7 The Biological Knowledge Gap J. J. BURNS
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Hoffmann-La Roche Inc., Nutley, N. J. 07110 New drug development—so has
slowed
because
rapid during
advances
the past 20
in biological
failed to keep pace with those in medicinal spite
successes
matory
cited in psychotherapeutic
drug development,
is hampered
by
further
inadequate
and
Where
Parkinson's
developed research under
more adequate disease,
recently. in drug
way
Others
in the
avoid unnecessary
'"phe A
criteria
can
be
and
and industry
areas
fundamental existing
exists, as in gout drugs
expected
have
been
from
basic
molecular
biology
now
industry.
However,
delay in introducing
for evaluating
in these
of action of
new
pharmaceutical
sities, government, lating
important
anti-inflam-
of
knowledge
metabolism
De-
progress
disease processes and of the mechanism drugs.
have
chemistry. and
knowledge
years—
science
future drugs,
must cooperate
drug safety and
in
to
univerformu-
efficacy.
last 20 years h a v e seen the r a p i d d e v e l o p m e n t of n e w d r u g s ,
l a r g e l y because of the advances i n m e d i c i n a l c h e m i s t r y discussed i n
this v o l u m e . F u t u r e d e v e l o p m e n t , h o w e v e r , w i l l b e m o r e d i f f i c u l t . W h i l e m e d i c i n a l c h e m i s t r y has a d v a n c e d b y finding n e w methods f o r synthesizi n g c o m p l i c a t e d m o l e c u l e s a n d i s o l a t i n g a n d i d e n t i f y i n g the active substances f r o m plants, b a c t e r i a , a n d m a m m a l s , o u r b i o l o g i c k n o w l e d g e has f a i l e d to keep pace.
W e l a c k basic k n o w l e d g e of d r u g a c t i o n a n d of
disease processes i n m a n , a n d this l a c k is c e r t a i n to d e l a y f u t u r e advances, e s p e c i a l l y i n t r e a t i n g diseases s u c h as cancer, v i r a l infections.
c o n g e n i t a l disease, a n d
E v e n w h e n n e w d r u g s are d e v e l o p e d , their i n t r o d u c t i o n
is often d e l a y e d because m e d i c a l o p i n i o n s differ o n w h a t constitutes v a l i d safety a n d efficacy data.
I n short, w e are c o n f r o n t e d b y a w i d e n i n g
biological knowledge gap.
Progress in Developing Psychotherapeutic Agents T h e r a p i d d e v e l o p m e n t of p s y c h o t h e r a p e u t i c agents a n d their success i n t r e a t i n g m e n t a l a n d e m o t i o n a l disorders w a s one of the m o r e sig166
In Drug Discovery; Bloom, B., et al.; Advances in Chemistry; American Chemical Society: Washington, DC, 1971.
7.
BURNS
The
Biological
nificant achievements decades.
Knowledge
167
Gap
of the p h a r m a c e u t i c a l
i n d u s t r y i n the
last
two
S i n c e c l i n i c i a n s first r e c o g n i z e d n e u r o l e p t i c , antidepressant, a n d
t r a n q u i l i z i n g effects of c e r t a i n d r u g s , l a b o r a t o r y scientists h a v e
sought
to u n d e r s t a n d t h e i r p s y c h o p h a r m a c o l o g y a n d to d e v e l o p t e c h n i q u e s
for
d i s c o v e r i n g i m p r o v e d d r u g s . T h e s e scientists d e v i s e d b e h a v i o r a l , electrop h y s i o l o g i c a l , a n d b i o c h e m i c a l concepts a n d t e c h n i q u e s a n d , i n d e e d , h a v e o b t a i n e d a w e a l t h of i n f o r m a t i o n o n h o w s u c h d r u g s interact w i t h b i o -
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l o g i c a l systems.
B e h a v i o r a l p h a r m a c o l o g y t e c h n i q u e s h a v e a d v a n c e d to
the p o i n t w h e r e t h e y n o w f o r m the h a r d core of the
pharmacological
profile of n e u r o l e p t i c s a n d t r a n q u i l i z e r s . S t i l l , w e l a c k m u c h i m p o r t a n t i n f o r m a t i o n i n this area. O n e of the most c h a l l e n g i n g p r o b l e m s has b e e n the search f o r w a y s to r e c o g n i z e d r u g s u s e f u l i n d e p r e s s i o n . S i n c e attempts to d e v e l o p a n i m a l m o d e l s of d e p r e s s i o n b y u s i n g d r u g s to depress the c e n t r a l n e r v o u s syst e m h a v e p r o v e d less t h a n successful, other a p p r o a c h e s h a v e b e e n t r i e d ; f o r e x a m p l e , e m p i r i c a l t e c h n i q u e s h a v e b e e n u s e d to e v a l u a t e the a b i l i t y of p o t e n t i a l antidepressant
agents to a n t a g o n i z e t e t r a b e n a z i n e
a n d re-
serpine, to potentiate a m p h e t a m i n e or cocaine, a n d to b l o c k the u p t a k e of n o r e p i n e p h r i n e , yet the l i m i t a t i o n s of s u c h t e c h n i q u e s increasingly obvious. analogous
have become
T h e y are u s e f u l f o r p r e d i c t i n g a c t i v i t y i n c l o s e l y
c o m p o u n d s w i t h i n a c h e m i c a l class k n o w n to be c l i n i c a l l y
effective, b u t t h e y are m u c h less u s e f u l i n p r e d i c t i n g s u c h a c t i v i t y i n a n e w c h e m i c a l class.
