转化型研究中的定量药理学

Q面J

◇Invited1.uavi6,w◇

Chinese

d34-1206/R.ISSN

2007

Phm蜥‘:;.1

ainPhannaeolTher

Society

1009-2501

E-mail:ccpl%@21cn.。∞

Oct;12(10)1081一10昭

Quantitativepharmacology

translationalresearch

in

environment

JeffreySBarrett

Laboratoryfor

aepi玩PK/PD。Clinical

of

TheChildren’5Hospital

University

Philadelphia;Pediatrics执舯唰,School

19104,USA

de.

Pharmacology&TherapeuticsDivision,

ofMedwine,

ofPennsylvania,Phihddphia,PA

is

AB鳓【RACr剐3ribed

as

Translationalresearch

generally

thetreatmentNeuroAIDSisusedtoillustratetheapplica・tionofquantitativepharmacologysearch

in,a

translational

re。

theapplicationofbasic

or

sciencediscoveriesto

or

thetreamaent

preventionofdisease

on

injury.Itsvalue

paradigm.

isusuallydeterminedbased

atory

or

thelikelihoodthatG—xp]or-

Call

developmentalresearch

yieldeffectivethem.

pies.Whilethepharmaceuticalindustryhasevdvedinto

AcCederesearchisan

importantcomponent

inthe

highlyspecializedsector

engaged

intranslational

community

Ie・

discoveryanddevelopmentofrlewmolecularentities.ⅡketheirindustrialandregulatOryfists

are

search,theacademicmedicalresearchhas

colle鹕,ues.acad鲥cscien-

similarlyembracedthisparadigmlargelythmnghthemoti-vationoftheNationalInstituteof

engagedinrespondingtoehansinsevolved

R&Dland—

Health(N珊)via

its

scapewhichdemandsbothefficiencyandinnovation.Theconceptoftranslationalresearchhasdecade

over

Roadmapinitiative.耵leClinicalandTranslationalSci.

enoA,Award(㈣)has

iOilswhich

Call

thepast

createdopportunitiesforinstitut.

and

haslikewisebeen

defined

the

inmanyways.A

providethemultidisciplinaryenvironment

reasonabledefinitionwould

be

applicationofbasic

requiredtoengagesuchresearch.Akeycomponentofthescientificdiscoveriesintoclinicallygermanefindingsand,simultaneously,the

generation

of

scientific

IIl口哩e

CrI姒and

all

elementofboththeNIHRoadmapandthePathisthebridgingofbenchandbedside

questions

m~Critical

based蚰clillicalobservatio璐[1。.A

lucidunder.

re・

scienceviaquantitativepharmacologicrelationships.,11leinfrastructureof

standing

can

befoundintheutilizationoftranslational

areas

the啪versity

of

Pennsylvania(Penn)/

CrSAishighlighted

searchmethodologiesinspecifictherapeuticoncology‘2’3l,nephrology‘4|,

such

as

Children’sHospitalofrelativeto

Philadelphhpain【5】’and

and

cognitive

de.

both

researchandeducationalobjectives

eflse

reliant

clinewithaging。6,j.Thehistorical

parallelcontextto

uponquantitativepharmacology.A

study.NⅡ{-

be

considered

when

discussingthegenesisoftranslational

smallPhRMAwerecont-

sponsoredreseawhprogramexploringNKlrantagonismfor

researchisthatwhilebigand

endingwithdiminishingpipelinesdespite

CorrespondenceAuthorandAddress:JeffreyS.Barrett,HID,FcP

improvements

in

bb0咖for

sion

AppliedPK/PD,Clinical

Plmrmacology&'l姗tics

Dt私l巾mllt

highthroughputscreeningandotherdiscovery・-basedinno・-

Divi-

vation¥.acad洲c

to

medical

centers

wereat

lossforhow

era

田mChildren’BHospitalofPhiladelphia

connectthebasicsciencesinthepost—genoIIlic

to

‰University

of

Pennsylvania

MedicalSchool,Pediatrics

clinicalresearcherswhohadheardofseldomvisited.Atthe戤Hne

the‘‘bench”but

had

AbramsonResearchCenter,Rm916H3615CivicCenterBIvdPhiladelphia,PA19104

time。their

and

governingregula-

roadma—

torycounterpartscraftedthecriticalpt引initiativesfromtheFDAdress

path…and

E-mail.-bm-mtj@email.chop.edu

Pholle;267426-5479

Fax:215-590-7544

NIHrespectivelytoad—

forresoh—

these咖oenls

and

providesuggestions

・1082・

tion.Atthecore

oftheseproposalsisa

clearrequestforthecreation

of

interdisciplinaryteams

thatwilldefine

quantitativerelationshipsbridgingdiscoveryanddevelop・mentalscienceandchallenging

hypotheses

regarding

basic

andchnicalpharmacology,facilitatingnovelexperimental

designsand

aiding

indrugdevelopmentdecisionmaking

ingeneral-"quantitativepharmacology”forlackof

better

NmRoADML心AND

THECLDⅡCAL

AND

TRANSLAT飘)N

SCmNCEAWARD

(CTSA)

Academicresearchisfundedbya

varietyofmecha—

nisms

including

thepublicandprivatesectors

withthe

major

investment

comingfromthe

NationalInstituteof

Health(NIH)which

will

use

muchofits

projected¥28.

6billion2(107budgettofundbiomedicalresearchintheUnitedStates[9|.The

structure

oftheNIHiscomposed

primarilyofdisease・-specificinstitutionswhichhashistori・-callycreated

compartmentalized

focus

on

disease

11e—

search;countertonewparadigmswhichencouragemul-tidisciplinaryteamsandthebasic・・to-appliedresearchcon・-

tinuumin

general.The

NIHRoadmapinitiative(http://

nihroadmap.nih.gov)seeks

toresolvethisinfrastructure

barrierand

ailnstoacoele玎ltena璐lati彻alDesearch[10J.

Itsmaingoalis“toidentifymajor

opportunitiesandgaps

inbiomedicalresearch

that

no

singleinstituteat

NIH

couldtackle

alone.’’The

roadmap

covers

threemain

themes:

“NowPathwaystoDiscovery”:tostimulatethede.velopmentofnovelapproachestounravel

thecom—

plexityofbiologicsystemsandtheirregulation.

