抗阿尔茨海默病药物非临床药效学评价体系的探索

阿尔茨海默病(Alzheimer’s disease, AD)是引发老年人痴呆的最常见的神经退行性疾病。目前, AD的发病机制尚不明确,已上市的药物全部为对症治疗药物,无法延缓或逆转疾病的进程,同时在研药物面临严峻的临床转化难题。因此,围绕AD展开新药研发,解决未被满足的临床需求具有重大的社会意义和经济价值。本文结合了近年来国内外抗AD药物的研发进展,主要从动物模型和药效评价指标两个方面对抗AD药物非临床药效学评价体系进行归纳总结,以期为抗AD药物的非临床开发提供参考。     

药动学-药效学模型在临床合理用药的应用价值分析

药动学-药效学（pharmacokinetics-pharmacodynamics,PK-PD）结合模型阐明了时间-药物浓度-效应三者间关系,能较全面地分析和预测特定给药方案下,药物效应随时间的变化情况,对新药研发,药物临床试验及临床合理用药具有重要的参考价值。现从给药方案优化,疗效和不良反应预测,相互作用分析等方面对近年来国内外PK-PD指导临床用药情况进行综述,阐明PK-PD模型对药物合理使用的意义。     

抗结核药物药效学非临床研究技术指南

摘要：研发新型抗结核药物极具挑战性,难度大,周期长,非临床研究的数据是开展临床试验的前提。全面充分的结核分 枝杆菌体外和在动物体内的药效学评价是临床试验前的重要步骤和关键内容。本技术指南主要适用于治疗由结核分枝杆菌引起 的肺结核病药物的研发,旨在为创新抗结核药物的临床前药效学研究提供参考。     

美国FDA关于抗HIV药物的临床前药效学评价标准

药物治疗是目前唯一有效治疗艾滋病的手段,而我国至今尚无自主知识产权的抗HIV药物上市,药物研发的任务紧迫且艰巨。药物的临床前药效学评价对后续的临床实验具有重要的指导意义。该文以Etravirine为例,介绍和讨论FDA抗HIV药物的临床前药效学评价指导原则,分析了抗HIV药物临床前药效学研究部分的实验要点和重点,希望为完善符合我国国情的抗HIV药物临床前研究标准提出参考。     

高原缺氧性脑病的非临床药效学评价体系

高原空气稀薄,属于低温、低氧、低压环境,人脑对缺氧最敏感,低压低氧会引发中枢神经系统功能障碍,出现高原缺氧性脑病,临床上包括高原头痛和严重的高原脑水肿。随着越来越多的人工作、生活在高原地区,开发抗高原缺氧性脑病药物具有很大的经济价值和社会意义。非临床药效学评价是药物开发的基础环节,对提高临床转化成功率和降低临床研究风险起到了关键作用。本文总结了高原缺氧性脑病的细胞模型和动物模型,以及用于评价药物药效的检测指标,旨在建立起规范的抗高原缺氧性脑病的非临床药效学评价体系,以期为广大药物研发人员提供参考,提高创新药物的临床转化的成功率。     

药物遗传学：药效学方面

个体间差异在药代动力学方面的认识已逾百年，但在药效学方面相应的认识却比较短暂。药物遗传学在药效学方面表现出两种不同的基本机制，一个是作为疾病异质性反应的Ⅰ型药物遗传学，另一个是作为疾病－病因学非相关的个体间差异反应的Ⅱ型药物遗传学，药物遗传学的药效学方面，对于认识临床药物反应，指导药物研发及临床实践将会发挥越来越重要的作用。     

