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Corrales-Hernández MG, Villarroel-Hagemann SK, Mendoza-Rodelo IE, Palacios-Sánchez L, Gaviria-Carrillo M, Buitrago-Ricaurte N, Espinosa-Lugo S, Calderon-Ospina CA, Rodríguez-Quintana JH. Development of Antiepileptic Drugs throughout History: From Serendipity to Artificial Intelligence. Biomedicines 2023; 11:1632. [PMID: 37371727 DOI: 10.3390/biomedicines11061632] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 05/24/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
This article provides a comprehensive narrative review of the history of antiepileptic drugs (AEDs) and their development over time. Firstly, it explores the significant role of serendipity in the discovery of essential AEDs that continue to be used today, such as phenobarbital and valproic acid. Subsequently, it delves into the historical progression of crucial preclinical models employed in the development of novel AEDs, including the maximal electroshock stimulation test, pentylenetetrazol-induced test, kindling models, and other animal models. Moving forward, a concise overview of the clinical advancement of major AEDs is provided, highlighting the initial milestones and the subsequent refinement of this process in recent decades, in line with the emergence of evidence-based medicine and the implementation of increasingly rigorous controlled clinical trials. Lastly, the article explores the contributions of artificial intelligence, while also offering recommendations and discussing future perspectives for the development of new AEDs.
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Affiliation(s)
- María Gabriela Corrales-Hernández
- Pharmacology Unit, Department of Biomedical Sciences, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111221, Colombia
| | - Sebastián Kurt Villarroel-Hagemann
- Pharmacology Unit, Department of Biomedical Sciences, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111221, Colombia
| | | | - Leonardo Palacios-Sánchez
- Neuroscience Research Group (NeURos), NeuroVitae Center for Neuroscience, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111221, Colombia
| | - Mariana Gaviria-Carrillo
- Neuroscience Research Group (NeURos), NeuroVitae Center for Neuroscience, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111221, Colombia
| | | | - Santiago Espinosa-Lugo
- Pharmacology Unit, Department of Biomedical Sciences, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111221, Colombia
| | - Carlos-Alberto Calderon-Ospina
- Pharmacology Unit, Department of Biomedical Sciences, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111221, Colombia
- Research Group in Applied Biomedical Sciences (UR Biomed), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111221, Colombia
| | - Jesús Hernán Rodríguez-Quintana
- Fundacion CardioInfantil-Instituto de Cardiologia, Calle 163a # 13B-60, Bogotá 111156, Colombia
- Hospital Universitario Mayor Mederi, Calle 24 # 29-45, Bogotá 111411, Colombia
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2
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Cummings JL. Translational Scoring of Candidate Treatments for Alzheimer's Disease: A Systematic Approach. Dement Geriatr Cogn Disord 2021; 49:22-37. [PMID: 32512572 DOI: 10.1159/000507569] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 03/26/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There are many failures in treatment development for Alzheimer's disease (AD). Some of these failures are the result of development programs that lacked critical information about candidate drugs as these were advanced from one phase of development to the next. Translational scoring (TS) has been proposed as a means of increasing the rigor with which treatment development programs are executed. Previously, these approaches were not specific to AD or to the phase of drug development. Detailed information on the characteristics needed to advance a candidate agent from one phase to the next is the basis for success in subsequent phases. SUMMARY The TS approach is presented with a score range of 0-25 for agents entering phases 1, 2, and 3 of development and those that have completed phase 3 and are being considered for regulatory review. Each phase has 5 essential categories scored from 0-5 indicating the completeness of the data available when the agent is being considered for promotion to the next phase. Lower scores suggest that the development program should be reexamined for missing information while higher scores increase the confidence that the agent has the potential to succeed in the next phase. Scoring guidelines are provided and examples of scores for drugs in recent development programs are provided to illustrate the principles of TS. Key Messages: Successful development of drugs for AD treatment requires disciplined informed decision-making at each phase of development. TS is a methodology for more rigorous drug development to help ensure that inadequately characterized drugs are not advanced and that the development platform at each phase is optimal to support success at the next phase.
