Phencyclidine has attracted the attention of neuroscientists for many years because of its ability to produce, in humans, a range of symptoms remarkably similar to those of patients suffering from schizophrenia. The main action of phencyclidine is as a non-competitive antagonist of the NMDA class of glutamate receptor. In the past few years, dramatic advances have been made in our understanding of the neuroanatomical and pathological basis of schizophrenia. In turn, these have allowed assessment of the ability of phencyclidine to produce equivalent changes in the rodent CNS. It has now become clear that chronic intermittent low doses of phencyclidine produce a pattern of metabolic and neurochemical changes in the rodent brain that mirror those observed in the brains of schizophrenic patients with impressive precision. This should be of enormous benefit in the search for new anti-psychotic drugs with improved efficacy against the full range of schizophrenic symptoms.
Schizophrenia might be considered a neurodevelopmental disease. However, the fundamental process(es) associated with this disease remain(s) uncertain. Many lines of evidence suggest that schizophrenia is associated with excessive stimulation of dopamine D2 receptors in the associative striatum, with a lack of stimulation of dopamine D1 receptors in prefrontal cortex, and with modifications in prefrontal neuronal connectivity involving glutamate transmission at N-methyl aspartate (NMDA) receptors. This article, whilst briefly discussing the current knowledge of the disease, mainly concentrates on the NMDA hypofunction hypothesis. However, there are also potential consequences for a Dopamine imbalance on NMDA function. Thus, it is proposed that schizophrenia has a complex aetiology associated with strongly interconnected aberrations of dopamine and glutamate transmission.
While many pharmacological agents have been shown to protect the brain from cerebral ischemia in animal models, none have translated successfully to human patients. One potential clinical neuroprotective strategy in humans may involve increasing the brain's tolerance to ischemia by preischemic conditioning (preconditioning). There are many methods to induce tolerance via preconditioning such as ischemia itself, pharmacological, hypoxia, endotoxin, and others. Inhalational anesthetic agents have also been shown to result in brain preconditioning. Mechanisms responsible for brain preconditioning are many, complex, and unclear and may involve Akt activation, ATP-sensitive potassium channels, and nitric oxide, amongst many others. Anesthetics, however, may play an important and unique role as preconditioning agents, particularly during the perioperative period.
Pharmacological agents have shown limited efficacy and consistency in the treatment of drug addiction. Hence, the development of new medications with improved long-term efficacy and reduced side effects should be given a high priority given the costs to society associated with drug abuse and drug-related pathologies. Neurochemical systems can be significantly altered by repeated exposure to drugs of abuse. These long-term molecular and neurochemical changes might, in turn, explain the core features of addiction--the compulsive seeking and taking of the drug--as well as the risk of relapse.
The main class of atypical antipsychotic drugs (APDs) in current use includes the protypical atypical APD, clozapine, as well as aripiprazole, asenapine, iloperidone, lurasidone, olanzapine, quetiapine, risperidone, and ziprasidone. At clinically effective doses, these agents produce extensive blockade of serotonin (5-HT)(2A) receptors, direct or indirect stimulation of 5-HT(1A) receptors, and to a lesser extent, reduction in dopamine (DA) D(2) receptor-mediated neurotransmission. This contrasts with typical APDs, for example haloperidol and perphenazine, which are mainly DA D(2/)D(3) receptor antagonists and have weaker, if any, potency as 5-HT(2A) receptor antagonists. Some, but not all, atypical APDs are also effective 5-HT(2C) receptor inverse agonists or neutral antagonists, 5-HT(6) or 5-HT(7) receptor antagonists. This diverse action on 5-HT receptors may contribute to significant differences in efficacy and tolerability among the atypical APDs. There is considerable preclinical and some clinical evidence that effects on 5-HT receptors contribute to the low risk of producing extrapyramidal side effects, which is the defining characteristic of an atypical APD, the lack of elevation in plasma prolactin levels (with risperidone and 9-hydroxyrisperidone being exceptions), antipsychotic action, and ability to improve some domains of cognition in patients with schizophrenia. The serotonergic actions of the atypical APDs, especially 5-HT(2A) receptor antagonism, are particularly important to the differential effects of typical and atypical APDs to overcome the effects of acute or subchronic administration of N-methyl-d-aspartate (NMDA) receptor antagonists, such as phencyclidine, ketamine, and dizocipline (MK-801). 5-HT(1A) receptor stimulation and 5-HT(6) and 5-HT(7) receptor antagonism may contribute to beneficial effects of these agents on cognition. In particular, 5-HT(7) receptor antagonism may be the basis for the pro-cognitive effects of the atypical APD, amisulpride, a D(2)/D(3) receptor antagonist, which has no effect on other 5-HT receptor. 5-HT(2C) receptor antagonism appears to contribute to the weight gain produced by some atypical APDs and may also affect cognition and psychosis via its influence on cortical and limbic dopaminergic activity.