CAR-T细胞治疗产品非临床药效学研究关注点

CAR-T细胞（Chimeric Antigen Receptor T Cells,CAR-T）是一种表达嵌合抗原受体的基因工程T细胞,也称"活的药物",可以增强基因工程T细胞的特异性,能够以MHC （主要组织相容性复合体,Major Histocompatibility Complex,MHC）非依赖性的方式高度靶向肿瘤抗原,是治疗肿瘤的一种新手段。最近,临床上使用CAR-T细胞治疗复发、难治性血液恶性肿瘤和多发性骨髓瘤取得了很好的疗效;同时,采用CAR-T细胞治疗实体瘤的研发也在积极开展。根据所构建的CAR-T细胞不同的适应证和作用原理,构建不同的动物肿瘤模型,研究CAR-T细胞在动物模型的抗肿瘤活性,可以对CAR-T细胞进行概念验证性研究并证明其体内药效学活性,为临床研究提供有力的数据支持。     

靶向溃疡性结肠炎相关通路的药物研究进展

溃疡性结肠炎(UC)是一种慢性的、病因未明的炎症性肠道疾病，目前的治疗药物以氨基水杨酸类、糖皮质激素类非特异性药物为主。通过靶向UC相关的信号通路来寻找靶向药物治疗UC,发展特异性的治疗措施是该病药物研发的必然要求。该文综合阐述了与UC相关的信号通路在发病机制中的作用及相关靶向药物的研究进展，以期为UC疾病的治疗提供完善的依据。     

探索用于非临床药效学研究的半抗原诱导小鼠特应性皮炎模型

特应性皮炎(atopic dermatitis, AD)是一种慢性、复发性、炎症性皮肤病,临床表现多样且难以治愈。目前多种治疗AD候选药物进入研发管线,为AD药物临床开发提供技术规范,国家药品监督管理局药品审评中心于2022年11月发布了《AD治疗药物临床试验技术指导原则》(征求意见稿)。非临床药效评价是受试药物进入临床试验前的重要研究内容,噁唑酮(oxazolone, OXA)和2,4-二硝基氟苯(2,4-dinitrofluorobenzene, DNFB)诱导的特应性皮炎小鼠模型是最常用的经典半抗原诱导AD小鼠模型,但在已有报道中,半抗原剂量、致敏部位、攻击次数和皮损严重程度评估方法都存在差异。本研究根据特应性皮炎患者病程和病理表现,结合AD治疗药物临床试验药效学评价要点构建AD小鼠模型,系统考察并比较不同构建方案(致敏部位、半抗原剂量和攻击次数等)与皮损指标间的关系,探索OXA和DNFB两种经典半抗原诱导AD小鼠的病变过程、模型强度和特点,为治疗AD候选药物的非临床药效学研究提供方法学依据。所有动物实验均经过中国医学科学院、北京协和医学院药物研究所实验动物管理与动物福利委员会批...     

不同盐基对药物临床效果和安全性的影响分析

成盐是改善活性药物分子（API）成药性的一个重要手段,目前活性成分相同而盐基不同的药物不断出现,本文就盐基对药物药动学、药效学及药物不良反应三个方面的影响作简要综述,以对临床遴选治疗药物及新药盐基的选择提供参考。     

Immunogenicity of biologically-derived therapeutics: Assessment and interpretation of nonclinical safety studies

An evaluation of potential antibody formation to biologic therapeutics during the course of nonclinical safety studies and its impact on the toxicity profile is expected under current regulatory guidance and is accepted standard practice. However, approaches for incorporating this information in the interpretation of nonclinical safety studies are not clearly established. Described here are the immunological basis of anti-drug antibody formation to biopharmaceuticals (immunogenicity) in laboratory animals, and approaches for generating and interpreting immunogenicity data from nonclinical safety studies of biotechnology-derived therapeutics to support their progression to clinical evaluation. We subscribe that immunogenicity testing strategies should be adapted to the specific needs of each therapeutic development program, and data generated from such analyses should be integrated with available clinical and anatomic pathology, pharmacokinetic, and pharmacodynamic data to properly interpret nonclinical studies.     

