表观遗传相关药物对癌症的治疗

表观遗传变化是指核酸序列不发生变化的情况下发生的可遗传变化。表观遗传变化在癌症发生和恶性转移的过程中发挥着重要的作用。目前,已有数种表观药物通过FDA认证并用于癌症的治疗,主要为DNA甲基转移酶抑制剂和组蛋白去乙酰化酶抑制剂;还有许多的新型表观药物处于实验室或者临床试验阶段,包括组蛋白乙酰化酶、组蛋白甲基化酶、组蛋白去甲基化酶以及表观解读蛋白的小分子抑制剂,它们都表现出显著的抗肿瘤活性。该文对这些表观修饰小分子抑制剂的最新进展和将来的应用前景进行了整理、总结。     

已检测出三种重要寄生原虫的基因组序列

Science2005年7月15日404-442页报道：非洲锥虫菊、南美洲锥虫病和利什曼病是三种致命的寄生虫病。全球每年有100万人死于这三种病。非洲锥虫病的病原体是布鲁斯氏锥虫,可引起神经疾患,从而影响睡眠周期。南美洲锥虫病的病原体是克鲁斯氏锥虫,可严重损害心、胃和脑。利什曼病的病原体是各种利什曼原虫,可侵犯肝脾。对于这三种寄生虫病目前没有预防性疫苗,已有的药物不仅有毒性副作用,而且寄生虫已对其产生了抗药性。     

环糊精的药学应用

环糊精是一类由D-吡喃型葡萄糖单体以α-1,4-糖苷键相互连接而成的环状低聚糖。这种环状的低聚糖形成了一种内穴疏水、外缘亲水的特殊结构。因此,环糊精能够和脂溶性药物分子形成包合物,从而可以增加脂溶性药物分子的水溶性和稳定性。同时,这些低聚糖自身无毒性,亦没有明显的药理活性。这些使得环糊精被广泛应用于食品、化妆品和药品当中。作为一种新型的药物赋形剂,环糊精广泛应用于口服、静脉注射和鼻下给药等多种药物剂型,目前在市场上至少有35种环糊精相关的药品,相信在不久的将来,环糊精在药学领域会得到越来越广泛的应用。本文综述了环糊精类的结构特点、包合性能、药物代谢、毒理学性质和目前在药学领域的应用。     

蛋白激酶抑制剂在抗肿瘤药物中的应用

该文从多靶点作用的激酶抑制剂、高度选择性的激酶抑制剂等方面介绍激酶抑制剂在抗肿瘤药物中的应用。目前,虽然分子靶抗癌药物治疗机制仍有不确定性,特别是针对多基因产物的分子靶抗癌药物更是如此,但这种新型的药物仍为人类攻克癌症开辟了广阔的前景。     

抗真菌感染新药研究进展

随着免疫功能缺陷人群的增多,侵袭性真菌感染（invasive fungal infections,IFIs）的发病率和死亡率逐年上升,严重威胁人类健康。目前临床常用抗侵袭性真菌感染药物有三唑类（氟康唑）、多烯类（两性霉素B）、棘白菌素类（卡泊芬净）等,然而这些药物并不能满足临床需要,侵袭性真菌感染的死亡率仍居高不下。因此,本文着重于目前处于临床研究阶段的抗真菌感染新药,根据作用靶点不同依次介绍：作用于细胞壁的新型葡聚糖合成酶抑制剂CD101和SCY-078、几丁质合成酶抑制剂尼可霉素Z、GPI锚定蛋白抑制剂APX001;作用于细胞膜的CYP51抑制剂VT-1161和VT-1129、破坏细胞膜通透性药物CAmB;影响细胞代谢的嘧啶合成抑制剂F901318,以及生物制剂包括细胞表面凝集素样序列3蛋白疫苗（NDV-3）和抗真菌感染抗体Mycograb。本文主要综述了上述新药的研究进展,包括作用机制、体内外活性、临床研究结果等,为相关药物的研发与未来的临床应用提供参考。     

表观遗传药物在肿瘤治疗中的应用

表观遗传调控基因的突变在许多肿瘤中都被发现,所造成后果主要体现在DNA启动子高甲基化、DNA广泛低甲基化、组蛋白和其相关修饰改变和染色质结构异常四个方面。使用表观遗传药物,如DNA甲基化酶抑制剂、组蛋白修饰酶抑制剂和其他表观遗传相关蛋白特异性的抑制剂,已成为肿瘤治疗的一种新途径。目前,表观遗传药物治疗在多种肿瘤中已取得明显的效果,许多表观遗传药物处于临床试验,部分已投入临床使用。因此,该文对肿瘤中突变的表观遗传基因相关表观遗传药物治疗的研究进展以及目前存在的问题进行简要综述。     

