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从基础到系统药效动力学模型的转变:皮质类固醇的经验教训。

Transitioning from Basic toward Systems Pharmacodynamic Models: Lessons from Corticosteroids.

机构信息

Department of Pharmaceutical Sciences University at Buffalo, School of Pharmacy and Pharmaceutical Sciences, Buffalo, New York.

Department of Pharmaceutical Sciences University at Buffalo, School of Pharmacy and Pharmaceutical Sciences, Buffalo, New York

出版信息

Pharmacol Rev. 2020 Apr;72(2):414-438. doi: 10.1124/pr.119.018101.

Abstract

Technology in bioanalysis, , and computation have evolved over the past half century to allow for comprehensive assessments of the molecular to whole body pharmacology of diverse corticosteroids. Such studies have advanced pharmacokinetic and pharmacodynamic (PK/PD) concepts and models that often generalize across various classes of drugs. These models encompass the "pillars" of pharmacology, namely PK and target drug exposure, the mass-law interactions of drugs with receptors/targets, and the consequent turnover and homeostatic control of genes, biomarkers, physiologic responses, and disease symptoms. Pharmacokinetic methodology utilizes noncompartmental, compartmental, reversible, physiologic [full physiologically based pharmacokinetic (PBPK) and minimal PBPK], and target-mediated drug disposition models using a growing array of pharmacometric considerations and software. Basic PK/PD models have emerged (simple direct, biophase, slow receptor binding, indirect response, irreversible, turnover with inactivation, and transduction models) that place emphasis on parsimony, are mechanistic in nature, and serve as highly useful "top-down" methods of quantitating the actions of diverse drugs. These are often components of more complex quantitative systems pharmacology (QSP) models that explain the array of responses to various drugs, including corticosteroids. Progressively deeper mechanistic appreciation of PBPK, drug-target interactions, and systems physiology from the molecular (genomic, proteomic, metabolomic) to cellular to whole body levels provides the foundation for enhanced PK/PD to comprehensive QSP models. Our research based on cell, animal, clinical, and theoretical studies with corticosteroids have provided ideas and quantitative methods that have broadly advanced the fields of PK/PD and QSP modeling and illustrates the transition toward a global, systems understanding of actions of diverse drugs. SIGNIFICANCE STATEMENT: Over the past half century, pharmacokinetics (PK) and pharmacokinetics/pharmacodynamics (PK/PD) have evolved to provide an array of mechanism-based models that help quantitate the disposition and actions of most drugs. We describe how many basic PK and PK/PD model components were identified and often applied to the diverse properties of corticosteroids (CS). The CS have complications in disposition and a wide array of simple receptor-to complex gene-mediated actions in multiple organs. Continued assessments of such complexities have offered opportunities to develop models ranging from simple PK to enhanced PK/PD to quantitative systems pharmacology (QSP) that help explain therapeutic and adverse CS effects. Concurrent development of state-of-the-art PK, PK/PD, and QSP models are described alongside experimental studies that revealed diverse CS actions.

摘要

半个世纪以来,生物技术、计算技术和生物分析技术的发展使得人们能够全面评估各种皮质甾类药物的分子到整体的药理学。这些研究推进了药代动力学和药效动力学(PK/PD)的概念和模型的发展,这些概念和模型通常可以推广到各种类别的药物。这些模型涵盖了药理学的“支柱”,即 PK 和药物暴露的靶点,药物与受体/靶点的质量作用关系,以及基因、生物标志物、生理反应和疾病症状的相应转化和动态平衡控制。药代动力学方法利用非房室、房室、可逆、生理[全生理基础药代动力学(PBPK)和最小 PBPK]和基于靶标的药物处置模型,同时考虑越来越多的药物计量学考虑因素和软件。已经出现了基本的 PK/PD 模型(简单直接、双相、慢受体结合、间接反应、不可逆、转化失活和转导模型),这些模型强调简约性,本质上是机械性的,并且是定量各种药物作用的非常有用的“自上而下”方法。这些模型通常是更复杂的定量系统药理学(QSP)模型的组成部分,这些模型可以解释对各种药物(包括皮质甾类药物)的各种反应。从分子(基因组、蛋白质组、代谢组)到细胞到全身水平,对 PBPK、药物-靶标相互作用和系统生理学的认识不断加深,为增强 PK/PD 到全面的 QSP 模型提供了基础。我们基于皮质甾类药物的细胞、动物、临床和理论研究的研究提供了思想和定量方法,广泛推进了 PK/PD 和 QSP 建模领域的发展,并说明了朝着全面、系统地理解各种药物作用的方向发展。意义陈述:在过去的半个世纪中,药代动力学(PK)和药代动力学/药效动力学(PK/PD)已经发展到提供一系列基于机制的模型,这些模型有助于定量大多数药物的处置和作用。我们描述了如何识别许多基本的 PK 和 PK/PD 模型组件,并且经常将其应用于皮质甾类药物(CS)的各种特性。CS 在处置方面存在复杂性,并且在多个器官中具有广泛的简单受体到复杂基因介导的作用。对这些复杂性的持续评估提供了机会,可以从简单的 PK 到增强的 PK/PD 到定量系统药理学(QSP)来开发模型,这些模型有助于解释皮质甾类药物的治疗和不良反应。同时描述了最先进的 PK、PK/PD 和 QSP 模型的开发,以及揭示 CS 各种作用的实验研究。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a597/7058984/4d70caae31f6/pr.119.018101absf1.jpg

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