Chatelain Eric, Konar Nandini
Drugs for Neglected Diseases initiative (DND i ), Geneva, Switzerland.
Merck & Co, Inc, Whitehouse Station, NJ, USA.
Drug Des Devel Ther. 2015 Aug 19;9:4807-23. doi: 10.2147/DDDT.S90208. eCollection 2015.
Chagas disease, or American trypanosomiasis, caused by Trypanosoma cruzi parasite infection is endemic in Latin America and presents an increasing clinical challenge due to migrating populations. Despite being first identified over a century ago, only two drugs are available for its treatment, and recent outcomes from the first clinical trials in 40 years were lackluster. There is a critical need to develop new drugs to treat Chagas disease. This requires a better understanding of the progression of parasite infection, and standardization of animal models designed for Chagas disease drug discovery. Such measures would improve comparison of generated data and the predictability of test hypotheses and models designed for translation to human disease. Existing animal models address both disease pathology and treatment efficacy. Available models have limited predictive value for the preclinical evaluation of novel therapies and need to more confidently predict the efficacy of new drug candidates in clinical trials. This review highlights the overall lack of standardized methodology and assessment tools, which has hampered the development of efficacious compounds to treat Chagas disease. We provide an overview of animal models for Chagas disease, and propose steps that could be undertaken to reduce variability and improve predictability of drug candidate efficacy. New technological developments and tools may contribute to a much needed boost in the drug discovery process.
恰加斯病,即美洲锥虫病,由克氏锥虫寄生虫感染引起,在拉丁美洲呈地方性流行,且由于人口迁移,其临床挑战日益增加。尽管该病在一个多世纪前就已首次被发现,但目前仅有两种药物可用于治疗,而且40年来首次临床试验的近期结果并不理想。迫切需要开发新的药物来治疗恰加斯病。这需要更好地了解寄生虫感染的进展情况,并对用于恰加斯病药物研发的动物模型进行标准化。这些措施将改善所生成数据的比较,以及为转化为人类疾病而设计的测试假设和模型的可预测性。现有的动物模型涉及疾病病理学和治疗效果。可用模型对新疗法的临床前评估的预测价值有限,需要更有信心地预测新药候选物在临床试验中的疗效。本综述强调了总体上缺乏标准化方法和评估工具,这阻碍了治疗恰加斯病有效化合物的开发。我们概述了恰加斯病的动物模型,并提出了可以采取的步骤,以减少变异性并提高候选药物疗效的可预测性。新的技术发展和工具可能有助于在药物研发过程中实现急需的推动。