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Kim GR, Kim S, Kim YO, Han X, Nagel J, Kim J, Song DI, Müller CE, Yoon MH, Jin MS, Kim YC. Discovery of Triazolopyrimidine Derivatives as Selective P2X3 Receptor Antagonists Binding to an Unprecedented Allosteric Site as Evidenced by Cryo-Electron Microscopy. J Med Chem 2024. [PMID: 39102524 DOI: 10.1021/acs.jmedchem.4c01214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Abstract
The P2X3 receptor (P2X3R), an ATP-gated cation channel predominantly expressed in C- and Aδ-primary afferent neurons, has been proposed as a drug target for neurological inflammatory diseases, e.g., neuropathic pain, and chronic cough. Aiming to develop novel, selective P2X3R antagonists, tetrazolopyrimidine-based hit compound 9 was optimized through structure-activity relationship studies by modifying the tetrazole core as well as side chain substituents. The optimized antagonist 26a, featuring a cyclopropane-substituted triazolopyrimidine core, displayed potent P2X3R-antagonistic activity (IC50 = 54.9 nM), 20-fold selectivity versus the heteromeric P2X2/3R, and high selectivity versus other P2XR subtypes. Noncompetitive P2X3R blockade was experimentally confirmed by calcium influx assays. Cryo-electron microscopy revealed that 26a stabilizes the P2X3R in its desensitized state, acting as a molecular barrier to prevent ions from accessing the central pore. In vivo studies in a rat neuropathic pain model (spinal nerve ligation) showed dose-dependent antiallodynic effects of 26a, thus presenting a novel, promising lead structure.
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Affiliation(s)
- Ga-Ram Kim
- School of Life Sciences, Gwangju Institute of Science and Technology, 123 Cheomdangwagi-ro, Buk-gu, Gwangju 61005, Republic of Korea
| | - Subin Kim
- School of Life Sciences, Gwangju Institute of Science and Technology, 123 Cheomdangwagi-ro, Buk-gu, Gwangju 61005, Republic of Korea
| | - Yeo-Ok Kim
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, 42 Jebong-ro, Dong-gu, Gwangju 61469, Republic of Korea
| | - Xuehao Han
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, 42 Jebong-ro, Dong-gu, Gwangju 61469, Republic of Korea
| | - Jessica Nagel
- PharmaCenter Bonn, Pharmaceutical Institute, Pharmaceutical & Medicinal Chemistry, University of Bonn, An der Immenburg 4, Bonn 53113, Germany
| | - Jihyun Kim
- School of Life Sciences, Gwangju Institute of Science and Technology, 123 Cheomdangwagi-ro, Buk-gu, Gwangju 61005, Republic of Korea
| | - Dahin Irene Song
- Bioengineering, University of Pennsylvania, 3451 Walnut St, Philadelphia, Pennsylvania 19104, United States
| | - Christa E Müller
- PharmaCenter Bonn, Pharmaceutical Institute, Pharmaceutical & Medicinal Chemistry, University of Bonn, An der Immenburg 4, Bonn 53113, Germany
| | - Myung-Ha Yoon
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, 42 Jebong-ro, Dong-gu, Gwangju 61469, Republic of Korea
| | - Mi Sun Jin
- School of Life Sciences, Gwangju Institute of Science and Technology, 123 Cheomdangwagi-ro, Buk-gu, Gwangju 61005, Republic of Korea
| | - Yong-Chul Kim
- School of Life Sciences, Gwangju Institute of Science and Technology, 123 Cheomdangwagi-ro, Buk-gu, Gwangju 61005, Republic of Korea
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Guilleminault L, Grassin-Delyle S, Mazzone SB. Drugs Targeting Cough Receptors: New Therapeutic Options in Refractory or Unexplained Chronic Cough. Drugs 2024; 84:763-777. [PMID: 38904926 DOI: 10.1007/s40265-024-02047-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2024] [Indexed: 06/22/2024]
Abstract
Refractory chronic cough is a disabling disease with very limited therapeutic options. A better understanding of cough pathophysiology has led to the development of emerging drugs targeting cough receptors. Recent strides have illuminated novel therapeutic avenues, notably centred on modulating transient receptor potential (TRP) channels, purinergic receptors, and neurokinin receptors. By modulating these receptors, the goal is to intervene in the sensory pathways that trigger cough reflexes, thereby providing relief without compromising vital protective mechanisms. These innovative pharmacotherapies hold promise for improvement of refractory chronic cough by offering improved efficacy and potentially mitigating adverse effects associated with current recommended treatments. A deeper comprehension of their precise mechanisms of action and clinical viability is imperative for optimising therapeutic interventions and elevating patient care standards in respiratory health. This review delineates the evolving landscape of drug development in this domain, emphasising the significance of these advancements in reshaping the paradigm of cough management.
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Affiliation(s)
- Laurent Guilleminault
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), INSERM UMR1291, CNRS UMR5051, University Toulouse III, 31024, Toulouse, France.
- Department of Respiratory Medicine, Faculty of Medicine, Hôpital Larrey, Toulouse University Hospital, 24 chemin de Pouvourville, 31059, Toulouse, France.
| | - Stanislas Grassin-Delyle
- Exhalomics®, Hôpital Foch, Suresnes, France
- Département de Biotechnologie de la Santé, Université Paris-Saclay, UVSQ, INSERM, Infection et inflammation (2I), U1173, Montigny le Bretonneux, France
| | - Stuart B Mazzone
- Department of Anatomy and Physiology, University of Melbourne, Melbourne, VIC, Australia
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Thach T, Dhanabalan K, Nandekar PP, Stauffer S, Heisler I, Alvarado S, Snyder J, Subramanian R. A Second Drug Binding Site in P2X3. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.06.10.598171. [PMID: 38915546 PMCID: PMC11195084 DOI: 10.1101/2024.06.10.598171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
Purinergic P2X3 receptors form trimeric cation-gated channels, which are activated by extracellular ATP. P2X3 plays a crucial role in chronic cough and affects over 10% of the population. Despite considerable efforts to develop drugs targeting P2X3, the highly conserved structure within the P2X receptor family presents obstacles for achieving selectivity. Camlipixant, a potent and selective P2X3 antagonist, is currently in phase III clinical trials. However, the mechanisms underlying receptor desensitization, ion permeation, principles governing antagonism, and the structure of P2X3 when bound to camlipixant remain elusive. In this study, we established a stable cell line expressing homotrimeric P2X3 and utilized a peptide scaffold to purify the complex and determine its structure using cryo-electron microscopy (cryo-EM). P2X3 binds to camlipixant at a previously unidentified drug-binding site and functions as an allosteric inhibitor. Structure-activity studies combined with modeling and simulations have shed light on the mechanisms underlying the selective targeting and inhibition of P2X3 by camlipixant, distinguishing it from other members of the P2X receptor family.
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Affiliation(s)
- Trung Thach
- Department of Biological Sciences, Purdue University, West Lafayette, IN-47907, USA
| | | | | | - Seth Stauffer
- Elanco Animal Health, 2500 Innovation Way, Greenfield, IN-46140, USA
| | - Iring Heisler
- Elanco Animal Health, 2500 Innovation Way, Greenfield, IN-46140, USA
| | - Sarah Alvarado
- Elanco Animal Health, 2500 Innovation Way, Greenfield, IN-46140, USA
| | - Jonathan Snyder
- Elanco Animal Health, 2500 Innovation Way, Greenfield, IN-46140, USA
| | - Ramaswamy Subramanian
- Department of Biological Sciences, Purdue University, West Lafayette, IN-47907, USA
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN-47907, USA
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Yamamoto S, Horita N, Hara J, Sasamoto M, Kanemitsu Y, Hara Y, Obase Y, Kaneko T, Niimi A, Mukae H. Benefit-Risk Profile of P2X3 Receptor Antagonists for Treatment of Chronic Cough: Dose-Response Model-Based Network Meta-Analysis. Chest 2024:S0012-3692(24)00693-7. [PMID: 38857780 DOI: 10.1016/j.chest.2024.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 05/05/2024] [Accepted: 05/07/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Refractory or unexplained chronic cough disrupts quality of life and burdens health care systems around the world. The P2X3 receptor antagonist gefapixant is approved in many countries for its antitussive effects, but taste disturbances are a common adverse effect. Four newer, more selective P2X3 receptor antagonists have been developed to address this problem. RESEARCH QUESTION How does the benefit-risk profile vary across the five available P2X3 receptor antagonists? STUDY DESIGN AND METHODS A systematic review and network meta-analysis was conducted to evaluate the efficacy of P2X3 receptor antagonists, including gefapixant, sivopixant, eliapixant, camlipixant, and filapixant. Primary outcomes were a reduction rate in 24-h cough frequency and incidence of taste disturbance. Dose-response curves and median effective dose (ED50) were calculated. Effect size at ED50 was ranked according to the surface under the cumulative ranking curve. The confidence was evaluated by Confidence In Network Meta-Analysis. RESULTS Sixteen randomized controlled trials involving 4,904 participants were analyzed. The gefapixant regimen demonstrated an ED50 of 90.7 mg/d for cough frequency reduction. Gefapixant showed the highest antitussive effectiveness at ED50 (reduction rate in 24-h cough frequency: median, 28.1%; 95% credible interval [CrI], 21.0%-35.6%; ranked 1 of 5; moderate certainty) but the highest prevalence of taste disturbance (absolute risk difference per 100 patients: median, 38; 95% CrI, 27-51; ranked 5 of 5; high certainty) and the highest prevalence of discontinuation. Camlipixant had a well-balanced profile (reduction rate in 24-h cough frequency: median, 14.7%; 95% CrI, 5.4%-26.0%; ranked 3 of 5; low certainty; and taste disturbance; absolute risk difference per 100 patients; median, 2; 95% CrI, 1-6; ranked 2 of 5; low certainty). Placebo had a mean of 33.1% reduction in 24-h cough frequency. INTERPRETATION When used at safe doses, gefapixant had a favorable risk-benefit profile compared with the other four agents. Camlipixant showed initial promise, which may be further investigated by phase III trials currently underway. CLINICAL TRIAL REGISTRATION UMIN000050622; URL.
