Klee Rebecca, Töllner Kathrin, Rankovic Vladan, Römermann Kerstin, Schidlitzki Alina, Bankstahl Marion, Löscher Wolfgang
Department of Pharmacology, Toxicology, and Pharmacy, University of Veterinary Medicine Hannover, 30559 Hannover, Germany; Center for Systems Neuroscience, 30559 Hannover, Germany.
Department of Pharmacology, Toxicology, and Pharmacy, University of Veterinary Medicine Hannover, 30559 Hannover, Germany; Center for Systems Neuroscience, 30559 Hannover, Germany.
Epilepsy Res. 2015 Dec;118:34-48. doi: 10.1016/j.eplepsyres.2015.11.003. Epub 2015 Nov 10.
Prevention of symptomatic epilepsy ("antiepileptogenesis") in patients at risk is a major unmet clinical need. Several drugs underwent clinical trials for epilepsy prevention, but none of the drugs tested was effective. Similarly, most previous preclinical attempts to develop antiepileptogenic strategies failed. In the majority of studies, drugs were given as monotherapy. However, epilepsy is a complex network phenomenon, so that it is unlikely that a single drug can halt epileptogenesis. We recently proposed multitargeted approaches ("network pharmacology") to interfere with epileptogenesis. One strategy, which, if effective, would allow a relatively rapid translation into the clinic, is developing novel combinations of clinically used drugs with diverse mechanisms that are potentially relevant for antiepileptogenesis. In order to test this strategy preclinically, we developed an algorithm for testing such drug combinations, which was inspired by the established drug development phases in humans. As a first step of this algorithm, tolerability of four rationally chosen, repeatedly administered drug combinations was evaluated by a large test battery in mice: A, levetiracetam and phenobarbital; B, valproate, losartan, and memantine; C, levetiracetam and topiramate; and D, levetiracetam, parecoxib, and anakinra. As in clinical trials, tolerability was separately evaluated before starting efficacy experiments to identify any adverse effects of the combinations that may critically limit the successful translation of preclinical findings to the clinic. Except combination B, all drug cocktails were relatively well tolerated. Based on previous studies, we expected that tolerability would be lower in the latent and chronic phases following status epilepticus in mice, but, except combinations C and D, no significant differences were determined between nonepileptic and post-status epilepticus animals. As a next step, the rationally chosen drug combinations will be evaluated for antiepileptogenic activity in mouse and rat models of symptomatic epilepsy.
预防有风险患者的症状性癫痫(“抗癫痫发生”)是一项尚未满足的重大临床需求。几种药物曾进行过预防癫痫的临床试验,但所测试的药物均无效。同样,此前大多数开发抗癫痫发生策略的临床前尝试也都失败了。在大多数研究中,药物采用单一疗法给药。然而,癫痫是一种复杂的网络现象,因此单一药物不太可能阻止癫痫发生。我们最近提出了多靶点方法(“网络药理学”)来干预癫痫发生。一种策略如果有效,将能相对快速地转化为临床应用,即开发临床上使用的具有不同机制的药物的新型组合,这些机制可能与抗癫痫发生相关。为了在临床前测试这一策略,我们开发了一种用于测试此类药物组合的算法,该算法的灵感来自于人类既定的药物开发阶段。作为该算法的第一步,通过在小鼠中进行的大量测试评估了四种合理选择的、重复给药的药物组合的耐受性:A,左乙拉西坦和苯巴比妥;B,丙戊酸盐、氯沙坦和美金刚;C,左乙拉西坦和托吡酯;D,左乙拉西坦、帕瑞昔布和阿那白滞素。与临床试验一样,在开始疗效实验之前分别评估耐受性,以确定可能严重限制临床前研究结果成功转化为临床应用的组合的任何不良反应。除了组合B,所有药物混合物的耐受性都相对较好。基于先前的研究,我们预计在小鼠癫痫持续状态后的潜伏期和慢性期耐受性会更低,但除了组合C和D,在非癫痫动物和癫痫持续状态后动物之间未发现显著差异。下一步,将在症状性癫痫的小鼠和大鼠模型中评估合理选择的药物组合的抗癫痫发生活性。