一类新型的抗病毒药物:病毒进入抑制剂

艾滋病是严重威胁人类健康的病毒性传染病.目前临床上抗人类免疫缺陷病毒(HIV)感染的药物主要是针对反转录酶和蛋白酶.反转录酶抑制剂和蛋白酶抑制剂的联合使用能显著降低HIV感染者的发病率和病死率,然而不良反应较大,价格昂贵,而且耐药的问题日益突出.近来一类新型抗HIV药物相继问世,其中T-20已经被美国食品药品管理局(FDA)批准正式在临床使用,此外几十种同类药物已经进入临床试验.     

PI3K 抑制剂抗肿瘤临床研究进展

磷脂酰肌醇-3-激酶 (PI3K) 是一种胞内磷脂酰肌醇激酶,在介导细胞生长、发育、分裂、分化和凋亡等过程中发挥重要作用,因此 PI3K 抑制剂的开发已成为当前抗癌新药研究的热点之一。目前已有多个 PI3K 抑制剂进入临床研究阶段或已上市,其单用或与其他药物联 用的疗效和安全性有待进一步临床验证。综述 PI3K 抑制剂作为抗肿瘤药物的临床研究进展,为其进一步研究与应用提供参考。     

关节置换术后抗凝药物预防深静脉血栓及相关并发症的临床研究进展

抗凝药物有助于预防全髋关节置换术和全膝关节置换术后深静脉血栓形成,临床上最常使用的传统抗凝药物如低分子肝素、华法林等可以起到很好的预防效果。目前有一类新的口服抗凝药物已经用于临床,为关节置换术后患者带来了一种更方便、安全和有效预防血栓的治疗选择。本篇综述主要针对传统抗凝药物低分子肝素及维生素K拮抗剂,直接凝血酶抑制剂达比加群,以及选择性Xa因子抑制剂利伐沙班和阿哌沙班,对迄今为止传统抗凝药物在全髋关节置换术和全膝关节置换术患者中的临床使用经验、优缺点、以及新型口服抗凝药物最新临床用药进展进行综述,为关节置换术后患者预防深静脉血栓提供用药参考。     

以布氏锥虫亮氨酰tRNA合成酶为靶标的抗锥虫药物筛选系统的建立

锥虫是人的血液寄生虫,对热带乃至拉丁美洲贫困地区影响极大,但目前的传统治疗药物存在副作用大、有效性不断降低的问题。根据亮氨酰tRNA合成酶在微生物中可作为药物靶点的事实,在新型抗锥虫药物筛选中,通过对锥虫的亮氨酰tRNA合成酶的克隆、表达和纯化,以及该酶活性测定的优化,建立了该酶抑制物的筛选系统。筛选结果表明,这一以锥虫亮氨酰tRNA合成酶为靶标的抗锥虫药物筛选系统可以有效筛选抗锥虫化合物,选出的化合物有一定的抗锥虫特异性,并可以用于化合物的进一步优化和测定其半抑制浓度。使用这一系统筛选到了对锥虫有较好抑制作用,但对人类细胞毒性较小的一系列新型化合物,因而锥虫亮氨酰tRNA合成酶很可能成为开发有效抗锥虫药物的新靶标。     

Synthesis and biological testing of novel pyridoisothiazolones as histone acetyltransferase inhibitors

We present a combination of database screening, synthesis and in vitro testing to identify novel histone acetyltransferase (HAT) inhibitors. The National Cancer Institute compound collection (NCI) and several commercial databases were filtered by similarity-based virtual screening to find new HAT inhibitors. Employing the recombinant HAT p300/CBP-associated factor (PCAF) and two different histone substrates for screening, pyridoisothiazolones were identified as inhibitors of human PCAF. Due to the limited solubility of the initial hits, we synthesized and tested them on PCAF. The compounds inhibit the proliferation of cancer cells. In summary, valuable chemical tools and potential lead candidates for new anticancer agents directed against HATs as new targets have been identified.     