Market launching of a new antibiotic requires knowing in advance its benefits and possible risks, and among them how rapidly resistance will emerge and spread among bacterial pathogens. This information is not only useful from a public health point of view, but also for pharmaceutical industry, in order to reduce potential waste of resources in the development of a compound that might be discontinued at the short term because of resistance development. Most assays currently used for predicting the emergence of resistance are based on culturing the target bacteria by serial passages in the presence of increasing concentrations of antibiotics. Whereas these assays may be valuable for identifying mutations that might cause resistance, they are not useful to establish how fast resistance might appear, neither to address the risk of spread of resistance genes by horizontal gene transfer. In this article, we review recent information pertinent for a more accurate prediction on the emergence and dispersal of antibiotic resistance.
11beta-hydroxysteroid dehydrogenases (11beta-HSDs) catalyse the interconversion of active cortisol and inert cortisone. Two isozymes have been discovered, each with unique properties and powerful biological roles. 11beta-HSD2 potently inactivates cortisol, protecting key tissues. By contrast, 11beta-HSD1 regenerates cortisol, amplifying its actions in liver, fat and brain. Overexpression of this isozyme may contribute to the pathogenesis of the metabolic syndrome. Its inhibition is a potential therapeutic target for both metabolic and glucocorticoid-associated CNS disorders.
For decades it has been thought that a neuron releases only one classical neurotransmitter from all of its processes. However, recent work has shown that most neuronal populations release more than one classical transmitter, and indeed that the transmitters can be segregated into different processes of the same neuron. Glutamate and gamma-aminobutyric acid, the major excitatory and inhibitory neurotransmitters in the mammalian central nervous system, appear to be co-released with most other transmitters, as well as with each other. The release of multiple transmitters by the same neuron enhances the spatial and temporal control of synaptic transmission. Moreover, dynamic regulation of neurotransmitter phenotypes increases the plasticity of neurotransmission, indicating potential avenues for therapeutic intervention.
Systemic glucocorticoid excess causes osteoporosis, insulin resistance and central obesity. Recently it has been recognized that tissue glucocorticoid levels can increase independently of circulating levels. This occurs through increased activity of the 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) enzyme which is expressed in bone, synovium, liver and adipose tissue. Mice with global 11β-HSD1 deletion exhibit increased severity of experimental arthritis. However, selective disruption of glucocorticoid signalling in osteoblasts and osteocytes attenuates murine experimental arthritis. In addition, such mice are protected against the adverse metabolic features caused by glucocorticoid excess. Taken together, these results indicate that bone cells, through local glucocorticoid signalling, are involved in the regulation of joint inflammation as well as systemic fuel metabolism. Clinical studies have demonstrated that specific inhibitors of 11β-HSD1 improve insulin sensitivity and reduce weight, suggesting that inhibition of this glucocorticoid-activating enzyme may have applications for treating the adverse metabolic features associated with rheumatic disease.
The intramembrane receptor-receptor interactions among GPCRs demonstrated in the beginning of the 80s in the CNS probably reflect the existence of allosteric mechanisms in receptor heteromers, and the postulated assemblies of multiple GPCRs coined 'receptor mosaics' in the early 80s probably represent higher order receptor heteromers, recently demonstrated with novel biophysical techniques in living cells. The receptor interface in the GPCR heteromers is beginning to be characterized and in adenosine A(2A)-dopamine D(2)-like heteromers the electrostatic arginine-phosphate salt bridge seems to be a hot spot in the interface with covalent-like stability, possibly participating in the allosteric interactions and making possible integration of heteromer receptor function. We discuss the possible relevance of some putative D(2) receptor heteromers in the treatment of Parkinson's disease and schizophrenia, respectively.
It is increasingly being appreciated that GABAA receptor subtypes, through their specific regional, cellular and subcellular localization, are linked to distinct neuronal circuits and consequently serve distinct functions. GABAA receptor subtype-selective drugs are therefore expected to provide novel pharmacological profiles. Receptors containing the alpha1 subunit mediate sedation and serve as targets for sedative hypnotics. Agonists selective for alpha2- and/or alpha3-containing GABAA receptors have been shown to provide anxiolysis without sedation in preclinical models, whereas inverse agonists selective for alpha5-containing GABAA receptors provide memory enhancement. Agonists selective for alpha3-containing GABAA receptors might be suitable for the treatment of deficits in sensorimotor processing in psychiatric disorders. Thus, a new pharmacology based on GABAA receptor subtype-specific actions is emerging.