“ResearchTeamsoftheFuture”:toreducethecul.turalandadministrativeb舢TieIBthatofteninlpederesearch

and

invoke

all

era

inwhichscientists

can

;cooperatein

new

anddifferentways.

“Re—engineering

theClinicalResearchEnterprise”:to

fundfacilities,re¥ources,orbothtobolsterelini.ealandtranslationalresearch.

Anoutgrowthoftheroadmapinitiativeisa

newpro-

gramthatfunds

institutionalClinicalandTranslational

Science

Awards(CTSAs).Through

this

mechanism(ht.tp:I/grants.nih.govlgrantslguidelnotice—files/NOT-RM一

05-013.h叫),applicants

mayproposetransformtiveef-forts

appropriate

totheirown

institutions.The

CISAswill

advancetheassemblyofinstitutionalacademic“homes’’

providingintegratedintellectualandphysical

re¥o嘲for

theconduct

of

original

clinical

andtranslationalsci-

enCe【11,12].

Itisexpectedthatthedevelopmentoftheseenviron-

mentswill,overtime,enhancethediscipline,provide

much-needededucationalprograms,contributetothe

growthofwell—structuredandwell—recognized

career

path-

ways,andprovide

researchenvironmentthatismore

nimble,conduciveto,andresponsivetothedemandsofmoderntranslationalandclinicalresearch.Toallowinsti—

tutions

to

buildaninnovativeandintegratedprogram,the

NIHhasaskedapplicantstoconsolidateGeneralClinicalResearch

Centers(GCRCs),T32andK12programs,andotherre¥ourcesas

appropriate.These

reflources

may

be

augmentedbysubstantialNIHRoadmapfundingredirect-

edfromotherinitiativesandtargetedtotheCTSApro—gram,withtheNationalCenterforResearchResources.astheleadNIHentity.Recently,theNIHawarded

con—

sortiumof12institutions(http://www.hen".nih.gov/

ncrrprog/madmap/CTSA一9-2006.asp)thefirstfundingthroughtheCISAprogramtotalingj5108millionthefirst

year.Theawards黜for

5yearsandtheprogramitself

willeventuallyreplacetheGCRCs[13].

0F咖。ADEI脚A3

咖P】盼州,C印匝DREN’SC瞰

II(熔P】呲Oneoftheinitial12CTSArecipientswasthePenn

and

itspartnerinstitutions,theChildren’sHospitalof

Philadelphia(CHOP),theWistar

InstituteandtheUni-

versityoftheSciencesinPhiladelphia.Theirapplication

includedparticipationfromthe

SchoolsofMedicine,

Nursing,Dentistry,Education,ArtsandSciences,Vet-eIiIlary,EngineeringandAppliedSciences,theAnnen—bergSchoolof

Communications,and

theWhartonBusi-

ness

SchoolwithinPenncombinedwithcolleaguesfrom

externalpartnershipsintonovel,interdisciplinary・struc-

tures

andprograms.PennandCHOP.together诵Ⅱ1their

partnerinstitutionsinclude

laI琴ecriticalIlm鹪ofsenior

facultyaccomplishedinthetranslationofa

diversearmy

oftherapeutic

modalities—small

molecules,proteins,

genes,vaccines—intotheclinicaldomain.Togetherthey

have

remarkabletrainingrecord—more

NIHsupported

拓ailliJlggrantsthananyotherinstitution,thela增estreed—icalsciencetrainingprograminthecountryandmultiple

・1083・

junior

facultyholdingKawards.Theyalsohavetwowellofnewmedicinesiswellappreciated

and

pervasiveinin-

establishedNIHfundedGCRCs诵tIlpotentialtobridgethepediatricsents

dustry.academiaandtheregulatorycommunityt1引.Fig2

contains

adultinterface.Finally,thegrouprepm—schematicofthepmposedbythePenn/CHOP

educational

program

singlegeographiccampusfacilitatingtheengage-supported

CTSA.TheITMAThad

mentof

chemists,engineers,statisticians,nurses,veteri—

sha-

proposedthen踟le“TranslationalMedicineandTherapeu-

tics'’toembracethe

narians,dentists,pharmacists,policymakersandprojectionofbasicdisciplinesinto

ofdevelopingnovel

pemandexpertsinconmmrcializationwithbiomedicalsci.theehnicaldomainwiththe

objective

entists,epidemiologistsand

7111e

Penn/CHOP

physicians.

plan

involves

therapeutics.Suchindividualswouldbetrainedinthede.

velopmentandfromcellular

transformational

commitmentbytheinstitutionsinvolvedto(a)collaborateandsupporttherecruitmentsandpmgramsinthefieldofclinicalandtranslational

projectionof.mechanismbasedbiomarkersandmodelsystemstoguiderationaldosese.

to

1ection.Furthermore,theywouldbetrained

emerging

use

applythe

research;(b)devote

substantial

andbioinformatic

as

analysisofoutputfrom

and

space(wetand

tional

dry

laboratories)to

clinicalandtransla-

ex.

technologies,such

pmteomies,metabolomics

research;and(c)foster

thetrails—institutionalgenomics,toselectbetweendiversemoleculesdirectedat

pausionofthe“academichome”ofthisenterprise—the

InstituteforTranslationalMedicineandTherapeutics(IT.

singulartarget.WhiletheKMAS

core

willprovidefunc-

tionalsupportofquantitativepharmacologyactivities,a

MAT)topermitdevelopmentofnewcenters.coresandPharmacometricTrainingUnitwillprovideeducationaltrainingresources

inadditionto

and

interdisciplinarypmgramsofresearchandeducation.Anpreviouslycreatedpro-

on

importantgoalforthePenn/CHOPplanisthedevelop・

mentoffocusedstrategicallianceswiththeFDA

gramsintranslationalmedicine.Initially,amodule

tracer

and

the

kinetics,pharmacokineties,andcompartmental

modeling

and

core

phammeeutiealandcomputingindustries.Besidesthesealliances,theengagementofBioAdvanee(http://www.bioadvanee.com),astatefundedentity

pharmaeometricrequirementeleetivelyasdegree

in

willbe

offeredas

Translational

Therapeuticstrackand

or

charged稍tll‰一

as-

standalonecourse

componentinother

teringthedevelopmentofthelifesciencesinsoutheasternPennsylvaniahasalsobeensecured.BioAdvancewillsistinproviding

resolll℃e

courses

administeredvia1TMATin

support

ofthe

CTSA.PhRMAandFDAstaffwillparticipate,bothas

fbftlle

acc,ess

oftraineesbased

facultyparticipantsandassitesforrotationsiteforCTSA

students.BioAdvancewillfacilitateregionalizationofeesstothisprogram.

ac—

withprimaryappointmentsinregional

institutionstothese

educationalinstrumentsandwillalsosupportthedevelop-

mentofand

regionalization

ofacces,a5to

bioinformatieslshowsthe

platformsdevelopedthroughthevarious

cores

C融~.Fig

CASEsTUDY:NKlr

ANI'AGoNISM

IN

centers

whichcomprise1TMATwiththeassociated

NEURoAⅡ烬

whichwillservicetheTranslationalResearchCen.