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Affiliation(s)
- Shota Yamamoto
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI.
| | - Nobuyuki Horita
- Chemotherapy Centre, Yokohama City University Hospital, Yokohama, Japan
| | - Johsuke Hara
- Department of Respiratory Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Mao Sasamoto
- Department of Respiratory Medicine, Kobari General Hospital, Noda, Japan
| | - Yoshihiro Kanemitsu
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yu Hara
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yasushi Obase
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takeshi Kaneko
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Akio Niimi
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Li X, Haranaka M, Li H, Liu P, Chen H, Klein S, Reif S, Francke K, Friedrich C, Okumura K. P2X3 Receptor Antagonist Eliapixant in Phase I Clinical Trials: Safety and Inter-ethnic Comparison of Pharmacokinetics in Healthy Chinese and Japanese Participants. Clin Pharmacokinet 2024; 63:901-915. [PMID: 38907175 DOI: 10.1007/s40262-024-01387-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND Afferent neuronal hypersensitization via P2X3 receptor signaling has been implicated as a driver of several disorders, including refractory chronic cough, endometriosis, diabetic neuropathic pain, and overactive bladder. Eliapixant, a selective P2X3 receptor antagonist, has been in clinical development for all four disorders. OBJECTIVE This paper describes pharmacokinetic (PK) and safety data from two phase I studies of eliapixant in healthy Japanese and Chinese participants and compares those data within the two populations and with previous multiple dose data from Caucasian participants. METHODS Two separate phase I, single-center, randomized, placebo-controlled studies were conducted with healthy male participants. The Japanese study was single-blind and the Chinese study was double-blind. Eliapixant was administered as an oral amorphous solid dispersion immediate-release tablet in strengths of 25 mg, 75 mg, and 150 mg. PK characteristics after a single dose (SD) and at steady state (multiple dose [MD], twice daily), adverse events (AEs), and tolerability were evaluated. A post hoc comparison of PK characteristics after SD of eliapixant in Japanese and Chinese participants, and after MD of eliapixant in Japanese, Chinese, and Caucasian participants, was performed. RESULTS Overall, 36/39 participants enrolled in the Japanese/Chinese studies, respectively (mean [standard deviation] age 25.4 [6.5] and 26.7 [5.0] years, respectively). After SD administration, maximum plasma concentration (Cmax) was higher among Japanese than Chinese participants in the 25 mg and 75 mg dose groups, but comparable in the 150 mg dose group. The area under the concentration-time curve (AUC) was comparable between Japanese and Chinese participants in the 25 mg and 75 mg dose groups, but lower among Japanese participants in the 150 mg group. Half-lives after SD and MD administration were also comparable in Japanese and Chinese participants. The post hoc analysis included 26 Japanese, 30 Chinese, and 50 Caucasian participants. Comparable exposure (Cmax,md and AUC[0-12]md) was observed after MD administration of eliapixant in Chinese and/or Japanese compared with Caucasian participants (geometric mean inter-ethnic ratios close to 1). The trough plasma concentration after eliapixant 150 mg MD, which was assumed to be relevant to eliapixant efficacy, was comparable across all ethnicity groups. Most AEs reported in the Japanese (eliapixant 75 mg SD, n = 2; eliapixant 150 mg MD, n = 2) and Chinese participants (eliapixant 25 mg SD, n = 7; eliapixant 75 mg SD, n = 6; eliapixant 150 mg SD, n = 7; eliapixant 150 mg MD, n = 9; placebo SD, n = 5; placebo MD, n = 1) were of mild intensity. Higher incidences of AEs in the Chinese population were likely due to differing standards of AE reporting between investigators. CONCLUSION Eliapixant was well tolerated by Japanese and Chinese participants. The inter-ethnic evaluation demonstrated similar PK characteristics across Japanese, Chinese, and Caucasian participants. REGISTRATION ClinicalTrials.gov identifier numbers: NCT04265781 and NCT04802343.
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Affiliation(s)
- Xuening Li
- Department of Clinical Pharmacology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Miwa Haranaka
- Hakata Clinic, Souseikai Global Clinical Research Center, Fukuoka, Japan
| | - Hui Li
- Department of Clinical Pharmacology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Pei Liu
- Bayer Healthcare Co. Ltd., Clinical Pharmacology Asia, Beijing, China.
| | - Huijun Chen
- Bayer Healthcare Co. Ltd., Clinical Pharmacology Asia, Beijing, China
| | - Stefan Klein
- Bayer AG, Clinical Pharmacology, Berlin, Germany
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Zeng Y, Hang F, Peng C, Zhao L, Ou S, Luo L, Liu B. Research progress in rodent models of endometriosis. J Reprod Immunol 2024; 163:104219. [PMID: 38422807 DOI: 10.1016/j.jri.2024.104219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/03/2024] [Accepted: 02/15/2024] [Indexed: 03/02/2024]
Abstract
Endometriosis is a common and frequent disease in gynecology; its etiology and pathogenesis are partially understood and still not clear. The construction of suitable animal models is beneficial for basic research related to the disease. Currently, rodents have the advantages of low cost, fast reproduction, easy rearing, and a similar endometrial structure to humans. Depending on the purpose of the experiment, different molding methods have their advantages. In this paper, we describe the traditional methods of constructing endometriosis rodent models, compare their advantages and disadvantages, and introduce newly developed rodent models, such as cell line injection models, pain models, genetically engineered mouse models, fluorescent tracer models, iron overload models, chemical induction models, and methods of constructing rodent models of different subtypes of endometriosis. Fertility and treatment of endometriosis rodent models are also described. This study provides a reference for researchers in the selection of animal models for pathogenesis and drug treatment studies.
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Affiliation(s)
- Yan Zeng
- Guangxi Reproductive Medical Center, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Fu Hang
- Guangxi Reproductive Medical Center, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Chuyu Peng
- Guangxi Reproductive Medical Center, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Ling Zhao
- Guangxi Reproductive Medical Center, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Shanshan Ou
- Guangxi Reproductive Medical Center, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Liumei Luo
- Guangxi Reproductive Medical Center, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Bo Liu
- Guangxi Reproductive Medical Center, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China.
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He Y, Qu L. Non-coding RNAs in diabetic peripheral neuropathy: their role and mechanisms underlying their effects. Metabolism 2024; 154:155833. [PMID: 38462040 DOI: 10.1016/j.metabol.2024.155833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/20/2024] [Accepted: 03/05/2024] [Indexed: 03/12/2024]
Abstract
Diabetic peripheral neuropathy (DPN) is a complication of diabetes with a high rate of disability. However, current clinical treatments for DPN are suboptimal. Non-coding RNAs (ncRNAs) are a type of RNAs that are not translated into proteins. NcRNAs perform functions that regulate epigenetic modifications, transcriptional or post-transcriptional regulators of proteins, and thus participate in the physiological and pathological processes of the body. NcRNAs play a role in the progress of DPN by affecting the processes of inflammation, oxidative stress, cellular autophagy or apoptosis. Therefore, ncRNAs treatment is regarded as a promising therapeutic approach for DPN. In addition, since some ncRNAs present stably in the blood of DPN patients, they are considered as potential biomarkers that contribute to early clinical diagnosis. In this paper, we review the studies on the role of ncRNAs in DPN in the last decade, and discuss the mechanisms of ncRNAs, aiming to provide a reference for the future research on the treatment and early diagnosis of DPN.
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Affiliation(s)
- Yiqian He
- Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, 100730 Beijing, China
| | - Ling Qu
- Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, 100730 Beijing, China.
