Perspective article: A proposal for rational drug class terminology

An assessment of the effects of neurokinin1 receptor antagonism against nausea and vomiting: Relative efficacy, sites of action and lessons for future drug development

A broad-spectrum anti-vomiting effect of neurokinin1 receptor antagonists (NK1 RA), shown in pre-clinical animal studies, has been supported by a more limited range of clinical studies in different indications. However, this review suggests that compared with vomiting, the self-reported sensation of nausea is less affected or possibly unaffected (depending on the stimulus) by NK1 receptor antagonism, a common finding for anti-emetics. The stimulus-independent effects of NK1 RAs against vomiting are explicable by actions within the central pattern generator (ventral brainstem) and the nucleus tractus solitarius (NTS; dorsal brainstem), with additional effects on vagal afferent activity for certain stimuli (e.g., highly emetogenic chemotherapy). The central pattern generator and NTS neurones are multifunctional so the notable lack of obvious effects of NK1 RAs on other reflexes mediated by the same neurones suggests that their anti-vomiting action is dependent on the activation state of the pathway leading to vomiting. Nausea requires activation of cerebral pathways by projection of information from the NTS. Although NK1 receptors are present in cerebral nuclei implicated in nausea, and imaging studies show very high receptor occupancy at clinically used doses, the variable or limited ability of NK1 RAs to inhibit nausea emphasizes: (i) our inadequate understanding of the mechanisms of nausea; and (ii) that classification of a drug as an anti-emetic may give a false impression of efficacy against nausea vs. vomiting. We discuss the potential mechanisms for the differential efficacy of NK1 RA and the implications for future development of drugs that can effectively treat nausea, an area of unmet clinical need.

Bibliometric development of Naunyn-Schmiedeberg's Archives of Pharmacology

Motivated by the 150-year anniversary of the Naunyn-Schmiedeberg's Archives of Pharmacology in 2023, we studied the bibliometric development of the journal. We evaluated data from Editorial Reports, Clarivate, and Springer Nature databases. Several parameters representing the journal's performance, such as the impact factor and social impact, were analyzed over the years. We analyzed the journal's meta-data and wrote an algorithm to retrieve cities and countries of origin. We could see a decrease in publications from Germany and an increase in papers from Brazil, China, Egypt, and Iran during the last years. The decrease in publications from Germany is probably a zeitgeist effect because this country places a strong emphasis on high-impact factor papers for academic promotion and winning grants. Germany was the country with the most publications throughout the 100 most-cited articles. Most of these articles were published between 1970 and 1990, when neurotransmitters were the most published topic. Klaus Starke (Freiburg) and Manfred Göthert (Bonn) were prominent drivers of this field. The most common topics nowadays are "Drugs for the Treatment of Malignant Tumor Diseases" and "Immunopharmacology." The internationality of the journal substantially increased after introduction of English as mandatory language in the 1970s. The journal also experienced substantial COVID-19 pandemic-related effects. This paper is not only of relevance for the field of pharmacology but for science in general in the sense that Naunyn-Schmiedeberg's Archives of Pharmacology is a case study for profound changes in a traditional scientific journal, requiring permanent adjustment by editors, referees, publisher, authors, and readers alike. The development of the journal has been strongly influenced by historic and political developments, cultural attitudes (zeitgeist), language changes, global changes in research topics, and eminent individuals who published many papers in Naunyn-Schmiedeberg's Archives of Pharmacology.

Anti-emetic effects of thalidomide: Evidence, mechanism of action, and future directions

The rationale for using thalidomide (THD) as a treatment for nausea and vomiting during pregnancy in the late 1950s appears to have been based on its sedative or hypnotic properties. In contrast to contemporaneous studies on the anti-emetic activity of phenothiazines, we were unable to identify publications reporting preclinical or clinical evaluation of THD as an anti-emetic. Our survey of the literature revealed a clinical study in 1965 showing THD reduced vomiting in cancer chemotherapy which was substantiated by similar studies from 2000, particularly showing efficacy in the delayed phase of chemotherapy-induced nausea and vomiting. To identify the mechanism(s) potentially involved in thalidomide's anti-emetic activity we reviewed its pharmacology in the light of nausea and vomiting mechanisms and their pharmacology with a particular emphasis on chemotherapy and pregnancy. The process identified the following potential mechanisms: reduced secretion of Growth Differentiation Factor 15, suppression of inflammation/prostaglandin production, downregulation of cytotoxic drug induced upregulation of iNOS, and modulation of BK (KCa1.1) channels and GABAA/glutamate transmission at critical points in the emetic pathways (nucleus tractus solitarius, area postrema). We propose ways to investigate these hypothesized mechanisms and discuss the associated challenges (e.g., objective quantification of nausea) in addition to some of the more general aspects of developing novel drugs to treat nausea and vomiting.