A d m i t t e d l y , the e v i d e n c e that some
antidepressants
decrease n o r e p i n e p h r i n e u p t a k e is c o n c e p t u a l l y a p p e a l i n g , b u t
whether
this c a n p r e d i c t antidepressant a c t i v i t y has yet to be d e m o n s t r a t e d . W e h a v e b e e n m o r e successful i n i d e n t i f y i n g a n d d e v e l o p i n g effective neuroleptics
(chloropromazine-like drugs)
or t r a n q u i l i z e r s
(meproba-
m a t e - l i k e , a n d c h l o r d i a z e p o x i d e - l i k e d r u g s ). O u r success has b e e n l a r g e l y the result of n e w t e c h n i q u e s i n b e h a v i o r a l p h a r m a c o l o g y .
F o r example,
i n h i b i t i o n of c o n d i t i o n e d a v o i d a n c e b e h a v i o r is g e n e r a l l y a c c e p t e d as a g o o d p r e d i c t o r of c h l o r p r o m a z i n e - or h a l o p e r i d o l - l i k e a n t i p s y c h o t i c tivity.
H o w e v e r , once a g a i n , c o m p o u n d s different f r o m the
ac-
established,
c l i n i c a l l y effective c h e m i c a l series h a v e f a i l e d to p r o d u c e the effects p r e d i c t e d o n the basis of this test.
O b v i o u s l y , w e w i l l n e e d greater u n d e r -
s t a n d i n g if w e are to i d e n t i f y n e w a n d u n r e l a t e d c h e m i c a l s w i t h i m p r o v e d therapeutic
properties.
T h e r e is a great d e a l of e n t h u s i a s m a n d i n c r e a s i n g confidence i n the v a l u e of a n t i c o n f l i c t p r o p e r t i e s of t r a n q u i l i z e r s i n a n i m a l s f o r p r e d i c t i n g anti-anxiety properties i n m a n . pressive a n d appears
reliable.
T o date, the c o r r e l a t i o n is i n d e e d i m Anti-aggressive activity, a
predominant
p r o p e r t y of m a n y n e u r o l e p t i c a n d t r a n q u i l i z i n g agents, also seems to h a v e predictive value.
In Drug Discovery; Bloom, B., et al.; Advances in Chemistry; American Chemical Society: Washington, DC, 1971.
168
DRUG DISCOVERY
F u r t h e r research i n p s y c h o p h a r m a c e u t i c a l s
is o b v i o u s l y i m p o r t a n t ,
b u t o u r interests s h o u l d be f o c u s e d o n the areas of greatest m e d i c a l n e e d . O n e s u c h area is s c h i z o p h r e n i a .
N o matter h o w effective today's d r u g s
are, m o r e effective ones w i l l b e r e q u i r e d . M o r e o v e r , research memory.
is n e e d e d i n n e w areas, s u c h as l e a r n i n g a n d
D r u g s to e n h a n c e the p e r f o r m a n c e of patients w i t h m e n t a l re
t a r d a t i o n , s e n i l i t y , a n d other m e n t a l deficiencies w o u l d c l e a r l y constitute
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a major c o n t r i b u t i o n . m e a n i n g f u l research.
F o r t u n a t e l y , sufficient k n o w l e d g e exists to b e g i n W e c a n measure l e a r n i n g a n d m e m o r y p e r f o r m a n c e ,
a n d certain drugs do enhance such performance.
W e also h a v e e v i d e n c e
of the p o s s i b l e r o l e of m a c r o m o l e c u l e s i n l e a r n i n g - m e m o r y f u n c t i o n s . N o w w e n e e d to e l u c i d a t e f u r t h e r the r e l a t i o n s h i p b e t w e e n a n i m a l b e h a v i o r a n d i n t e l l e c t u a l f u n c t i o n s i n m a n a n d also the r e l a t i o n s h i p s of r e l e v a n t neurobiochemical and neurophysiological functions.
T h e task of i n v e s t i
g a t i n g d r u g s that m a y e n h a n c e s u c h f u n c t i o n s is f o r m i d a b l e because c l i n i c a l l y effective standards d o not exist.
T h e s e are the challenges
we
face.
Animal Models for Evaluating Anti-Inflammatory Drugs I n m a n , arthritis p r o d u c e s p a i n , s w e l l i n g , redness, t e m p e r a t u r e of joints.
and
increased
I n a n i m a l s , the same s y m p t o m s c a n be p r o d u c e d
as p a r t of a n i n f l a m m a t o r y process i n w h i c h m e m b r a n e p e r m e a b i l i t y i n creases l e a d i n g to c e l l u l a r d e s t r u c t i o n .