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Affiliation(s)
- Jeffrey L Cummings
- Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas, Nevada, USA, .,Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, Nevada, USA,
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3
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Cummings J. The Role of Biomarkers in Alzheimer's Disease Drug Development. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1118:29-61. [PMID: 30747416 DOI: 10.1007/978-3-030-05542-4_2] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Biomarkers have a key role in Alzheimer's disease (AD) drug development. Biomarkers can assist in diagnosis, demonstrate target engagement, support disease modification, and monitor for safety. The amyloid (A), tau (T), neurodegeneration (N) Research Framework emphasizes brain imaging and CSF measures relevant to disease diagnosis and staging and can be applied to drug development and clinical trials. Demonstration of target engagement in Phase 2 is critical before advancing a treatment candidate to Phase 3. Trials with biomarker outcomes are shorter and smaller than those required to show clinical benefit and are important to understanding the biological impact of an agent and inform go/no-go decisions. Companion diagnostics are required for safe and effective use of treatments and may emerge in AD drug development programs. Complementary biomarkers inform the use of therapies but are not mandatory for use. Biomarkers promise to de-risk AD drug development, attract sponsors to AD research, and accelerate getting new drugs to those with or at risk for AD.
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Affiliation(s)
- Jeffrey Cummings
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA.
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4
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Hunter R. Developing tomorrow's antipsychotics: the need for a more personalised approach. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.bp.110.008235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
SummaryThere has been little pharmacological advance in the treatment of schizophrenia since the introduction of chlorpromazine in the 1950s. This may be set to change as recent advances in molecular biology offer the prospect of a better understanding of the pathophysiology of the disorder and allow investigation of the complex interplay of genetic and environmental risk factors. In this review I discuss future approaches to antipsychotic drug development, highlighting the need to better define symptom areas and develop drugs based on an understanding of neurobiological mechanisms. The development of biomarkers has the potential in future to improve differential diagnosis and help predict response to treatment. These developments herald the possibility of a more integrated drug discovery approach and the subsequent provision of more stratified healthcare, and hopefully significant improvements in patient care and improved long-term outcomes.
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5
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Oleksiak A, Kruk M, Lenarczyk E, Pawelec M, Rajska E, Wilkońska P, Dzielińska Z, Demkow M, Witkowski A, Pręgowski J, Kępka C, Rużyłło W. Biomarkers for risk stratification in secondary cardiovascular prevention. A role of red blood cell distribution width and calcium score. Atherosclerosis 2016; 246:57-62. [DOI: 10.1016/j.atherosclerosis.2015.12.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 12/24/2015] [Accepted: 12/25/2015] [Indexed: 12/30/2022]
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6
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Ranganathan R. NINDS translational programs: priming the pump of neurotherapeutics discovery and development. Neuron 2014; 84:515-20. [PMID: 25442927 DOI: 10.1016/j.neuron.2014.10.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The National Institute of Neurological Disorders and Stroke (NINDS) at the National Institutes of Health (NIH) recently issued a new suite of funding opportunities for neurotherapeutics development. The goals are to build a contiguous bridge from basic science, accelerate the advancement of promising projects to clinical testing with the contributions of multidisciplinary teams, and enhance hand-off to subsequent funders.
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Affiliation(s)
- Rajesh Ranganathan
- Office of Translational Research, Office of the Director, The National Institute of Neurological Disorders and Stroke, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD 20892, USA.