An

exampleofthe

integrationofthe

all

quantitative

ter.’nlesupportofquantitativepharmacologypracticewillbeprovidedby

pharmacologyapproachappliedtotionalresearchinitiativefortstoexplore

can

academictransla—

tlleⅪ垤AS(KineticModelingandSimula-beillustratedwithrecentel-

totreatNeu—

tion)Core(http://www.reed.upenn.edulkmasl)whichWill(a)aidinthedevelopmentofdrugassays;(b)pm—

moteandassistintheperformanceoftracerkineticstud—

NKlreceptorantagonism

mAIDS.nis

projectisfundedbytheNationalInstitutes

ofAllergyandInfectioustionalInstitutesofMental

Disease(NIAID)andHealth(NIMH)of

seekstoestablish

theNa—the

ies;(c)developnovelapproaches

to

kineticdataanalys-

kineticmodel.

Nm

mul-

is;(d)providePK,PK/PD,and

tracer

program(PAR-03—138)which

ing;and(e)developeducationalmodulesinphannacoki-neticsandtiltcerkineticstopopulatetheeducationaliniti-

ativespursuedwithintheCTSA.

AcentralmissionofITMAThas

beeneducation.

tidisciplinaryresearchanddevelopmentprogramtargetedtowardthediscovery,developmentandevaluationofinno—vativetherapiesforHIVinfection(http://grants.nih.gov/

grants/guide/pa-files/PAR一03—138.html).%e

goaloftheprogramisto

overall

’nledeficiencyofhumancapitalintranslationalresearch.particularlywithrespectto’thedevelopmentandevaluation

andtechnicalprogress

supportandacceleratescientificinnon—traditionalandtraditional

.・

1084・

drug-basedtherapiesthatexploitnovelviralandcellulartargetsofimportanceinHIVinfection.Abenchmarkfora

SUCCesSfUlprogramisthedevelopmentof

newtreatment

concept

that

call

beintroduced

to

clinicalpractice.Theabilityofneurokinin・1receptor(NK—lR)antagoniststotargetthesubstanceP(SP)receptordemonstratingantivi-ralandimmunomodulatoryeffects[15—17]renew

therapeutictargetwiththepotentialtointerrupt

pathway

criticaltoHIVreplication【18,19‘.ThegoalofthisspecificIntegratedPreclinical/ClinicalProgram(IPCP)istoiden—tify

an

NK-IRantagonistthatis:(a)active

a8

ananti—HIVagenttIlrougIlinteractionwithchemokine/cytokinereceptom(Project1);(b)specific

forchemokineandG-

proteincoupledreceptors(Project2);(c)safefor

nile

in

SIV・-infectednon・-humanprimatesandprovidesproofof

concept

related

to

antiviral,immunomodulatory,and

neu—

robehavioraleffects(Project3);and(d)safeinhumansandhaspositiveimmunomodulatoryeffects(Project4).

Allprojectscontributetounderstandingthebasicvirolog—ie,molecularandcellularimmunologic

mechanismsof

SP,NK一1R

antagonists,and

HIV/SIVinfection.

AkeyelementintheIPCPistheintegrationofmod—

and

simulation

s£m硒es

to

supportthe

valjous

projects

as

wellasinformtheadministrativecore.Specifi—

cally,computationaltechniquesale

employedtochallengethe“drnggabililty”of

the

candidateagents.Insilico

ADMEtechniques

are

usedaspartoftherankingcriteria

bywhichwewillprioritizetheadvancementofselected

agents.Theapproach

enablesthecalculationofmolecular

descriptomandpredictionofdrug-likeness

data

using2D

structures,andwithouttheneedforspecial

computationalchemistryknowledge.Aspharumeology

and

biology/mechanismdata

ale

generated

forthevariousagents(Projects

and2),thegenemlizability

of

QSAR

QSPK

relationshipsforthiscompoundclasswill

be

explored.Fig3illustratestheintegrationofquantitative

pharmacologyapplication

acroK¥projects

forthisIPCP.

TheNKlRprojectisdependenton

two

primarypro—

pathways:(1)examine

theextenttowhichtheRantagonist

aprepitantis

suitableagentforART

in

NeuroAIDS

patientsbased

on

exlx挎ure—-re・・

criteriaconstructedfromits

presumed

actionsand

(2)examinethecorrelationbetweenaprepitantpreclinical

pharmacology,druggabilitycriteriaandPK/PDrelation-shipstogeneralizeandultimatelyranksuitablehack-up

compounds.Within

thefirstpathwaythereis

progres—

sionofexperiments,predefinedcriteriaforstageadvance-

mentanddecision

trees

thatguidetheoverallprogression.

These

ar;e

facilitatedbymodelingandsimUlationexercises

permittingscenariotestingforsubsequentexperimentsandtestingof

assumptions

fundamentaltokeyassumptionsfor

theoverallprogram.OneoftheessentialbridgesinthisIF-CPisthe

suitabilityofan

SIV

pharmacology/disease

modeltopredict

success

outcomesinHIV.Intheseries

ofexperimentsthathasensued,thePK/PDofaprepitantmSIV—infectedanimalshavebeencharacterizedandusedin

conjunctionwith

relevantdatafromchemotherapy--in-・

duced

nausea

andvomiting(CmV)patients

to

buildsim-

ulationmodelsthatprojectresponse

inHIV-・infectedpa--

tients.The

use

ofmodelingandsimulation

to

advance

compoundprogressionofantiretroviralagentsrecentlyice—

viewedbyBarrett[驯contains

morethoroughdescription

ofthis

case

study.