This inflammation, induced by
s u c h substances as p h e n y l q u i n o n e , c a r r a g e e n i n , a n d yeast, c a n b e p a r t i a l l y p r e v e n t e d b y a n t i - i n f l a m m a t o r y d r u g s , s u c h as a s p i r i n a n d p h e n y l butazone.
Screening
indomethacin
with
these tests, scientists
and mefanamic
a c i d f r o m large
were
able
groups of
to
select
compounds.
H o w e v e r , w i t h these same tests t h e y i d e n t i f i e d m a n y other c o m p o u n d s , w h i c h t h e y later h a d to d i s c a r d as false positives or p r o d u c e r s of toxic effects, p a r t i c u l a r l y u l c e r o g e n i c effects. A m o r e r e c e n t m o d e l of i n f l a m m a t i o n is the k i l l e d M y c o b a c t e r i u m a d j u v a n t a r t h r i t i s test. Besides a n a c u t e i n f l a m m a t o r y phase, it p r o d u c e s a s e c o n d a r y phase c h a r a c t e r i z e d b y i n d u c t i o n of a n i n f l a m m a t o r y lesion at sites distant f r o m the i n i t i a l l e s i o n a n d also b y the d e v e l o p m e n t b i o c h e m i c a l alterations m e a s u r e d b y changes i n b l o o d p o l y s a c c h a r i d e s a n d α-globulin.
fibrinogen,
of
muco
T h e s e distant changes m a y be m e d i a t e d
b y the k i n i n systems, s u c h as b r a d y k i n i n . T h i s n e w m o d e l is affected b y most drugs a c t i v e i n t h e h u m a n arthritis a n d p r o m i s e s better p r e d i c t i v e v a l u e t h a n ea rlier m o d e l s , w h i c h m e a s u r e d p r i m a r i l y the acute phases.
It
p e r m i t s m e a s u r i n g i n m a n a n d a n i m a l s s u c h b i o c h e m i c a l parameters
as
i n f l a m m a t i o n units r e l a t e d to the α-globulins.
S u c h measurements
In Drug Discovery; Bloom, B., et al.; Advances in Chemistry; American Chemical Society: Washington, DC, 1971.
may
7.
BURNS
The Biological
Knowledge
169
Gap
increase o u r u n d e r s t a n d i n g of the a r t h r i t i c process a n d g i v e better p r e d i c t a b i l i t y f o r n e w classes of c o m p o u n d s . After promising compounds
are i d e n t i f i e d i n a n i m a l s ,
formidable
p r o b l e m s of d r u g a b s o r p t i o n , b l o o d levels, u l c e r o g e n i c a c t i v i t y , a n d l i v e r t o x i c i t y m u s t b e s o l v e d . A h u g e effort has b e e n m o u n t e d b y major p h a r m a c e u t i c a l houses i n the synthesis of a n t i - i n f l a m m a t o r y c o m p o u n d s , e v a l uation b y current a n i m a l models, extended pharmacological examination,
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t o x i c i t y studies, p h a r m a c o d y n a m i c studies, a n d t h e subjective i n a r t h r i t i c patients.
screening
So far, this costly effort has not b e e n v e r y p r o d u c -
t i v e ; n o d r u g has b e e n f o u n d to b e s u p e r i o r to a s p i r i n i n efficacy a n d safety f o r l o n g - t e r m use, y e t there is r o o m f o r m u c h i m p r o v e m e n t .
No
d r u g cures arthritis. N o d r u g affects t h e i m m u n o l i g i c aspects of the h u m a n disease, a n d m e a n i n g f u l a n i m a l m o d e l s are almost nonexistent.
T h e fact
that m a n y s c r e e n i n g tests are u n r e l i a b l e i n d i c a t o r s of d r u g efficacy i n m a n presents a p r o b l e m i n i n t e r p r e t a t i o n .
S c r e e n i n g results must b e c o n s i d -
e r e d c a r e f u l l y b e f o r e d e c i d i n g to b e g i n the vast effort r e q u i r e d to c o m p l e t e the d e v e l o p m e n t of a n e w d r u g .
If a p h a r m a c o l o g i s t s h o u l d d i s c o v e r a n
a c t i v e c o m p o u n d t o m o r r o w , six years o r m o r e m i g h t elapse b e f o r e i t c o u l d be i n t r o d u c e d to t h e m e d i c a l profession.
Deficient Knowledge of Drug Action and Disease Processes T h e search f o r n e w drugs w o u l d be greatly f a c i l i t a t e d i f w e k n e w more about currently used drugs. a b o u t the m e c h a n i s m
I n fact, w e k n o w s u r p r i s i n g l y little
of a c t i o n of s u c h w i d e l y u s e d d r u g s as a s p i r i n ,
b a r b i t u r a t e s , t h e p h e n o t h i a z i n e s , m o r p h i n e , a n d a n t i - i n f l a m m a t o r y agents —phenylbutazone
and indomethacin.
p h e n y l b u t a z o n e exerts its t h e r a p e u t i c
If, f o r e x a m p l e ,
we knew how
effect i n r h e u m a t o i d arthritis, w e
c o u l d d e v e l o p a m o r e r a t i o n a l screening p r o g r a m . W e also n e e d to k n o w m o r e about the disease to b e treated.