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7
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Abou-Gharbia M, Childers WE. Discovery of Innovative Therapeutics: Today’s Realities and Tomorrow’s Vision. 2. Pharma’s Challenges and Their Commitment to Innovation. J Med Chem 2014; 57:5525-53. [DOI: 10.1021/jm401564r] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Magid Abou-Gharbia
- Moulder
Center for Drug Discovery
Research, Temple University School of Pharmacy, 3307 North Broad Street, Philadelphia, Pennsylvania 19140, United States
| | - Wayne E. Childers
- Moulder
Center for Drug Discovery
Research, Temple University School of Pharmacy, 3307 North Broad Street, Philadelphia, Pennsylvania 19140, United States
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9
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Becerra L, Upadhyay J, Chang PC, Bishop J, Anderson J, Baumgartner R, Schwarz AJ, Coimbra A, Wallin D, Nutile L, George E, Maier G, Sunkaraneni S, Iyengar S, Evelhoch JL, Bleakman D, Hargreaves R, Borsook D. Parallel buprenorphine phMRI responses in conscious rodents and healthy human subjects. J Pharmacol Exp Ther 2013; 345:41-51. [PMID: 23370795 DOI: 10.1124/jpet.112.201145] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Pharmacological magnetic resonance imaging (phMRI) is one method by which a drug's pharmacodynamic effects in the brain can be assessed. Although phMRI has been frequently used in preclinical and clinical settings, the extent to which a phMRI signature for a compound translates between rodents and humans has not been systematically examined. In the current investigation, we aimed to build on recent clinical work in which the functional response to 0.1 and 0.2 mg/70 kg i.v. buprenorphine (partial µ-opioid receptor agonist) was measured in healthy humans. Here, we measured the phMRI response to 0.04 and 0.1 mg/kg i.v. buprenorphine in conscious, naive rats to establish the parallelism of the phMRI signature of buprenorphine across species. PhMRI of 0.04 and 0.1 mg/kg i.v. buprenorphine yielded dose-dependent activation in a brain network composed of the somatosensory cortex, cingulate, insula, striatum, thalamus, periaqueductal gray, and cerebellum. Similar dose-dependent phMRI activation was observed in the human phMRI studies. These observations indicate an overall preservation of pharmacodynamic responses to buprenorphine between conscious, naive rodents and healthy human subjects, particularly in brain regions implicated in pain and analgesia. This investigation further demonstrates the usefulness of phMRI as a translational tool in neuroscience research that can provide mechanistic insight and guide dose selection in drug development.
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Affiliation(s)
- Lino Becerra
- Imaging Consortium for Drug Development, P.A.I.N. Group, Harvard Medical School, Children’s Hospital of Boston, Waltham, Massachusetts 02453, USA.
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Zhou J, Wu D, Liu X, Yuan S, Yang X, Wang X. Translational medicine as a permanent glue and force of clinical medicine and public health: perspectives (1) from 2012 Sino-American symposium on clinical and translational medicine. Clin Transl Med 2012; 1:21. [PMID: 23369646 PMCID: PMC3560983 DOI: 10.1186/2001-1326-1-21] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 08/21/2012] [Indexed: 12/01/2022] Open
Abstract
Abstracts Health systems globally face challenges and opportunities in balancing quality, access, and cost, where clinical and translational medicine (CTM) should play more important and powerful roles in the identification, development and validation of solutions and strategies. Strategic collaboration can gather global strengths and resources and improve health systems, care delivery, regulations and policies. CTM-driven innovation and development has the potential to achieve step-change improvements across three dimensions. Thus, we have the reasons to believe that CTM will play even more roles in the development of new diagnostics, therapies, healthcare, and policies and SAS-CTM will become more and more important platform to obtain the latest development in CTM internationally and explore new opportunities in the international collaborations.
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Affiliation(s)
- Jiebai Zhou
- Department of Pulmonary Medicine, Fudan University School of Medicine, Zhongshan Hospital, Shanghai, China.
