Cystinuria, a genetic disorder of cystine transport, is characterized by excessive excretion of L-cystine in the urine and recurrent cystine stones in the kidneys and, to a lesser extent, in the bladder. Current treatment of cystinuria has not changed over the last three decades. Patients are advised to drink substantial amounts of water (>4 liters/day) to reduce the concentration of free L-cystine in urine and to alkalinize the urine to increase cystine solubility, advice that challenges patient adherence. Drug therapy in severe conditions is limited to two thiol drugs that react with L-cystine to form more soluble mixed disulfides, but these drugs have poor patient compliance due to adverse reactions that, in some cases, may be life-threatening. Thus, there is a need to reduce or eliminate the risks associated with therapy for cystinuria. In this application, we propose a new approach to prevent recurrent cystine stone formation in patients with cystinuria. Our substantive in vitro studies indicate that L-cystine diamides are potent inhibitors of cystine crystallization, which is a required condition for stone formation. Our preliminary in vivo studies indicate that one compound (LH708) from this family is effective in preventing L-cystine stone formation in Slc3a1 knockout mice, which we generated in our laboratories as a model for cystinuria. Building on our in vitro and in vivo data, we will design, synthesize, and evaluate new analogs and prodrugs of L-cystine diamides with sufficient metabolic stability and oral bioavailability that can effectively inhibit L-cystine crystallization in vivo and thus prevent L-cystine stone formation. The effectiveness of these new compounds to inhibit L-cystine crystallization will be tested using a combination of in vitro fluorescence-based solubility and real-time in situ crystal growth inhibition assays. The most effective inhibitors then will be evaluated for their in vivo efficacy, safety, and bioavailability in Slc3a1 knockout mice and for their preclinical ADME-Tox properties. The combined results from these studies will enable the selection of one top drug candidate and one backup candidate for IND-directed preclinical evaluations, for which we will seek assistance from the NIH NCATS program.

Public Health Relevance

Cystinuria is a rare genetic disorder that affects about 1 in 7,000 people worldwide and approximately 1 in 15,000 in the US. It is characterized by high concentrations of the poorly soluble amino acid cystine in the urine. Cystinuria is a chronic, lifelong condition and affected patients have a >50% chance of stone formation in the kidneys or the bladder during their lifetime. Currently, there is no effective therapy available for cystinuria. The goal of this project is to develop an effective therapy that can be used to prevent recurrent stone formation in patients with cystinuria.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Research Project (R01)
Project #
Application #
Study Section
Special Emphasis Panel (ZRG1)
Program Officer
Kirkali, Ziya
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Rutgers University
Schools of Arts and Sciences
United States
Zip Code
Yang, Yanhui; Albanyan, Haifa; Lee, Sumi et al. (2018) Design, synthesis, and evaluation of l-cystine diamides as l-cystine crystallization inhibitors for cystinuria. Bioorg Med Chem Lett 28:1303-1308
Sahota, Amrik; Tischfield, Jay A; Goldfarb, David S et al. (2018) Cystinuria: genetic aspects, mouse models, and a new approach to therapy. Urolithiasis :
Poloni, Laura N; Zhu, Zina; Garcia-Vázquez, Nelson et al. (2017) Role of Molecular Recognition in l-Cystine Crystal Growth Inhibition. Cryst Growth Des 17:2767-2781