Drug repositioning applies existing drugs to new disease indications. A prerequisite for drug repurposing is drug promiscuity - a drug's ability to bind to several targets, possibly leading to side effects on the other hand. One reason for drug promiscuity is binding site similarity between (otherwise unrelated) proteins. In this thesis, a new algorithm for remote binding site similarity assessment and its application to the whole of the Protein Data Bank (PDB) is presented, forming the base for off-target identification and drug repositioning. The present thesis contributes to a long-standing debate on the reasons for drug promiscuity, being one of the pioneer studies investigating these from a protein structural point of view. Except for a small influence of flexibility, the analysis of all promiscuous drugs in the PDB revealed that drug properties are of minor importance. However, a strong correlation between promiscuity and binding site similarity of protein targets is found (r = 0.81), suggesting binding site similarity as the main reason for drug promiscuity. For 71 % of the promiscuous drugs at least one pair of their targets' binding sites is similar and for 18 % all are similar. In order to overcome issues in detection of remotely similar binding sites, a score for binding site similarity is developed: LigandRMSD measures the similarity of the aligned ligands and uncovers remote local similarities in proteins. It can be applied to arbitrary binding site alignments and also works on distinct ligands on a structural proteome scale. To answer the question on which other targets might be hit when targeting a particular protein, an all-to-all binding site alignment of 32,202 protein structures is analyzed. Of the hundreds of million possible protein pairs, 0.27 % were found to have similar binding sites. Extrapolating to the human proteome, for one human protein are 54 proteins with a similar binding site expected on average. Clearly, this is in contrast to the one drug-one target paradigm in drug development. Based on these data, disadvantageous off-targets can be uncovered and drug-repositioning candidates inferred. The enormous potential is demonstrated with the example of Viagra, proposing it for repositioning to Alzheimer's disease and prostate cancer. The findings in this thesis question the established single-target dogma in drug discovery. Drugs are triggered to modulate multiple targets simultaneously by the widespread binding site similarity. With the presented pipeline, drug targets can be reliably predicted: Starting from a target protein, additional targets are predicted based on binding site similarity and prioritized according to the resulting ligand structural overlap. Identifying drug targets helps to understand severe side effects and opens the door for drug repositioning.

Drug repositioning applies existing drugs to new disease indications. A prerequisite for drug repurposing is drug promiscuity - a drug's ability to bind to several targets, possibly leading to side effects on the other hand. One reason for drug promiscuity is binding site similarity between (otherwise unrelated) proteins. In this thesis, a new algorithm for remote binding site similarity assessment and its application to the whole of the Protein Data Bank (PDB) is presented, forming the base for off-target identification and drug repositioning. The present thesis contributes to a long-standing debate on the reasons for drug promiscuity, being one of the pioneer studies investigating these from a protein structural point of view. Except for a small influence of flexibility, the analysis of all promiscuous drugs in the PDB revealed that drug properties are of minor importance. However, a strong correlation between promiscuity and binding site similarity of protein targets is found (r = 0.81), suggesting binding site similarity as the main reason for drug promiscuity. For 71 % of the promiscuous drugs at least one pair of their targets' binding sites is similar and for 18 % all are similar. In order to overcome issues in detection of remotely similar binding sites, a score for binding site similarity is developed: LigandRMSD measures the similarity of the aligned ligands and uncovers remote local similarities in proteins. It can be applied to arbitrary binding site alignments and also works on distinct ligands on a structural proteome scale. To answer the question on which other targets might be hit when targeting a particular protein, an all-to-all binding site alignment of 32,202 protein structures is analyzed. Of the hundreds of million possible protein pairs, 0.27 % were found to have similar binding sites. Extrapolating to the human proteome, for one human protein are 54 proteins with a similar binding site expected on average. Clearly, this is in contrast to the one drug-one target paradigm in drug development. Based on these data, disadvantageous off-targets can be uncovered and drug-repositioning candidates inferred. The enormous potential is demonstrated with the example of Viagra, proposing it for repositioning to Alzheimer's disease and prostate cancer. The findings in this thesis question the established single-target dogma in drug discovery. Drugs are triggered to modulate multiple targets simultaneously by the widespread binding site similarity. With the presented pipeline, drug targets can be reliably predicted: Starting from a target protein, additional targets are predicted based on binding site similarity and prioritized according to the resulting ligand structural overlap. Identifying drug targets helps to understand severe side effects and opens the door for drug repositioning.