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See LP, Sripinun P, Lu W, Li J, Alboloushi N, Alvarez-Periel E, Lee SM, Karabucak B, Wang S, Jordan Sciutto KL, Theken KN, Mitchell CH. Increased Purinergic Signaling in Human Dental Pulps With Inflammatory Pain is Sex-Dependent. THE JOURNAL OF PAIN 2024; 25:1039-1058. [PMID: 37956743 PMCID: PMC11129867 DOI: 10.1016/j.jpain.2023.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/22/2023] [Accepted: 10/28/2023] [Indexed: 11/15/2023]
Abstract
An enhanced understanding of neurotransmitter systems contributing to pain transmission aids in drug development, while the identification of biological variables like age and sex helps in the development of personalized pain management and effective clinical trial design. This study identified enhanced expression of purinergic signaling components specifically in painful inflammation, with levels increased more in women as compared to men. Inflammatory dental pain is common and potentially debilitating; as inflammation of the dental pulp can occur with or without pain, it provides a powerful model to examine distinct pain pathways in humans. In control tissues, P2X3 and P2X2 receptors colocalized with PGP9.5-positive nerves. Expression of the ecto-nucleotidase NTPDase1 (CD39) increased with exposure to extracellular adenosine triphosphate (ATP), implying CD39 acted as a marker for sustained elevation of extracellular ATP. Both immunohistochemistry and immunoblots showed P2X2, P2X3, and CD39 increased in symptomatic pulpitis, suggesting receptors and the ATP agonist were elevated in patients with increased pain. The increased expression of P2X3 and CD39 was more frequently observed in women than men. In summary, this study identifies CD39 as a marker for chronic elevation of extracellular ATP in fixed human tissue. It supports a role for increased purinergic signaling in humans with inflammatory dental pain and suggests the contribution of purines shows sexual dimorphism. This highlights the potential for P2X antagonists to treat pain in humans and stresses the need to consider sex in clinical trials that target pain and purinergic pathways. PERSPECTIVE: This article demonstrates an elevation of ATP-marker CD39 and of ATP receptors P2X2 and P2X3 with inflammatory pain and suggests the rise is greater in women. This highlights the potential for P2X antagonists to treat pain and stresses the consideration of sexual dimorphism in studies of purines and pain.
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Affiliation(s)
- Lily P. See
- Departments of Basic and Translational Science, University of Pennsylvania, Philadelphia, PA 19104
- Department of Endodontics, University of Pennsylvania, Philadelphia, PA 19104
| | - Puttipong Sripinun
- Departments of Basic and Translational Science, University of Pennsylvania, Philadelphia, PA 19104
- Department of Orthodontics, University of Pennsylvania, Philadelphia, PA 19104
| | - Wennan Lu
- Departments of Basic and Translational Science, University of Pennsylvania, Philadelphia, PA 19104
| | - Jiaqi Li
- Departments of Basic and Translational Science, University of Pennsylvania, Philadelphia, PA 19104
| | - Naela Alboloushi
- Department of Endodontics, University of Pennsylvania, Philadelphia, PA 19104
- Department of Oral Medicine, University of Pennsylvania, Philadelphia, PA 19104
| | | | - Su-Min Lee
- Department of Endodontics, University of Pennsylvania, Philadelphia, PA 19104
| | - Bekir Karabucak
- Department of Endodontics, University of Pennsylvania, Philadelphia, PA 19104
| | - Steven Wang
- Department of Oral Surgery, University of Pennsylvania, Philadelphia, PA 19104
| | | | - Katherine N. Theken
- Department of Oral Surgery, University of Pennsylvania, Philadelphia, PA 19104
| | - Claire H. Mitchell
- Departments of Basic and Translational Science, University of Pennsylvania, Philadelphia, PA 19104
- Department of Physiology, University of Pennsylvania, Philadelphia, PA 19104
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Andersson KE. Promising therapeutic targets for the treatment of urine storage dysfunction: what's the status? Expert Opin Ther Targets 2024; 28:251-258. [PMID: 38629152 DOI: 10.1080/14728222.2024.2344698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 04/15/2024] [Indexed: 04/22/2024]
Abstract
INTRODUCTION Opinions differ on what drugs have both a rationale and a development potential for the treatment of bladder storage dysfunction. AREAS COVERED In the present review, the focus is given to small molecule blockers of TRP channels (TRPV1, TRPV4, TRPA1, and TRPM8), P2 × 3receptor antagonists, drugs against oxidative stress, antifibrosis agents, cyclic nucleotide - dependent pathways, and MaxiK±channel - gene therapy. EXPERT OPINION TRPV1 channel blockers produce hypothermia which seems to be a problem even with the most efficacious second-generation TRPV1 antagonists. This has so far precluded their application to urine storage disorders. Other TRP channel blockers with promising rationale have yet to be tested on the human lower urinary tract. The P2 × 3receptor antagonist, eliapixant, was tested in a randomized controlled clinical trial, was well tolerated but did not meet clinical efficacy endpoints. Antifibrosis agent still await application to the human lower urinary tract. New drug principles for oxidative stress, purine nucleoside phosphorylase inhibition, and NOX inhibition are still at an experimental stage, and so are soluble guanylate cyclase stimulators. Gene therapy with MaxiK±channels is still an interesting approach but no new trials seem to be in pipeline.
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Affiliation(s)
- Karl-Erik Andersson
- Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston Salem, NC, USA
- Department of Laboratory Medicine, Lund University, Lund, Sweden
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10
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Bouhassira D, Tesfaye S, Sarkar A, Soisalon-Soininen S, Stemper B, Baron R. Efficacy and safety of eliapixant in diabetic neuropathic pain and prediction of placebo responders with an exploratory novel algorithm: results from the randomized controlled phase 2a PUCCINI study. Pain 2024; 165:785-795. [PMID: 37851336 DOI: 10.1097/j.pain.0000000000003085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 08/18/2023] [Indexed: 10/19/2023]
Abstract
ABSTRACT Phase 2a of the PUCCINI study was a placebo-controlled, double-blind, parallel-group, multicenter, proof-of-concept study evaluating the efficacy and safety of the selective P2X3 antagonist eliapixant in patients with diabetic neuropathic pain (DNP) ( ClinicalTrials.gov NCT04641273). Adults with type 1 or type 2 diabetes mellitus with painful distal symmetric sensorimotor neuropathy of >6 months' duration and neuropathic pain were enrolled and randomized 1:1 to 150 mg oral eliapixant twice daily or placebo for 8 weeks. The primary endpoint was change from baseline in weekly mean 24-hour average pain intensity score at week 8. In total, 135 participants completed treatment, 67 in the eliapixant group and 68 in the placebo group. At week 8, the change from baseline in posterior mean 24-hour average pain intensity score (90% credible interval) in the eliapixant group was -1.56 (-1.95, -1.18) compared with -2.17 (-2.54, -1.80) for the placebo group. The mean treatment difference was 0.60 (0.06, 1.14) in favor of placebo. The use of a model-based framework suggests that various factors may contribute to the placebo-responder profile. Adverse events were mostly mild or moderate in severity and occurred in 51% of the eliapixant group and 48% of the placebo group. As the primary endpoint was not met, the PUCCINI study was terminated after completion of phase 2a and did not proceed to phase 2b. In conclusion, selective P2X3 antagonism in patients with DNP did not translate to any relevant improvement in different pain intensity outcomes compared with placebo. Funding: Bayer AG.
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Affiliation(s)
- Didier Bouhassira
- INSERM U987, APHP, CHU Ambroise Paré, UVSQ, Paris-Saclay, Boulogne-Billancourt, France
| | - Solomon Tesfaye
- Diabetes Research Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Arnab Sarkar
- Research & Development, Pharmaceuticals, Bayer AG, Berlin, Germany
| | | | - Brigitte Stemper
- Research & Development, Pharmaceuticals, Bayer AG, Berlin, Germany
- Department of Neurology, University Erlangen Nürnberg, Erlangen, Germany
| | - Ralf Baron
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
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Heiliczer S, Yanko R, Sharav Y, Aframian DJ, Klutstein M, Wilensky A, Haviv Y. Oxidative stress-mediated proapoptosis signaling: A novel theory on the mechanism underlying the pathogenesis of burning mouth syndrome. J Am Dent Assoc 2024; 155:258-267. [PMID: 37966403 DOI: 10.1016/j.adaj.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 08/16/2023] [Accepted: 08/30/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND Burning mouth syndrome (BMS) is a chronic oral pain disorder characterized by a generalized burning sensation in the oral mucosa without apparent medical or dental causes. Despite various hypotheses proposed to explain BMS pathogenesis, a clear understanding of the cellular-level events and associated histologic and molecular findings is lacking. Advancing our understanding of BMS pathogenesis could facilitate the development of more targeted therapeutic interventions. TYPES OF STUDIES REVIEWED The authors conducted an extensive literature search and review of cellular mechanisms, focusing on evidence-based data that support a comprehensive hypothesis for BMS pathogenesis. The authors explored novel and detailed mechanisms that may account for the characteristic features of BMS. RESULTS The authors proposed that BMS symptoms arise from the uncontrolled activation of proapoptotic transmembrane calcium permeable channels expressed in intraoral mucosal nerve fibers. Elevated levels of reactive oxygen species or dysfunctional antiapoptosis pathways may lead to uncontrolled oxidative stress-mediated apoptosis signaling, resulting in upregulation of transmembrane transient receptor potential vanilloid type 1 and P2X 3 calcium channels in nociceptive fibers. Activation of these channels can cause nerve terminal depolarization, leading to generation of action potentials that are centrally interpreted as pain. CONCLUSIONS AND PRACTICAL IMPLICATIONS The authors present a novel hypothesis for BMS pathogenesis, highlighting the role of proapoptotic transmembrane calcium permeable channels and oxidative stress-mediated apoptosis signaling in the development of BMS symptoms. Understanding these underlying mechanisms could provide new insights into the development of targeted therapeutic interventions for BMS. Additional research is warranted to validate this hypothesis and explore potential avenues for effective management of BMS.
