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GLP-1 receptor agonists, are we witnessing the emergence of a paradigm shift for neuro-cardio-metabolic disorders? GLP-1 受体激动剂,我们是否正在见证神经-心血管-代谢疾病治疗模式的转变?
IF 12 1区 医学 Q1 PHARMACOLOGY & PHARMACY Pub Date : 2025-02-19 DOI: 10.1016/j.pharmthera.2025.108824
Abdelilah Arredouani
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have emerged as groundbreaking therapeutic agents in managing a spectrum of metabolic disorders, demonstrating remarkable efficacy across multiple organ systems and disease states. These compounds are not only well-established in the treatment of type 2 diabetes (T2D) and obesity—conditions for which they have received widespread approval—but also exhibit promising potential in addressing cardiovascular disease (CVD) and Metabolic dysfunction-associated steatotic liver disease (MASLD).
Recent investigations have begun to illuminate the utility of GLP-1RAs in the management of type 1 diabetes (T1D), as well as neurodegenerative disorders such as Alzheimer's and Parkinson's disease and various behavioral disorders. A plethora of clinical trials have consistently validated the capacity of GLP-1RAs to improve glycemic control, promote weight loss, and mitigate cardiovascular risk factors in individuals with T2D and obesity. While their application in T1D remains limited due to safety concerns—particularly regarding the risks of hypoglycemia and hyperglycemic ketoacidosis—emerging data suggest that GLP-1RAs may offer hepatoprotective benefits, potentially reducing liver fat content and decelerating the progression of MASLD.
The neuroprotective attributes of GLP-1 RAs have garnered significant interest, with research indicating their potential to alleviate cognitive decline associated with neurodegenerative diseases. Furthermore, preliminary findings highlight the role of GLP-1 RAs in addressing behavioral disorders, emphasizing their extensive therapeutic promise.
This comprehensive review synthesizes the current evidence supporting the diverse therapeutic applications of GLP-1RAs, positioning them as “magic drug” therapies for metabolic and neurological disorders. As ongoing research continues to explore innovative applications and combinations of GLP-1RAs, the landscape of disease management in metabolic and neurological contexts is poised for transformative advancements. This review will also critically assess safety considerations and underscore the need for personalized treatment strategies to optimize patient outcomes in these complex and often comorbid conditions.
胰高血糖素样肽-1受体激动剂(GLP-1RAs)已成为管理一系列代谢紊乱的开创性治疗药物,在多器官系统和疾病状态中显示出显着的疗效。这些化合物不仅在治疗2型糖尿病(T2D)和肥胖方面得到了广泛的认可,而且在治疗心血管疾病(CVD)和代谢功能障碍相关的脂肪变性肝病(MASLD)方面也表现出了良好的潜力。最近的研究已经开始阐明GLP-1RAs在1型糖尿病(T1D)以及神经退行性疾病(如阿尔茨海默病和帕金森病)和各种行为障碍治疗中的效用。大量的临床试验一致证实了GLP-1RAs在t2dm和肥胖患者中改善血糖控制、促进体重减轻和减轻心血管危险因素的能力。虽然由于安全性考虑,GLP-1RAs在T1D中的应用仍然有限,尤其是低血糖和高血糖酮症酸中毒的风险,但新出现的数据表明,GLP-1RAs可能具有肝脏保护作用,可能降低肝脏脂肪含量,减缓MASLD的进展。GLP-1 RAs的神经保护特性引起了极大的兴趣,研究表明它们有可能减轻与神经退行性疾病相关的认知能力下降。此外,初步研究结果强调了GLP-1 RAs在解决行为障碍中的作用,强调了它们广泛的治疗前景。本综述综合了目前支持GLP-1RAs多种治疗应用的证据,将其定位为治疗代谢和神经疾病的“神奇药物”。随着正在进行的研究继续探索GLP-1RAs的创新应用和组合,代谢和神经环境下的疾病管理领域正准备取得变革性进展。本综述还将严格评估安全性考虑因素,并强调个性化治疗策略的必要性,以优化这些复杂且通常合并症的患者预后。
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引用次数: 0
G protein-coupled estrogen receptor biased signaling in health and disease G蛋白偶联雌激素受体偏倚信号在健康和疾病中的作用。
IF 12 1区 医学 Q1 PHARMACOLOGY & PHARMACY Pub Date : 2025-02-18 DOI: 10.1016/j.pharmthera.2025.108822
Aisha Bushi , Yixuan Ma , Joseph Adu-Amankwaah , Rong Wang , Fen Cui , Rui Xiao , Jinming Zhao , Jinxiang Yuan , Rubin Tan
