Women's & Newborn Services, Royal Brisbane and Women's Hospital , Herston, Queensland, Australia.
Expert Opin Investig Drugs. 2020 May;29(5):507-523. doi: 10.1080/13543784.2020.1752661. Epub 2020 Apr 29.
Preterm birth is the leading cause of neonatal morbidity and mortality globally and poses a substantial economic burden. Consequently, there is a need for the identification of therapeutic targets and novel experimental drugs for the inhibition of preterm labor to improve neonatal outcomes.
The authors review the pathophysiology of labor and the inflammatory pathways underpinning it. The interruption of these pathways forms the basis of therapeutic targets to inhibit preterm labor. Current drugs available for the treatment of preterm labor are reviewed, followed by experimental drugs including toll-like receptor 4 (TLR-4) antagonists, cytokine suppressive anti-inflammatory drugs (CSAIDs), N-acetyl cysteine (NAC), Sulfasalazine (SSZ), tumor necrosis factor-alpha (TNF-α) antagonists, interleukin-1 receptor (IL-1) inhibitors, omega-3 polyunsaturated fatty acids and lipid metabolites, and the polyphenols.
A number of new therapeutic strategies for the prevention of preterm labor are being investigated. These have the potential to improve neurodevelopmental outcomes and survival in babies born preterm, reducing the economic and healthcare costs of caring for the complex needs of these children in the immediate and long term. It is likely that over the next decade there will be a new treatment option that targets the pathological inflammatory processes involved in preterm labor.
早产是全球新生儿发病率和死亡率的主要原因,同时也造成了巨大的经济负担。因此,有必要寻找治疗靶点和新型实验性药物来抑制早产,以改善新生儿结局。
作者综述了分娩的病理生理学以及支撑其的炎症途径。中断这些途径是抑制早产的治疗靶点的基础。本文回顾了目前可用于治疗早产的药物,接着介绍了一些实验性药物,包括 Toll 样受体 4(TLR-4)拮抗剂、细胞因子抑制性抗炎药物(CSAIDs)、N-乙酰半胱氨酸(NAC)、柳氮磺胺吡啶(SSZ)、肿瘤坏死因子-α(TNF-α)拮抗剂、白介素-1 受体(IL-1)抑制剂、ω-3 多不饱和脂肪酸和脂质代谢物,以及多酚。
目前正在研究许多新的预防早产的治疗策略。这些策略有可能改善早产儿的神经发育结局和存活率,减少这些儿童在近期和长期内对复杂需求的护理的经济和医疗保健成本。在未来十年内,很可能会出现一种新的针对早产相关病理性炎症过程的治疗选择。