Just
h a v i n g suitable a n i m a l m o d e l s of h u m a n disease helps b y f u r n i s h i n g m o r e r e l i a b l e s c r e e n i n g tests. search,
L a c k of s u c h m o d e l s has h i n d e r e d arthritis re-
a n d the a v a i l a b i l i t y of a n i m a l m o d e l s has c o n t r i b u t e d
to o u r
l i m i t e d success i n h y p e r t e n s i o n a n d h y p e r l i p e m i a research. A n e x a m p l e of the v a l u e of u n d e r s t a n d i n g the nature of the disease is t h e c o n s i d e r a b l e progress m a d e i n gout t h e r a p y .
G o u t is c h a r a c t e r i z e d
b y a n o v e r p r o d u c t i o n of u r i c a c i d , w h i c h a c c u m u l a t e s i n the b o d y , resulti n g i n a p a i n f u l a r t h r i t i c c o n d i t i o n . D r u g s , s u c h as p r o b e n e c i d a n d sulfinp y r a z o n e , r e d u c e u r i c a c i d levels b y p r o m o t i n g its excretion i n the u r i n e . H o w e v e r , these d r u g s are less effective i n g o u t y patients w i t h i m p a i r e d r e n a l f u n c t i o n . F o r s u c h patients the d e v e l o p m e n t of a l l o p u r i n o l , w h i c h i n h i b i t s t h e synthesis of u r i c a c i d , has offered a n effective n e w t h e r a p y . A l l o p u r i n o l acts b y i n h i b i t i n g x a n t h i n e oxidase, t h e k e y e n z y m e f o r c o n -
In Drug Discovery; Bloom, B., et al.; Advances in Chemistry; American Chemical Society: Washington, DC, 1971.
170
DRUG DISCOVERY
v e r t i n g x a n t h i n e t h r o u g h h y p o x a n t h i n e to u r i c a c i d . T h e x a n t h i n e p r e cursors are excreted m o r e r a p i d l y t h a n u r i c a c i d , a n d thus t h e y d o not a c c u m u l a t e ( 1 ). A n o t h e r e x a m p l e is l e v o d o p a , a p r o m i s i n g d r u g f o r P a r k i n s o n ' s disease.
It was m a d e p o s s i b l e because of o u r c o n s i d e r a b l e k n o w l e d g e of
t h e m e t a b o l i s m a n d b i o l o g i c a l a c t i o n of l e v o d o p a a n d c a t e c h o l a m i n e s i n general.
P a r k i n s o n i s m patients h a v e l o w e r e d levels of d o p a m i n e i n spe-
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cific areas of the b r a i n . B u t since d o p a m i n e does not penetrate i n t o the b r a i n to a n y a p p r e c i a b l e extent, it w a s necessary to a d m i n i s t e r its p r e cursor, l e v o d o p a , to correct the d e f i c i e n c y .
Subsequently, Cotzias
(2)
c o n t r i b u t e d to the successful treatment of P a r k i n s o n i s m b y s h o w i n g that large doses of l e v o d o p a w e r e most effective.
Advances in Drug Metabolism and Molecular Biology D r u g m e t a b o l i s m studies h a v e g r o w n i n c r e a s i n g l y i m p o r t a n t . A c o m m o n a p p r o a c h i n m a n y laboratories is to ask w h e t h e r a n e w d r u g is a c t i v e i n its o w n r i g h t or w h e t h e r it owes its a c t i v i t y a n d side effects to one or more metabolites.
T h i s a p p r o a c h has r e s u l t e d i n i m p r o v e d d r u g s f o r the
treatment of r h e u m a t o i d arthritis, gout, m e n t a l d e p r e s s i o n , a n d schistosomiasis.
A l s o , i n c r e a s e d k n o w l e d g e of d r u g m e t a b o l i s m has f u r n i s h e d
clues to the synthesis
of c o m p o u n d s w i t h m o r e d e s i r a b l e
absorption,
excretion, m e t a b o l i s m , a n d tissue d i s t r i b u t i o n characteristics. D r u g m e t a b o l i s m studies h a v e b e e n r e v o l u t i o n i z e d b y p h y s i c a l c h e m i c a l t e c h n i q u e s s u c h as mass s p e c t r o m e t r y a n d n u c l e a r m a g n e t i c nance.
T h e y m a k e p o s s i b l e m e t a b o l i s m studies i n a f e w w e e k s
resothat
p r e v i o u s l y w o u l d h a v e t a k e n m o n t h s or years. P h a r m a c e u t i c a l laboratories h a v e set u p extensive p r o g r a m s i n d r u g m e t a b o l i s m research, w h i c h s h o u l d establish a basis for the f u t u r e d r u g d e v e l o p m e n t . T h e past d e c a d e w i l l s u r e l y be r e m e m b e r e d f o r the n o t a b l e advances i n m o l e c u l a r b i o l o g y . M u c h i n f o r m a t i o n is n o w b e c o m i n g a v a i l a b l e : the steps i n the expression of genetic
i n f o r m a t i o n , the i n t r i c a t e details
of
t r a n s c r i p t i o n a n d t r a n s l a t i o n , a n d the m e c h a n i s m s w h e r e b y D N A directs p r o t e i n synthesis.
