Frontiers in Pharmacology最新文献

Alcohol use disorder (AUD) remains a significant problem in the United States, resulting in over 178,000 alcohol-related deaths annually. A central problem in treating AUD is the high rate of relapse to alcohol use even after protracted periods of abstinence. Stress is a major contributor to the chronic relapsing and compulsive nature of AUD, and it alters neurocircuitry mediating craving and drug seeking. Chronic alcohol use dysregulates the neuropeptides orexin (OX)/hypocretin and dynorphin (DYN), which contribute to alcohol seeking and relapse. OX neurons originate exclusively in the hypothalamus and co-express DYN. Although OX and DYN are localized in the same synaptic vesicles and co-released when the hypothalamus is stimulated, they play opposing roles in reward, motivation, and substance use. OX, via OX receptor (OXR) signaling, promotes reward-seeking behavior, whereas DYN, acting through κ-opioid receptors (KOPs), increases depressive-like states and plays a key role in mediating aversive effects of stress. OX neurons densely innervate the paraventricular nucleus of the thalamus (PVT), a brain region that is involved in the regulation of reward function, stress, anxiety, and drug-directed behavior. In individuals with AUD, chronic alcohol use damages the thalamus, resulting in volume reductions and cognitive deficits. Therefore, lasting changes in PVT OX/DYN transmission and their interaction following chronic alcohol use may underlie stress-induced alcohol craving and relapse. Although their opposing roles in the PVT are established, implications of their interaction, particularly under conditions of stress, are limited in the context of alcohol use and reinstatement. This review synthesizes evidence from preclinical evidence and complementary clinical observations that implicate the co-transmission of OX and DYN in the PVT, with an emphasis on the posterior PVT (pPVT), which receives the most OX afferents, during the stress-induced reinstatement of alcohol seeking. We also discuss the potential of targeting OXRs and KOPs pharmacologically to reduce stress-induced alcohol craving and reinstatement. This review will help disentangle individual vs. interactive contributions of OX and DYN, and elucidate how their modulation within stress- and reward-related circuits may reveal novel insights for preventing relapse in individuals with AUD.

Background: Hypertriglyceridemia (HTG) and mixed dyslipidemia are significant risk factors for cardiovascular diseases. Despite the widespread use of traditional therapies, many patients continue to experience elevated triglycerides and residual cardiovascular risk. Small interfering RNA (siRNA) therapies represent a novel approach to lipid-lowering treatment.

Methods: A systematic review and meta-analysis were conducted on randomized controlled trials comparing siRNA versus placebo for hypertriglyceridemia or mixed dyslipidemia. The search included PubMed, Cochrane Library, Web of Science, and Embase databases from inception to 1 October 2025, limited to English-language publications. Data extraction was performed independently by two authors.

Results: Eight RCTs involving 2,671 participants met the inclusion criteria. siRNA therapies significantly reduced triglycerides (TG) (MD, -52%; 95%, -57.9 to -46.2), non-high-density lipoprotein cholesterol (non-HDL-C) (MD, -21.9%; 95%, -26 to -17.7), very low-density lipoprotein cholesterol (VLDL-C) (MD, -49.5%; 95%, -60.1 to -38.9), apolipoprotein B (apoB) (MD, -12.6%; 95%, -16.4 to -8.8), and remnant cholesterol (MD, -64.8%; 95%, -81.7 to -47.9)compared with placebo. The reduction in TG was particularly notable. Subgroup analysis revealed that ANGPTL3-targeted therapies resulted in more substantial reductions in low-density lipoprotein cholesterol (MD, -13.2%; 95% CI, -20.1 to -6.2), while APOC3-targeted therapies had a neutral effect on LDL-C levels (MD, 0.6%; 95% CI, -5.7-6.9) (p for interaction = 0.00001). On the other hand, APOC3-targeted therapies significantly increased high-density lipoprotein cholesterol levels (MD, 40.9%; 95% CI, 31.6-50.2), whereas ANGPTL3-targeted therapies led to a reduction in HDL-C levels (MD, -20.2%; 95% CI, -25.4 to -14.9) (p for interaction = 0.00001). No significant differences were observed in the risk of adverse events between siRNA therapy and placebo (RR, 1.02; 95% CI, 0.96-1.09).

Conclusion: siRNA therapies demonstrate significant efficacy in reducing triglycerides and improving lipid profiles in patients with HTG and mixed dyslipidemia. APOC3-targeted treatments primarily reduce triglycerides while increasing HDL-C, whereas ANGPTL3-targeted therapies offer broader lipid modulation, including substantial reductions in LDL-C. Both therapies demonstrate favorable safety profiles.