5CONCIjUSIoN

Itisclearthatacademicmedicalcenterswillbe

all

importantplayerin

the

evolving

R&Dparadigms

which

willguidethediscoveryof

new

molecularentitiesinthe

yearstocome.Translationalresearchisan

approachthat

reliesheavily

on

theinteractionbetweenbasicand

clinical

scientistsandtheappropriatecommunicationofideas,hy・

pothesesandexperimentaldesigns

toevaluatediseasetherapies.,11leconceptof

quantitativephanmeology

is.in

essence,a

communication

platformbywhichtranslational

researchcanbediscussedand

in

which

h.ssumptions,

modelsandsimulations

are

integrated

intodecision.mak.

ingtools.ItisalsoclearthattherecenteffortsoftheFDAandNIHreflecttherecognitionthatthisskillsetisin

short

supplyandwillrequirededicatedprogramstotrainfuture

generationsofscientiststhat

conduct

translational

re-

search.

A删眦。EDE^诬Ⅳ巧:Dr.Barrett’5

effortissup—

byNlHGrant’s.P01饕MH076388andtU54

#R尺0235f订.0】

clingmolecularand

gressionNKItherapy

portedsponse

・1085・

../厂

r,

’;

Tf.anslational

I啪m…edica吲l

In酬for肾m

t.cs

蕞慕豫衙藩商赢≥

甑t

ResearchCenter

!。ging‘C,en¨,J}、灌

ChemicalBiologyInTI.anslation

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inT『翟nslation

惑。N.

1.|

I’

CENTER

TransIationaIResearchcenter

ASSoClATEDCoRES

圆圈圃

匣匝习匹习

~∥||K;/

Figure1InstituteforTranslaiionalMedicineandTherapeutics(ITMAT)Centersproposedwithinthe

Penll/CHOPCTSAgrantandthenewcoressupportingtheTranslationalResearchCenter.TheKMAS(KineticModelingandSimulation)corewillprovidetechnologicexpertiseforintegrationofquantitativepharmacologyintothetranslationalresearchparadigm.TRL=TranslationalResearchLaboratories,SDAB=StudyDesignandBiostatistics

TATCO=TranslationalandClinicalTrialOrganization

E一,IDS、]i:@

CCS=ClinicalCoreServices

OHSAP=O伍ceofHumanSubiectAdvocacy&Protection

RNC=ResearchNurseCore

IDS=InvestigationalDrugService

KMAS=Kinetics.ModelingandSimulation

1086・

Chin

JClinPham——mcolTher2007Oct;12(10)

Figure2ThePenn/CHOPeducationalprogramproposedfortheCTSAtargetsthefullspectrumofpotentialandexistingtrainees,fromundergraduatestograduatestudents,fellows,andfaculty.Asindividualsrequiredifferentlevelsandtypesoftrainingateachstageoftheiracademicdevelopment,multipleoptionsprovidedforexposuretotranslationalresearchrangingfrompreview/awareness

courses

are

to

certification,

mastersanddoctoraldegreeprograms.

1087・

Quantitation/M&STasks

Literatureandexperimentalpriori;:

・80%InhibitionofHWBaIstraininmonocy慷derivedmacrophages(io・6H1

‘AssumeexPOsuretargetsimilartoinvitro

activity?target

Translational肋rkflow

HypothesesbyStage

・DoesthestructuresuggestN3MEpropertieswhichconsistentwith"druggable”agents?

・isthecompound”active。intherangeofconcentraUonswhich

wouldbe

trough瞻concent怕Uon~

100—500ng/mL.

・Hetabolized

primadlybyCYP3A4;minor

metabolismby“P1A2andcYp2C19.・Enzymeinductionreducestheexposure

foIlowingchronicadministraUon.・ProteinbiridIng一95%;F

9-13hr

pharmacologically

achievable?

・Isthereevidenceofsynergywith

thevariousexperimentalagentsandmarketedanUrotrovirals?

・WhatistheQSARbetweenCCR5

andNKlreceptors?

60"6S%;HaIf-life:

・Moderatevariabili~inClearanceandVolume

0fdistribuUon

・Staged

first-orderinput

explainsabsomuon

・Isthe

monkey

the

areasonable

l‘a1I‘|2

——斗

presumedNKlr

mechanism(s)ofaction?

mode}for

・Canthe

extrapolated

SW/monkeymodelbe

tothehumanP“PD

behavior(neourocogn砌ve,

antirotroviral,etc)?

・Can

theSIv/monkeymodeIbe

tothehumanHⅣ

disease?

extrapolated

・Canactivitybedemonstratedat

thedoseandduraUonoftherapynegotiatedwithFDA?・Doesthe

.S..1.m....u..1.a...U...o..n....M...o..d...e..1..R...e..s..u...1.t.s.:

・Therapeuticwindowlikelysusceptibleto

・Inductionmay

variationin

response

suggestiveofresD0nder/non-responderpartitiongiventhe

。small・Is

interactions,adherence

bemanageable

・ARV/doselikelyexceedsofCINVdose

samplesize?

thePK/PDadequatelydefinedsuchthatdoseextrapolaUoncanbemadereliably?

・isthereSU仟icientcorrelaUon

betweenQSAPaandtherankingsuggestaback-up

apropt口nc,

・IsthereatherapeuticresponseforNeuroAIDSbasedonthe

aprepitantPhaseIbtrialthatcanbetargetedfromearlier

compoundtocriteriato

T■_M

(preclinical)data?

^啊■-●岫:一●■一一_I■_

CINV=chemotherapy-inducednauseaandvomitingSIV=simianimmunodeficiencyvirusARV=antiretroviral

Figure

3An

example

ofquantitative

pharmacologicalprinciplesapplied

totranslationalresearch:

Relationshipswithaprepitantfrominvitrodata,invivodatainanimals,andinvivodatainCINVpatientsused

to

predictHIV-infectedpatientresponseandNeuroAIDsdiseaseprogression.

・1088・

new

vision[J].Nr,w,1J

Med,2005;353:162l一1623.

and

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ZerllouniEA,Al、rir瞩B.Climcalawards:aframework1.0rRes,2006;148:4—5.