A l l this w i l l s u r e l y h e l p solve some of o u r c u r r e n t
problems, but we need m u c h more information. O n l y b y understanding biochemical
changes
accompanying viral
search for a n t i v i r a l d r u g s .
infection can w e rationally
O n l y b y u n d e r s t a n d i n g h o w k n o w l e d g e is
stored a n d r e c a l l e d i n the c e n t r a l n e r v o u s system a n d w h e t h e r m a c r o m o l e c u l e s are i n v o l v e d i n the m e m o r y process c a n w e s y s t e m a t i c a l l y seek d r u g s to alter l e a r n i n g a n d m e m o r y . advances
c a n be e x p e c t e d
I n the foreseeable f u t u r e , s t r i k i n g
i n t r e a t i n g those genetic
defects i n w h i c h
specific proteins are m i s s i n g or so a l t e r e d as to p r o d u c e a m e t a b o l i c l e s i o n .
In Drug Discovery; Bloom, B., et al.; Advances in Chemistry; American Chemical Society: Washington, DC, 1971.
7.
BURNS
The
Biological
Knowledge
171
Gap
T o a c h i e v e these advances, p h a r m a c e u t i c a l firms h a v e i n c r e a s i n g l y e m p h a s i z e d research i n m o l e c u l a r b i o l o g y . H o f f m a n n - L a R o c h e has
set
u p the R o c h e Institute of M o l e c u l a r B i o l o g y w i t h a staff of 200, i n c l u d i n g 70 at the doctorat e l e v e l (3, 4).
T h e s e scientists h a v e f r e e d o m to select
basic research p r o b l e m s b a s e d solely o n scientific m e r i t . T h e y h a v e access to a l l the firm's m o d e r n f a c i l i t i e s a n d c a n c o l l a b o r a t e if t h e y w i s h w i t h c o m p a n y scientists o n p r o b l e m s that m i g h t b e i m p o s s i b l e to solve w i t h
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the l i m i t e d f a c i l i t i e s a n d staff of the u s u a l a c a d e m i c i n s t i t u t i o n .
The Need for Safety and Efficacy Criteria A n i m p o r t a n t g a p exists i n o u r k n o w l e d g e of the best means to e v a l uate the safety a n d efficacy of d r u g s .
O f t e n w e discover a c o m p o u n d
w i t h p o t e n t i a l l y v a l u a b l e t h e r a p e u t i c effects i n a n i m a l s o n l y to h a v e its use i n h u m a n disease l i m i t e d b y t o x i c i t y . O r p e r h a p s the d r u g m u s t b e a b a n d o n e d because the c l i n i c a l i n v e s t i g a t o r cannot establish its efficacy in man.
Species differ g r e a t l y : a d r u g m a y act one w a y i n the d o g , a n -
other w a y i n the rat, a n d s t i l l another w a y i n m a n .
H o w then can w e
extrapolate p h a r m a c o l o g i c a l a n d t o x i c o l o g i c a l d a t a f r o m a n i m a l to m a n ? R e c e n t studies s h o w that m e t a b o l i c différencies e x p l a i n m a n y of the v a r i ations i n species response.
Thus, using drug metabolism data w e can,
w i t h more certainty, infer d r u g action i n m a n f r o m pharmacological-toxic o l o g i c a l studies i n a n i m a l s . T o evaluate the safety of a c o m p o u n d , it m u s t be g i v e n to a n i m a l s f o r e x t e n d e d p e r i o d s — p e r i o d s as l o n g as one to t w o years i n rodents a n d , i n some instances, e v e n l o n g e r i n dogs.
R e c e n t research shows that the
m e t a b o l i s m of m a n y d r u g s is a c c e l e r a t e d m a r k e d l y after r e p e a t e d a d m i n i s t r a t i o n , a n d this m a y l e a d to less t o x i c i t y w i t h c o n t i n u e d dosage.
Such
i n f o r m a t i o n bears i m p o r t a n t l y o n the i n t e r p r e t a t i o n a n d d e s i g n of c h r o n i c t o x i c i t y tests. D e t e r m i n i n g the significance of m a l f o r m a t i o n s p r o d u c e d i n a n i m a l s w i t h h i g h doses of a n e w d r u g poses d i f f i c u l t p r o b l e m s
(5).
r e a c t i o n to the t h a l i d o m i d e disaster has fostered a n a t t e m p t
A n overto
ensure
c o m p l e t e safety b y a n i m a l e x p e r i m e n t a t i o n .
T h i s a d m i t t e d l y is a n i m -
possible goal; under certain circumstances,
even such commonly used
d r u g s as a s p i r i n cause m a l f o r m a t i o n s i n rats a n d other a n i m a l s . C l e a r l y , m o r e research is necessary to establish b e t t e r protocols for these studies and their interpretation. I n recent years p e o p l e h a v e b e c o m e c o n c e r n e d a b o u t the p o s s i b i l i t y of genetic d a m a g e c a u s e d b y d r u g s as w e l l as pesticides, f o o d i n g r e d i e n t s a n d a d d i t i v e s , i n d u s t r i a l c h e m i c a l s , a n d other substances i n the e n v i r o n m e n t (6, 7 ) .