Current treatment for atherosclerotic heart disease consists mainly of the administration of 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors or 'statin' class of drugs. Statins, which lower low-density lipoprotein cholesterol levels and have numerous other effects in the arterial wall, have shown remarkable efficacy and an exemplary safety profile in preventing both primary and secondary atherosclerotic events. These agents, however, are less effective at raising high-density lipoprotein, lowering triglycerides and decreasing insulin resistance--all of which are important targets for the prevention of ischemic vascular disease. Agonists of the peroxisome proliferator-activated receptors (PPARs) are among the most promising drug candidates to target these treatment gaps. Only PPARalpha agonists have been shown clinically to improve the outcome of atherosclerotic heart disease; however, it will only be a matter of time before we know whether compounds that modulate the function of PPARgamma and beta/delta are also efficacious at combating atherosclerosis.
Chronic vulnerability to relapse is a formidable challenge for the treatment of drug addiction. The neurobiological basis of relapse and its prevention has, therefore, attracted major attention in addiction research. Current conceptualizations of addiction recognize craving as a central driving force for ongoing drug use, as well as for relapse following abstinence. Progress has been made in understanding experiential factors, neurocircuitry components and signaling mechanisms that mediate conditioned drug-seeking behaviour, craving and long-lasting susceptibility to relapse. Importantly, stress contributes to drug craving, and there is evidence for overlap between the neural and neuroendocrine mechanisms implicated in drug desire evoked by drug cues and stress. Recent research has substantially advanced our understanding of the neurobiological factors responsible for drug craving and relapse, with promising therapeutic implications.
As pointed out by Nishimura , angiotensin II (Ang II) is an ancient peptide, even found in some primitive vertebrates and most probably evolved as a regulator of salt and water balance. Since the discovery of a pressor agent emanating from the mammalian kidney [2,3] focus on the rennin–angiotensin system (RAS) has been pivotal in fostering our understanding of the pathogenesis of a variety of cardiovascular and renal diseases. In this issue of Current Opinion in Pharmacology the emphasis is on novel mechanisms that involve the RAS and the mechanisms of its diverse functions. In a recent Pub Med search (1/28/2011) the term ‘angiotensin’ found 94,836 papers published since 1945. The impact of the physiology and pharmacology surrounding this peptide and its receptors is enormous. The treatment of hypertension and chronic heart failure has been revolutionized by drugs that target the production of Ang II and the blockade of its primary membrane target, the AT1 receptor. Angiotensin Converting Enzyme (ACE) Inhibitors and Ang II receptor blockers result in significant reductions in mortality and cardiovascular events for patients with hypertension and heart failure [4,5].
The development of the novel γ-aminobutyric acid type-B receptor (GABAB) agonist lesogaberan is presented as an example of a partly successful translational strategy in the field of gastroenterology. Data on transient lower esophageal sphincter relaxations (TLESRs) and gastroesophageal reflux inhibition from preclinical models translated well to clinical studies in healthy volunteers and patients with gastroesophageal reflux disease (GERD). Animal models have also been used successfully to predict the effect of other target mechanisms on TLESRs in humans. However, while translation of physiology to symptomatology in patients with GERD was achieved, the effect size was too small to be of clinical significance. A deeper understanding of the cause of symptoms in different patient categories is therefore required.
Combinations of beta-lactams and beta-lactamase inhibitors have become one of the most successful antibacterial strategies in our global battle against bacterial infections. The success of these agents is particularly emphasized by the continued efficacy of Augmenting (amoxicillin and clavulanate) after nearly 20 years of clinical use. The clinical situation now dictates that second-generation beta-lactamase inhibitors capable of encompassing both class A and class C beta-lactamases would combat emerging resistance and provide a vital addition to our armory of hospital antibiotics. This realization has generated a renewed interest in beta-lactamase inhibitors and improved the prospects for the delivery of such agents in the future.
Cytokines play a major role in maintaining lymphocyte homeostasis under both steady-state and inflammatory conditions. Unregulated lymphocytes in steady-state conditions can lead to autoimmunity, whereas during inflammation they can cause excessive tissue damage. Regulatory cytokines function in combination with other environmental signals to properly modulate the function and the extent of lymphocyte activation. Many recent studies have highlighted the importance of regulatory cytokines in controlling the differentiation and function of lymphocytes under steady-state and inflammatory conditions, as well as minimizing tissue damage.
Increasing evidence suggests that bipolar disorder (BPD) is associated with regional brain volumetric reductions, accompanied by cellular atrophy and/or loss. Considerable data suggest that the protypical drugs for BPD--lithium and valproate--when administered in therapeutically relevant paradigms regulate neurotrophic signaling cascades. Notably, brain-derived neurotrophic factor, the extracellular signal-regulated kinase pathway, the glycogen synthase kinase-3-mediated pathway and Bcl-2 are major targets for mood stabilizers. Further data suggest that agents which directly target neurotrophic signaling cascades may have considerable utility for the treatment of this devastating illness.