G protein-coupled estrogen receptor (GPER) is now recognized for its pivotal role in cellular signaling, influencing diverse physiological processes and disease states. Unlike classical estrogen receptors, GPER exhibits biased signaling, wherein ligand binding triggers selective pathways over others, significantly impacting cellular responses. This review explores the nuanced mechanisms of biased signaling mediated by GPER, underscoring its relevance in cardiovascular health, neurological function, immune modulation, and oncogenic processes. Despite its critical implications, biased signaling through GPER remains underexplored compared to traditional signaling paradigms. We explore recent progress in understanding GPER signaling specificity and its potential therapeutic implications across various diseases. Future research directions aim to uncover the molecular basis of biased signaling, develop selective ligands, and translate these insights into personalized therapeutic approaches. Exploiting the therapeutic potential of GPER biased signaling represents a promising frontier in precision medicine, offering innovative strategies to address unmet medical needs.
G蛋白偶联雌激素受体(GPER)在细胞信号传导中起着关键作用,影响多种生理过程和疾病状态。与经典雌激素受体不同,GPER表现出偏置信号,其中配体结合触发选择性途径,显著影响细胞反应。这篇综述探讨了GPER介导的偏倚信号的细微机制,强调了其在心血管健康、神经功能、免疫调节和致癌过程中的相关性。尽管其具有重要意义,但与传统的信号范式相比,通过GPER进行的偏置信号仍未得到充分探索。我们探讨了了解GPER信号特异性及其在各种疾病中的潜在治疗意义的最新进展。未来的研究方向旨在揭示偏倚信号的分子基础,开发选择性配体,并将这些见解转化为个性化的治疗方法。利用GPER偏倚信号的治疗潜力代表了精准医学的一个有前途的前沿,为解决未满足的医疗需求提供了创新的策略。
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引用次数: 0
The tumor suppressor role and epigenetic regulation of 15-hydroxyprostaglandin dehydrogenase (15-PGDH) in cancer and tumor microenvironment (TME) 15-羟基前列腺素脱氢酶(15-PGDH)在肿瘤和肿瘤微环境(TME)中的抑瘤作用和表观遗传调控。
IF 12 1区 医学 Q1 PHARMACOLOGY & PHARMACY Pub Date : 2025-02-17 DOI: 10.1016/j.pharmthera.2025.108826
SubbaRao V. Tulimilli , Medha Karnik , Anjali Devi S. Bettadapura , Olga A. Sukocheva , Edmund Tse , Gowthamarajan Kuppusamy , Suma M. Natraj , SubbaRao V. Madhunapantula
Oxidative stress and inflammation may initiate carcinogenesis and facilitate metastasis via activation of pro-inflammatory signaling network. The side product of arachidonic acid processing by cyclooxygenase-2 (COX-2), the prostaglandin E2 (PGE2), plays a key role in various metabolic disorders and during inflammation-mediated tumorigenesis. It has been demonstrated that PGE2 increases the proliferation, migration, invasion, metastasis, and resistance of cancer cells to apoptosis and other forms of programmed cell death. The expression level of PGE2 metabolizing enzyme 15-hydroxyprostaglandin dehydrogenase (15-PGDH) is often decreased in various malignancies. However, the role of 15-PGDH and PGE2 in the regulation of carcinogenesis remains controversial. Numerous cancer cell lines and mouse models have demonstrated the role of 15-PGDH as a tumor suppressor. Downregulation of 15-PGDH increased cancer cell proliferation, migration, anchorage independent growth, colony formation while overexpression reversed these effects, by inducing apoptosis and cell cycle arrest in vitro and in vivo. The expression of 15-PGDH is regulated by various mechanisms, including (a) epigenetic alterations (methylation of promoter region, histone deacetylases, microRNAs (miR-21, miR-26a/b, miR-106b-5p, miR-146b-3p, miR-155, miR-218-5p, and miR-620)); and (b) dysregulated oxidative stress and associated mediators (elevated levels of growth factors and proinflammatory cytokines (such as IL1β and TNFα)). Several transcription factors, such as HNF3β, β-catenin, Snail, Slug, can bind to 15-PGDH promoter region and downregulate the enzyme expression. In contrast, the expression of 15-PGDH can be upregulated by several anti-inflammatory cytokines and anti-cancer agents, such as IL10 and vitamin D. The functional activity of 15-PGDH protein can be modulated by signaling effectors and oxidative stress, including increased production of reactive oxygen species (ROS). However, the role of oxidative stress regulator protein, i.e., nuclear factor erythroid 2-related factor 2 (Nrf2), in the control of 15-PGDH expression remains unclear. This article provides insights and comprehensive overview of the tumor suppressor role of 15-PGDH in various cancers. Epigenetic and post-translational mechanisms regulating 15-PGDH expression and the role of novel ROS-Nrf2–15-PGDH axis were discussed and accented as potential drug targets.
