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Published on: September 23, 2015
Translating 5-HT receptor pharmacology
1Wingate Institute of Neurogastroenterology, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK. g.sanger@qmul.ac.uk
Researchers are developing new gastrointestinal prokinetic drugs targeting the 5-HT(4) receptor. Prucalopride shows promise for treating constipation with improved selectivity and efficacy compared to earlier compounds.
Area of Science:
- Pharmacology
- Gastroenterology
- Drug Development
Background:
- Metoclopramide's development spurred research for gastrointestinal prokinetic agents.
- Early compounds like mosapride and cisapride had limitations due to non-selectivity and side effects.
- Understanding of serotonin (5-HT) receptors has evolved, influencing drug design.
Purpose of the Study:
- To review the development of 5-HT(4) receptor agonists for gastrointestinal prokinetic activity.
- To evaluate the selectivity and efficacy of compounds like prucalopride.
- To compare newer agents with historical compounds and identify potential therapeutic advantages.
Main Methods:
- Review of existing literature on 5-HT(4) receptor agonists.
- Analysis of drug selectivity profiles, including interactions with dopamine D(2) and other 5-HT receptors.
- Assessment of intrinsic activity at gastrointestinal 5-HT(4) receptors and potential cardiac liabilities.
Main Results:
- Several early 5-HT(4) agonists (mosapride, cisapride, renzapride, tegaserod) exhibited non-selectivity and adverse effects.
- Prucalopride demonstrates high selectivity for intestinal 5-HT(4) receptors with minimal cardiac effects.
- Newer compounds like ATI-7505 and TD-5108 are emerging with differentiated profiles.
Conclusions:
- Prucalopride represents a significant advancement in 5-HT(4) receptor agonist development.
- Improved selectivity and intrinsic activity are key to overcoming limitations of earlier drugs.
- Further clinical evaluation of prucalopride and similar agents is warranted for chronic constipation treatment.
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