新型生物制剂治疗肺动脉高压。
Emerging biologics for the treatment of pulmonary arterial hypertension.
机构信息
Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA.
Department of Biological Sciences, University of Arkansas, Fayetteville, Arkansas, USA.
出版信息
J Drug Target. 2023 Jun;31(5):1-15. doi: 10.1080/1061186X.2023.2199351. Epub 2023 Apr 26.
Pulmonary arterial hypertension (PAH) is a rare pulmonary vascular disorder, wherein mean systemic arterial pressure (mPAP) becomes abnormally high because of aberrant changes in various proliferative and inflammatory signalling pathways of pulmonary arterial cells. Currently used anti-PAH drugs chiefly target the vasodilatory and vasoconstrictive pathways. However, an imbalance between bone morphogenetic protein receptor type II (BMPRII) and transforming growth factor beta (TGF-β) pathways is also implicated in PAH predisposition and pathogenesis. Compared to currently used PAH drugs, various biologics have shown promise as PAH therapeutics that elicit their therapeutic actions akin to endogenous proteins. Biologics that have thus far been explored as PAH therapeutics include monoclonal antibodies, recombinant proteins, engineered cells, and nucleic acids. Because of their similarity with naturally occurring proteins and high binding affinity, biologics are more potent and effective and produce fewer side effects when compared with small molecule drugs. However, biologics also suffer from the limitations of producing immunogenic adverse effects. This review describes various emerging and promising biologics targeting the proliferative/apoptotic and vasodilatory pathways involved in PAH pathogenesis. Here, we have discussed sotatercept, a TGF-β ligand trap, which is reported to reverse vascular remodelling and reduce PVR with an improved 6-minute walk distance (6-MWDT). We also elaborated on other biologics including BMP9 ligand and anti-gremlin1 antibody, anti-OPG antibody, and getagozumab monoclonal antibody and cell-based therapies. Overall, recent literature suggests that biologics hold excellent promise as a safe and effective alternative to currently used PAH therapeutics.
肺动脉高压(PAH)是一种罕见的肺血管疾病,其中平均体动脉压(mPAP)由于肺动脉细胞各种增殖和炎症信号通路的异常变化而变得异常高。目前使用的抗 PAH 药物主要针对血管扩张和血管收缩途径。然而,骨形态发生蛋白受体型 II(BMPRII)和转化生长因子-β(TGF-β)途径之间的失衡也与 PAH 的易感性和发病机制有关。与目前使用的 PAH 药物相比,各种生物制剂作为 PAH 治疗药物具有很大的应用前景,它们通过与内源性蛋白相似的作用机制发挥治疗作用。迄今为止,作为 PAH 治疗药物探索的生物制剂包括单克隆抗体、重组蛋白、工程细胞和核酸。由于其与天然存在的蛋白质相似且具有高结合亲和力,与小分子药物相比,生物制剂更有效、更有效,副作用更少。然而,生物制剂也存在产生免疫原性不良反应的局限性。本文描述了各种针对 PAH 发病机制中增殖/凋亡和血管舒张途径的新兴和有前途的生物制剂。在这里,我们讨论了 sotatercept,一种 TGF-β配体陷阱,据报道它可以逆转血管重塑并降低 PVR,同时提高 6 分钟步行距离(6-MWDT)。我们还详细介绍了其他生物制剂,包括 BMP9 配体和抗 gremlin1 抗体、抗 OPG 抗体、getagozumab 单克隆抗体和基于细胞的疗法。总的来说,最近的文献表明,生物制剂作为目前使用的 PAH 治疗药物的安全有效替代品具有巨大的应用前景。