Particular therapeutic challenges are raised by the spondyloarthropathies which represent a key area of unmet medical need. Recent investigations have shown that these conditions are characterised both by altered responsiveness to interleukin(IL)-23 and expansion of IL-23 responsive cells as well as increased production of IL-23. The gut in particular has emerged as a key site of IL-23 production, and gut inflammation is known to be strongly clinically associated with these conditions. Moreover, HLA-B27, which is strongly associated with spondyloarthropathy, has also been shown to stimulate IL-23 production. The view is thus emerging that dysregulation of IL-23 biology is a unifying feature of spondyloarthropathy, suggesting that treatments targeting this cytokine are likely to be highly efficacious.
Corticotropin-releasing factor (CRF) and its related family members are implicated in stress-related disorders such as anxiety and depression. Recently, two new members of this neuropeptide family have been discovered in the brain: urocortin II (also known as stresscopin-related peptide) and urocortin III (also known as stresscopin). These urocortins are selective agonists for the CRF(2) receptor, show a distinct neuroanatomical localization and are involved in stress-coping responses such as anxiolysis. Thus, CRF, the urocortins and their receptors form an intricate network in the brain involved in the acute phase as well as the recovery phase of the stress response.
Benzodiazepine (BZ) anxiolytics mediate their clinical effects by enhancing the effect of gamma-aminobutyric acid (GABA) at the GABA-A receptor. Classical BZ full agonists such as diazepam, which maximally enhance the function of GABA-A receptors, are effective anxiolytics but carry unwanted side effects including sedation, dependence and abuse liability, limiting their utility. Although a second generation of 'partial agonist' BZs have been pursued, promising preclinical data, in terms of anxiolytic efficacy and decreased unwanted effects, have so far failed to translate to the clinic. Following the insights into GABA-A receptor subtypes mediating the effects of BZs, a third generation of 'receptor subtype-selective' BZ site ligands have been developed. However, it remains to be determined whether promising preclinical data are recapitulated in the clinic.
Inflammatory cells are thought to be instrumental in the pathophysiology of pulmonary diseases, and control of their recruitment and activation in the lung would appear to be an attractive strategy for therapeutic intervention. Interleukin-8 and related CXC chemokines are involved in the function of neutrophils and T cells, and have been implicated in several lung diseases. Small-molecule antagonists of the interleukin-8 receptors have been identified, which may help elucidate the role of interleukin-8 and related chemokines in the pathophysiology of lung diseases.
Steroid insensitivity in severe asthma is rare but has huge health care costs. Thus, 5% of asthmatic patients account for approximately 50% of total health care costs. Incorrect diagnosis, non-compliance with therapy and psychological problems are all confounding issues, and can account for a failure to respond to steroids in many of these patients. A recent report (ENFUMOSA) has suggested that severe asthma, of which steroid-resistant asthma is a component, consists of at least one, possibly more, distinct disease(s) with differing pathologies. Future studies such as Bio-Air and TENOR could confirm this; therefore, it is not surprising that well-characterised steroid-resistant and steroid-dependent asthma have multiple mechanisms to account for a lack of steroid sensitivity, including defective ligand binding to the steroid receptor, abnormal receptor nuclear translocation and abnormal association with pro-inflammatory nuclear proteins. Distinct treatments might have to be tailored to the individual patient; for example, drugs that enhance receptor nuclear translocation will only be effective in patients in whom this is a problem. Once issues of diagnosis, compliance and psychological disorders have been resolved, true steroid resistance or dependence is unlikely to be an issue for most clinicians, who will rarely, if ever, see these patients. However, management of those few patients with true steroid resistance will require novel therapies tailored to specific subgroups of patients.
Botulinal neurotoxins (BoNTs) produced by anaerobic bacteria of the genus Clostridium are the most toxic proteins known, with mouse LD(50) values in the range of 1-5 ng/kg. They are responsible for the pathophysiology of botulism. BoNTs are metalloproteinases that enter peripheral cholinergic nerve terminals, where they cleave one or two of the three core proteins of the neuroexocytosis apparatus and elicit persistent but reversible inhibition of neurotransmitter release. Their specificity of action has made them useful therapeutic agents for many human syndromes caused by hyperactivity of cholinergic nerve terminals. Their range of clinical applications is continuously growing, and BoNT/A is being used extensively as a pharmaco-cosmetic.
Myostatin, which was cloned in 1997, is a potent inhibitor of skeletal muscle growth and member of the tumour growth factor-beta family. Disruption of the myostatin gene in mice induces a dramatic increase in muscle mass, caused by a combination of hypertrophy and hyperplasia. Natural mutations occurring in cattle were also associated with a significant increase in muscle mass and, recently, an inactivating myostatin mutation associated with the same phenotype was identified in humans. Studies into the molecular basis of this antimyogenic influence led to the conclusion that myostatin inhibits myoblast proliferation and differentiation through a classical tumour growth factor-beta pathway involving the activin receptor ActRIIB and Smads 2 and 3. Approaches that induce myostatin depletion or inactivation have led to a significant improvement in muscle regeneration processes, especially in degenerative diseases, through stimulation of satellite cell proliferation and differentiation. These promising data open the way to new therapeutic approaches in muscle diseases through targeting of the myostatin pathway.