氧化应激和炎症可能通过激活促炎信号网络引发癌变和促进转移。环氧合酶-2 (COX-2)处理花生四烯酸的副产物前列腺素E2 (PGE2)在各种代谢紊乱和炎症介导的肿瘤发生过程中起着关键作用。已经证明PGE2增加了癌细胞的增殖、迁移、侵袭、转移以及对凋亡和其他形式的程序性细胞死亡的抵抗。PGE2代谢酶15-羟基前列腺素脱氢酶(15-PGDH)在各种恶性肿瘤中的表达水平经常下降。然而,15-PGDH和PGE2在癌变调控中的作用仍存在争议。许多癌细胞系和小鼠模型已经证明了15-PGDH作为肿瘤抑制因子的作用。15-PGDH的下调增加了癌细胞的增殖、迁移、锚定独立生长和集落形成,而过表达通过诱导细胞凋亡和细胞周期阻滞,在体外和体内逆转了这些作用。15-PGDH的表达受多种机制调控,包括(a)表观遗传改变(启动子区域甲基化、组蛋白去乙酰化酶、microrna (miR-21) (miR-26a/b、miR-106b-5p、miR-146b-3p、miR-155、miR-218-5p和miR-620));(b)氧化应激和相关介质(生长因子和促炎细胞因子(如il - 1β和tnf - α)水平升高)失调。HNF3β、β-catenin、Snail、Slug等转录因子可结合15-PGDH启动子区下调酶的表达。相反,15-PGDH的表达可被多种抗炎细胞因子和抗癌药物(如il - 10和维生素d)上调。15-PGDH蛋白的功能活性可被信号效应物和氧化应激调节,包括活性氧(ROS)的产生增加。然而,氧化应激调节蛋白,即核因子红细胞2相关因子2 (Nrf2)在控制15-PGDH表达中的作用尚不清楚。本文就15-PGDH在各种癌症中的抑瘤作用提供了见解和全面的概述。讨论了调控15-PGDH表达的表观遗传和翻译后机制,以及新型ROS-Nrf2-15-PGDH轴在15-PGDH表达上游的作用,并强调了15-PGDH作为潜在的药物靶点。
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引用次数: 0
Biomarker identification in bipolar disorder 双相情感障碍的生物标志物鉴定
IF 12 1区 医学 Q1 PHARMACOLOGY & PHARMACY Pub Date : 2025-02-17 DOI: 10.1016/j.pharmthera.2025.108823
Francesca Martella , Andrea Caporali , Monica Macellaro , Rita Cafaro , Francesco De Pasquale , Bernardo Dell'Osso , Claudio D'Addario
Bipolar disorder (BD) is a severe psychiatric condition whose pathophysiology is complex and multifactorial. Genetic, environmental and social risk factors play a role in its development as well as in its progressive course. Research is currently focusing on the identification of the biological basis underlying these processes in order to suggest novel biomarkers capable to predict BD etiopathogenesis and staging. Staging has been recognized as of great value for the treatment and management of many illnesses and might also be suitable for mental health issues, particularly in disorders like BD, which progress from an initial mild phase to a more severe and thus difficult-to-treat situation. Thus, it would be of great help the characterization of to suggest better treatment requirements and improve prognosis across the different stages of the illness. Here, we summarize current research on the biological hypotheses of BD and the biomarkers associated with its progression, reviewing clinical studies available in the literature.