KRAS is one of the most frequently mutated oncogenes in non-small cell lung cancer (NSCLC), particularly in lung adenocarcinoma, with mutation rates ranging from 15% to 25%. Historically considered "undruggable," KRAS has recently become a viable therapeutic target with the development of selective KRAS G12C inhibitors such as sotorasib (AMG510) and adagrasib (MRTX849). These inhibitors have demonstrated promising clinical efficacy; however, their effectiveness is frequently limited by the emergence of resistance mechanisms. This review provides a comprehensive analysis of KRAS G12C structural biology, its role in oncogenic signaling, and the challenges associated with targeted therapy. We discuss the mechanisms of intrinsic and acquired resistance, current monotherapy limitations, and the rationale for combination strategies aimed at overcoming resistance. Additionally, we explore future therapeutic perspectives, including novel inhibitors, combination regimens, and emerging precision medicine approaches, to optimize treatment outcomes for patients with KRAS G12C-mutant NSCLC.

Ganoderic acid A (GAA), a major bioactive triterpenoid from Ganoderma lucidum, is known for its anti-inflammatory effects; however, its precise molecular targets in sepsis-related liver injury (SRLI) remain unclear. Integrating network pharmacology and transcriptomic analysis, we identified Tumor Necrosis Factor-alpha (TNFα) as a primary candidate target. Subsequent biophysical validation using surface plasmon resonance (SPR) and molecular dynamics (MD) simulations confirmed that GAA directly binds to TNFα. Functionally, this interaction inhibits the TNFα/NF-κB signaling axis, thereby suppressing macrophage M1 polarization and ameliorating liver injury in vitro and in vivo. This study identifies TNFα as a primary candidate target of GAA, providing a mechanistic basis for its hepatoprotective effects and therapeutic potential.

Ovarian aging is characterized by follicular depletion and declining oocyte quality, encompassing both physiological age-related decline and pathological forms such as diminished ovarian reserve, premature ovarian insufficiency and premature ovarian failure. These changes are associated with long-term systemic comorbidities across the female life course, particularly in the context of estrogen deficiency. Ginseng as a botanical drug (Panax ginseng C.A.Mey.) and its active compounds, including ginsenosides Rg1, Rb1 and Rg3, the gut-derived metabolite Compound K and ginseng polysaccharides, have emerged as multitarget candidates for delaying ovarian aging-associated functional decline and supporting reproductive health. This review integrates preclinical evidence on how ginseng-related compounds attenuate oxidative stress, preserve mitochondrial function, support energy metabolism and modulate ovarian inflammaging and the senescence-associated secretory phenotype. They also rebalance apoptosis and autophagy, thereby supporting granulosa cell survival and follicle development. We summarize their regulatory effects on hypothalamic-pituitary-ovarian axis activity and on ovarian hormone receptor expression, which may help preserve ovarian endocrine function during aging. Across mechanistic domains, the most consistent ovary-relevant evidence converges on redox control and mitochondrial integrity and function, together with dampening of NF-κB and NLRP3-linked inflammatory signaling and SASP-associated features, whereas evidence for direct hypothalamic-pituitary modulation and for durable multisystem outcome modification remains more exploratory. Preclinical studies indicate that ginseng-related compounds can influence skeletal, cardiovascular, hepatic, metabolic and neurocognitive phenotypes that accompany estrogen deficiency. However, the evidence base remains heterogeneous and largely preclinical, and causal links to long-term functional reproductive outcomes are still limited. Interpretation of the existing literature is hampered by differences in botanical sources, processing methods, formulations, dosing regimens, treatment duration and routes of administration, which complicate evaluation of in vivo exposure and pharmacodynamic response, particularly for orally administered ginsenosides that undergo microbiota-mediated biotransformation and show inter-individual pharmacokinetic variability in some studies, with consequent uncertainty in dose relevance and exposure consistency across populations. Further progress toward clinical application may be facilitated by traceable and chemically defined ginseng preparations, exposure-guided oral dosing and rigorously designed clinical trials that better define efficacy, safety, plausible drug-drug interaction considerations and long-term reproductive and systemic outcomes with stage-stratified designs and prioritized functional outcome measures.

Background: Given the lack of targeted therapies and frequent resistance to apoptosis-based treatments, triple-negative breast cancer (TNBC) remains a major clinical challenge. Exploring non-apoptotic cell death mechanisms may offer new therapeutic avenues to circumvent drug resistance in TNBC.

Methods: The anticancer activity of a novel cyclometalated iridium (III) compound, CIr2, was evaluated using cytotoxicity, clonogenic, and migration assays in multiple breast cancer cell lines. Mechanistic investigations included analyses of mitochondrial dysfunction, reactive oxygen species (ROS) production, ATP depletion, endoplasmic reticulum (ER) stress, and MAPK signaling. Transcriptomic profiling (RNA-seq), ultrastructural and morphological analyses, as well as pharmacological inhibitor studies targeting distinct cell death pathways, were performed to elucidate the mode of cell death induced by CIr2. The in vivo antitumor efficacy and safety of CIr2 were further assessed using a TNBC xenograft mouse model.