Increasing evidence is accumulating for the importance of the aggrecanases ADAMTS-4 and ADAMTS-5 in cartilage degradation in arthritis. Recent work from a number of laboratories has begun to provide insight into the regulation of the expression and activity of these proteins and the molecular basis of their role in aggrecan catabolism. Recombinant ADAMTS-4 and ADAMTS-5 cleave aggrecan at five distinct sites along the core protein and aggrecan fragments generated by cleavage at all of these sites have been identified in cartilage explants undergoing matrix degradation. This proteolytic activity of the aggrecanases can be modulated by several means, including altered expression, activation by proteolytic cleavage at a furin-sensitive site, binding to the aggrecan substrate through the C-terminal thrombospondin motif, activation through post-translational processing of a portion of the C-terminus and inhibition of activity by the endogenous inhibitor TIMP-3. ADAMTS-4 and ADAMTS-5 activity is detected in joint capsule and synovium in addition to cartilage, and may be upregulated in arthritic synovium at either the message level or through post-translational processing. Additional substrates have now been identified, including the chondroitin-sulfate proteoglycans brevican and versican. Finally, advances are occurring in the development of selective aggrecanase inhibitors designed to serve as therapeutics for the treatment of arthritis.
The neuromuscular junction lies beyond the protection of the blood-brain barrier and is particularly vulnerable to antibody-mediated attack. In myasthenia gravis, the expression of acetylcholine receptors (AChRs) in the thymus is under the control of the autoimmune regulator protein (AIRE), and polymorphisms in the AChR correlate with early onset of disease. In some 'AChR seronegative' patients, thymic abnormalities associated with complement-activating antibodies binding only clustered AChRs have been demonstrated, and in others anti-muscle-specific kinase (MuSK) antibodies that show pathogenic effects in vivo. In Guillain-Barré syndrome, newly described antibodies bind to complex gangliosides. General immunosuppression is still the main treatment, but novel treatments that reduce complement-mediated damage or inhibit the binding of pathogenic antibodies are beginning to look promising.
Evidence has emerged in the last two decades that at the molecular level most chronic diseases, including cancer, are caused by a dysregulated inflammatory response. The identification of transcription factors such as NF-kappaB, AP-1 and STAT3 and their gene products such as tumor necrosis factor, interleukin-1, interleukin-6, chemokines, cyclooxygenase-2, 5 lipooxygenase, matrix metalloproteases, and vascular endothelial growth factor, adhesion molecules and others have provided the molecular basis for the role of inflammation in cancer. These inflammatory pathways are activated by tobacco, stress, dietary agents, obesity, alcohol, infectious agents, irradiation, and environmental stimuli, which together account for as much as 95% of all cancers. These pathways have been implicated in transformation, survival, proliferation, invasion, angiogenesis, metastasis, chemoresistance, and radioresistance of cancer, so much so that survival and proliferation of most types of cancer stem cells themselves appear to be dependent on the activation of these inflammatory pathways. Most of this evidence, however, is from preclinical studies. Whether these pathways have any role in prevention, progression, diagnosis, prognosis, recurrence or treatment of cancer in patients, is the topic of discussion of this review. We present evidence that inhibitors of inflammatory biomarkers may have a role in both prevention and treatment of cancer.
Psoriasis is a common but severe skin disease with significant health consequences, both physical and psychological. Evidence has emerged during the past several years pointing to a key role for IL-36 in psoriasis. Overexpression of IL-36 in mouse skin leads to a disease quite similar to human plaque psoriasis, and inhibition of IL-36 in human psoriatic skin ameliorates the inflammation. Loss of the natural antagonist of IL-36, IL-36Ra, results in a different, more severe skin disease known as pustular psoriasis. These effects are likely a consequence of the actions of IL-36 both on cells of the immune system as well as on components of skin including fibroblasts and keratinocytes.
Recent advances in studies of nicotinic agents in humans have begun to more carefully define cognitive operations that can be influenced by nicotinic stimulation and/or blockade. Careful separation of the cognitive domains affected by nicotinic stimulation has identified attentional performance as the most likely candidate to be positively influenced by nicotinic receptor activation. Studies of the effects of nicotinic systems and/or nicotinic receptor stimulation in pathological disease states such as Alzheimer's disease, Parkinson's disease, attention deficit/hyperactivity disorder and schizophrenia show the potential for therapeutic utility of nicotinic drugs. In contrast to studies in pathological states, studies of nicotine in normal-non-smokers tend to show deleterious effects. This contradiction can be resolved by consideration of cognitive and biological baseline dependency differences between study populations in terms of the relationship of optimal cognitive performance to nicotinic receptor activity. Although normal individuals are unlikely to show cognitive benefits after nicotinic stimulation except under extreme task conditions, individuals with a variety of disease states can benefit from nicotinic drugs. Attentional function/dysfunction may serve as an endophenotypic therapeutic target for nicotinic drug development.
