Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri 63110, USA; email:
Center for Clinical Pharmacology, University of Health Sciences and Pharmacy and Washington University School of Medicine, St. Louis, Missouri 63110, USA.
Annu Rev Biochem. 2021 Jun 20;90:739-761. doi: 10.1146/annurev-biochem-061620-044044. Epub 2021 Mar 23.
Opioids such as morphine and oxycodone are analgesics frequently prescribed for the treatment of moderate or severe pain. Unfortunately, these medications are associated with exceptionally high abuse potentials and often cause fatal side effects, mainly through the μ-opioid receptor (MOR). Efforts to discover novel, safer, and more efficacious analgesics targeting MOR have encountered challenges. In this review, we summarize alternative strategies and targets that could be used to develop safer nonopioid analgesics. A molecular understanding of G protein-coupled receptor activation and signaling has illuminated not only the complexities of receptor pharmacology but also the potential for pathway-selective agonists and allosteric modulators as safer medications. The availability of structures of pain-related receptors, in combination with high-throughput computational tools, has accelerated the discovery of multitarget ligands with promising pharmacological profiles. Emerging clinical evidence also supports the notion that drugs targeting peripheral opioid receptors have potential as improved analgesic agents.
阿片类药物如吗啡和羟考酮是常用于治疗中度或重度疼痛的镇痛药。不幸的是,这些药物具有极高的滥用潜力,经常导致致命的副作用,主要是通过μ-阿片受体(MOR)。发现针对 MOR 的新型、更安全和更有效的镇痛药的努力遇到了挑战。在这篇综述中,我们总结了可以用来开发更安全的非阿片类镇痛药的替代策略和靶点。对 G 蛋白偶联受体激活和信号转导的分子理解不仅阐明了受体药理学的复杂性,还阐明了途径选择性激动剂和变构调节剂作为更安全药物的潜力。疼痛相关受体结构的可用性,结合高通量计算工具,加速了具有有前途的药理学特征的多靶配体的发现。新兴的临床证据也支持这样一种观点,即靶向外周阿片受体的药物有作为改良镇痛剂的潜力。
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