双相情感障碍(BD)是一种严重的精神疾病,其病理生理复杂且多因素。遗传、环境和社会风险因素在其发展和发展过程中起着重要作用。目前的研究重点是确定这些过程背后的生物学基础,以提出能够预测双相障碍发病和分期的新生物标志物。分期已被认为对许多疾病的治疗和管理具有重要价值,也可能适用于精神健康问题,特别是像双相障碍这样的疾病,它从最初的轻度阶段发展到更严重,因此难以治疗。因此,这将有助于在疾病的不同阶段提出更好的治疗要求和改善预后。在这里,我们总结了目前关于双相障碍的生物学假设和与其进展相关的生物标志物的研究,回顾了文献中的临床研究。
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引用次数: 0
Biased signaling by human follicle-stimulating hormone variants 人类促卵泡激素变异的偏倚信号:碳水化合物背后的秘密。
IF 12 1区 医学 Q1 PHARMACOLOGY & PHARMACY Pub Date : 2025-02-15 DOI: 10.1016/j.pharmthera.2025.108821
Alfredo Ulloa-Aguirre , Teresa Zariñán , James A. Dias , T. Rajendra Kumar , George R. Bousfield
Follicle-stimulating hormone (FSH) or follitropin plays a fundamental role in several mammalian species, including humans. This gonadotropin is produced by the anterior pituitary gland and has as its main targets the granulosa cells of the ovary and the Sertoli cells of the testis. Structurally, FSH is composed of two non-convalently linked subunits, the α- and β-subunit, as well as highly heterogenous oligosaccharide structures, which play a key role in determining a number of physiological and biological features of the hormone. Glycosylation in FSH and the other members belonging to the glycoprotein hormone family, is essential for many functions of the gonadotropin, including subunit assembly and stability, secretion, circulatory half-life and biological activity. Carbohydrate heterogeneity in FSH comes in two forms, microheterogeneity, which results from variations in the carbohydrate structural complexity in those oligosaccharides attached to the α- or β-subunit of the hormone and macroheterogeneity, which results from the absence of carbohydrate chain at FSHβ Asn-glycosylation sites. A number of in vitro and in vivo studies have conclusively demonstrated differential, unique and even opposing effects provoked by variations in the carbohydrate structures of FSH, including circulatory survival, binding to and activation of its cognate receptor in the gonads, intracellular signaling, and activation/inhibition of a number of FSH-regulated genes essential for follicle development. Herein, we review the effects of the FSH oligosaccharides on several functions of FSH, and how variations in these structures have been shown to lead to functional selectivity of the hormone.
卵泡刺激素(FSH)或促卵泡激素在包括人类在内的多种哺乳动物中发挥着重要作用。这种促性腺激素由垂体前叶分泌,主要作用靶点是卵巢的颗粒细胞和睾丸的Sertoli细胞。从结构上看,FSH 由两个非等价连接的亚基(α- 和 β-亚基)以及高度异源的寡糖结构组成,这些结构在决定激素的一系列生理和生物学特征方面起着关键作用。FSH 和其他属于糖蛋白激素家族的成员中的糖基化对促性腺激素的许多功能至关重要,包括亚基的组装和稳定性、分泌、循环半衰期和生物活性。FSH 中的碳水化合物异质性有两种形式,一种是微异质性,即附着在激素 α 或 β 亚基上的低聚糖的碳水化合物结构复杂性发生变化;另一种是大异质性,即 FSHβ Asn-糖基化位点上没有碳水化合物链。许多体外和体内研究已证实,FSH碳水化合物结构的变化会产生不同、独特甚至相反的效应,包括循环存活、与其性腺中的同源受体结合并激活、细胞内信号传导以及激活/抑制卵泡发育所必需的一系列FSH调控基因。在此,我们回顾了 FSH 寡糖对 FSH 几种功能的影响,以及这些结构的变化如何导致激素的功能选择性。
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引用次数: 0
Therapeutic PCSK9 targeting: Inside versus outside the hepatocyte? 治疗性PCSK9靶向:肝细胞内还是肝细胞外?