Poly (ADP-ribose) Polymerase (PARP) has a well-established role in DNA repair processes, and small molecule inhibitors of PARP have been developed as chemotherapy sensitisers for the treatment of cancer. The subsequent demonstration that PARP inhibition is selective for BRCA1 or BRCA2 deficiency suggests that PARP inhibitors may be particularly useful for the treatment of cancer with BRCA mutations. This would represent one of the first clinically implemented examples of a synthetic lethal approach for cancer treatment. However, there are still unanswered questions surrounding PARP inhibitors, namely the levels of specificity and potency that are required to elicit BRCA selectivity. The recent identification of mechanisms of cellular resistance to PARP inhibitors may provide indications as to how these drugs may be best used in the clinic.
The human glutathione S-transferase, GSTs, possess both enzymatic and non-enzymatic functions and are involved in many important cellular processes, such as, phase II metabolism, stress response, cell proliferation, apoptosis, oncogenesis, tumor progression and drug resistance. The non-enzymatic functions of GSTs involve their interactions with cellular proteins, such as, JNK, TRAF, ASK, PKC, and TGM2, during which, either the interacting protein partner undergoes functional alteration or the GST protein itself is post-translationally modified and/or functionally altered. The majority of GST genes harbor polymorphisms that influence their transcription and/or function of their encoded proteins. This overview focuses on recent insights into the biology and pharmacogenetics of GSTs as a determinant of cancer drug resistance and response of cancer patients to therapy.
Tubulin poisons were first discovered decades ago, but the recent clinical and commercial success of Taxol has led to a renaissance in the search for novel mitotic spindle poisons to treat cancer. Many tubulin poisons have been identified, but few have demonstrated clinical utility. Recent studies have begun to identify the factors that differentiate the efficacy of these agents. In addition, promising alternative approaches to targeting the mitotic spindle have been identified from detailed studies of mitotic regulation and mechanics.
Chronic obstructive pulmonary disease (COPD) and lung cancer are leading cause of death, and both are associated with cigarette smoke exposure. It has been shown that 50-70% of patients diagnosed with lung cancer suffer from COPD, and reduced lung function is an important event in lung cancer suggesting an association between COPD and lung cancer. However, a causal relationship between COPD and lung tumorigenesis is not yet fully understood. Recent studies have suggested a central role of chronic inflammation in the pathogenesis of both the diseases. For example, immune dysfunction, abnormal activation of NF-kappaB, epithelial-to-mesenchymal transition, altered adhesion signaling pathways, and extracellular matrix degradation/altered signaling are the key underlying mechanisms in both COPD and lung cancer. These parameters along with other processes, such as chromatin modifications/epigenetic changes, angiogenesis, and autophagy/apoptosis are altered by cigarette smoke, are crucial in the development of COPD and lung cancer. Understanding the cellular and molecular mechanisms underlying these processes will provide novel avenues for halting the chronic inflammation in COPD and devising therapeutic strategies against lung cancer.
Clinical trials of selective small-molecule inhibitors of epidermal growth factor receptor tyrosine kinase activity have shown that these targeted inhibitors of proliferative signal transduction provide well-tolerated antitumour activity in patients. Preclinical pharmacology studies illustrate the potential use of these new cancer therapeutics in combination with chemotherapy, radiotherapy and hormone therapy, and in chemoprevention, in a spectrum of solid human tumours.
Targeted delivery of cytotoxic agents to tumours is believed to improve both their anti-tumour efficacy and their safety. Antibodies specific for tumour-associated antigens have been used to deliver cytotoxic agents to tumour cells. Calicheamicin is a potent cytotoxic agent that causes double-strand DNA breaks, resulting in cell death. When conjugated to monoclonal antibodies specific for tumour-associated antigens, calicheamicin exerts strong antigen-specific anti-tumour effects against human tumour xenografts in preclinical models. Antibody-targeted chemotherapy with immunoconjugates of calicheamicin, exemplified by gemtuzumab ozogamicin (Mylotarg), is a clinically validated therapeutic strategy for the treatment of human cancer.
N-methyl-D-aspartate receptors (NMDARs) are glutamate-gated ion channels widely expressed in the central nervous system that play key roles in excitatory synaptic transmission. Because of their involvement in numerous neurological disorders, NMDARs are also targets of therapeutic interest. NMDARs occur as multiple subtypes which differ in their subunit composition and in their biophysical and pharmacological properties. In particular, NMDARs contain a diversity of sites at which endogenous ligands or pharmacological agents can act to modulate receptor activity in a subunit-selective manner, and recent structural and functional data have started to reveal the molecular determinants for this subunit selectivity. These include the binding sites for glutamate, the ion-channel pore and the recently identified allosteric sites on the N-terminal domain. Other potential sites yet unexplored by medicinal chemistry programs are also considered, in particular at the interface between subunits. Given the growing body of evidence that diverse brain disorders implicate different NMDAR subtypes, such as NR2B in pain or NR3A in white matter injury, there is a growing interest in exploiting the pharmacological heterogeneity of NMDARs for the development of novel NMDAR subtype-selective compounds.