Kinetoplastida: new therapeutic strategies

New formulations and therapeutic switching of the established drugs, amphotericin B and paromomycin, together with the discovery of miltefosine, have significantly improved the opportunities for treatment of visceral leishmaniasis (VL) chemotherapy. However, for human African trypanosomiasis (HAT), Chagas disease and cutaneous leishmaniases there has been limited progress. For HAT, a novel diamidine, parfuramidine, is in phase III clinical trial for early-stage disease, but for the treatment of late-stage disease there are no new drugs and combinations of eflornithine with melarsoprol or nifurtimox have been the focus of clinical studies. For Chagas disease, different classes of compounds that have validated biochemical targets, sterol biosynthesis methylases and cysteine proteases, are in various stages of development. The genome sequences that are now available for the pathogens that cause the leishmaniases and trypanosomiases, and new methods for rapid validation of targets, are part of the solution to discover new drugs. The integration of medicinal chemistry, pharmacokinetics, project planning and interaction with the pharma/biotech sector are essential if progress is to be made. Although there are financial constraints, the appearance of new funding sources and not-for-profit product development partnerships offers hope for drug development.     

Carbohydrate-Binding Non-Peptidic Pradimicins for the Treatment of Acute Sleeping Sickness in Murine Models

Current treatments available for African sleeping sickness or human African trypanosomiasis (HAT) are limited, with poor efficacy and unacceptable safety profiles. Here, we report a new approach to address treatment of this disease based on the use of compounds that bind to parasite surface glycans leading to rapid killing of trypanosomes. Pradimicin and its derivatives are non-peptidic carbohydrate-binding agents that adhere to the carbohydrate moiety of the parasite surface glycoproteins inducing parasite lysis in vitro. Notably, pradimicin S has good pharmaceutical properties and enables cure of an acute form of the disease in mice. By inducing resistance in vitro we have established that the composition of the sugars attached to the variant surface glycoproteins are critical to the mode of action of pradimicins and play an important role in infectivity. The compounds identified represent a novel approach to develop drugs to treat HAT.     

Update on field use of the available drugs for the chemotherapy of human African trypanosomiasis

Despite the fact that eflornithine was considered as the safer drug to treat human African trypanosomiasis (HAT) and has been freely available since 2001, the difficulties in logistics and cost burden associated with this drug meant that the toxic melarsoprol remained the drug of choice. The World Health Organization responded to the situation by designing a medical kit containing all the materials needed to use eflornithine, and by implementing a training and drugs distribution programme which has allowed a transition to this much safer treatment. The introduction of the combination of nifurtimox and eflornithine (NECT) has accelerated the shift from melarsoprol to the best treatment available, due to reduced dosage and treatment time for eflornithine that has significantly lessened the cost and improved the burden of logistics encountered during treatment and distribution. The decrease in the use of more dangerous but cheaper melarsoprol has meant a rise in the per patient cost of treating HAT. Although NECT is cheaper than eflornithine monotherapy, an unexpected consequence has been a continuing rise in the per patient cost of treating HAT. The ethical decision of shifting to the best available treatment imposes a financial burden on HAT control programmes that might render long-term application unsustainable. These factors call for continuing research to provide new safer and more effective drugs that are simple to administer and cheaper when compared to current drugs.     

Cardiac Alterations in Human African Trypanosomiasis (T.b. gambiense) with Respect to the Disease Stage and Antiparasitic Treatment

Background

In Human African Trypanosomiasis, neurological symptoms dominate and cardiac involvement has been suggested. Because of increasing resistance to the available drugs for HAT, new compounds are desperately needed. Evaluation of cardiotoxicity is one parameter of drug safety, but without knowledge of the baseline heart involvement in HAT, cardiologic findings and drug-induced alterations will be difficult to interpret. The aims of the study were to assess the frequency and characteristics of electrocardiographic findings in the first stage of HAT, to compare these findings to those of second stage patients and healthy controls and to assess any potential effects of different therapeutic antiparasitic compounds with respect to ECG changes after treatment.

Methods

Four hundred and six patients with first stage HAT were recruited in the Democratic Republic of Congo, Angola and Sudan between 2002 and 2007 in a series of clinical trials comparing the efficacy and safety of the experimental treatment DB289 to the standard first stage treatment, pentamidine. These ECGs were compared to the ECGs of healthy volunteers (n = 61) and to those of second stage HAT patients (n = 56).

Results

In first and second stage HAT, a prolonged QTc interval, repolarization changes and low voltage were significantly more frequent than in healthy controls. Treatment in first stage was associated with repolarization changes in both the DB289 and the pentamidine group to a similar extent. The QTc interval did not change during treatment.

