Figure 2.
Intracellular activation of ciclesonide and reversible esterification of desisobutyryl-ciclesonide (des-CIC). Ciclesonide is activated by intracellular esterases to active metabolite, des-CIC, which has high affinity to the glucocorticosteroid (GCS) receptor. Desisobutyryl-ciclesonide can undergo reversible esterification to des-CIC oleate (fatty acid ester). Reprinted with permission from Nave R, Meyer W, Fuhst R, Zech K. Formation of fatty acid conjugates of ciclesonide active metabolite in the rat lung after 4-week inhalation of ciclesonide. Pulm Pharmacol Ther. 2005;18:390–396.62 Copyright © 2005 Elsevier.