Interleukin (IL)-15 is a pleiotropic pro-inflammatory cytokine that is expressed in several inflammatory disorders, including rheumatoid arthritis, psoriasis and pulmonary inflammatory diseases. IL-15 promotes activation of T cells, neutrophils and macrophages, and is critical to dendritic cell function in several model systems. Recent emerging data suggest that IL-15 may serve as a useful therapeutic target across a range of disease states. Advances in the past year highlight the beneficial effect of IL-15 neutralisation in models of psoriasis and diabetes. Further evidence for IL-15 expression and effector function has emerged across a range of rheumatic disorders, including juvenile inflammatory arthritis, rheumatoid arthritis and Kawasaki disease. These data hold promise for therapeutic targeting in ongoing human studies and those in the near future.
Regulation of protein function through post-translational modifications (PTM) can be important pharmacological target, and there are drugs developed to modulate specific PTM such as protein kinase or histone deacetylase inhibitors. We are still far behind in considering protein glutathionylation as pharmacological target as the biological consequences and role of this PTM are still unclear. We discuss the possible relevance of glutathionylation in diseases and its biases compared with other PTM. In particular, we discuss the different roles of glutathionylation in the context of redox regulation as opposed to that of oxidative stress, and the difficulties arising from the overlaps of these two concepts.
Prostate cancer may be the most common preventable cancer among men in the United States (US) and the rest of the developed world. Emerging insights into the molecular pathogenesis of prostate cancer suggest that damage to the prostate epithelium, potentially inflicted by a variety of exposures, triggers procarcinogenic inflammatory processes to promote disease development. In this milieu, the damaged epithelium may generate proliferative inflammatory atrophy (PIA) lesions, which may progress to prostatic intraepithelial neoplasia (PIN) or to prostate cancer. To attenuate prostatic carcinogenesis driven by chronic or recurrent prostate inflammation, rational chemoprevention has thus far featured anti-inflammatory drugs and antioxidants. Results from clinical trials of these approaches have been mixed, emphasizing the need for mechanistic studies of the contribution of inflammation to prostatic carcinogenesis, more extensive analyses of the pharmacology, including distribution of drugs into target tissue, and, rational development of biomarkers to identify patients that are most likely to respond to anti-inflammatory drugs and antioxidants (targeted chemoprevention), alone, or in combination (combination chemoprevention).
The phosphoinositide 3-kinase (PI3K) family of enzymes consists of several closely related isoforms that are thought to have distinct biological roles. Until now, researchers have been frustrated by poor selectivity of the available pharmacological inhibitors, which are unable to distinguish adequately the activities of different PI3K isoforms. Recently published patent specifications describe new PI3K inhibitors, including several that are selective for the PI3Kdelta isoform. There is now cautious optimism that isoform-selective PI3K inhibitors will provide new avenues for therapeutic applications in a range of diseases.
Coagulation cascade and innate immunity are intimately linked in their endeavor to organize the body's response to injury. Protease-activated receptors (PARs) are important mediators of inflammatory response that can be activated by proteases of the coagulation cascade. Their recent discovery has shed new light on the crosstalk between coagulation and innate immunity. Recent studies have investigated the physiological relevance of PARs in the context of immunity and vascular injury, suggesting that these receptors could be used as therapeutic targets for the treatment of pathologies related to innate immunity, endothelial functions and coagulation processes.
When prostate cancers progress following androgen depletion therapy, there are currently few treatment options with only one, docetaxel, that has been shown to prolong life. Recent work has shown that castration-resistant prostate cancers (CRPCs) continue to depend on androgen receptor (AR) signaling which is reactivated despite low serum androgen levels. Currently available AR-targeted therapy, including GnRH agonists and antiandrogens, cannot completely shut down AR signaling. Several mechanisms that enhance AR signaling in an androgen-depleted environment have been elucidated. These include AR mutations that allow activation by low androgen levels or by other endogenous steroids, AR overexpression, increased local intracrine synthesis of androgens, and upregulation of tyrosine kinase pathways. This has led to the development of a number of novel agents targeting the AR signaling pathway, including more effective antiandrogens, inhibitors of CYP17, an enzyme required for androgen synthesis, inhibitors of 5alpha-reductase, inhibitors of HSP90 which protects AR from degradation, inhibitors of histone deacetylases which is required for optimal AR-mediated transcription, as well as inhibitors of tyrosine kinase inhibitors. Many of these strategies are currently being tested in clinical trials in CRPC.
