Cosyntropin

Summary

Cosyntropin (CHEMBL2103784) is an approved protein diagnostic agent (ATC H01AA02) targeting MC2R; indicated across 4 conditions including membranous glomerulonephritis and adrenal gland disorder.

At a glance

• Status: Approved (max clinical phase 4)
• Modality: Protein
• ATC class: H01AA02
• Targets: 1 (MC2R)
• Indications: 4 conditions
• Clinical trials: 19
• Chemistry: 2933.4 Da · C136H210N40O31S

Identifiers

Drug identity and classification

Field	Value
ChEMBL ID	CHEMBL2103784
Name	Cosyntropin
Type	Protein
Max phase	4
FDA approved	no
PubChem CID	16133802
ChEBI	CHEBI:3901
ATC	H01AA02
Molecular formula	C136H210N40O31S
Molecular weight	2933.4
InChIKey	ZOEFCCMDUURGSE-SQKVDDBVSA-N

SMILES: CC(C)[C@@H](C(=O)NCC(=O)N[C@@H](CCCCN)C(=O)N[C@@H](CCCCN)C(=O)N[C@@H](CCCNC(=N)N)C(=O)N[C@@H](CCCNC(=N)N)C(=O)N1CCC[C@H]1C(=O)N[C@@H](C(C)C)C(=O)N[C@@H](CCCCN)C(=O)N[C@@H](C(C)C)C(=O)N[C@@H](CC2=CC=C(C=C2)O)C(=O)N3CCC[C@H]3C(=O)O)NC(=O)[C@@H]4CCCN4C(=O)[C@H](CCCCN)NC(=O)CNC(=O)[C@H](CC5=CNC6=CC=CC=C65)NC(=O)[C@H](CCCNC(=N)N)NC(=O)[C@H](CC7=CC=CC=C7)NC(=O)[C@H](CC8=CNC=N8)NC(=O)[C@H](CCC(=O)O)NC(=O)[C@H](CCSC)NC(=O)[C@H](CO)NC(=O)[C@H](CC9=CC=C(C=C9)O)NC(=O)[C@H](CO)N

IUPAC name: (2S)-1-[(2S)-2-[[(2S)-2-[[(2S)-6-amino-2-[[(2S)-2-[[(2S)-1-[(2S)-2-[[(2S)-2-[[(2S)-6-amino-2-[[(2S)-6-amino-2-[[2-[[(2S)-2-[[(2S)-1-[(2S)-6-amino-2-[[2-[[(2S)-2-[[(2S)-2-[[(2S)-2-[[(2S)-2-[[(2S)-2-[[(2S)-2-[[(2S)-2-[[(2S)-2-[[(2S)-2-amino-3-hydroxypropanoyl]amino]-3-(4-hydroxyphenyl)propanoyl]amino]-3-hydroxypropanoyl]amino]-4-methylsulfanylbutanoyl]amino]-4-carboxybutanoyl]amino]-3-(1H-imidazol-4-yl)propanoyl]amino]-3-phenylpropanoyl]amino]-5-carbamimidamidopentanoyl]amino]-3-(1H-indol-3-yl)propanoyl]amino]acetyl]amino]hexanoyl]pyrrolidine-2-carbonyl]amino]-3-methylbutanoyl]amino]acetyl]amino]hexanoyl]amino]hexanoyl]amino]-5-carbamimidamidopentanoyl]amino]-5-carbamimidamidopentanoyl]pyrrolidine-2-carbonyl]amino]-3-methylbutanoyl]amino]hexanoyl]amino]-3-methylbutanoyl]amino]-3-(4-hydroxyphenyl)propanoyl]pyrrolidine-2-carboxylic acid

ChEBI definition: A synthetic peptide that is identical to the 24-amino acid segment at the N-terminal of adrenocorticotropic hormone (corticotropin). A segment similar in all species, it contains the biological activity that stimulates production of corticosteroids in the adrenal cortex. It is used diagnostically to investigate adrenocortical insufficiency.

Pharmacological roles (ChEBI): diagnostic agent.

Also known as: Corticotropin tetracosapeptide, Cortrosyn, Cosyntropin, Cosyntropin acetate, Cosyntropin hexaacetate, Synacthen, Synacthen depot, Tetracosactida, Tetracosactide, Tetracosactide acetate, Tetracosactide hexaacetate, Tetracosactide hexacetate

Patent coverage: 2,066 distinct patent families (8,166 SureChEMBL compound mentions), from 4 matched compound structure(s). Mentions count patents naming the compound (not distinct inventions), so promiscuous / reference molecules inflate the mention figure — families are the dedup metric.

Targets

Targets

Primary targets (GtoPdb curated mechanism): the Cancer dependency column is the DepMap CRISPR fitness signal (% of screened cell lines dependent on the target).

Gene	Target	Action	pAffinity	Cancer dependency	UniProt
MC2R	MC2 receptor	Agonist		0%	Q01718

Broader ChEMBL bioactivity targets: 1 (assay-derived). Sample: Melanocortin receptor 4.

Bioactivity

ChEMBL activities: 1 potent at pChembl ≥ 5 of 1 total. Top 30 by potency (10 = 0.1 nM, 6 = 1 µM):

Target	pChembl	Type	Value	Unit	Activity ID
MC4R	9.19	EC50	0.65	nM	CHEMBL_ACT_14729151

Target pathways

Aggregated over 1 target gene(s): MC2R.