IF 12 1区 医学 Q1 PHARMACOLOGY & PHARMACY Pub Date : 2025-02-11 DOI: 10.1016/j.pharmthera.2025.108812
Alberto Corsini , Henry N. Ginsberg , M. John Chapman
As a major regulator of LDL receptor (LDLR) activity and thus of LDL-cholesterol (LDL-C) levels, proprotein convertase subtilisin/kexin type 9 (PCSK9) represents an obvious therapeutic target for lipid lowering. The PCSK9 inhibitors, alirocumab and evolocumab, are human monoclonal antibodies (mAbs) that act outside the cell by complexing circulating PCSK9 and thus preventing its binding to the LDLR. In contrast, inclisiran, a small interfering RNA (siRNA), inhibits hepatic synthesis of PCSK9, thereby resulting in reduced amounts of the protein inside and outside the cell. Both approaches result in decreased plasma LDL-C concentrations and improved cardiovascular outcomes. Marginally superior LDL-C reduction (≈ 60 %) is achieved with mAbs as compared to the siRNA (≈ 50 %); head-to-head comparisons are required to confirm between-class differences in efficacy. Both drug classes have shown variability in LDL-C lowering response between individuals in waterfall analyses. Whereas mAb-mediated inhibition leads to a compensatory increase in plasma PCSK9 levels, siRNA treatment reduces them. These agents differ in their pharmacokinetic and pharmacodynamic features, which may translate into distinct clinical opportunities under acute (e.g. acute coronary syndromes) as compared to chronic conditions. Both drug classes provide additional reduction in LDL-C levels (up to 50 %) beyond those achieved with statin therapy, facilitating attainment of guideline-recommended LDL-C goals in high and very high-risk patients. Additional PCSK9 inhibitors, including an oral macrocyclic peptide, a small PCSK9 binding protein and a novel small molecule, plus hepatic gene editing of PCSK9, are under development. This review critically appraises pharmacological strategies to target PCSK9 either inside or outside the cell.
作为低密度脂蛋白受体(LDLR)活性和LDL-胆固醇(LDL- c)水平的主要调节因子,枯草素/蛋白转化酶9 (PCSK9)是一个明显的降脂治疗靶点。PCSK9抑制剂alirocumab和evolocumab是人单克隆抗体(mab),通过络合循环PCSK9在细胞外起作用,从而阻止其与LDLR结合。相反,小干扰RNA (siRNA) inclisiran抑制PCSK9的肝脏合成,从而导致细胞内外蛋白质量减少。两种方法均可降低血浆LDL-C浓度,改善心血管预后。与siRNA(≈50 %)相比,单克隆抗体的LDL-C降低率(≈60 %)略优于siRNA(≈50 %);需要进行头对头比较,以确认不同类别之间的疗效差异。在瀑布分析中,这两类药物在个体之间的LDL-C降低反应中表现出可变性。单克隆抗体介导的抑制导致血浆PCSK9水平代偿性增加,而siRNA治疗可降低PCSK9水平。这些药物的药代动力学和药效学特征不同,与慢性疾病相比,这可能在急性(如急性冠状动脉综合征)下转化为不同的临床机会。与他汀类药物治疗相比,这两种药物都能进一步降低LDL-C水平(高达50% %),有助于实现指南推荐的高危患者LDL-C目标。其他PCSK9抑制剂,包括口服大环肽、PCSK9小结合蛋白和一种新型小分子,以及PCSK9的肝脏基因编辑,正在开发中。这篇综述批判性地评价了针对PCSK9细胞内外的药理学策略。
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引用次数: 0
Insights into the results of Resmetirom trials: Can a thyroid hormone receptor agonist be the holy grail of MASH therapy? 雷司替龙试验结果的见解:甲状腺激素受体激动剂能否成为MASH治疗的圣杯?