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Yeh TY, Chang MF, Kan YY, Chiang H, Hsieh ST. HSP27 Modulates Neuropathic Pain by Inhibiting P2X3 Degradation. Mol Neurobiol 2024; 61:707-724. [PMID: 37656312 DOI: 10.1007/s12035-023-03582-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 08/14/2023] [Indexed: 09/02/2023]
Abstract
The role of heat shock protein 27 (HSP27), a chaperone, in neuropathic pain after nerve injury has not been systematically surveyed despite its neuroprotective and regeneration-promoting effects. In this study, we found that HSP27 expression in sensory neurons of the dorsal root ganglia (DRG) mediated nerve injury-induced neuropathic pain. Neuropathic pain behaviors were alleviated by silencing HSP27 in the DRG of a rat spinal nerve ligation (SNL) model. Local injection of an HSP27-overexpression construct into the DRG of naïve rats elicited neuropathic pain behaviors. HSP27 interacted with a purinergic receptor, P2X3, and their expression patterns corroborated the induction and reversal of neuropathic pain according to two lines of evidence: colocalization immunohistochemically and immunoprecipitation biochemically. In a cell model cotransfected with HSP27 and P2X3, the degradation rate of P2X3 was reduced in the presence of HSP27. Such an alteration was mediated by reducing P2X3 ubiquitination in SNL rats and was reversed after silencing HSP27 in the DRGs of SNL rats. In summary, the interaction of HSP27 with P2X3 provides a new mechanism of injury-induced neuropathic pain that could serve as an alternative therapeutic target.
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Affiliation(s)
- Ti-Yen Yeh
- Department of Anatomy and Cell Biology, College of Medicine, National Taiwan University, Taipei, 10051, Taiwan
| | - Ming-Fong Chang
- Department of Anatomy and Cell Biology, College of Medicine, National Taiwan University, Taipei, 10051, Taiwan
| | - Yu-Yu Kan
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, 80424, Taiwan
| | | | - Sung-Tsang Hsieh
- Department of Anatomy and Cell Biology, College of Medicine, National Taiwan University, Taipei, 10051, Taiwan.
- Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei, 10051, Taiwan.
- Center of Precision Medicine, College of Medicine, National Taiwan University, Taipei, 10051, Taiwan.
- Department of Neurology, National Taiwan University Hospital, Taipei, 10002, Taiwan.
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Mishra S, Shelke V, Dagar N, Lech M, Gaikwad AB. Molecular insights into P2X signalling cascades in acute kidney injury. Purinergic Signal 2024:10.1007/s11302-024-09987-w. [PMID: 38246970 DOI: 10.1007/s11302-024-09987-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 01/18/2024] [Indexed: 01/23/2024] Open
Abstract
Acute kidney injury (AKI) is a critical health issue with high mortality and morbidity rates in hospitalized individuals. The complex pathophysiology and underlying health conditions further complicate AKI management. Growing evidence suggests the pivotal role of ion channels in AKI progression, through promoting tubular cell death and altering immune cell functions. Among these channels, P2X purinergic receptors emerge as key players in AKI pathophysiology. P2X receptors gated by adenosine triphosphate (ATP), exhibit increased extracellular levels of ATP during AKI episodes. More importantly, certain P2X receptor subtypes upon activation exacerbate the situation by promoting the release of extracellular ATP. While therapeutic investigations have primarily focused on P2X4 and P2X7 subtypes in the context of AKI, while understanding about other subtypes still remains limited. Whilst some P2X antagonists show promising results against different types of kidney diseases, their role in managing AKI remains unexplored. Henceforth, understanding the intricate interplay between P2X receptors and AKI is crucial for developing targeted interventions. This review elucidates the functional alterations of all P2X receptors during normal kidney function and AKI, offering insights into their involvement in AKI. Notably, we have highlighted the current knowledge of P2X receptor antagonists and the possibilities to use them against AKI in the future. Furthermore, the review delves into the pathways influenced by activated P2X receptors during AKI, presenting potential targets for future therapeutic interventions against this critical condition.
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Affiliation(s)
- Swati Mishra
- Laboratory of Molecular Pharmacology, Department of Pharmacy, Birla Institute of Technology and Science, Pilani Campus, Pilani, Rajasthan, 333031, India
| | - Vishwadeep Shelke
- Laboratory of Molecular Pharmacology, Department of Pharmacy, Birla Institute of Technology and Science, Pilani Campus, Pilani, Rajasthan, 333031, India
| | - Neha Dagar
- Laboratory of Molecular Pharmacology, Department of Pharmacy, Birla Institute of Technology and Science, Pilani Campus, Pilani, Rajasthan, 333031, India
| | - Maciej Lech
- Division of Nephrology, Department of Medicine IV, LMU University Hospital, Ludwig Maximilians University Munich, 80336, Munich, Germany
| | - Anil Bhanudas Gaikwad
- Laboratory of Molecular Pharmacology, Department of Pharmacy, Birla Institute of Technology and Science, Pilani Campus, Pilani, Rajasthan, 333031, India.
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Ewerton F, Cruz F, Kapp M, Klein S, Roehm P, Chapple C. Efficacy and Safety of Eliapixant in Overactive Bladder: The 12-Week, Randomised, Placebo-controlled Phase 2a OVADER Study. Eur Urol Focus 2024; 10:90-97. [PMID: 37563004 DOI: 10.1016/j.euf.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/29/2023] [Accepted: 07/24/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Effective, well-tolerated novel treatments for overactive bladder (OAB) are lacking. The P2X3 receptor antagonist eliapixant demonstrated potential to reduce OAB symptoms in preclinical studies. OBJECTIVE To evaluate the safety, tolerability, and efficacy of eliapixant in patients with OAB with urgency urinary incontinence (UUI). DESIGN, SETTING AND PARTICIPANTS OVADER was a 12-wk, randomised, placebo-controlled, double-blind, parallel-group, multicentre, phase 2a study (NCT04545580) conducted between 2020 and 2022 in private and institutional clinical practices. Eligible patients were aged ≥18 yr with wet OAB symptoms (urgency, urinary frequency, and urinary incontinence) for ≥3 mo before screening. INTERVENTION Randomisation (1:1 ratio) to oral eliapixant 125 mg or placebo twice daily. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary endpoint was the mean change from baseline in the mean number of UUI episodes/24 h over weeks 4, 8, and 12 according to an electronic bladder diary, evaluated using a repeated-measurement model in a Bayesian framework. RESULTS AND LIMITATIONS Of 202 patients enrolled, 85 were valid for per-protocol analysis. The primary efficacy endpoint was not met. The posterior probability for eliapixant superiority over placebo was 40% (point estimate 0.05, 95% credible interval -∞ to 0.38), which did not meet the predefined criterion of ≥90% probability. Secondary and exploratory endpoints were not met. The incidence of adverse events was similar in the eliapixant (n = 32, 63%) and placebo (n = 27, 56%) groups; most were mild and five led to discontinuation of eliapixant. CONCLUSIONS OVADER did not meet its clinical efficacy endpoints. Potential reasons include the nonspecific OAB symptom complex, the poorly understood pathophysiology, and the coinciding COVID-19 pandemic. PATIENT SUMMARY We tested whether a new drug called eliapixant would reduce symptoms of overactive bladder in comparison to placebo. We found that the drug did not work. More knowledge on how overactive bladder occurs is needed to find new drugs to treat this condition.