Origins, practices and future of safety pharmacology

The origins of safety pharmacology are grounded upon observations that organ functions (like organ structures) can be toxicological targets in humans exposed to novel therapeutic agents, and that drug effects on organ functions (unlike organ structures) are not readily detected by standard toxicological testing. Safety pharmacology is " em leader those studies that investigate the potential undesirable pharmacodynamic effects of a substance on physiological functions in relationship to exposure in the therapeutic range and above em leader " [International Conference on Harmonization (ICH) S7A guidelines; Safety Pharmacology Studies for Human Pharmaceuticals]. This publication provides a comprehensive review of the history of safety pharmacology, international regulatory guidelines that govern the practices of this important field, and the scientific challenges that are being faced by its rapid emergence in pharmaceutical development. The criticality of identifying undesired adverse effects of new drugs in nonclinical models, which reflect the overall human condition, is reflected in the importance of generating an integrated and accurate assessment of possible human risk. The conundrum posed by the challenge of formulating a reliable risk assessment is the importance of improving and enhancing the safe progression of new drugs to the marketplace, while preventing unnecessary delays (or discontinuances), based on nonclinical findings that are not relevant or interpretable in terms of clinical response or human risk.     

Electroencephalogram-based pharmacodynamic measures: a review

Pharmacokinetics and pharmacodynamics can provide a useful modeling framework for predicting drug activity and can serve as a basis for dose optimization. Determining a suitable biomarker or surrogate measure of drug effect for pharmacodynamic models can be challenging. The electroencephalograph is a widely-available and non-invasive tool for recording brainwave activity simultaneously from multiple brain regions. Certain drug classes (such as drugs that act on the central nervous system) also generate a reproducible electroencephalogram (EEG) effect. Characterization of such a drug-induced EEG effect can produce pharmacokinetic/pharmacodynamic models useful for titrating drug levels and expediting development of chemically-similar drug analogs. This paper reviews the relevant concepts involved in pharmacokinetic/pharmacodynamic modeling using EEG-based pharmacodynamic measures. In addition, examples of such models for various drugs are organized by drug activity as well as chemical structure and presented.     

How adverse drug reactions can play a role in innovative drug research

We describe how adverse drug reactions (ADRs) can play an important role in pharmaceutical research and drug development. Not only do ADRs represent the risks and drawbacks associated with drugs but they can also be related to other knowledge available in pharmaceutical and medical research. We offer a model that can be used to systematically map the pathways through which ADRs can lead to innovative research. These pathways include chemical, therapeutic or pathophysiological steps that can be taken to arrive at new knowledge based on ADRs. We used the development of angiotensin-converting enzyme inhibitors, especially captopril, as a case study. The similarity between the ADR profiles of captopril and penicillamine was a starting point for further innovation. Historical analysis shows that in several instances research in the field of angiotensin-converting enzyme inhibitors has been triggered by ADRs. The model presented here might be applicable to other areas of innovative drug research.     

Therapeutic drug concentration monitoring using saliva samples. Focus on anticonvulsants.

In the last 30 years there has been great interest in the use of saliva in therapeutic drug monitoring. Numerous investigators have suggested that saliva be used as an alternative body fluid for the therapeutic drug monitoring of anticonvulsant drugs. Not only can saliva be obtained easily on multiple occasions with minimal discomfort to the patient but, more importantly, useful relationships exist between the saliva and blood concentrations of the most commonly used anticonvulsant drugs. The measurement of anticonvulsant drug concentrations in saliva has been applied to pharmacokinetic and pharmacodynamic studies, and for therapeutic drug monitoring in a variety of seizure disorders. However, this simple and non-invasive method is not widely accepted in clinical practice. Several recent developments in sample collection and analytical methods, and the growing interest in free drug concentrations, provide a renewed impetus for saliva sampling for therapeutic drug monitoring of anticonvulsant drugs. Salivary flow rates vary significantly both between individuals and under different conditions. The use of stimulated saliva has several advantages over resting saliva. The salivary flow rate and pH, sampling conditions, contamination and many other pathophysiological factors may influence the concentrations of the medication in saliva. However, under standardised and well-controlled sampling condition, therapeutic drug monitoring of anticonvulsant drugs in saliva can be useful for determining compliance with medication in paediatric patients, for analysing the concentration of free drug and in situations where repeated sampling is necessary. Saliva is an alternative matrix for the therapeutic drug monitoring of carbamazepine, phenytoin, primidone and ethosuximide because the concentrations of these medications in saliva reflect the concentrations of the drug in serum. This is not the case for valproic acid (valproate sodium) and some controversy exists for phenobarbital. Further studies are required to assess the clinical value of monitoring anticonvulsant drugs and their metabolites in saliva, to examine the influence of pathophysiological factors on salivary drug concentrations, to improve the design of special devices to reproducibly and conveniently collect saliva samples, and to develop and use new analytical methods to achieve more sensitive and accurate results.     