A t present, n o one c a n p r e d i c t the risk to f u t u r e h u m a n
generations b a s e d o n c h e m i c a l m u t a g e n i c tests i n b a c t e r i a , m o l d s , f r u i t
In Drug Discovery; Bloom, B., et al.; Advances in Chemistry; American Chemical Society: Washington, DC, 1971.
DRUG DISCOVERY
172
flies, a n d h u m a n cells i n tissue c u l t u r e . A c o n f e r e n c e o n " E v a l u a t i o n of M u t a g e n i c E f f e c t s of C h e m i c a l s " h e l d N o v . 4 - 6 ,
1970
in Washington,
D . C , w a s s p o n s o r e d b y the D r u g R e s e a r c h B o a r d of t h e N a t i o n a l A c a d e m y of S c i e n c e s - N a t i o n a l R e s e a r c h C o u n c i l , together w i t h the E n v i r o n mental
M u t a g e n Society,
the
N a t i o n a l Institute
of
General
Medical
Sciences, F o o d a n d D r u g A d m i n i s t r a t i o n , a n d the P h a r m a c e u t i c a l M a n u facturers
Association Foundation.
T h e p a r t i c i p a n t s i n this
conference
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e v a l u a t e d v a r y i n g a p p r o a c h e s to m u t a g e n i c testing a n d c o n s i d e r e d n e w areas of r e s e a r c h
(S).
P u b l i c c o n c e r n has f o c u s e d o n the p o s s i b l e c a r c i n o g e n i c effects of d r u g s a n d other c h e m i c a l s .
L o n g - t e r m c h r o n i c t o x i c i t y studies i n a v a -
r i e t y of species h a v e b e e n started i n the h o p e of m i n i m i z i n g p o t e n t i a l r i s k of c a n c e r i n m a n . H o w e v e r , the results of s u c h studies are difficult, sometimes i m p o s s i b l e , to i n t e r p r e t .
Yet their economic impact can
be
e n o r m o u s , as s h o w n b y the w i t h d r a w a l of c y c l a m a t e s w h e n b l a d d e r c a n cer w a s o b s e r v e d i n a l i m i t e d n u m b e r of rodents.
Inevitably drugs w i l l
b e affected too; a l r e a d y the safety of c e r t a i n o r a l c o n t r a c e p t i v e s has b e e n q u e s t i o n e d b e c a u s e of p o s s i b l e c a r c i n o g e n i c effects i n the breasts of dogs after e x t e n d e d use. I m m u n o l o g i c effects of d r u g s r e m a i n u n p r e d i c t a b l e b a s e d o n a n i m a l test d a t a , despite i n t e n s i v e research effort.
The pharmaceutical industry
has reason f o r c o n c e r n ; the rare o c c u r r e n c e of b l o o d d y s c r a s i a , e v e n w i t h a n e e d e d d r u g , c a n seriously l i m i t its use.
Years of w o r k o n c h l o r a m -
p h e n i c o l , f o r e x a m p l e , h a v e f a i l e d to d i s c o v e r w h y it depresses the b o n e m a r r o w i n some i n d i v i d u a l s .
N o r h a v e scientists l e a r n e d to p r e d i c t s u c h
severe s k i n reactions as e x f o l i a t i v e d e r m a t i t i s f r o m e x p e r i m e n t a l studies. F o r t u n a t e l y , progress i n p r e d i c t i n g p e n i c i l l i n s e n s i t i v i t y justifies a degree of o p t i m i s m that s i m i l a r progress c a n b e m a d e w i t h other d r u g s . N o d i s c u s s i o n of the b i o l o g i c a l k n o w l e d g e g a p w o u l d be w i t h o u t m e n t i o n i n g d r u g abuse.
complete
T h i s is one of the most c r i t i c a l p r o b l e m s
of o u r t i m e , yet o u r u n d e r s t a n d i n g of the p h a r m a c o l o g y of abuse is a l most t o t a l l y deficient.
W h y d o some i n d i v i d u a l s abuse narcotics, L S D ,
m a r i j u a n a , or a m p h e t a m i n e s ?
H o w c a n w e p r e d i c t , b a s e d o n a n i m a l tests,
the abuse p o t e n t i a l of a n e w c o m p o u n d ?
Right n o w w e can only infer
abuse p o t e n t i a l f o r c o m p o u n d s r e l a t e d c h e m i c a l l y or p h a r m a c o l o g i c a l l y to d r u g s w i t h k n o w n abuse p o t e n t i a l . W h a t is the m e c h a n i s m of tolera n c e a n d a d d i c t i o n ? P e r h a p s there is a n i m m u n o l o g i c a l basis f o r m o r p h i n e a n d h e r o i n tolerence.
P e r h a p s i n d u c t i o n of d r u g m e t a b o l i z i n g e n z y m e s i n
l i v e r m i c r o s o m e s m a y e x p l a i n tolerance to some b a r b i t u r a t e s .