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11
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Baker S, Chin CL, Basso AM, Fox GB, Marek GJ, Day M. Xanomeline modulation of the blood oxygenation level-dependent signal in awake rats: development of pharmacological magnetic resonance imaging as a translatable pharmacodynamic biomarker for central activity and dose selection. J Pharmacol Exp Ther 2012; 341:263-73. [PMID: 22267203 DOI: 10.1124/jpet.111.188797] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
In vivo translational imaging techniques, such as positron emission tomography and single-photon emission-computed tomography, are the only ways to adequately determine that a drug engages its target. Unfortunately, there are far more experimental mechanisms being tested in the clinic than there are radioligands, impeding the use of this risk-mitigating approach in modern drug discovery and development. Pharmacological magnetic resonance imaging (phMRI) offers an approach for developing new biomarkers with the potential to determine central activity and dose selection in animals and humans. Using phMRI, we characterized the effects of xanomeline on ketamine-induced activation on blood oxygen level-dependent (BOLD) signal. In the present studies, xanomeline alone dose-dependently increased the BOLD signal across several regions of interest, including association and motor and sensory cortical regions. It is noteworthy that xanomeline dose-dependently attenuated ketamine-induced brain activation patterns, effects that were antagonized by atropine. In conclusion, the muscarinic 1/4-preferring receptor agonist xanomeline suppressed the effects of the N-methyl-D-aspartate channel blocker ketamine in a number of brain regions, including the association cortex, motor cortex, and primary sensory cortices. The region-specific brain activation observed in this ketamine challenge phMRI study may provide a method of confirming central activity and dose selection for novel antipsychotic drugs in early clinical trials for schizophrenia, if the data obtained in animals can be recapitulated in humans.
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Affiliation(s)
- Scott Baker
- Translational Sciences, Advanced Technology, Global Pharmaceutical Research and Development, Abbott Laboratories, Abbott Park, IL, USA
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12
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Determination of enalapril and enalaprilat in small human serum quantities for pediatric trials by HPLC-tandem mass spectrometry. Biomed Chromatogr 2011; 26:697-702. [DOI: 10.1002/bmc.1716] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 08/14/2011] [Indexed: 01/13/2023]
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13
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Day M, Fox GB, Marek GJ. Translational medicine special issue. Biochem Pharmacol 2011; 81:1353-5. [PMID: 21296055 DOI: 10.1016/j.bcp.2011.01.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Revised: 01/19/2011] [Accepted: 01/19/2011] [Indexed: 11/17/2022]
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14
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Sakoğlu U, Upadhyay J, Chin CL, Chandran P, Baker SJ, Cole TB, Fox GB, Day M, Luo F. Paradigm shift in translational neuroimaging of CNS disorders. Biochem Pharmacol 2011; 81:1374-87. [PMID: 21219879 DOI: 10.1016/j.bcp.2010.12.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Revised: 12/29/2010] [Accepted: 12/29/2010] [Indexed: 12/29/2022]
Abstract
During the last two decades, functional neuroimaging technology, especially functional magnetic resonance imaging (fMRI), has improved tremendously, with new attention towards resting-state functional connectivity of the brain. This development has allowed scientists to study changes in brain structure and function, and probe these two properties under conditions of evoked stimulation, disease and drug administration. In the domain of functional imaging, the identification and characterization of central nervous system (CNS) functional networks have emerged as potential biomarkers for CNS disorders in humans. Recent attempts to translate clinical neuroimaging methodology to preclinical studies have also been carried out, which offer new opportunities in translational neuroscience research. In this paper, we review recent developments in structural and functional MRI and their use to probe functional connectivity in various CNS disorders such as schizophrenia, mood disorders, Alzheimer's disease (AD) and pain.