IF 12 1区 医学 Q1 PHARMACOLOGY & PHARMACY Pub Date : 2025-02-10 DOI: 10.1016/j.pharmthera.2025.108811
Konstantinos Arvanitakis , Theocharis Koufakis , Evangelos Cholongitas , Sven Francque , Georgios Germanidis
Despite the heavy individual patient and socioeconomic burden of metabolic dysfunction-associated steatohepatitis (MASH), until recently, no pharmacological therapy for MASH was approved, with available treatment options geared towards associated cardiometabolic risk factors. Accelerated approval of resmetirom, a thyroid hormone receptor-β agonist to be used in conjunction with diet and exercise, marks a significant step forward in the treatment of MASH, offering tempered optimism to healthcare providers and millions of patients around the world for more effective management. Evidence from phase 2 and 3 clinical trials suggests that resmetirom has the potential to alleviate hepatic fibrosis and inflammation and significantly reduce liver lipid content. Notwithstanding this landmark event, the clinical implementation of resmetirom comes with important challenges, for example, ensuring patient access to treatment and demonstrating effects on hard MASH-related outcomes, such as progression to cirrhosis and hepatocellular carcinoma. Additional considerations include the evaluation of co-administration with other hepatoprotective treatments and the assessment of the efficacy in specific MASH sub-phenotypes. Furthermore, the accumulation of real-world data and experience is expected to help answer the remaining questions about the (long-term) effectiveness and safety profile of the drug. The purpose of this article is to provide an updated and critical review of the mechanisms of action, efficacy, and safety of resmetirom based on the latest clinical trials, to define its place within the broader landscape of MASH management, and to highlight current knowledge gaps and opportunities for future research in the field.
尽管代谢功能障碍相关脂肪性肝炎(MASH)的个体患者和社会经济负担沉重,但直到最近,还没有针对MASH的药物治疗被批准,现有的治疗方案针对相关的心脏代谢危险因素。雷司替罗是一种甲状腺激素受体-β激动剂,可与饮食和运动联合使用,加速批准标志着MASH治疗向前迈出了重要一步,为医疗保健提供者和全球数百万患者提供了更有效的管理。来自2期和3期临床试验的证据表明,雷司替龙有可能减轻肝纤维化和炎症,并显着降低肝脏脂质含量。尽管取得了这一里程碑式的成就,但雷司替龙的临床应用仍面临着重大挑战,例如,确保患者获得治疗,并证明其对肝硬化和肝细胞癌进展等硬相关性结局的影响。其他考虑因素包括评估与其他肝保护治疗的联合给药以及评估特定MASH亚表型的疗效。此外,实际数据和经验的积累有望帮助回答有关药物(长期)有效性和安全性的剩余问题。本文的目的是根据最新的临床试验,对雷司替米的作用机制、疗效和安全性进行最新的批判性回顾,以确定其在更广泛的MASH管理领域中的地位,并强调当前的知识差距和该领域未来研究的机会。
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引用次数: 0
From barbiturates to ganaxolone: The importance of chirality in drug development and in understanding the actions of old and new antiseizure medications 从巴比妥类药物到加那洛酮:手性在药物开发中的重要性以及对新旧抗癫痫药物作用的理解。
IF 12 1区 医学 Q1 PHARMACOLOGY & PHARMACY Pub Date : 2025-02-05 DOI: 10.1016/j.pharmthera.2025.108808
Meir Bialer , Emilio Perucca
Out of 37 antiseizure medications (ASMs) currently in the market, 17 are chiral molecules and an additional one (oxcarbazepine) is a prodrug of the chiral compound licarbazepine. Of the 17 chiral ASMs, six (ethosuximide, fenfluramine, methsuximide, mephobarbital, stiripentol and vigabatrin) are marketed as racemates, and the remainder are licensed as enantiomerically pure medicines. Of note, all chiral ASMs introduced prior to 1990 were marketed as racemates. Stiripentol, fenfluramine and vigabatrin are the only racemic ASMs approved by the FDA >10 years after the release of regulatory guidelines on the development of chiral medicines. Despite the fact that pharmacokinetic and pharmacodynamic differences between enantiomers have been recognized for decades, the importance of chirality in understanding the biological actions of ASMs is not widely appreciated, and many recent publications on racemic ASMs refer to these medications as if they were a single molecular entity. In the present article, we provide a critical review of chiral ASMs developed between the 1920s, when mephobarbital was introduced, and 2022, when the last chiral ASM (ganaxolone) was approved. We summarize available data on stereoselective differences in pharmacokinetics and pharmacodynamics of ASMs marketed as racemates. We also discuss regulatory aspects related to the introduction of racemic medicines within the current regulatory scenario in Europe and the U.S., focusing on stiripentol, vigabatrin and fenfluramine as examples of different approaches. We identified a number of critical knowledge gaps that are relevant to the use of chiral drugs in epilepsy, including a remarkable lack of published information on the comparative pharmacokinetics, toxicity and antiseizure activity of the enantiomers of most racemic ASMs. The importance of chirality aspects in understanding the clinical actions of racemic ASMs is discussed, together with the rationale for the development of enantiomerically pure follow-up compounds with potentially improved efficacy, safety and commercial viability.
