Department of Neuroscience, Genentech Inc., South San Francisco, CA, 94080, USA.
Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA, 30322, USA.
Neuropsychopharmacology. 2024 Jan;49(1):51-66. doi: 10.1038/s41386-023-01614-3. Epub 2023 Jun 27.
N-methyl-D-aspartate (NMDA) receptors mediate a slow component of excitatory synaptic transmission, are widely distributed throughout the central nervous system, and regulate synaptic plasticity. NMDA receptor modulators have long been considered as potential treatments for psychiatric disorders including depression and schizophrenia, neurodevelopmental disorders such as Rett Syndrome, and neurodegenerative conditions such as Alzheimer's disease. New interest in NMDA receptors as therapeutic targets has been spurred by the findings that certain inhibitors of NMDA receptors produce surprisingly rapid and robust antidepressant activity by a novel mechanism, the induction of changes in the brain that well outlast the presence of drug in the body. These findings are driving research into an entirely new paradigm for using NMDA receptor antagonists in a host of related conditions. At the same time positive allosteric modulators of NMDA receptors are being pursued for enhancing synaptic function in diseases that feature NMDA receptor hypofunction. While there is great promise, developing the therapeutic potential of NMDA receptor modulators must also navigate the potential significant risks posed by the use of such agents. We review here the emerging pharmacology of agents that target different NMDA receptor subtypes, offering new avenues for capturing the therapeutic potential of targeting this important receptor class.
N-甲基-D-天冬氨酸(NMDA)受体介导兴奋性突触传递的缓慢成分,广泛分布于中枢神经系统,并调节突触可塑性。NMDA 受体调节剂长期以来一直被认为是治疗包括抑郁症和精神分裂症在内的精神疾病、雷特综合征等神经发育障碍以及阿尔茨海默病等神经退行性疾病的潜在方法。由于发现某些 NMDA 受体抑制剂通过一种新的机制产生了令人惊讶的快速和强大的抗抑郁作用,NMDA 受体作为治疗靶点的新兴趣被激发,这种机制诱导了大脑的变化,远远超过了药物在体内的存在。这些发现推动了对 NMDA 受体拮抗剂在一系列相关疾病中应用的全新范式的研究。与此同时,NMDA 受体的正变构调节剂也在被用于增强 NMDA 受体功能低下的疾病中的突触功能。尽管前景广阔,但开发 NMDA 受体调节剂的治疗潜力还必须应对此类药物使用带来的潜在重大风险。我们在这里回顾了针对不同 NMDA 受体亚型的药物的新兴药理学,为利用这一重要受体类别的治疗潜力提供了新的途径。
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