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Affiliation(s)
| | - Francisco Cruz
- Department of Urology, São João University Hospital Centre, Porto, Portugal; Faculty of Medicine and I3S Institute for Investigation and Innovation in Health, University of Porto, Porto, Portugal
| | | | | | | | - Christopher Chapple
- Department of Urology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
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Lima RA, Souza IBJ, Frota GM, Prazeres TCMM, Albuquerque IC, de Sousa EM, Cartagenes MDSS, Carvalho RC, Ferreira ASP, Garcia JBS. Recent advances in the treatment of pain in endometriosis: A bibliometric analysis of experimental models. Vet World 2023; 16:2329-2339. [PMID: 38152263 PMCID: PMC10750748 DOI: 10.14202/vetworld.2023.2329-2339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/16/2023] [Indexed: 12/29/2023] Open
Abstract
Background and Aim Treatment of endometriosis involves pain relief which is achieved through the administration of analgesics and non-steroidal anti-inflammatory drugs, with or without the addition of hormone therapy. At present, studies investigating endometriosis pain management using experimental rat models and the use of medications are scarce. Therefore, this study aimed to systematically evaluate research trends and critical points in the field of endometriosis pain management using experimental models. Materials and Methods A total of 30 publications related to this topic that were published from 2012 to 2022 were retrieved from various databases, including Web of Science, Scopus, PubMed, Embase, and CINAHL, using appropriate English keywords. The quality of the publications was evaluated using impact metrics, productivity, term density mapping, and author network. Results The average publication rate was three articles per year, reaching its peak in 2021 at five articles per year. The United States and China were found to be the most productive countries, with 12 and 10 publications per year, respectively. The field of medicine (37.0%) was the most abundant, although the H-index was relatively low (13:13). Term density mapping involved the search of 542 keywords, of which 35 were selected, with only 8 exhibiting significant density. Conclusion In the past decade, there has been a shortage of publications that have addressed pain in endometriosis in experimental models and, within this context the majority of the production and publication in this field has been performed by the United States and China. After performing this bibliometric review, it can be inferred that more research is required in this field, to develop new approaches and treatments for endometriotic pain.
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Affiliation(s)
- Rafael Abreu Lima
- Graduate Program in Health Sciences, Center for Biological and Health Sciences, Federal University of Maranhão, São Luís, 65085-580, Brazil
| | - Isabela Bastos Jácome Souza
- Graduate Program in Health Sciences, Center for Biological and Health Sciences, Federal University of Maranhão, São Luís, 65085-580, Brazil
| | - Gustavo Medeiros Frota
- Northeast Biotechnology Network, Center for Biological and Health Sciences, Federal University of Maranhão, São Luís, 65085-580, Brazil
| | | | - Ingrid Campos Albuquerque
- Department of Nursing, Center for Biological and Health Sciences, Federal University of Maranhão, São Luís, 65085-580, Brazil
| | - Eduardo Martins de Sousa
- Graduate Program in Health Sciences, Center for Biological and Health Sciences, Federal University of Maranhão, São Luís, 65085-580, Brazil
- Graduate Program in Microbial Biology, CEUMA University, São Luís, 65-75-120, Brazil
| | - Maria do Socorro Sousa Cartagenes
- Graduate Program in Health Sciences, Center for Biological and Health Sciences, Federal University of Maranhão, São Luís, 65085-580, Brazil
- Northeast Biotechnology Network, Center for Biological and Health Sciences, Federal University of Maranhão, São Luís, 65085-580, Brazil
| | - Rafael Cardoso Carvalho
- Graduate Program in Health Sciences, Center for Biological and Health Sciences, Federal University of Maranhão, São Luís, 65085-580, Brazil
| | - Adalgisa Sousa Paiva Ferreira
- Graduate Program in Health Sciences, Center for Biological and Health Sciences, Federal University of Maranhão, São Luís, 65085-580, Brazil
| | - João Batista Santos Garcia
- Graduate Program in Health Sciences, Center for Biological and Health Sciences, Federal University of Maranhão, São Luís, 65085-580, Brazil
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Yi B, Wang S, Li W, Xu X, Yu L. Potential applications of P2X3 receptor antagonists in the treatment of refractory cough. Respir Med 2023; 217:107336. [PMID: 37364722 DOI: 10.1016/j.rmed.2023.107336] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 05/24/2023] [Accepted: 06/20/2023] [Indexed: 06/28/2023]
Abstract
Refractory chronic cough is defined as a clinical condition in which the cause of the cough remains unclear after comprehensive examination and treatment, or the cause is clear but symptomatic treatment is ineffective. Patients with refractory chronic cough experience a variety of physiological and psychological issues that significantly lower their quality of life and place a significant socio-economic burden on society. As a result, research both domestically and internationally has turned heavily toward these patients. Recently, several studies have identified P2X3 receptor antagonists for the treatment of refractory chronic cough, and this paper reviews the background, mechanism of action, evidence-based proof and application prospects of this class of drugs. KEY MESSAGE: There were plenty of studies about P2X3 receptor antagonists in the past, and in recent years this series of drugs are effective in refractory chronic cough. Although review articles summarizing have been published previously, most have focused on their chemical properties rather than their clinical aspects, with some omitting drugs that have been in clinical studies for nearly two years such as Eliapixant and Sivopixant. Focusing on four P2X3 receptor antagonists with proven efficacy in clinical studies, we analyzed the characteristics and disadvantages of each drug by comparing their clinical results of them and theoretically explained the common side effects of these drugs, as well as their potential for treating refractory chronic cough. This article can be used as a reference for the follow-up studies of P2X3 receptor antagonists in chronic cough. Additionally, it also has implications for the clinical focus of the drug and the approaches to relieve some side effects.
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Affiliation(s)
- Baiyi Yi
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, No. 389 Xincun Road, Shanghai, 200065, China
| | - Shengyuan Wang
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, No. 389 Xincun Road, Shanghai, 200065, China
| | - Wanzhen Li
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, No. 389 Xincun Road, Shanghai, 200065, China
| | - Xianghuai Xu
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, No. 389 Xincun Road, Shanghai, 200065, China.
| | - Li Yu
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, No. 389 Xincun Road, Shanghai, 200065, China.
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17
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Costantino RC, Leonard J, Gorman EF, Ventura D, Baltz A, Gressler LE. Benzonatate Safety and Effectiveness: A Systematic Review of the Literature. Ann Pharmacother 2023; 57:1221-1236. [PMID: 36688284 DOI: 10.1177/10600280221135750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE To review the available literature regarding the treatment effects and efficacy of benzonatate needed to better inform patients, providers, and regulators evaluating its role in modern medical therapies. DATA SOURCES Comprehensive literature searches were conducted in PubMed, Embase (Elsevier), Cochrane Library, and Scopus for original research articles evaluating the effectiveness, tolerability, and safety profile of benzonatate from January 1956 through August 2022. STUDY SELECTION AND DATA EXTRACTION The identified studies were screened for relevance and then assessed for inclusion through a full-text review, data extraction, and quality assessment by multiple reviewers using the online software Covidence. DATA SYNTHESIS The selection process resulted in 37 articles consisting of 21 cohort studies, 5 experimental studies, and 11 case studies and series. Initial clinical studies exploring potential therapeutic benefits collected data from very small populations and limited clinical settings. Safety is primarily assessed in terms of toxicity due to overdose or inappropriate use. Quality assessment raised concerns for high degrees of biases primarily related to the limited sample size, data collection, generalizability, and study design. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE This review reveals substantial limitations within existing evidence pertaining to the safety and clinical effectiveness of benzonatate and thus, a need for large observational studies or randomized trials to better characterize its role and value in modern medical practice. CONCLUSIONS Rising safety concerns should bring closer scrutiny upon the prescription of benzonatate whose approval is founded upon evidence that would not stand up to current regulatory review.
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Affiliation(s)
- Ryan C Costantino
- Enterprise Intelligence and Data Solutions Program Management Office, Program Executive Office, Defense Healthcare Management Systems, Rosslyn, VA, USA
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
- Department of Military and Emergency Medicine, Uniformed Services University, Bethesda, MD, USA
| | - James Leonard
- Maryland Poison Center, Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Emily F Gorman
- Health Sciences and Human Services Library, University of Maryland, Baltimore, MD, USA
| | | | - Alan Baltz
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
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18
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Yu J, Berga SL, Zou E, Schrepf AD, Clauw DJ, As-Sanie S, Taylor RN. Neurotrophins and Their Receptors, Novel Therapeutic Targets for Pelvic Pain in Endometriosis, Are Coordinately Regulated by IL-1β via the JNK Signaling Pathway. THE AMERICAN JOURNAL OF PATHOLOGY 2023; 193:1046-1058. [PMID: 37164275 PMCID: PMC10433690 DOI: 10.1016/j.ajpath.2023.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 02/27/2023] [Accepted: 04/18/2023] [Indexed: 05/12/2023]
Abstract
Pelvic pain in women with endometriosis is attributed to neuroinflammation and afferent nociceptor nerves in ectopic and eutopic endometrium. The hypothesis that uterine nociception is activated by IL-1β, a prominent cytokine in endometriosis, was tested herein. Immunofluorescence histochemistry confirmed the presence of neurons in human endometrial tissue. Expression of nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) and their receptors in endometrial tissue and cells was validated by immunohistochemistry and Western blotting. Isolated endometrial stromal cells (ESCs) were subjected to dose-response and time-course experiments with IL-1β and kinase inhibitors to characterize in vitro biomarkers. Neural biomarkers were co-localized in endometrial nerve fibers. NGF, BDNF, and their receptors tropomyosin receptor kinase (Trk) A, TrkB, and p75 neurotrophin receptor were all expressed in primary ESCs. IL-1β stimulated higher TrkA/B expression in ESCs derived from endometriosis cases (2.8- ± 0.2-fold) than cells from controls (1.5- ± 0.3-fold, t-test, P < 0.01), effects that were mediated via the c-Jun N-terminal kinase (JNK) pathway. BDNF concentrations trended higher in peritoneal fluid of endometriosis cases but were not statistically different from controls (P = 0.16). The results support the hypothesis that NGF and BDNF and their corresponding receptors orchestrate innervation of the endometrium, which is augmented by IL-1β. We postulate that JNK inhibitors, such as SP600125, have the potential to reduce neuroinflammation in women with endometriosis.
