Department of Clinical Medicine, Aarhus University Hospital, Aarhus 8200, Denmark.
Nuffield Department of Clinical Neurosciences, Oxford Centre for Neuroinflammation, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK.
EBioMedicine. 2023 Nov;97:104840. doi: 10.1016/j.ebiom.2023.104840. Epub 2023 Oct 18.
JAK inhibitors impact multiple cytokine pathways simultaneously, enabling high efficacy in treating complex diseases such as cancers and immune-mediated disorders. However, their broad reach also poses safety concerns, which have fuelled a demand for increasingly selective JAK inhibitors. Deucravacitinib, a first-in-class allosteric TYK2 inhibitor, represents a remarkable advancement in the field. Rather than competing at kinase domain catalytic sites as classical JAK1-3 inhibitors, deucravacitinib targets the regulatory pseudokinase domain of TYK2. It strikingly mirrors the functional effect of an evolutionary conserved naturally occurring TYK2 variant, P1104A, known to protect against multiple autoimmune diseases yet provide sufficient TYK2-mediated cytokine signalling required to prevent immune deficiency. The unprecedentedly high functional selectivity and efficacy-safety profile of deucravacitinib, initially demonstrated in psoriasis, combined with genetic support, and promising outcomes in early SLE clinical trials make this inhibitor ripe for exploration in other autoimmune diseases for which better, safe, and efficacious treatments are urgently needed.
JAK 抑制剂同时影响多种细胞因子通路,使其在治疗癌症和免疫介导性疾病等复杂疾病方面具有高效性。然而,其广泛的作用也引起了安全性方面的担忧,这促使人们对越来越具有选择性的 JAK 抑制剂产生了需求。德瓦鲁单抗是一种首创的变构 TYK2 抑制剂,代表了该领域的重大进展。与经典的 JAK1-3 抑制剂在激酶结构域催化位点竞争不同,德瓦鲁单抗靶向 TYK2 的调节假激酶结构域。它惊人地模拟了一种进化上保守的天然 TYK2 变体 P1104A 的功能效应,该变体已知可预防多种自身免疫性疾病,但提供了足够的 TYK2 介导的细胞因子信号,以防止免疫缺陷。德瓦鲁单抗在银屑病中最初表现出的前所未有的高功能选择性和疗效-安全性特征,加上遗传支持,以及早期 SLE 临床试验中的有希望结果,使得这种抑制剂有望在其他自身免疫性疾病中进行探索,这些疾病迫切需要更好、更安全和更有效的治疗方法。