在目前市场上的37种抗癫痫药物中,17种是手性分子,另外一种(奥卡西平)是手性化合物利卡巴西平的前药。在17种手性镇痛药中,有6种(乙索克肟胺、芬氟拉明、甲索克肟胺、甲比巴比妥、斯立哌醇和维加巴丁)作为外消旋物销售,其余的作为对映体纯药物获得许可。值得注意的是,1990年之前引入的所有手性asm都是外消旋物。Stiripentol、fenfluramine和vigabatrin是继手性药物开发监管指南发布后,FDA于2010年 年批准的仅有的外消旋性ASMs。尽管对映体之间的药代动力学和药效学差异已经被认识了几十年,但手性在理解asm的生物作用中的重要性并没有得到广泛的认识,最近许多关于外消旋asm的出版物将这些药物视为单个分子实体。在本文中,我们对20世纪20年代甲比妥被引入到2022年最后一种手性ASM(加那洛酮)被批准的手性ASM进行了批判性回顾。我们总结了作为外消旋体销售的asm在药代动力学和药效学方面的立体选择性差异的现有数据。我们还讨论了在欧洲和美国目前的监管情况下,与引入外消旋药物相关的监管方面,重点介绍了施曲妥醇、维加巴林和芬氟拉明作为不同方法的例子。我们发现了一些与手性药物在癫痫中的使用相关的关键知识空白,包括大多数外消旋性抗癫痫药的对映体的比较药代动力学、毒性和抗癫痫活性的公开信息的显著缺乏。讨论了手性方面在理解外消旋性asm临床作用中的重要性,以及开发具有潜在提高疗效、安全性和商业可行性的对映体纯后续化合物的基本原理。
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引用次数: 0
Understanding the molecular bridges between the drugs and immune cell 了解药物和免疫细胞之间的分子桥梁
IF 12 1区 医学 Q1 PHARMACOLOGY & PHARMACY Pub Date : 2025-02-04 DOI: 10.1016/j.pharmthera.2025.108805
Umesh Chandra Dash , Vinayak Nayak , Hiten Shanker Navani , Rashmi Rekha Samal , Palak Agrawal , Anup Kumar Singh , Sanatan Majhi , Devraj Ganpat Mogare , Asim K. Duttaroy , Atala Bihari Jena
The interactions of drugs with the host's immune cells determine the drug's efficacy and adverse effects in patients. Nonsteroidal Anti-Inflammatory Drugs (NSAID), such as corticosteroids, NSAIDs, and immunosuppressants, affect the immune cells and alter the immune response. Molecularly, drugs can interact with immune cells via cell surface receptors, changing the antigen presentation by modifying the co-stimulatory molecules and interacting with the signaling pathways of T cells, B cells, Natural killer (NK) cells, mast cells, basophils, and macrophages. Immunotoxicity, resulting from drug-induced changes in redox status, generation of Reactive Oxygen Species (ROS)/Reactive Nitrogen Species (RNS), and alterations in antioxidant enzymes within immune cells, leads to immunodeficiency. This, in turn, causes allergic reactions, autoimmune diseases, and cytokine release syndrome (CRS). The treatment options should include the evaluation of immune status and utilization of the concept of pharmacogenomics to minimize the chances of immunotoxicity. Many strategies in redox, like targeting the redox pathway or using redox-active agents, are available for the modulation of the immune system and developing drugs. Case studies highlight significant drug-immune cell interactions and patient outcomes, underscoring the importance of understanding these complexities. The future direction focuses on the drugs to deliver antiviral therapy, new approaches to immunomodulation, and modern technologies for increasing antidote effects with reduced toxicity. In conclusion, in-depth knowledge of the interaction between drugs and immune cells is critical to protect the patient from the adverse effects of the drug and improve therapeutic outcomes of the treatment process. This review focuses on the multifaceted interactions of drugs and their consequences at the cellular levels of immune cells.
