Egli Mark
Division of Neuroscience and Behavior, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA.
Handb Exp Pharmacol. 2018;248:537-578. doi: 10.1007/164_2017_85.
Animal models provide rapid, inexpensive assessments of an investigational drug's therapeutic potential. Ideally, they support the plausibility of therapeutic efficacy and provide a rationale for further investigation. Here, I discuss how the absence of clear effective-ineffective categories for alcohol use disorder (AUD) medications and biases in the clinical and preclinical literature affect the development of predictive preclinical alcohol dependence (AD) models. Invoking the analogical argument concept from the philosophy of science field, I discuss how models of excessive alcohol drinking support the plausibility of clinical pharmacotherapy effects. Even though these models are not likely be completely discriminative, they are sensitive to clinically effective medications and have revealed dozens of novel medication targets. In that context, I discuss recent preclinical work on GLP-1 receptor agonists, phosphodiesterase inhibitors, glucocorticoid receptor antagonists, nociception agonists and antagonists, and CRF1 antagonists. Clinically approved medications are available for each of these drug classes. I conclude by advocating a translational approach in which drugs are evaluated highly congruent preclinical models and human laboratory studies. Once translation is established, I suggest the burden is to develop hypothesis-based therapeutic interventions maximizing the impact of the confirmed pharmacotherapeutic effects in the context of additional variables falling outside the model.
动物模型能够快速、低成本地评估研究性药物的治疗潜力。理想情况下,它们能支持治疗效果的合理性,并为进一步研究提供理论依据。在此,我将讨论酒精使用障碍(AUD)药物缺乏明确的有效-无效分类以及临床和临床前文献中的偏差如何影响预测性临床前酒精依赖(AD)模型的开发。借鉴科学哲学领域的类比论证概念,我将讨论过度饮酒模型如何支持临床药物治疗效果的合理性。尽管这些模型不太可能具有完全的区分性,但它们对临床有效药物敏感,并揭示了数十个新的药物靶点。在此背景下,我将讨论近期关于胰高血糖素样肽-1受体激动剂、磷酸二酯酶抑制剂、糖皮质激素受体拮抗剂、伤害感受激动剂和拮抗剂以及促肾上腺皮质激素释放因子1拮抗剂的临床前研究工作。这些药物类别均有临床批准的药物。我主张采用一种转化方法,即对药物进行高度一致的临床前模型和人体实验室研究评估。一旦建立了转化关系,我建议责任在于开发基于假设的治疗干预措施,在模型之外的其他变量背景下最大化已确认的药物治疗效果的影响。