M o r e re-
search is r e q u i r e d to a n s w e r these questions. A m a j o r p r o b l e m i n t h e r a p y is i n d i v i d u a l differences i n d r u g response a p p a r e n t l y c o n t r o l l e d b y genetic factors
(9).
W h a t is a safe dose f o r
one p a t i e n t m a y be either ineffective or t o x i c i n another because of faster
In Drug Discovery; Bloom, B., et al.; Advances in Chemistry; American Chemical Society: Washington, DC, 1971.
7.
BURNS
The Biological
Knowledge
or s l o w e r m e t a b o l i c t r a n s f o r m a t i o n .
173
Gap
Patients m a y r e c e i v e s e v e r a l d r u g s
s i m u l t a n e o u s l y w h i c h poses t h e q u e s t i o n of d r u g i n t e r a c t i o n s
(10).
A
v a r i e t y of d r u g interactions h a v e b e e n r e p o r t e d , i n c l u d i n g t h e a b i l i t y of one d r u g to s t i m u l a t e o r i n h i b i t the m e t a b o l i s m of another,
interference
w i t h r e n a l m e c h a n i s m s , d i s p l a c e m e n t of d r u g s that b i n d t o p l a s m a p r o teins, a n d i n t e r f e r e n c e
w i t h intestinal absorption.
vestigation
factors
of genetic
and drug
Almost certainly, i n -
interaction
will
help
explain
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a d v e r s e reactions a n d l e a d to i m p r o v e d d r u g safety.
The Work of Government and Industry Groups I n r e c e n t years the W o r l d H e a l t h O r g a n i z a t i o n has p u b l i s h e d several reports o n t h e p r i n c i p l e s of safety e v a l u a t i o n (11)
as has t h e C o m m i t t e e
o n P r o b l e m s of D r u g S a f e t y of t h e N a t i o n a l A c a d e m y of S c i e n c e s - N a t i o n a l R e s e a r c h C o u n c i l (12).
T h e c o m m i t t e e has s t u d i e d t h e q u e s t i o n
of h o w m u c h m e t a b o l i c d a t a is u s e f u l at each stage i n t h e i n v e s t i g a t i o n of a n e w d r u g a n d s u r v e y e d t h e status a n d f u t u r e needs f o r d r u g safety research.
It has also a t t e m p t e d to f a m i l i a r i z e p h a r m a c o l o g i s t s , b i o c h e m -
ists, a n d m e d i c i n a l chemists w i t h t h e t h e o r e t i c a l a n d p r a c t i c a l aspects of d r u g m e t a b o l i s m studies.
It has h e l d s y m p o s i u m s to r e v i e w advances i n
d e v e l o p m e n t a l p h a r m a c o l o g y , i m m u n o p h a r m a c o l o g y , m e c h a n i s m of d r u g o x i d a t i o n , c h e m i c a l mutagenesis, adverse d r u g reactions r e p o r t i n g systems, a n d a n a p p l i c a t i o n of n e w e r p h y s i c a l t e c h n i q u e s
for drug
metabolism
study. T h r o u g h p r o g r a m project a n d center grants a n d t h r o u g h
contracts
w i t h p h a r m a c e u t i c a l firms, t h e P h a r m a c o l o g y - T o x i c o l o g y P r o g r a m of t h e N a t i o n a l Institute
of G e n e r a l M e d i c a l Sciences has i n v e s t i g a t e d
questions c o n c e r n e d w i t h d r u g safety.
many
T h e s e p r o g r a m a n d center grants
s p e e d t h e s t u d y of d r u g safety i n m a n b y g r o u p i n g together
first-rate
scientists i n p h a r m a c o l o g y , m e d i c i n a l c h e m i s t r y a n d t h e basic sciences. T h e P h a r m a c e u t i c a l M a n u f a c t u r e r s A s s o c i a t i o n F o u n d a t i o n has also f u r n i s h e d grants to m a n y u n i v e r s i t i e s to s t u d y m e c h a n i s m s of d r u g t o x i c i t y . Government a n d industry organizations have considered what constitutes a d e q u a t e c l i n i c a l efficacy as w e l l as s a f e t y — e s p e c i a l l y t h e d i f f i c u l t p r o b l e m of efficacy d a t a f o r a n t i c o n v u l s a n t , analgesic, a n d p s y c h o p h a r m a c o l o g i c agents. P a r t i c u l a r l y n o t e w o r t h y is t h e effort of a c o m b i n e d T a s k F o r c e of the A m e r i c a n C o l l e g e of N e u r o p s y c h o p h a r m a c o l o g y a n d t h e N a t i o n a l Institute of M e n t a l H e a l t h to e s t a b l i s h p r i n c i p l e s f o r e v a l u a t i n g psychotropic drugs.
Recently, the Pharmaceutical Manufacturers Asso-
c i a t i o n set u p panels to f o r m u l a t e efficacy g u i d e l i n e s f o r several p e u t i c classes.
thera-
T h e D r u g E f f i c a c y S t u d y of the N a t i o n a l A c a d e m y of
Sciences has p i n p o i n t e d m a n y of the p r o b l e m s i n this
field,
furthering
f u t u r e c l i n i c a l d r u g investigations.