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3Keloff

scb【盯幽p

0f

mtegration[J].Acad

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fion:progress2088.4

and删∞lJJ.EIlr

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HoWZ,CnaanA,“YH,d以.Su]粥taneePmodttlateshu.mallblood

immunoddlciencyvirusIeplicationin

humanpenpher.1

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Mao

J.Transitionalpainresearch:晡dgingtllegapbetween

16Ho

WZ,hiJP,UY,甜af.ⅧV

basic卸delimcalre=e,lreh[J].Pain,2002;97:183—187.

BrownSC,ParkI)C.Theoreticalmodel80fcogniive

pressioninhumanilnnllme—618.

eells[J].眦B

in

enhanc∞substance

J,2002;16:616

agingand

imptcafiomfortranslationalresearchiIlmedicine[J].Gemntol—o西st,2003;43:57—67.

17场JP,HoWz,ZlumGX,税以.subs咖Pantagonist(CP-

96.345)inhibits

HIV-l酬ication

NailAead

humanmoflonuclo_.,alr

CI)阴,US

Foodand

DmgAdministration.IllnOvllIJonandstag-

On

pllagoc归[J].Proc

sci吣~,2001;98:3970—

substanceP

nation:Challenge锄dopportunity

medicinalproducts|S8

thecritical

p讪to

new

1.2004.

ZerhouniE.Nedicine.711leNIH302:63—72.

R0蛳[J].science,2003;

andopportu-

18叫鹪SD,Ho

levels19

3975.

in阱i瓶ectedmen[J].AIDs,200l;15:2043—2045.

J,PerkimD0,髓以.Stress-associated

WZ,Gettes

DR,甜以.Eh砷ed

EvansDL,Lef℃Ilmlm

I_osealzo

J.TtleNIHbudgetandthe缸tureofbiomedieal陀.

Engl

reduetiomofcvtoto菇cT

search[J].N

10

norignm鹤iII708.1l

JMed,2006;354:1665—1667.

20

船)吼l栅mtic

543—550.Barrett

lymphoc舾锄dnaturalkillereelsirI

HⅣi如lon[JJ.AmJPsycIlia何,1995;152:

c伽咖und

progression0fanti|etroviral

H,Marin砒E,Marin池F1VI.0bslacles

trans舢onal

research[J].Nat

Med,20Q5;ll:705—

JS.Faclimfing

agentsvia

modelllg卸dsimuladon[J].JNettroimmunePhar—

Ze由ourliEA.Translationaland

clillical∞ier妒time

for

llmcol。20I昕;2:58—71.

转化型研究中的定量药理学

摘要转化型研究一般是指将基础科学发现应用到治疗或预防疾病或损伤,其价值通常是基于探索或

品药物管理局的关键路径计划中的一个元素就是通

过定量药理学研究桥接基础与临床科学。美国宾夕法尼亚大学/费城儿童医院临床和转化型研究相对

发展可产生有效疗法的可能性。当今的制药工业已发展成为一个从事转化型研究的高度专业化行业,在美国国立卫生研究院的倡议及激励下,医学科研

队伍同样接受了这一模式。临床和转化型研究奖的

突出,两项研究和教育目标均依赖于定量药理学。美国国立卫生研究院所赞助的一项旨在探索神经激

肽l受体拮抗用于治疗神经性爱滋病的研究案例,

设立可以为能从事此类研究机构所需的多学科环境创造机会。临床和转化型研究奖的一个关键组成部分以及美国国立卫生研究院的工作路线图和美国食

正是用来说明运用定量药理进行转化型研究的范

例。

Q面J

◇Invited1.uavi6,w◇

Chinese

d34-1206/R.ISSN

2007

Phm蜥‘:;.1

ainPhannaeolTher

Society

1009-2501

E-mail:ccpl%@21cn.。∞

Oct;12(10)1081一10昭

Quantitativepharmacology

translationalresearch

in

environment

JeffreySBarrett

Laboratoryfor

aepi玩PK/PD。Clinical

of

TheChildren’5Hospital

University

Philadelphia;Pediatrics执舯唰,School

19104,USA

de.

Pharmacology&TherapeuticsDivision,

ofMedwine,

ofPennsylvania,Phihddphia,PA

is

AB鳓【RACr剐3ribed

as

Translationalresearch

generally

thetreatmentNeuroAIDSisusedtoillustratetheapplica・tionofquantitativepharmacologysearch

in,a

translational

re。

theapplicationofbasic

or

sciencediscoveriesto

or

thetreamaent

preventionofdisease

on

injury.Itsvalue

paradigm.

isusuallydeterminedbased

atory

or

thelikelihoodthatG—xp]or-

Call

developmentalresearch

yieldeffectivethem.

pies.Whilethepharmaceuticalindustryhasevdvedinto

AcCederesearchisan

importantcomponent

inthe

highlyspecializedsector

engaged

intranslational

community

Ie・

discoveryanddevelopmentofrlewmolecularentities.ⅡketheirindustrialandregulatOryfists

are

search,theacademicmedicalresearchhas

colle鹕,ues.acad鲥cscien-

similarlyembracedthisparadigmlargelythmnghthemoti-vationoftheNationalInstituteof

engagedinrespondingtoehansinsevolved

R&Dland—

Health(N珊)via

its

scapewhichdemandsbothefficiencyandinnovation.Theconceptoftranslationalresearchhasdecade

over

Roadmapinitiative.耵leClinicalandTranslationalSci.

enoA,Award(㈣)has

iOilswhich

Call

thepast

createdopportunitiesforinstitut.

and

haslikewisebeen

defined

the

inmanyways.A

providethemultidisciplinaryenvironment

reasonabledefinitionwould

be

applicationofbasic

requiredtoengagesuchresearch.Akeycomponentofthescientificdiscoveriesintoclinicallygermanefindingsand,simultaneously,the

generation

of

scientific

IIl口哩e

CrI姒and

all

elementofboththeNIHRoadmapandthePathisthebridgingofbenchandbedside

questions

m~Critical

based蚰clillicalobservatio璐[1。.A

lucidunder.