儿童生理药代动力学模型及其在儿科药物研究中的应用

生理药代动力学(physiologically based pharmacokinetic, PBPK)模型是预测药物在特殊人群中的药代动力学、药效学和安全性的重要工具。尤其对于儿童这类不易开展临床试验的人群, PBPK模型的应用更是能有效促进儿科药物的开发以及儿童的临床用药。目前, PBPK模型在儿科药物开发中的主要应用有以下几种:临床试验设计、药物相互作用(drug-drug interaction, DDI)的风险评估和儿童给药剂量的确立等。本综述简介了儿童生理药动学模型在儿科药物研究中的优越性,总结了PBPK模型如何实现从成人到儿童的外推,儿童生理药动学模型的理论基础,建模过程及所要注意的重要生理参数,列举了目前PBPK模型在儿科药物研究中的一些应用实例。最后简述了儿童PBPK模型当前的局限性和未来发展方向。     

The role of pharmacodynamic research in the assessment and development of new antibacterial drugs

Antibacterial resistance continues to increase world wide, with some bacterial pathogens exhibiting resistance to virtually all available drugs. As the plague of antibacterial resistance continues to grow and create serious therapeutic problems, it is essential that the development of new antibacterial agents continue. Pharmacodynamic research plays an important role in the development of new antibacterial agents, as pharmacodynamic data can help define the clinical potential of a new drug and identify the strengths and weaknesses in comparison to other drugs already on the market. Furthermore, pharmacodynamic experiments can help focus the clinical phases of drug development by providing key information on the pharmacodynamic parameters that influence efficacy and the pharmacodynamic targets that should be achieved to optimize clinical success. Characterization of these pharmacodynamic properties for a new drug in development can help direct the design of the best dose and dosing strategy for clinical trials. This review will focus on the tools, methods, and strategies used to characterize the pharmacodynamics of antibacterial agents and aide in their development for clinical use.     

聚乙二醇修饰小分子药物的研究进展

聚乙二醇修饰技术是目前药物化学修饰的研究热点,它能够显著提高药物分子水溶性,同时改善药物的药动学和药效学特性,增加了药物临床应用的范围和疗效,具有较好的开发应用前景;但同时也存在诸多问题,有待改进,目前在国内研究相对较少,值得进一步研究开发。本文从聚乙二醇修饰技术被修饰的小分子药物种类、连接臂类型、聚乙二醇载体以及修饰后药物药动学性质和药效学性质改变等方面进行系统综述。     

以药效学参数为终点指标的生物等效性评价方法

生物等效性是仿制药一致性评价的重要阶段。以药效学参数为终点指标评价生物等效性方法逐渐引发关注。在药动学方法无法实施或药动学参数无法灵敏地体现两药差异的情况下,选择合理的药效学参数作为终点指标可有效地评价药品之间的差异。参考相关指南、法规及文献,系统地阐述药效学方法的适用条件,根据量效曲线选择终点指标,终点参数分析以及具体药物方法设计等,为相关研究提供参考和帮助。