Discovery of Non-benzoazacyclic V2R Antagonists for the Treatment of Autosomal Dominant Polycystic Kidney Disease

Vasopressin V2 receptor (V2R) is a validated therapeutic target for autosomal dominant polycystic kidney disease (ADPKD). Most reported V2R antagonists share a benzoazacyclic scaffold with limited structural diversity. In this study, structural analysis of V2R bound to the FDA-approved V2R antagonist tolvaptan and a previously reported derivative (compound 18) revealed that the interaction with a hydrophobic subpocket formed by residues V2065.39, I2095.42, and F2876.51 plays a critical role in antagonistic activity. Guided by this structural insight, we designed a series of non-benzoazacyclic analogs. Compound 29 (XYDC2050) exhibited high V2R binding affinity (Ki = 2.8 ± 0.1 nM) and potent cAMP inhibition (IC50 = 12.0 ± 2.0 nM). Notably, XYDC2050 displayed 162-fold selectivity over V1AR, surpassing that of tolvaptan (123-fold). In vitro and in vivo studies demonstrated that XYDC2050 effectively suppressed renal cyst formation and slowed disease progression. These results support XYDC2050 as a potential lead compound for ADPKD therapy.