Top Reactome pathways

10 total, by targets touching each:

Pathway	Targets	Genes
Signal Transduction	1	MC2R
Disease	1	MC2R
Signaling by GPCR	1	MC2R
Class A/1 (Rhodopsin-like receptors)	1	MC2R
Peptide ligand-binding receptors	1	MC2R
GPCR downstream signalling	1	MC2R
G alpha (s) signalling events	1	MC2R
GPCR ligand binding	1	MC2R
Defective ACTH causes obesity and POMCD	1	MC2R
Diseases of metabolism	1	MC2R

Dominant GO biological processes

GO term	Targets
G protein-coupled receptor signaling pathway	1
G protein-coupled receptor signaling pathway, coupled to cyclic nucleotide second messenger	1
adenylate cyclase-activating G protein-coupled receptor signaling pathway	1
signal transduction	1
neuropeptide signaling pathway	1

Indications & clinical

Indications

4 indications (0 at ChEMBL trial phase 4). Phase below is the highest clinical-trial phase recorded for this drug against each disease — not the molecule’s overall approval status (that is in the Summary).

Indication	Trial phase	MONDO	EFO
membranous glomerulonephritis	2	MONDO:0005376	EFO:0004254
adrenal gland disorder	1	MONDO:0005495	EFO:0005539
hypertensive disorder	0	MONDO:0005044	EFO:0000537

1 further indication record had no mapped disease name (EFO/MeSH-only) or were duplicates, and are omitted.

Clinical trials

Total trials: 19.

Phase distribution

Phase	Trials
Not specified	8
PHASE4	4
PHASE2	3
PHASE1	2
PHASE3	1
EARLY_PHASE1	1

Top trials by phase / activity

NCT	Phase	Status	Title
NCT00851942	PHASE4	COMPLETED	Determination of Method-specific Normal Cortisol and Adrenal Hormone Responses to the Short Synacthen Test
NCT01371526	PHASE4	COMPLETED	Revival of Stem Cells in Addison’s Study
NCT02394457	PHASE4	COMPLETED	Cosyntropin Versus Epidural Blood Patch (EBP) for Treatment of Treatment of Post Dural Puncture Headache
NCT03752190	PHASE4	WITHDRAWN	Comparison of Intramuscular and Intravenous ACTH Stimulation Test in Normal Volunteers
NCT03368066	PHASE3	COMPLETED	Is Adrenal Insufficiency Under-diagnosed in Hospitalized Cirrhosis Patients?
NCT03514589	PHASE2	RECRUITING	NeSST2: The Development of a Noninvasive Short Synacthen Test
NCT00694863	PHASE2	COMPLETED	Treatment With Synthetic ACTH in High Risk Patients With Membranous Nephropathy
NCT02813655	PHASE2	TERMINATED	Evaluation of the Effectiveness and Tolerance of Tetracosactide Synacthen® in the Treatment of Post Dural Puncture Headaches (ESYBRECHE)
NCT01673087	PHASE1	COMPLETED	Stress Biomarkers:Attaching Biological Meaning to Field Friendly Salivary Measures
NCT01839812	PHASE1	COMPLETED	Adrenal Responsiveness During the Perioperative Period in Children Undergoing Congenital Cardiac Surgery
NCT01422733	EARLY_PHASE1	WITHDRAWN	Effect of Longer-term Adrenal Suppression Using Low Dose Hydrocortisone on Androgen Overproduction
NCT00006270	Not specified	UNKNOWN	Study of the Approximate Entropy of Adrenocorticotropic Hormone and Cortisol Secretion in Patients With Head Injury
NCT00552487	Not specified	COMPLETED	Isolated ACTH Deficiency in Patients With Hashimoto Thyroiditis
NCT01411046	Not specified	UNKNOWN	Difference in GC-induced Adrenal Insufficiency in RA Related to Polymorphisms in the Glucocorticoid Receptor Gene
NCT01421797	Not specified	UNKNOWN	Evaluation of Adrenal Androgens in Normal and Obese Girls After Suppression and Stimulation
NCT01764711	Not specified	COMPLETED	Adrenocorticotropic Hormone Stimulation in Postural Orthostatic Tachycardia Syndrome (POTS)
NCT02339506	Not specified	COMPLETED	Stress and the Nervous System
NCT03136562	Not specified	COMPLETED	Prevalence of Adrenal Insufficiency in Kidney Transplanted Patients in Glucocorticoid Treatment
NCT04642391	Not specified	COMPLETED	Defining the Mechanisms Underlying Adrenal Insufficiency in Cirrhosis

Clinical evidence (CIViC)

No CIViC predictive evidence (expected for non-precision-medicine drugs).

Pharmacology

Pharmacogenomics

No PharmGKB pharmacogenomic data curated for this drug.

Related molecules

Related molecules

Molecules sharing ≥1 of this drug’s curated primary targets, merged from two biobtree sources and ranked by shared-target count, then clinical phase: ChEMBL clinical-stage candidates (development phase ≥2) and PubChem drug-class bioactivity (approved / known drugs acting on the target). Deduplicated by drug name; the drug’s own salt forms are excluded. Note: for a drug with few primary targets a shared-target match can reflect off-target / promiscuous binding rather than the same therapeutic mechanism — the phase ordering surfaces bona-fide therapeutics first.

1 molecules share ≥1 primary target. Top 1 by shared-target count:

Molecule	Source	Status	Shared targets
ATUMELNANT	ChEMBL	Phase 2	MC2R