Conclusions

Cardiac involvement in HAT, as demonstrated by ECG alterations, appears early in the evolution of the disease. The prolongation of the QTC interval comprises a risk of fatal arrhythmias if new drugs with an additional potential of QTC prolongation will be used. During treatment ECG abnormalities such as repolarization changes consistent with peri-myocarditis occur frequently and appear to be associated with the disease stage, but not with a specific drug.     

New models towards assessing anti-cancer therapeutics

Cancer is the subject of intense research around the world, but many questions about how the disease works remain unanswered. How exactly does cancer start and how do tumours grow? In fact, at present there are ten times more anticancer drugs being tested in clinical trials than there were 15 years ago. However, many of the new anticancer agents are predicted to show clinical benefit in only small subpopulations of patients. The cancer stem cell model could explain not only how some cancers work but also why patients suffer relapses, providing a good opportunity to gain insight into the reasons why agents work or, more commonly, don't work, before going into a clinical trial.     

Some aspects of medical management of gastrointestinal disease. I.

Summary: Among drugs recently introduced into Canada for treatment of gastrointestinal disease are carbenoxolone sodium (used in treating gastric ulcer) and metoclopramide hydrochloride (which modifies upper gastrointestinal tract motility). A third drug, lactulose (useful in treating hepatic encephalopathy), will soon be available. Clinical experience with these drugs has been most extensive in Europe. In a new class of agents are histamine H2-receptor antagonists, which are currently under clinical trial. These drugs are the most potent inhibitors of gastric acid secretion yet investigated, and are potentially the most exciting agents to appear in many years. Part I of this paper is a review of the actions, clinical use, side effects, and dosage and administration of these new drugs.     

Chemotherapy against human African trypanosomiasis: is there a road to success?

For over fifty years, human African trypanosomiasis (HAT, sleeping sickness) has been treated with suramin, pentamidine and the very toxic organo-arsenical melarsoprol that was the only drug available for effective treatment of the second stage of the disease. Recently there have been significant efforts using molecular and biochemical approaches to drug design, including high-throughput screening, but the number of lead compounds with promising activity against T. brucei spp. and an acceptable toxicity index has remained astonishingly small. Clinical research continues to be difficult due to the economic constraints and the complexity of trials on a low prevalence disease in remote and impoverished African regions. Despite those limitations the situation for the patients is improving thanks to the combination of a number of critical factors. By the late 1990s the disease had reached epidemic levels that triggered political support. WHO would sign a donation agreement with the manufacturers for all drugs to treat HAT. A result of this agreement was that eflornithine which is much safer than melarsoprol became available and widely used by non-governmental organizations. The Impamel I and II programmes demonstrated that against all odds the conduct of clinical trials on HAT was feasible. This allowed the initiation of trials on combination therapies which eventually resulted in the nifurtimox-eflornithine combination treatment (NECT). This combination is currently being introduced as first line treatment, and there is even the prospect of having a new compound, fexinidazole, in the development pipeline. This review summarizes the key information about the existing drugs and gives a comprehensive summary about the recent and currently ongoing efforts towards new drugs.     

Fluorescent cyclin-dependent kinase inhibitors block the proliferation of human breast cancer cells

Inhibitors of cyclin-dependent kinases (CDKs) are an emerging class of drugs for the treatment of cancers. CDK inhibitors are currently under evaluation in clinical trials as single agents and as sensitizers in combination with radiation therapy and chemotherapies. Drugs that target CDKs could have important inhibitory effects on cancer cell cycle progression, an extremely important mechanism in the control of cancer cell growth. Using rational drug design, we designed and synthesized fluorescent CDK inhibitors (VMY-1-101 and VMY-1-103) based on a purvalanol B scaffold. The new agents demonstrated more potent CDK inhibitory activity, enhanced induction of G2/M arrest and modest apoptosis as compared to purvalanol B. Intracellular imaging of the CDK inhibitor distribution was performed to reveal drug retention in the cytoplasm of treated breast cancer cells. In human breast cancer tissue, the compounds demonstrated increased binding as compared to the fluorophore. The new fluorescent CDK inhibitors showed undiminished activity in multidrug resistance (MDR) positive breast cancer cells, indicating that they are not a substrate for p-glycoprotein. Fluorescent CDK inhibitors offer potential as novel theranostic agents, combining therapeutic and diagnostic properties in the same molecule.