re・

scienceviaquantitativepharmacologicrelationships.,11leinfrastructureof

standing

can

befoundintheutilizationoftranslational

areas

the啪versity

of

Pennsylvania(Penn)/

CrSAishighlighted

searchmethodologiesinspecifictherapeuticoncology‘2’3l,nephrology‘4|,

such

as

Children’sHospitalofrelativeto

Philadelphhpain【5】’and

and

cognitive

de.

both

researchandeducationalobjectives

eflse

reliant

clinewithaging。6,j.Thehistorical

parallelcontextto

uponquantitativepharmacology.A

study.NⅡ{-

be

considered

when

discussingthegenesisoftranslational

smallPhRMAwerecont-

sponsoredreseawhprogramexploringNKlrantagonismfor

researchisthatwhilebigand

endingwithdiminishingpipelinesdespite

CorrespondenceAuthorandAddress:JeffreyS.Barrett,HID,FcP

improvements

in

bb0咖for

sion

AppliedPK/PD,Clinical

Plmrmacology&'l姗tics

Dt私l巾mllt

highthroughputscreeningandotherdiscovery・-basedinno・-

Divi-

vation¥.acad洲c

to

medical

centers

wereat

lossforhow

era

田mChildren’BHospitalofPhiladelphia

connectthebasicsciencesinthepost—genoIIlic

to

‰University

of

Pennsylvania

MedicalSchool,Pediatrics

clinicalresearcherswhohadheardofseldomvisited.Atthe戤Hne

the‘‘bench”but

had

AbramsonResearchCenter,Rm916H3615CivicCenterBIvdPhiladelphia,PA19104

time。their

and

governingregula-

roadma—

torycounterpartscraftedthecriticalpt引initiativesfromtheFDAdress

path…and

E-mail.-bm-mtj@email.chop.edu

Pholle;267426-5479

Fax:215-590-7544

NIHrespectivelytoad—

forresoh—

these咖oenls

and

providesuggestions

・1082・

tion.Atthecore

oftheseproposalsisa

clearrequestforthecreation

of

interdisciplinaryteams

thatwilldefine

quantitativerelationshipsbridgingdiscoveryanddevelop・mentalscienceandchallenging

hypotheses

regarding

basic

andchnicalpharmacology,facilitatingnovelexperimental

designsand

aiding

indrugdevelopmentdecisionmaking

ingeneral-"quantitativepharmacology”forlackof

better

NmRoADML心AND

THECLDⅡCAL

AND

TRANSLAT飘)N

SCmNCEAWARD

(CTSA)

Academicresearchisfundedbya

varietyofmecha—

nisms

including

thepublicandprivatesectors

withthe

major

investment

comingfromthe

NationalInstituteof

Health(NIH)which

will

use

muchofits

projected¥28.

6billion2(107budgettofundbiomedicalresearchintheUnitedStates[9|.The

structure

oftheNIHiscomposed

primarilyofdisease・-specificinstitutionswhichhashistori・-callycreated

compartmentalized

focus

on

disease

11e—

search;countertonewparadigmswhichencouragemul-tidisciplinaryteamsandthebasic・・to-appliedresearchcon・-

tinuumin

general.The

NIHRoadmapinitiative(http://

nihroadmap.nih.gov)seeks

toresolvethisinfrastructure

barrierand

ailnstoacoele玎ltena璐lati彻alDesearch[10J.

Itsmaingoalis“toidentifymajor

opportunitiesandgaps

inbiomedicalresearch

that

no

singleinstituteat

NIH

couldtackle

alone.’’The

roadmap

covers

threemain

themes:

“NowPathwaystoDiscovery”:tostimulatethede.velopmentofnovelapproachestounravel

thecom—

plexityofbiologicsystemsandtheirregulation.

“ResearchTeamsoftheFuture”:toreducethecul.turalandadministrativeb舢TieIBthatofteninlpederesearch

and

invoke

all

era

inwhichscientists

can

;cooperatein

new

anddifferentways.

“Re—engineering

theClinicalResearchEnterprise”:to

fundfacilities,re¥ources,orbothtobolsterelini.ealandtranslationalresearch.

Anoutgrowthoftheroadmapinitiativeisa

newpro-

gramthatfunds

institutionalClinicalandTranslational

Science

Awards(CTSAs).Through

this

mechanism(ht.tp:I/grants.nih.govlgrantslguidelnotice—files/NOT-RM一

05-013.h叫),applicants

mayproposetransformtiveef-forts

appropriate

totheirown

institutions.The

CISAswill

advancetheassemblyofinstitutionalacademic“homes’’

providingintegratedintellectualandphysical

re¥o嘲for

theconduct

of

original

clinical

andtranslationalsci-

enCe【11,12].

Itisexpectedthatthedevelopmentoftheseenviron-

mentswill,overtime,enhancethediscipline,provide

much-needededucationalprograms,contributetothe

growthofwell—structuredandwell—recognized

career

path-

ways,andprovide

researchenvironmentthatismore

nimble,conduciveto,andresponsivetothedemandsofmoderntranslationalandclinicalresearch.Toallowinsti—

tutions

to

buildaninnovativeandintegratedprogram,the

NIHhasaskedapplicantstoconsolidateGeneralClinicalResearch

Centers(GCRCs),T32andK12programs,andotherre¥ourcesas

appropriate.These

reflources

may

be

augmentedbysubstantialNIHRoadmapfundingredirect-

edfromotherinitiativesandtargetedtotheCTSApro—gram,withtheNationalCenterforResearchResources.astheleadNIHentity.Recently,theNIHawarded

con—

sortiumof12institutions(http://www.hen".nih.gov/

ncrrprog/madmap/CTSA一9-2006.asp)thefirstfundingthroughtheCISAprogramtotalingj5108millionthefirst

year.Theawards黜for

5yearsandtheprogramitself

willeventuallyreplacetheGCRCs[13].