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Affiliation(s)
- Unal Sakoğlu
- Translational Imaging/Advanced Technology, Global Pharmaceutical Research and Development, Abbott Laboratories, 100 Abbott Park Road, Abbott Park, IL 60064, USA
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15
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Chin CL, Upadhyay J, Marek GJ, Baker SJ, Zhang M, Mezler M, Fox GB, Day M. Awake rat pharmacological magnetic resonance imaging as a translational pharmacodynamic biomarker: metabotropic glutamate 2/3 agonist modulation of ketamine-induced blood oxygenation level dependence signals. J Pharmacol Exp Ther 2010; 336:709-15. [PMID: 21172908 DOI: 10.1124/jpet.110.173880] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Neuroimaging techniques have been exploited to characterize the effect of N-methyl-d-aspartate (NMDA) receptor antagonists on brain activation in humans and animals. However, most preclinical imaging studies were conducted in anesthetized animals and could be confounded by potential drug-anesthetic interactions as well as anesthetic agents' effect on brain activation, which may affect the translation of these basic research findings to the clinical setting. The main aim of the current study was to examine the brain activation elicited by the infusion of a subanesthetic dose of ketamine using blood oxygenation level dependence (BOLD) pharmacological magnetic resonance imaging (phMRI) in awake rats. However, a secondary aim was to determine whether a behaviorally active metabotropic glutamate 2/3 receptor agonist, (1S,2R,5R,6R)-2-amino-4-oxabicyclo[3.1.0]hexane-2,6-dicarboxylic acid (LY379268), could modulate the effects of ketamine-induced brain activation. Our data indicate that ketamine produces positive BOLD signals in several cortical and hippocampal regions, whereas negative BOLD signals were observed in regions, such as periaqueductal gray (PAG) (p < 0.05). Furthermore, pretreatment of LY379268 significantly attenuated ketamine-induced brain activation in a region-specific manner (posterior cingulate, entorhinal, and retrosplenial cortices, hippocampus CA1, and PAG). The [corrected] region-specific brain activations observed in this ketamine phMRI study may afford a method of confirming central activity and dose selection in early clinical trials for novel experimental therapeutics. [corrected]
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Affiliation(s)
- Chih-Liang Chin
- Translational Imaging, Advanced Technology, Global Pharmaceutical Research and Development, Abbott Laboratories, Abbott Park, IL 60064, USA
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Abstract
Laboratory medicine has evolved from basic scientific observation and good experimental practice, with a strong emphasis on establishing the mechanisms of disease processes, linked with biomarker discovery, and development of analytical technologies. That evolution is set to move on apace with the mapping of the human genome. However, laboratory medicine is not solely based on robust basic science, but also on the translation of that knowledge into establishing the clinical utility of a marker, translation into evidence of the impact on health outcomes, as well as transformational change to integrate this new knowledge into the delivery of better care for patients. This translational research and the focus on transformational change are crucial in demonstrating value-for-money in the laboratory medicine service.
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Affiliation(s)
- Christopher P Price
- Department of Clinical Biochemistry, University of Oxford, John Radcliffe Hospital, Headington, Oxford, UK.
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17
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Cummings JL. Integrating ADNI results into Alzheimer's disease drug development programs. Neurobiol Aging 2010; 31:1481-92. [PMID: 20447734 DOI: 10.1016/j.neurobiolaging.2010.03.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Revised: 03/15/2010] [Accepted: 03/21/2010] [Indexed: 11/18/2022]
Abstract
The Alzheimer's Disease Neuroimaging Initiative (ADNI) is providing critical new information on biomarkers in cognitively normal elderly, persons with mild cognitive impairment (MCI), and patients with mild Alzheimer's disease (AD). The data provide insights into the progression of the pathology of AD over time, assist in understanding which biomarkers might be most useful in clinical trials, and facilitate development of disease-modifying treatments. ADNI results are intended to support new AD treatment development; this report considers how ADNI information can be integrated in AD drug development programs. Cerebrospinal fluid (CSF) amyloid beta protein (Abeta) measures can be used in Phase I studies to detect any short term effects on Abeta levels in the CSF. Phase II studies may benefit most from biomarker measures that can inform decisions about Phase III. CSF Abeta levels, CSF total tau and phospho-tau measures, fluorodeoxyglucose positron emission tomography (FDG PET), Pittsburgh Compound B (PIB) amyloid imaging, or magnetic resonance imaging (MRI) may be employed to select patients in enriched trials or as outcomes for specific disease-modifying interventions. Use of biomarkers may allow Phase II trials to be conducted more efficiently with smaller populations of patients or shorted treatment times. New drug applications (NDAs) may include biomarker outcomes of phase III trials. ADNI patients are highly educated and are nearly all of Caucasian ethnicity limiting the generalizability of the results to other populations commonly included in global clinical trials. ADNI has inspired or collaborates with biomarker investigations worldwide and together these studies will provide biomarker information that can reduce development times and costs, improve drug safety, optimize drug efficacy, and bring new treatments to patients with or at risk for AD.
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Affiliation(s)
- Jeffrey L Cummings
- Mary S. Easton Center for Alzheimer's Disease Research at UCLA, Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-7226, United States.
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