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.
Epilepsy Res. 2019 Mar;151:48-66. doi: 10.1016/j.eplepsyres.2019.02.010. Epub 2019 Feb 25.
Network-based approaches in drug discovery comprise both development of novel drugs interacting with multiple targets and repositioning of drugs with known targets to form novel drug combinations that interact with cellular or molecular networks whose function is disturbed in a disease. Epilepsy is a complex network phenomenon that, as yet, cannot be prevented or cured. We recently proposed multitargeted, network-based approaches to prevent epileptogenesis by combinations of clinically available drugs chosen to impact diverse epileptogenic processes. In order to test this strategy preclinically, we developed a multiphase sequential study design for evaluating such drug combinations in rodents, derived from human clinical drug development phases. Because pharmacokinetics of such drugs are known, only the tolerability of novel drug combinations needs to be evaluated in Phase I in öhealthy" controls. In Phase IIa, tolerability is assessed following an epileptogenic brain insult, followed by antiepileptogenic efficacy testing in Phase IIb. Here, we report Phase I and Phase IIa evaluation of 7 new drug combinations in mice, using 10 drugs (levetiracetam, topiramate, gabapentin, deferoxamine, fingolimod, ceftriaxone, α-tocopherol, melatonin, celecoxib, atorvastatin) with diverse mechanisms thought to be important in epileptogenesis. Six of the 7 drug combinations were well tolerated in mice during prolonged treatment at the selected doses in both controls and during the latent phase following status epilepticus induced by intrahippocampal kainate. However, none of the combinations prevented hippocampal damage in response to kainate, most likely because treatment started only 16-18 h after kainate. This suggests that antiepileptogenic or disease-modifying treatment may need to start earlier after the brain insult. The present data provide a rich collection of tolerable, network-based combinatorial therapies as a basis for antiepileptogenic or disease-modifying efficacy testing.
基于网络的药物发现方法既包括开发与多个靶点相互作用的新型药物,也包括将具有已知靶点的药物重新定位以形成新的药物组合,这些药物组合与细胞或分子网络相互作用,而这些网络的功能在疾病中受到干扰。癫痫是一种复杂的网络现象,迄今为止还无法预防或治愈。我们最近提出了基于多靶点的网络方法,通过选择具有不同致痫作用的临床可用药物组合来预防癫痫发生。为了在临床前阶段测试这种策略,我们开发了一种多阶段序贯研究设计,用于评估啮齿动物中的此类药物组合,该设计源自人类临床药物开发阶段。由于这些药物的药代动力学是已知的,因此仅需要在 I 期健康对照中评估新型药物组合的耐受性。在 IIa 期,在致痫性脑损伤后评估耐受性,然后在 IIb 期进行抗癫痫发生疗效测试。在这里,我们报告了在小鼠中使用 10 种药物(左乙拉西坦、托吡酯、加巴喷丁、去铁胺、芬戈莫德、头孢曲松、α-生育酚、褪黑素、塞来昔布、阿托伐他汀)的 7 种新药物组合的 I 期和 IIa 期评估,这些药物具有不同的机制,被认为在癫痫发生中很重要。在选择剂量下,在对照和海马内海人酸诱导癫痫持续状态后的潜伏期内,7 种药物组合中的 6 种在小鼠中进行了长时间治疗,耐受性良好。然而,没有一种组合能预防海人酸引起的海马损伤,这很可能是因为治疗仅在海人酸后 16-18 小时开始。这表明抗癫痫发生或疾病修饰治疗可能需要在脑损伤后更早开始。目前的数据提供了丰富的可耐受的基于网络的组合治疗方法,为抗癫痫发生或疾病修饰疗效测试提供了基础。
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