0F咖。ADEI脚A3

咖P】盼州,C印匝DREN’SC瞰

II(熔P】呲Oneoftheinitial12CTSArecipientswasthePenn

and

itspartnerinstitutions,theChildren’sHospitalof

Philadelphia(CHOP),theWistar

InstituteandtheUni-

versityoftheSciencesinPhiladelphia.Theirapplication

includedparticipationfromthe

SchoolsofMedicine,

Nursing,Dentistry,Education,ArtsandSciences,Vet-eIiIlary,EngineeringandAppliedSciences,theAnnen—bergSchoolof

Communications,and

theWhartonBusi-

ness

SchoolwithinPenncombinedwithcolleaguesfrom

externalpartnershipsintonovel,interdisciplinary・struc-

tures

andprograms.PennandCHOP.together诵Ⅱ1their

partnerinstitutionsinclude

laI琴ecriticalIlm鹪ofsenior

facultyaccomplishedinthetranslationofa

diversearmy

oftherapeutic

modalities—small

molecules,proteins,

genes,vaccines—intotheclinicaldomain.Togetherthey

have

remarkabletrainingrecord—more

NIHsupported

拓ailliJlggrantsthananyotherinstitution,thela增estreed—icalsciencetrainingprograminthecountryandmultiple

・1083・

junior

facultyholdingKawards.Theyalsohavetwowellofnewmedicinesiswellappreciated

and

pervasiveinin-

establishedNIHfundedGCRCs诵tIlpotentialtobridgethepediatricsents

dustry.academiaandtheregulatorycommunityt1引.Fig2

contains

adultinterface.Finally,thegrouprepm—schematicofthepmposedbythePenn/CHOP

educational

program

singlegeographiccampusfacilitatingtheengage-supported

CTSA.TheITMAThad

mentof

chemists,engineers,statisticians,nurses,veteri—

sha-

proposedthen踟le“TranslationalMedicineandTherapeu-

tics'’toembracethe

narians,dentists,pharmacists,policymakersandprojectionofbasicdisciplinesinto

ofdevelopingnovel

pemandexpertsinconmmrcializationwithbiomedicalsci.theehnicaldomainwiththe

objective

entists,epidemiologistsand

7111e

Penn/CHOP

physicians.

plan

involves

therapeutics.Suchindividualswouldbetrainedinthede.

velopmentandfromcellular

transformational

commitmentbytheinstitutionsinvolvedto(a)collaborateandsupporttherecruitmentsandpmgramsinthefieldofclinicalandtranslational

projectionof.mechanismbasedbiomarkersandmodelsystemstoguiderationaldosese.

to

1ection.Furthermore,theywouldbetrained

emerging

use

applythe

research;(b)devote

substantial

andbioinformatic

as

analysisofoutputfrom

and

space(wetand

tional

dry

laboratories)to

clinicalandtransla-

ex.

technologies,such

pmteomies,metabolomics

research;and(c)foster

thetrails—institutionalgenomics,toselectbetweendiversemoleculesdirectedat

pausionofthe“academichome”ofthisenterprise—the

InstituteforTranslationalMedicineandTherapeutics(IT.

singulartarget.WhiletheKMAS

core

willprovidefunc-

tionalsupportofquantitativepharmacologyactivities,a

MAT)topermitdevelopmentofnewcenters.coresandPharmacometricTrainingUnitwillprovideeducationaltrainingresources

inadditionto

and

interdisciplinarypmgramsofresearchandeducation.Anpreviouslycreatedpro-

on

importantgoalforthePenn/CHOPplanisthedevelop・

mentoffocusedstrategicallianceswiththeFDA

gramsintranslationalmedicine.Initially,amodule

tracer

and

the

kinetics,pharmacokineties,andcompartmental

modeling

and

core

phammeeutiealandcomputingindustries.Besidesthesealliances,theengagementofBioAdvanee(http://www.bioadvanee.com),astatefundedentity

pharmaeometricrequirementeleetivelyasdegree

in

willbe

offeredas

Translational

Therapeuticstrackand

or

charged稍tll‰一

as-

standalonecourse

componentinother

teringthedevelopmentofthelifesciencesinsoutheasternPennsylvaniahasalsobeensecured.BioAdvancewillsistinproviding

resolll℃e

courses

administeredvia1TMATin

support

ofthe

CTSA.PhRMAandFDAstaffwillparticipate,bothas

fbftlle

acc,ess

oftraineesbased

facultyparticipantsandassitesforrotationsiteforCTSA

students.BioAdvancewillfacilitateregionalizationofeesstothisprogram.

ac—

withprimaryappointmentsinregional

institutionstothese

educationalinstrumentsandwillalsosupportthedevelop-

mentofand

regionalization

ofacces,a5to

bioinformatieslshowsthe

platformsdevelopedthroughthevarious

cores

C融~.Fig

CASEsTUDY:NKlr

ANI'AGoNISM

IN

centers

whichcomprise1TMATwiththeassociated

NEURoAⅡ烬

whichwillservicetheTranslationalResearchCen.

An

exampleofthe

integrationofthe

all

quantitative

ter.’nlesupportofquantitativepharmacologypracticewillbeprovidedby

pharmacologyapproachappliedtotionalresearchinitiativefortstoexplore

can

academictransla—

tlleⅪ垤AS(KineticModelingandSimula-beillustratedwithrecentel-

totreatNeu—

tion)Core(http://www.reed.upenn.edulkmasl)whichWill(a)aidinthedevelopmentofdrugassays;(b)pm—

moteandassistintheperformanceoftracerkineticstud—

NKlreceptorantagonism

mAIDS.nis

projectisfundedbytheNationalInstitutes

ofAllergyandInfectioustionalInstitutesofMental

Disease(NIAID)andHealth(NIMH)of

seekstoestablish

theNa—the

ies;(c)developnovelapproaches

to

kineticdataanalys-

kineticmodel.

Nm

mul-

is;(d)providePK,PK/PD,and

tracer

program(PAR-03—138)which

ing;and(e)developeducationalmodulesinphannacoki-neticsandtiltcerkineticstopopulatetheeducationaliniti-

ativespursuedwithintheCTSA.