The pharmaceutical industry is currently abandoning its antibacterial discovery research efforts. This seems to be part of a cyclical pattern in this therapeutic area. The reasons behind these ongoing cycles of feast and famine are multiple, but most revolve around the perception of market opportunities from the continuing emergence of resistance, balanced against the difficulties in the discovery of novel antibacterial compounds, the costs of development and the general regulatory and financial environment in which companies find themselves. Relief for the industry will require both regulatory and legislative action at a time when this will be politically difficult to achieve. In the meantime, the problems of antimicrobial resistance are not going away.
Chronic hepatitis C virus (HCV) infection is a pressing medical problem worldwide. Current therapy with pegylated interferon plus ribavirin (Peg-IFN/RBV) is associated with a poor risk benefit profile, a long treatment duration (48 weeks) and inadequate success rate (approximately 40-50%) of SVR (sustained viral response) in patients infected with genotype 1 HCV. This review is focused on recent clinical trial results with specifically targeted antiviral therapy for HCV (STAT-C) protease and polymerase inhibitors. In the past decade, anti-HCV drug discovery has focused first on targeting host factors required for viral replication and second on multiple HCV antiviral agents. Owing to the large number of HCV inhibitors currently in pre-clinical and clinical development today, we have focused on the most advanced compounds in the HCV polymerase and HCV protease inhibitor classes. Within each class, compounds will be used to illustrate some of the properties associated with inhibitors that bind to the active site of HCV polymerase, the active site of HCV protease (macrocyclic and linear ketoamide inhibitors) and allosteric polymerase inhibitors.
Zebrafish combine the relevance of a vertebrate with the scalability of an invertebrate. They can live in 96-well plate format and readily absorb chemicals from the water. These features have stimulated the use of zebrafish by medical researchers to model human disease and then assess the action of compounds in a whole organism. Examples of the power of this system have been illustrated with the cloning of zebrafish human ether-a-go-go-related gene (HERG), which shows near 100% homology in key domains, and the associated ability to identify drugs that prolong the QT interval both rapidly and with tiny amounts (micrograms) of compound.
Microglia are the immune cells of the central nervous system (CNS). They patrol the brain environment with their ramifications and they respond quickly in the presence of pathogens and brain damages. Others and we have recently reported the existence of two different types of microglia, the resident and the newly differentiated microglia that are derived from the bone marrow stem cells. Of great interest is the fact that blood-derived microglial cells are associated with amyloid plaques and these cells are able to prevent the formation or eliminate the presence of amyloid deposits in mice that develop the major hallmark of Alzheimer's disease (AD). These cells are also recruited in the brain of other mouse models of brain diseases and acute injuries. They represent, therefore, a fantastic new vehicle for delivering key molecules to improve recovery, repair, and elimination of toxic proteins. However, recent studies have challenged this concept and raised concerns regarding the physiological relevance of bone-marrow-derived microglia. This review discusses both sides of the story and why the models used to follow the phenotypic fate of these cells are so crucial to reach the proper conclusion. Blood-derived progenitors have the ability to populate the CNS, especially during injuries and chronic diseases. However they do not do it in an efficient manner. Such a lack of proper recruitment may explain the delay in recovery and repair after acute damages and accumulation of toxic proteins in chronic brain diseases.
The technique of functional magnetic resonance imaging (fMRI) has the capacity to acquire data with spatial and temporal resolution that far exceeds other currently available methods of non-invasive investigation of brain function. This coupled with its ability for serial studies makes it an attractive prospect for investigating the effects of pharmacological agents in the brain. Recent advances in fMRI have been made in the areas of reward and dependence, brain trauma and injury, psychotropic drugs and pain using small animals. Although the use of fMRI in pharmacological studies is becoming popular, there are various associated complications, such as the possible interference of drugs with the mechanisms that give rise to the pharmacological fMRI signal, and local or global cardiovascular changes that might produce functional responses unrelated to neural activity. Consideration of these concerns, coupled with careful attention to experimental detail and verification procedures, promises to make pharmacological fMRI use a valuable tool for understanding the actions of drugs in the brain.
The large FK506-binding protein FKBP52 has been characterized as an important positive regulator of androgen, glucocorticoid and progesterone receptor signaling pathways. FKBP52 associates with receptor-Hsp90 complexes and is proposed to have roles in both receptor hormone binding and receptor subcellular localization. Data from biochemical and cellular studies have been corroborated in whole animal models as fkbp52-deficient male and female mice display characteristics of androgen, glucocorticoid and/or progesterone insensitivity. FKBP52 receptor specificity and the specific phenotypes displayed by the fkbp52-deficient mice have firmly established FKBP52 as a promising target for the treatment of a variety of hormone-dependent diseases. Recent studies demonstrated that the FKBP52 FK1 domain and the proline-rich loop within this domain are functionally important for FKBP52 regulation of receptor function. Based on these data, efforts are currently underway to target the FKBP52 FK1 domain and the proline-rich loop with small molecule inhibitors.