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Affiliation(s)
- Jie Yu
- Departments of Obstetrics and Gynecology and Pathology and Anatomical Sciences, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York; Department of Obstetrics and Gynecology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Sarah L Berga
- Departments of Obstetrics and Gynecology and Pathology and Anatomical Sciences, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Eric Zou
- Departments of Obstetrics and Gynecology and Pathology and Anatomical Sciences, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Andrew D Schrepf
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Daniel J Clauw
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Sawsan As-Sanie
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | - Robert N Taylor
- Departments of Obstetrics and Gynecology and Pathology and Anatomical Sciences, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York; Department of Obstetrics and Gynecology, Wake Forest School of Medicine, Winston-Salem, North Carolina.
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Kyawsoewin M, Manokawinchoke J, Namangkalakul W, Egusa H, Limraksasin P, Osathanon T. Roles of extracellular adenosine triphosphate on the functions of periodontal ligament cells. BDJ Open 2023; 9:28. [PMID: 37422449 DOI: 10.1038/s41405-023-00147-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 04/07/2023] [Accepted: 04/14/2023] [Indexed: 07/10/2023] Open
Abstract
OBJECTIVE Adenosine triphosphate (ATP) is an essential nucleotide that is normally present in both intracellular and extracellular compartments. Extracellular ATP (eATP) has a pivotal role in both physiological and pathological processes of periodontal ligament tissues. Here, this review aimed to explore the various functions of eATP that are involved in the control of behaviours and functions of periodontal ligament cells. METHODS To identify the included publications for review, the articles were searched in PubMed (MEDLINE) and SCOPUS with the keywords of adenosine triphosphate and periodontal ligament cells. Thirteen publications were used as the main publications for discussion in the present review. RESULTS eATP has been implicated as a potent stimulator for inflammation initiation in periodontal tissues. It also plays a role in proliferation, differentiation, remodelling, and immunosuppressive functions of periodontal ligament cells. Yet, eATP has diverse functions in regulating periodontal tissue homeostasis and regeneration. CONCLUSION eATP may provide a new prospect for periodontal tissue healing as well as treatment of periodontal disease especially periodontitis. It may be utilized as a useful therapeutic tool for future periodontal regeneration therapy.
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Affiliation(s)
- Maythwe Kyawsoewin
- Dental Stem Cell Biology Research Unit and Department of Anatomy, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence for Regenerative Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Jeeranan Manokawinchoke
- Dental Stem Cell Biology Research Unit and Department of Anatomy, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence for Regenerative Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Worachat Namangkalakul
- Dental Stem Cell Biology Research Unit and Department of Anatomy, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence for Regenerative Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Hiroshi Egusa
- Division of Molecular and Regenerative Prosthodontics, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
- Center for Advanced Stem Cell and Regenerative Research, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
| | - Phoonsuk Limraksasin
- Dental Stem Cell Biology Research Unit and Department of Anatomy, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand.
- Center of Excellence for Regenerative Dentistry, Chulalongkorn University, Bangkok, Thailand.
- Division of Molecular and Regenerative Prosthodontics, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan.
| | - Thanaphum Osathanon
- Dental Stem Cell Biology Research Unit and Department of Anatomy, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence for Regenerative Dentistry, Chulalongkorn University, Bangkok, Thailand
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Dicpinigaitis PV, Morice AH, Smith JA, Sher MR, Vaezi M, Guilleminault L, Niimi A, Gude K, Krahn U, Saarinen R, Pires PV, Wosnitza M, McGarvey L. Efficacy and Safety of Eliapixant in Refractory Chronic Cough: The Randomized, Placebo-Controlled Phase 2b PAGANINI Study. Lung 2023:10.1007/s00408-023-00621-x. [PMID: 37261531 DOI: 10.1007/s00408-023-00621-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/19/2023] [Indexed: 06/02/2023]
Abstract
INTRODUCTION The PAGANINI study evaluated the efficacy and safety of the selective P2X3 antagonist eliapixant in patients with refractory chronic cough (RCC). METHODS PAGANINI was a randomized, double-blind, parallel-group, placebo-controlled, multicenter, dose-finding, phase 2b study. Adults with RCC lasting ≥ 12 months and cough severity ≥ 40 mm on a visual analog scale at screening were enrolled. Participants were randomized 1:1:1:1 to twice-daily 25 mg, 75 mg, or 150 mg oral eliapixant or placebo for 12 weeks. The primary endpoint was change from baseline in 24-h cough count after 12 weeks of intervention. RESULTS Overall, 310 participants were randomized to twice-daily eliapixant 25 mg (n = 75), 75 mg (n = 78), 150 mg (n = 80), or placebo (n = 77). A statistically significant dose-response signal with eliapixant was detected for the primary endpoint (all dose-response models, adjusted p < 0.1; one-sided). Adverse events (AEs) were reported in 39 (51%) participants with placebo and 43-51 (57-65%) participants receiving eliapixant. The most common AE was dysgeusia, occurring in 1% (n = 1) of the placebo group and 1-16% (n = 1-13) of the eliapixant groups in a dose-related manner. One case of a moderate drug-induced liver injury occurred in a participant receiving 150 mg twice-daily eliapixant. CONCLUSION Eliapixant demonstrated efficacy and a favorable taste tolerability profile in RCC. However, a drug-induced liver injury contributed to intensified liver monitoring in clinical trials with eliapixant and discontinuation of the entire development program in all indications by Bayer AG. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT04562155; registered September 18, 2020.
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Affiliation(s)
- Peter V Dicpinigaitis
- Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Alyn H Morice
- Centre for Clinical Sciences, Hull York Medical School, University of Hull, Hull, UK
| | - Jaclyn A Smith
- Division of Immunology, Immunity to Infection and Respiratory Medicine, The University of Manchester, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Michael Vaezi
- Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Laurent Guilleminault
- Pôle des Voies Respiratoires, CHU de Toulouse, Toulouse, France
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), University of Toulouse, Toulouse, France
| | - Akio Niimi
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University, Nagoya, Japan
| | | | - Ulrike Krahn
- Research and Development, Bayer AG, Wuppertal, Germany
| | | | | | | | - Lorcan McGarvey
- Wellcome Wolfson Institute of Experimental Medicine, Queen's University Belfast, Belfast, UK.
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Friedrich C, Francke K, Birring SS, van den Berg JWK, Marsden PA, McGarvey L, Turner AM, Wielders P, Gashaw I, Klein S, Morice AH. The P2X3 receptor antagonist filapixant in patients with refractory chronic cough: a randomized controlled trial. Respir Res 2023; 24:109. [PMID: 37041539 PMCID: PMC10088222 DOI: 10.1186/s12931-023-02384-8] [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: 12/22/2022] [Accepted: 03/07/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND P2X3 receptor antagonists seem to have a promising potential for treating patients with refractory chronic cough. In this double-blind, randomized, placebo-controlled study, we investigated the efficacy, safety, and tolerability of the novel selective P2X3 receptor antagonist filapixant (BAY1902607) in patients with refractory chronic cough. METHODS Following a crossover design, 23 patients with refractory chronic cough (age: 60.4 ± 9.1 years) received ascending doses of filapixant in one period (20, 80, 150, and 250 mg, twice daily, 4-days-on/3-days-off) and placebo in the other. The primary efficacy endpoint was the 24-h cough frequency on Day 4 of each dosing step. Further, subjective cough severity and health-related quality of life were assessed. RESULTS Filapixant at doses ≥ 80 mg significantly reduced cough frequency and severity and improved cough health-related quality of life. Reductions in 24-h cough frequency over placebo ranged from 17% (80 mg dose) to 37% (250 mg dose), reductions over baseline from 23% (80 mg) to 41% (250 mg) (placebo: 6%). Reductions in cough severity ratings on a 100-mm visual analog scale ranged from 8 mm (80 mg) to 21 mm (250 mg). No serious or severe adverse events or adverse events leading to discontinuation of treatment were reported. Taste-related adverse events occurred in 4%, 13%, 43%, and 57% of patients treated with filapixant 20, 80, 150, and 250 mg, respectively, and in 12% treated with placebo. CONCLUSIONS Filapixant proved to be efficacious, safe, and-apart from the occurrence of taste disturbances, especially at higher dosages-well tolerated during the short therapeutic intervention. Clinical trial registration EudraCT, eudract.ema.europa.eu, 2018-000129-29; ClinicalTrials.gov, NCT03535168.
