Di Stefano Antonio, Sozio Piera, Cerasa Laura Serafina
Department of Drug Sciences, G. d'Annunzio University, School of Pharmacy, Via dei Vestini 31, 66100 Chieti, Italy.
Molecules. 2008 Jan 16;13(1):46-68. doi: 10.3390/molecules13010046.
Parkinson's disease (PD) is a progressive, neurodegenerative disorder which involves the loss of dopaminergic neurons of the substantia nigra pars compacta. Current therapy is essentially symptomatic, and L-Dopa (LD), the direct precursor of dopamine(DA), is the treatment of choice in more advanced stages of the disease. Substitution therapy with LD is, however, associated with a number of acute problems. The peripheral conversion of LD by amino acid decarboxylase (AADC) to DA is responsible for the typical gastrointestinal (nausea, emesis) and cardiovascular (arrhythmia, hypotension) side effects. To minimize the conversion to DA outside the central nervous system (CNS) LD is usually given in combination with peripheral inhibitors of AADC (carbidopa and benserazide). In spite of that, other central nervous side effects such as dyskinesia, on-off phenomenon and end-of-dose deterioration still remain. The main factors responsible for the poor bioavailability and the wide range of inter- and intra-patient variations of plasma levels are the drug's physical-chemical properties: low water and lipid solubility, resulting in unfavourable partition, and the high susceptibility to chemical and enzymatic degradation. In order to improve the bioavailability, the prodrug approach appeared to be the most promising and some LD prodrugs have been prepared in an effort to solve these problems. We report here a review of progress in antiparkinson prodrugs, focusing on chemical structures mainly related to LD, DA and dopaminergic agonists.
帕金森病(PD)是一种进行性神经退行性疾病,涉及黑质致密部多巴胺能神经元的丧失。目前的治疗主要是对症治疗,左旋多巴(LD)作为多巴胺(DA)的直接前体,是该疾病更晚期阶段的首选治疗药物。然而,用LD进行替代治疗会带来一些急性问题。氨基酸脱羧酶(AADC)将LD在外周转化为DA,这是典型的胃肠道(恶心、呕吐)和心血管(心律失常、低血压)副作用的原因。为了尽量减少在中枢神经系统(CNS)外转化为DA,LD通常与外周AADC抑制剂(卡比多巴和苄丝肼)联合使用。尽管如此,其他中枢神经副作用,如运动障碍、开关现象和剂量末期恶化仍然存在。导致生物利用度差以及患者间和患者内血浆水平差异广泛的主要因素是药物的物理化学性质:低水溶性和脂溶性,导致分配不利,以及对化学和酶促降解的高度敏感性。为了提高生物利用度,前药方法似乎最有前景,并且已经制备了一些LD前药以努力解决这些问题。我们在此报告抗帕金森病前药的研究进展综述,重点关注主要与LD、DA和多巴胺能激动剂相关的化学结构。