Screening the receptorome reveals molecular targets responsible for drug-induced side effects: focus on 'fen-phen'

The in vitro pharmacological profiling of drugs using a large panel of cloned receptors (e.g., G protein-coupled receptors, ligand-gated ion channels, Na(+)-dependent monoamine transporters), an approach that has come to be known as 'receptorome screening', has unveiled novel molecular mechanisms responsible for the actions and/or side effects of certain drugs. For instance, receptorome screening has been employed to uncover novel molecular targets involved in the actions of antipsychotic medications and the hallucinogenic mint extract salvinorin A. This review highlights the recent application of receptorome screening to discover why the anorexigen fenfluramine causes serious cardiopulmonary side effects. Receptorome screening has implicated N-deethylation of fenfluramine and serotonin 5-hydroxy-t-ryptamine 2B receptors in the adverse effects of the drug; subsequent studies corroborated this finding. The results discussed highlight the utility of determining the potential activity of drugs -- and, importantly, of their in vivo metabolites -- at as many molecular targets as possible in order to reliably predict side effect profiles. Receptorome screening represents one of the most effective methods for identifying potentially serious drug-related side effects at the preclinical stage, thereby avoiding significant economic and human health consequences.