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Affiliation(s)
- Christian Friedrich
- Research and Development, Pharmaceuticals, Bayer AG, 13353, Berlin, Germany.
| | - Klaus Francke
- Research and Development, Pharmaceuticals, Bayer AG, 13353, Berlin, Germany
| | - Surinder S Birring
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine and King's College Hospital, London, UK
| | | | - Paul A Marsden
- School of Biological Sciences, Faculty of Biology, Medicine and Health Sciences, University of Manchester and North West Lung Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Lorcan McGarvey
- Wellcome Wolfson Institute of Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Alice M Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Pascal Wielders
- Department of Pulmonary Diseases, Catharina Hospital, Eindhoven, The Netherlands
| | - Isabella Gashaw
- Research and Development, Pharmaceuticals, Bayer AG, 13353, Berlin, Germany
| | - Stefan Klein
- Research and Development, Pharmaceuticals, Bayer AG, 13353, Berlin, Germany
| | - Alyn H Morice
- Hull York Medical School, University of Hull, Castle Hill Hospital, Cottingham, E Yorkshire, UK
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22
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Neto AC, Santos-Pereira M, Abreu-Mendes P, Neves D, Almeida H, Cruz F, Charrua A. The Unmet Needs for Studying Chronic Pelvic/Visceral Pain Using Animal Models. Biomedicines 2023; 11:biomedicines11030696. [PMID: 36979674 PMCID: PMC10045296 DOI: 10.3390/biomedicines11030696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 03/03/2023] Open
Abstract
The different definitions of chronic pelvic/visceral pain used by international societies have changed over the years. These differences have a great impact on the way researchers study chronic pelvic/visceral pain. Recently, the role of systemic changes, including the role of the central nervous system, in the perpetuation and chronification of pelvic/visceral pain has gained weight. Consequently, researchers are using animal models that resemble those systemic changes rather than using models that are organ- or tissue-specific. In this review, we discuss the advantages and disadvantages of using bladder-centric and systemic models, enumerating some of the central nervous system changes and pain-related behaviors occurring in each model. We also present some drawbacks when using animal models and pain-related behavior tests and raise questions about possible, yet to be demonstrated, investigator-related bias. We also suggest new approaches to study chronic pelvic/visceral pain by refining existing animal models or using new ones.
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Affiliation(s)
- Ana Catarina Neto
- Experimental Biology Unit, Department of Biomedicine, Faculty of Medicine of University of Porto, 4200-319 Porto, Portugal
- I3S—Instituto de Investigação e Inovação em Saúde, University of Porto, 4200-135 Porto, Portugal
| | - Mariana Santos-Pereira
- Experimental Biology Unit, Department of Biomedicine, Faculty of Medicine of University of Porto, 4200-319 Porto, Portugal
- I3S—Instituto de Investigação e Inovação em Saúde, University of Porto, 4200-135 Porto, Portugal
| | - Pedro Abreu-Mendes
- I3S—Instituto de Investigação e Inovação em Saúde, University of Porto, 4200-135 Porto, Portugal
- Department of Urology, Centro Hospitalar de São João, 4200-319 Porto, Portugal
- Physiology and Surgery Department, Faculty of Medicine of University of Porto, 4200-319 Porto, Portugal
| | - Delminda Neves
- Experimental Biology Unit, Department of Biomedicine, Faculty of Medicine of University of Porto, 4200-319 Porto, Portugal
- I3S—Instituto de Investigação e Inovação em Saúde, University of Porto, 4200-135 Porto, Portugal
| | - Henrique Almeida
- Experimental Biology Unit, Department of Biomedicine, Faculty of Medicine of University of Porto, 4200-319 Porto, Portugal
- I3S—Instituto de Investigação e Inovação em Saúde, University of Porto, 4200-135 Porto, Portugal
- Ginecologia-Obstetrícia, Hospital-CUF Porto, 4100-180 Porto, Portugal
| | - Francisco Cruz
- I3S—Instituto de Investigação e Inovação em Saúde, University of Porto, 4200-135 Porto, Portugal
- Department of Urology, Centro Hospitalar de São João, 4200-319 Porto, Portugal
- Physiology and Surgery Department, Faculty of Medicine of University of Porto, 4200-319 Porto, Portugal
| | - Ana Charrua
- Experimental Biology Unit, Department of Biomedicine, Faculty of Medicine of University of Porto, 4200-319 Porto, Portugal
- I3S—Instituto de Investigação e Inovação em Saúde, University of Porto, 4200-135 Porto, Portugal
- Correspondence:
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23
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Andersson KE. Emerging drugs for the treatment of bladder storage dysfunction. Expert Opin Emerg Drugs 2022; 27:277-287. [PMID: 35975727 DOI: 10.1080/14728214.2022.2113057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Current drug treatment of lower urinary tract disorders, for example, overactive bladder syndrome and lower urinary tract symptoms associated with benign prostatic hyperplasia, is moderately effective, has a low treatment persistence and some short- and long-term adverse events. Even if combination therapy with approved drugs may offer advantages in some patients, there is still a need for new agents. AREAS COVERED New b3-adrenoceptor agonists, antimuscarinics, the naked Maxi-K channel gene, a novel 5HT/NA reuptake inhibitor and soluble guanylate cyclase activators are discussed. Focus is given to P2X3 receptor antagonists, small molecule blockers of TRP channels, the roles of cannabis on incontinence in patients with multiple sclerosis, and of drugs acting directly on CB1 and CB2 receptor or indirectly via endocannabinoids by inhibition of fatty acid aminohydrolase. EXPERT OPINION New potential alternatives to currently used drugs/drug principles are emerging, but further clinical testing is required before they can be evaluated as therapeutic alternatives. It seems that for the near future individualized treatment with approved drugs and their combinations will be the prevailing therapeutic approach.
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Affiliation(s)
- Karl-Erik Andersson
- Wake Forest Institute for Regenerative Medicine, Wake Forest University, Winston Salem, NC, USA.,Department of Laboratory Medicine, Lund University, Lund, Sweden
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24
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AI-based prediction of new binding site and virtual screening for the discovery of novel P2X3 receptor antagonists. Eur J Med Chem 2022; 240:114556. [DOI: 10.1016/j.ejmech.2022.114556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/15/2022] [Accepted: 06/18/2022] [Indexed: 11/17/2022]
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25
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Zhang M, Sykes DL, Sadofsky LR, Morice AH. ATP, an attractive target for the treatment of refractory chronic cough. Purinergic Signal 2022; 18:289-305. [PMID: 35727480 PMCID: PMC9209634 DOI: 10.1007/s11302-022-09877-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 06/08/2022] [Indexed: 11/25/2022] Open
Abstract
Chronic cough is the most common complaint in respiratory clinics. Most of them have identifiable causes and some may respond to common disease-modifying therapies. However, there are many patients whose cough lacks effective aetiologically targeted treatments or remains unexplained after thorough assessments, which have been described as refractory chronic cough. Current treatments for refractory chronic cough are limited and often accompanied by intolerable side effects such as sedation. In recent years, various in-depth researches into the pathogenesis of chronic cough have led to an explosion in the development of drugs for the treatment of refractory chronic cough. There has been considerable progress in the underlying mechanisms of chronic cough targeting ATP, and ongoing or completed clinical studies have confirmed the promising antitussive efficacy of P2X3 antagonists for refractory cough. Herein, we review the foundation on which ATP target was developed as potential antitussive medications and provide an update on current clinical progresses.
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Affiliation(s)
- Mengru Zhang
- Respiratory Research Group, Hull York Medical School, Cottingham, UK.,Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Dominic L Sykes
- Respiratory Research Group, Hull York Medical School, Cottingham, UK
| | - Laura R Sadofsky
- Respiratory Research Group, Hull York Medical School, Cottingham, UK
| | - Alyn H Morice
- Respiratory Research Group, Hull York Medical School, Cottingham, UK.
