicited time-dependent inhibition of CYP3A. This was rather unexpected as it was previously purported that PEM did not pose any metabolism-dependent liabilities due to the absence of glutathione-related conjugates in metabolic profiling experiments conducted in human liver microsomes. Consequently, we posited that PEM is bioactivated by CYP3A to a hard electrophile, thereby allowing it to elude glutathione trapping and detection in the aforementioned reactive metabolite screen. Here, we confirmed that PEM inhibited both CYP3A isoforms in a time-, concentration-, and cofactor-dependent manner consistent with MBI - with K , k , and partition ratio of 8.69 and 11.95 μM, 0.108 and 0.042 min , and ~44 and ~47 for CYP3A4 and CYP3A5 respectively, when rivaroxaban was employed as the probe substrate. While the rate of inactivation was diminished by coincubation with an alternative substrate (testosterone) or direct inhibitor of CYP3A (ketoconazole), the inclusion of nucleophilic trapping agents afforded no such protection. Furthermore, the lack of catalytic activity recovery following dialysis and oxidation with potassium ferricyanide coupled with the absence of a spectrally resolvable peak in the Soret region collectively implied that the underlying mechanism of inactivation was not elicited via the formation of pseudoirreversible metabolite-intermediate complexes. Utilizing cyanide trapping and high-resolution mass spectrometry, we illuminated the direct and sequential oxidative bioactivation of PEM and its major O-desmethylated metabolite at its distal morpholine moiety to a reactive iminium ion intermediate that could covalently modify the CYP3A apoprotein and/or prosthetic heme and culminate in its MBI. Finally, structural determinants gleaned from our in silicocovalent docking simulations suggested that the discrepancies in MBI potencies between both CYP3A isoforms might be alluded to the propensity for PEM to interact more favourably with an accessible active-site serine residue in position 312 of CYP3A4 as compared to CYP3A5. Further physiologically based pharmacokinetic modelling studies are currently underway to better discern the clinical implications of our findings.