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Dichlorophenyl piperazines, including a recently-approved atypical antipsychotic, are potent inhibitors of DHCR7, the last enzyme in cholesterol biosynthesis.

  • Genaro-Mattos, Thiago C1
  • Tallman, Keri A1
  • Allen, Luke B2
  • Anderson, Allison3
  • Mirnics, Karoly3
  • Korade, Zeljka2
  • Porter, Ned A4
  • 1 Department of Chemistry, Vanderbilt Institute of Chemical Biology, Nashville, TN, United States. , (United States)
  • 2 Department of Pediatrics and Biochemistry, Molecular Biology, UNMC, Omaha, NE 68198, United States. , (United States)
  • 3 Munroe-Meyer Institute for Genetics and Rehabilitation, Omaha, NE 68198, United States. , (United States)
  • 4 Department of Chemistry, Vanderbilt Institute of Chemical Biology, Nashville, TN, United States; Vanderbilt Kennedy Center for Research on Human Development, Nashville, TN, United States. Electronic address: [email protected] , (United States)
Published Article
Toxicology and Applied Pharmacology
Publication Date
Apr 23, 2018
DOI: 10.1016/j.taap.2018.04.029
PMID: 29698737


While antipsychotic medications provide important relief from debilitating psychotic symptoms, they also have significant adverse side effects, which might have relevant impact on human health. Several research studies, including ours, have shown that commonly used antipsychotics such as haloperidol and aripiprazole affect cholesterol biosynthesis at the conversion of 7-dehydrocholesterol (7-DHC) to cholesterol. This transformation is promoted by the enzyme DHCR7 and its inhibition causes increases in plasma and tissue levels of 7-DHC. The inhibition of this enzymatic step by mutations in the Dhcr7 gene leads to Smith-Lemli-Opitz syndrome, a devastating human condition that can be replicated in rats by small molecule inhibitors of DHCR7. The fact that two compounds, brexpiprazole and cariprazine, that were recently approved by the FDA have substructural elements in common with the DHCR7 inhibitor aripiprazole, prompted us to evaluate the effect of brexpiprazole and cariprazine on cholesterol biosynthesis. We report that cariprazine affects levels of 7-DHC and cholesterol in cell culture incubations at concentrations as low as 5 nM. Furthermore, a common metabolite of cariprazine and aripiprazole, 2,3-(dichlorophenyl) piperazine, inhibits DHCR7 activity at concentrations comparable to those of the potent teratogen AY9944. The cell culture experiments were corroborated in mice in studies showing that treatment with cariprazine elevated 7-DHC in brain and serum. The consequences of sterol inhibition by antipsychotics in the developing nervous system and the safety of their use during pregnancy remains to be established.

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