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26
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Friedrich C, Francke K, Gashaw I, Scheerans C, Klein S, Fels L, Smith JA, Hummel T, Morice A. Safety, Pharmacodynamics, and Pharmacokinetics of P2X3 Receptor Antagonist Eliapixant (BAY 1817080) in Healthy Subjects: Double-Blind Randomized Study. Clin Pharmacokinet 2022; 61:1143-1156. [PMID: 35624408 PMCID: PMC9349145 DOI: 10.1007/s40262-022-01126-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2022] [Indexed: 12/12/2022]
Abstract
Background and Objective There is no licensed treatment for refractory chronic cough; off-label therapies have limited efficacy and can produce adverse effects. Excessive adenosine triphosphate signaling via P2X3 receptors is implicated in refractory chronic cough, and selective P2X3 receptor antagonists such as eliapixant (BAY 1817080) are under investigation. The objective of the study was to investigate the safety and tolerability of ascending repeated oral doses of eliapixant in healthy volunteers. Methods We conducted a repeated-dose, double-blind, randomized, placebo-controlled study in 47 healthy male individuals. Subjects received repeated twice-daily ascending oral doses of eliapixant (10, 50, 200, and 750 mg) or placebo for 2 weeks. The primary outcome was frequency and severity of adverse events. Other outcomes included pharmacokinetics and evaluation of taste disturbances, which have occurred with the less selective P2X3 receptor antagonist gefapixant. Results Peak plasma concentrations of eliapixant were reached 3–4 h after administration of the first and subsequent doses. With multiple dosing, steady-state plasma concentrations were reached after ~ 6 days, and plasma concentrations predicted to achieve ≥ 80% P2X3 receptor occupancy (the level required for efficacy) were reached at 200 and 750 mg. Increases in plasma concentrations with increasing doses were less than dose proportional. After multiple dosing, mean plasma concentrations of eliapixant showed low peak–trough fluctuations and were similar for 200- and 750-mg doses. Eliapixant was well tolerated with a low incidence of taste-related adverse events. Conclusions Eliapixant (200 and 750 mg) produced plasma concentrations that cover the predicted therapeutic threshold over 24 h, with good safety and tolerability. These results enabled eliapixant to progress to clinical trials in patients with refractory chronic cough. Clinical Trial Registration Clinicaltrials.gov: NCT03310645 (initial registration: 16 October, 2017). Supplementary Information The online version contains supplementary material available at 10.1007/s40262-022-01126-1. There are few effective treatments for patients with a long-term (chronic) cough. It is thought that chronic cough is caused by nerves becoming oversensitive, wrongly causing a cough when there is no need. We tested a new drug called eliapixant in 47 healthy men. Eliapixant reduces the excessive nerve signaling responsible for chronic cough. We looked for side effects of eliapixant and measured how it behaves in the body. In particular we looked for side effects relating to the sense of taste because gefapixant, a similar drug to eliapixant, can affect taste. Participants took one of four eliapixant doses or a placebo twice daily for 2 weeks. The highest levels of eliapixant in the blood were seen 3–4 h after taking the drug, and stable concentrations were seen after about 6 days. At the two highest doses, eliapixant reached concentrations in the body that should be high enough to work in patients with chronic cough. Side effects were generally similar between eliapixant and placebo. Taste-related side effects were mild and went away without needing treatment. The positive results of this study meant that eliapixant could be tested in patients with chronic cough.
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Affiliation(s)
- Christian Friedrich
- Bayer AG Research & Development, Pharmaceuticals Clinical Pharmacology, 1 Building M004, 13353, Berlin, Germany.
| | - Klaus Francke
- Bayer AG Research & Development, Pharmaceuticals Clinical Pharmacology, 1 Building M004, 13353, Berlin, Germany
| | - Isabella Gashaw
- Bayer AG Research & Development, Pharmaceuticals Clinical Pharmacology, 1 Building M004, 13353, Berlin, Germany.,Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
| | - Christian Scheerans
- Bayer AG Research & Development, Pharmaceuticals Clinical Pharmacology, 1 Building M004, 13353, Berlin, Germany
| | - Stefan Klein
- Bayer AG Research & Development, Pharmaceuticals Clinical Pharmacology, 1 Building M004, 13353, Berlin, Germany
| | - Lueder Fels
- Bayer AG Research & Development, Pharmaceuticals Clinical Pharmacology, 1 Building M004, 13353, Berlin, Germany
| | - Jaclyn A Smith
- University of Manchester, Manchester University NHS Foundation Trust and Manchester Academic Health Science Centre, Manchester, UK
| | - Thomas Hummel
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
| | - Alyn Morice
- Centre for Clinical Sciences, Hull York Medical School, University of Hull, Hull, UK
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27
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Tozaki-Saitoh H, Takeda H, Inoue K. The Role of Microglial Purinergic Receptors in Pain Signaling. Molecules 2022; 27:molecules27061919. [PMID: 35335282 PMCID: PMC8949888 DOI: 10.3390/molecules27061919] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/10/2022] [Accepted: 03/14/2022] [Indexed: 12/25/2022] Open
Abstract
Pain is an essential modality of sensation in the body. Purinergic signaling plays an important role in nociceptive pain transmission, under both physiological and pathophysiological conditions, and is important for communication between both neuronal and non-neuronal cells. Microglia and astrocytes express a variety of purinergic effectors, and a variety of receptors play critical roles in the pathogenesis of neuropathic pain. In this review, we discuss our current knowledge of purinergic signaling and of the compounds that modulate purinergic transmission, with the aim of highlighting the importance of purinergic pathways as targets for the treatment of persistent pain.
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Affiliation(s)
- Hidetoshi Tozaki-Saitoh
- Department of Pharmacology, School of Pharmacy at Fukuoka, International University of Health and Welfare, 137-1 Enokizu, Okawa 831-8501, Japan;
- Correspondence: ; Tel.: +81-944-32-6137
| | - Hiroshi Takeda
- Department of Pharmacology, School of Pharmacy at Fukuoka, International University of Health and Welfare, 137-1 Enokizu, Okawa 831-8501, Japan;
| | - Kazuhide Inoue
- Institute for Advanced Study, Kyushu University, 744 Motooka, Nishi-ku, Fukuoka 819-0395, Japan;
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28
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Mustafa M, Winum JY. The importance of sulfur-containing motifs in drug design and discovery. Expert Opin Drug Discov 2022; 17:501-512. [PMID: 35193437 DOI: 10.1080/17460441.2022.2044783] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Sulfur-containing functional groups are privileged motifs that occur in various pharmacologically effective substances and several natural products. Various functionalities are found with a sulfur atom at diverse oxidation states, as illustrated by thioether, sulfoxide, sulfone, sulfonamide, sulfamate, and sulfamide functions. They are valuable scaffolds in the field of medicinal chemistry and are part of a large array of approved drugs and clinical candidates. AREA COVERED Herein, the authors review the current research on the development of organosulfur-based drug discovery. This article also covers details of their roles in the new lead compounds reported in the literature over the past five years 2017-2021. EXPERT OPINION Given its prominent role in medicinal chemistry and its importance in drug discovery, sulfur has attracted continuing interest and has been used in the design of various valuable compounds that demonstrate a variety of biological and pharmacological feature activities. Overall, sulfur's role in medicinal chemistry continues to grow. However, many sulfur functionalities remain underused in small-molecule drug discovery and deserve special attention in the armamentarium for treating diverse diseases. Research efforts are also still required for the development of a synthetic methodology for direct access to these functions and late-stage functionalization.
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Affiliation(s)
- Muhamad Mustafa
- IBMM, Univ. Montpellier, CNRS, ENSCM, Montpellier, France.,Department of Medicinal Chemistry, Faculty of Pharmacy, Deraya Unuversity, Minia, Egypt
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29
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Bin Arifin MN, Tarek M, Rahman Khan MM. Efficient Treatment of Organic Pollutants by Boron Doped TiO2 Photocatalysts under Visible Light Radiation. Chem Eng Res Des 2022. [DOI: 10.1016/j.cherd.2022.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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30
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Selectivity of the P2X3 receptor antagonist Eliapixant, and its potential use in the treatment of endometriosis. Purinergic Signal 2022; 18:1-3. [PMID: 34978027 DOI: 10.1007/s11302-021-09831-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 10/19/2022] Open
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31
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Velho RV, Taube E, Sehouli J, Mechsner S. Neurogenic Inflammation in the Context of Endometriosis-What Do We Know? Int J Mol Sci 2021; 22:ijms222313102. [PMID: 34884907 PMCID: PMC8658724 DOI: 10.3390/ijms222313102] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/26/2021] [Accepted: 12/01/2021] [Indexed: 12/25/2022] Open
Abstract
Endometriosis (EM) is an estrogen-dependent disease characterized by the presence of epithelial, stromal, and smooth muscle cells outside the uterine cavity. It is a chronic and debilitating condition affecting ~10% of women. EM is characterized by infertility and pain, such as dysmenorrhea, chronic pelvic pain, dyspareunia, dysuria, and dyschezia. Although EM was first described in 1860, its aetiology and pathogenesis remain uncertain. Recent evidence demonstrates that the peripheral nervous system plays an important role in the pathophysiology of this disease. Sensory nerves, which surround and innervate endometriotic lesions, not only drive the chronic and debilitating pain associated with EM but also contribute to a growth phenotype by secreting neurotrophic factors and interacting with surrounding immune cells. Here we review the role that peripheral nerves play in driving and maintaining endometriotic lesions. A better understanding of the role of this system, as well as its interactions with immune cells, will unearth novel disease-relevant pathways and targets, providing new therapeutics and better-tailored treatment options.
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Affiliation(s)
- Renata Voltolini Velho
- Department of Gynecology Charité with Center of Oncological Surgery, Endometriosis Research Center Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany; (R.V.V.); (J.S.)
| | - Eliane Taube
- Institute of Pathology, Charité Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany;
| | - Jalid Sehouli
- Department of Gynecology Charité with Center of Oncological Surgery, Endometriosis Research Center Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany; (R.V.V.); (J.S.)
| | - Sylvia Mechsner
- Department of Gynecology Charité with Center of Oncological Surgery, Endometriosis Research Center Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany; (R.V.V.); (J.S.)
- Correspondence: ; Tel.: +49-030-450664866
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