Results: CIr2 selectively inhibited the proliferation and migration of TNBC cells while exerting minimal cytotoxic effects on normal breast epithelial cells. CIr2 preferentially accumulated in mitochondria, leading to mitochondrial membrane potential collapse, excessive ROS production, and profound ATP depletion. Transcriptomic profiling and morphological analyses revealed pronounced ER stress, MAPK pathway activation, and paraptosis-associated ultrastructural alterations, including mitochondrial swelling and extensive cytoplasmic vacuolization. Pharmacological inhibition of apoptosis, necroptosis, ferroptosis, autophagy, ER stress, or p38 MAPK signaling failed to rescue CIr2-induced cytotoxicity, whereas ROS scavenging effectively reversed these effects, confirming a mitochondrial dysfunction and ROS-driven paraptotic mode of cell death. In vivo, CIr2 markedly suppressed TNBC xenograft tumor growth with minimal systemic toxicity.

Conclusion: CIr2 induces paraptosis through mitochondrial dysfunction and ER stress, offering a potential therapeutic strategy to overcome apoptosis resistance in TNBC. These findings provide a new mechanistic insight into iridium-based paraptosis induction.

Glial cells-comprising astrocytes, microglia, and oligodendrocytes-are fundamental to central nervous system (CNS) homeostasis, yet their interactions with anesthetics are not fully elucidated. This review narratively synthesizes current evidence on the differential effects of local and general anesthetics on these cells, revealing a complex duality of neuroprotective and neurotoxic outcomes. Local anesthetics such as lidocaine can confer protection by inducing astrocytic autophagy and suppressing microglial pro-inflammatory responses, whereas bupivacaine may impair astrocytic mitochondrial function and potentiate excitotoxicity. Conversely, general anesthetics exhibit divergent impacts: propofol demonstrates protective properties against oxidative stress and neuroinflammation, but isoflurane often induces astrocytic cytotoxicity, activates microglia via the NF-κB pathway, and triggers apoptosis in developing oligodendrocytes, thereby disrupting myelination. These effects are critically influenced by anesthetic type, concentration, exposure duration, and the pathological context. Our analysis underscores the necessity of understanding these glial-centric mechanisms to optimize anesthetic safety, particularly for vulnerable populations such as the young and the elderly. Ultimately, advancing the knowledge of how anesthetics modulate glial cell function is pivotal for developing personalized anesthesia strategies that minimize neurotoxicity and harness potential protective effects, thereby improving postoperative neurological outcomes and guiding future translational research.

Systemic inflammation induced by adipose tissue is common in obese individuals and is often overlooked due to its subclinical nature. The constant secretion of proinflammatory factors shifts the balance toward inflammation, affecting the body's homeostasis and facilitating the development of various chronic diseases. In the liver, proinflammatory markers, free fatty acids (FFAs), and the hormone leptin, all of which originate from adipose tissue, trigger an inflammatory response that favors fibrogenesis. Conversely, serum levels of proinflammatory factors can be used to assess both the risk of liver fibrosis and the effectiveness of treatment. Their application is straightforward due to their non-invasive nature, but it is important to confirm their reliability in future investigations. Moreover, dietary approaches to therapy, along with physical activity, deserve more attention as their effectiveness has frequently been demonstrated and they are recommended by official guidelines. The focus on reducing body weight through fat loss is especially crucial. To enhance the quality and value of dietary strategies in therapy, it is also necessary to refine and expand their potential.

[This corrects the article DOI: 10.3389/fphar.2020.00951.].

Objective: This study aimed to investigate the ameliorative effect of the ethyl acetate extract of Gastrodia elata (EEGE) on vascular dementia (VD) and its underlying mechanisms.

Methods: A VD rat model was established using the two-vessel occlusion method, while an in vitro cerebral ischemia injury model was constructed by subjecting HT22 cells to oxygen-glucose deprivation. The mechanisms were systematically explored through behavioral tests, ELISA, integrated network analysis, and combined metabolomic and transcriptomic techniques. Key targets were further validated by Western blot.

Results: EEGE significantly improved cognitive function in VD rats. Integrated multi-omics and network analysis predicted that its effects involved two key targets, TNF and IGF1, and identified Parishin A and p-hydroxybenzaldehyde as prioritized drug metabolites for assessment. Subsequent experiments confirmed that EEGE effectively downregulated serum levels of IL-6, TNF-α, and IL-1β by modulating the IGF1-TREM2 signaling axis and the AMPK-SIRT1-FoxO1-NF-κB pathway.

Conclusion: The improvement of cognitive dysfunction in vascular dementia by EEGE is closely associated with its regulation of the IGF1-TREM2 axis and the AMPK-SIRT1-FoxO1-NF-κB pathway, thereby mitigating neuroinflammation. This study provides experimental evidence and a potential mechanistic basis for further exploration of EEGE in VD intervention.