药物与宿主免疫细胞的相互作用决定了药物对患者的疗效和不良反应。非甾体抗炎药(NSAID),如皮质类固醇、非甾体抗炎药和免疫抑制剂,会影响免疫细胞并改变免疫反应。在分子上,药物可以通过细胞表面受体与免疫细胞相互作用,通过修饰共刺激分子改变抗原呈递,并与T细胞、B细胞、自然杀伤细胞(NK)细胞、肥大细胞、嗜碱性粒细胞和巨噬细胞的信号通路相互作用。免疫毒性是由药物引起的氧化还原状态的改变、活性氧(ROS)/活性氮(RNS)的产生以及免疫细胞内抗氧化酶的改变导致免疫缺陷。这反过来又会引起过敏反应、自身免疫性疾病和细胞因子释放综合征(CRS)。治疗方案应包括免疫状态的评估和利用药物基因组学的概念,以尽量减少免疫毒性的机会。许多氧化还原策略,如靶向氧化还原途径或使用氧化还原活性药物,可用于调节免疫系统和开发药物。案例研究强调了重要的药物免疫细胞相互作用和患者结果,强调了理解这些复杂性的重要性。未来的方向集中在提供抗病毒治疗的药物,免疫调节的新方法,以及增加解毒剂作用和降低毒性的现代技术。总之,深入了解药物与免疫细胞之间的相互作用对于保护患者免受药物不良反应的影响并改善治疗过程的治疗结果至关重要。这篇综述着重于药物的多方面相互作用及其在免疫细胞水平上的后果。
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引用次数: 0
Targeting TAK1: Evolution of inhibitors, challenges, and future directions 靶向TAK1:抑制剂的发展、挑战和未来方向。
IF 12 1区 医学 Q1 PHARMACOLOGY & PHARMACY Pub Date : 2025-02-03 DOI: 10.1016/j.pharmthera.2025.108810
Nika Strašek Benedik , Matic Proj , Christian Steinebach , Matej Sova , Izidor Sosič
The increasing incidence of inflammatory and malignant diseases signifies the need to develop first-in-class drugs with novel mechanisms of action. In this respect, the transforming growth factor (TGF)-β-activated kinase 1 (TAK1), an essential part of several signaling pathways, is considered relevant and promising. This manuscript provides a brief overview of the signal transduction orchestrated by TAK1 within these pathways, followed by an in-depth and thorough analysis of the chemical matter demonstrated to inhibit this kinase. Special attention is given to the selectivity profiling of inhibitors, as well as to the outcomes of their biological characterization. Because published TAK1 inhibitors differ significantly in their kinome selectivity, active-site binding, and biological activity, we hope that this review will allow a judicial estimation of their quality and usefulness for TAK1-addressing assays. Our thoughts on the perspectives and possible developments of the field are also provided to assist scientists who are involved in the design and development of TAK1-targeting modulators.
炎症和恶性疾病的发病率不断增加,这意味着需要开发具有新型作用机制的一流药物。在这方面,转化生长因子(TGF)-β-活化激酶1 (TAK1)作为几个信号通路的重要组成部分,被认为是相关的和有前途的。本文简要概述了TAK1在这些途径中的信号转导,然后对抑制这种激酶的化学物质进行了深入和彻底的分析。特别注意抑制剂的选择性分析,以及其生物学表征的结果。由于已发表的TAK1抑制剂在其激酶体选择性、活性位点结合和生物活性方面存在显著差异,我们希望这篇综述将允许对它们的质量和对TAK1定位测定的有用性进行公正的评估。我们对该领域的观点和可能的发展的想法也提供给参与tak1靶向调节剂的设计和开发的科学家。
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引用次数: 0
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Pharmacology & Therapeutics
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