In Drug Discovery; Bloom, B., et al.; Advances in Chemistry; American Chemical Society: Washington, DC, 1971.
174
DRUG DISCOVERY
Conclusion O b v i o u s l y m a n y constraints
are o p e r a t i n g against t h e d e v e l o p m e n t
of n e w d r u g s . A m o n g t h e most i m p o r t a n t is deficient b a s i c k n o w l e d g e of d r u g a c t i o n a n d of disease processes. T o h e l p r e m e d y these deficiencies, p h a r m a c e u t i c a l firms h a v e b e g u n b a s i c research i n t o cancer, v i r a l diseases, o r g a n transplants, a n d a host of d e g e n e r a t i v e c o n d i t i o n s . H o w e v e r , b a s i c research
w i l l require
ever-increasing
financial
commitments
over
long
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p e r i o d s b e f o r e i m p o r t a n t n e w d r u g s w i l l b e c o m e a v a i l a b l e to t h e m e d i c a l profession. I n t r o d u c t i o n of n e w d r u g s is o f t e n d e l a y e d b y differences of o p i n i o n on w h a t constitutes
v a l i d safety a n d efficacy d a t a .
In many
c o n f u s i o n is c a u s e d b y difficulties i n i n t e r p r e t i n g a n i m a l t o x i c i t y and
inadequate
instances, findings
c r i t e r i a f o r safety a n d efficacy of a n e w d r u g i n m a n .
T o prevent unnecessarily delayed d r u g introductions, the academic com m u n i t y together w i t h t h e F o o d a n d D r u g A d m i n i s t r a t i o n a n d t h e p h a r m a c e u t i c a l i n d u s t r y s h o u l d w o r k together to establish v a l i d g u i d e l i n e s . S u c h c o o p e r a t i o n w i l l b e p a r t i c u l a r l y r e q u i r e d w h e n c u r r e n t b a s i c research y i e l d s potent n e w drugs f o r e v a l u a t i o n . Scientists
have become concerned
about the cutbacks
i n research
grant p r o g r a m s of t h e N a t i o n a l Institutes of H e a l t h a n d t h e N a t i o n a l S c i e n c e F o u n d a t i o n . E q u a l l y i m p o r t a n t is a c o n t i n u i n g generous
support
for p r e d o c t o r a l a n d p o s t d o c t o r a l t r a i n i n g p r o g r a m s , as w e l l as t r a i n i n g programs for pharmacology, medicinal chemistry, a n d related disciplines. O t h e r w i s e , advances
i n the pharmaceutical
sciences m a y b e seriously
i m p a i r e d b y t h e l a c k of a p p r o p r i a t e l y t r a i n e d researchers.
Literature Cited (1) Elion, B., Kovensky, Α., Hitchings, G. H., Metz, E., Rundles, R. W., "Metabolic Studies of Allopurinol, An Inhibitor of Xanthine Oxidase," Biochem. Pharmacol. (1966) 15, 863-880. (2) Cotzias, G.C.,Papavasiliou,P. S., Gellene, R., "Modification of Parkin sonism—Chronic Treatment with L-Dopa," New Eng. J. Med. (1969) 280 (7), 382-383. (3) Greenberg, D. S., "Molecular Biology—Drug Firm to Establish New Re search Center," Sci. (1967) 157, 408-409. (4) Hoffmann-La Roche Pioneering Innovation, The Roche Institute of Mo lecular Biology, Congressional Record (1967) 113 (129), H10558. (5) "Principles for the Testing of Drugs for Teratogenicity," WHO Tech. Rept. Ser. (1967) 364, 5-18. (6) Sanders, H. J., "Part I. Chemical Mutagens—The Road to Genetic Disas ter?," Chem. Eng. News (May 19, 1969) 47, 51-71. (7) Sanders, H. J., "Part II. Chemical Mutagens—An Expanding Roster of Suspects," Chem. Eng. News (June 2, 1969) 47, 54-68. (8) Harris, M., "Mutagenicity of Chemicals and Drugs," Sci. (1971) 171, 51-52.
In Drug Discovery; Bloom, B., et al.; Advances in Chemistry; American Chemical Society: Washington, DC, 1971.
7.
BURNS
The Biological
Knowledge
Gap
175
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(9) "Pharmacogenetics," B. N. La Du, W. Kalow, Eds., Ann. Ν. Y. Acad. Sci. (1968) 151 (2). (10) "Symposium on Clincal Effects of Interaction Between Drugs," Proc. Roy. Soc. Med. (1965) 58 (11) Pt. 2. (11) "Principles for Pre-Clinical Testing of Drug Safety," WHO Tech. Rept. Ser. (1966) 341. (12) Report of the Committee on Problems of Drug Safety, Drug Research Board, National Academy of Sciences-National Research Council, "Application of Metabolic Data to Drug Safety Evaluation," Clin. Pharmacol. Ther. (1969) 6 (5) 607-634. RECEIVED November 5, 1970.
In Drug Discovery; Bloom, B., et al.; Advances in Chemistry; American Chemical Society: Washington, DC, 1971.