AcentralmissionofITMAThas

beeneducation.

tidisciplinaryresearchanddevelopmentprogramtargetedtowardthediscovery,developmentandevaluationofinno—vativetherapiesforHIVinfection(http://grants.nih.gov/

grants/guide/pa-files/PAR一03—138.html).%e

goaloftheprogramisto

overall

’nledeficiencyofhumancapitalintranslationalresearch.particularlywithrespectto’thedevelopmentandevaluation

andtechnicalprogress

supportandacceleratescientificinnon—traditionalandtraditional

.・

1084・

drug-basedtherapiesthatexploitnovelviralandcellulartargetsofimportanceinHIVinfection.Abenchmarkfora

SUCCesSfUlprogramisthedevelopmentof

newtreatment

concept

that

call

beintroduced

to

clinicalpractice.Theabilityofneurokinin・1receptor(NK—lR)antagoniststotargetthesubstanceP(SP)receptordemonstratingantivi-ralandimmunomodulatoryeffects[15—17]renew

therapeutictargetwiththepotentialtointerrupt

pathway

criticaltoHIVreplication【18,19‘.ThegoalofthisspecificIntegratedPreclinical/ClinicalProgram(IPCP)istoiden—tify

an

NK-IRantagonistthatis:(a)active

a8

ananti—HIVagenttIlrougIlinteractionwithchemokine/cytokinereceptom(Project1);(b)specific

forchemokineandG-

proteincoupledreceptors(Project2);(c)safefor

nile

in

SIV・-infectednon・-humanprimatesandprovidesproofof

concept

related

to

antiviral,immunomodulatory,and

neu—

robehavioraleffects(Project3);and(d)safeinhumansandhaspositiveimmunomodulatoryeffects(Project4).

Allprojectscontributetounderstandingthebasicvirolog—ie,molecularandcellularimmunologic

mechanismsof

SP,NK一1R

antagonists,and

HIV/SIVinfection.

AkeyelementintheIPCPistheintegrationofmod—

and

simulation

s£m硒es

to

supportthe

valjous

projects

as

wellasinformtheadministrativecore.Specifi—

cally,computationaltechniquesale

employedtochallengethe“drnggabililty”of

the

candidateagents.Insilico

ADMEtechniques

are

usedaspartoftherankingcriteria

bywhichwewillprioritizetheadvancementofselected

agents.Theapproach

enablesthecalculationofmolecular

descriptomandpredictionofdrug-likeness

data

using2D

structures,andwithouttheneedforspecial

computationalchemistryknowledge.Aspharumeology

and

biology/mechanismdata

ale

generated

forthevariousagents(Projects

and2),thegenemlizability

of

QSAR

QSPK

relationshipsforthiscompoundclasswill

be

explored.Fig3illustratestheintegrationofquantitative

pharmacologyapplication

acroK¥projects

forthisIPCP.

TheNKlRprojectisdependenton

two

primarypro—

pathways:(1)examine

theextenttowhichtheRantagonist

aprepitantis

suitableagentforART

in

NeuroAIDS

patientsbased

on

exlx挎ure—-re・・

criteriaconstructedfromits

presumed

actionsand

(2)examinethecorrelationbetweenaprepitantpreclinical

pharmacology,druggabilitycriteriaandPK/PDrelation-shipstogeneralizeandultimatelyranksuitablehack-up

compounds.Within

thefirstpathwaythereis

progres—

sionofexperiments,predefinedcriteriaforstageadvance-

mentanddecision

trees

thatguidetheoverallprogression.

These

ar;e

facilitatedbymodelingandsimUlationexercises

permittingscenariotestingforsubsequentexperimentsandtestingof

assumptions

fundamentaltokeyassumptionsfor

theoverallprogram.OneoftheessentialbridgesinthisIF-CPisthe

suitabilityofan

SIV

pharmacology/disease

modeltopredict

success

outcomesinHIV.Intheseries

ofexperimentsthathasensued,thePK/PDofaprepitantmSIV—infectedanimalshavebeencharacterizedandusedin

conjunctionwith

relevantdatafromchemotherapy--in-・

duced

nausea

andvomiting(CmV)patients

to

buildsim-

ulationmodelsthatprojectresponse

inHIV-・infectedpa--

tients.The

use

ofmodelingandsimulation

to

advance

compoundprogressionofantiretroviralagentsrecentlyice—

viewedbyBarrett[驯contains

morethoroughdescription

ofthis

case

study.

5CONCIjUSIoN

Itisclearthatacademicmedicalcenterswillbe

all

importantplayerin

the

evolving

R&Dparadigms

which

willguidethediscoveryof

new

molecularentitiesinthe

yearstocome.Translationalresearchisan

approachthat

reliesheavily

on

theinteractionbetweenbasicand

clinical

scientistsandtheappropriatecommunicationofideas,hy・

pothesesandexperimentaldesigns

toevaluatediseasetherapies.,11leconceptof

quantitativephanmeology

is.in

essence,a

communication

platformbywhichtranslational

researchcanbediscussedand

in

which

h.ssumptions,

modelsandsimulations

are

integrated

intodecision.mak.

ingtools.ItisalsoclearthattherecenteffortsoftheFDAandNIHreflecttherecognitionthatthisskillsetisin

short

supplyandwillrequirededicatedprogramstotrainfuture

generationsofscientiststhat

conduct

translational

re-

search.

A删眦。EDE^诬Ⅳ巧:Dr.Barrett’5

effortissup—

byNlHGrant’s.P01饕MH076388andtU54

#R尺0235f订.0】

clingmolecularand

gressionNKItherapy

portedsponse

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Figure1InstituteforTranslaiionalMedicineandTherapeutics(ITMAT)Centersproposedwithinthe

Penll/CHOPCTSAgrantandthenewcoressupportingtheTranslationalResearchCenter.TheKMAS(KineticModelingandSimulation)corewillprovidetechnologicexpertiseforintegrationofquantitativepharmacologyintothetranslationalresearchparadigm.TRL=TranslationalResearchLaboratories,SDAB=StudyDesignandBiostatistics

TATCO=TranslationalandClinicalTrialOrganization

E一,IDS、]i:@

CCS=ClinicalCoreServices

OHSAP=O伍ceofHumanSubiectAdvocacy&Protection

RNC=ResearchNurseCore

IDS=InvestigationalDrugService

KMAS=Kinetics.ModelingandSimulation

1086・

Chin

JClinPham——mcolTher2007Oct;12(10)

Figure2ThePenn/CHOPeducationalprogramproposedfortheCTSAtargetsthefullspectrumofpotentialandexistingtrainees,fromundergraduatestograduatestudents,fellows,andfaculty.Asindividualsrequiredifferentlevelsandtypesoftrainingateachstageoftheiracademicdevelopment,multipleoptionsprovidedforexposuretotranslationalresearchrangingfrompreview/awareness

courses

are

to

certification,

mastersanddoctoraldegreeprograms.

1087・

Quantitation/M&STasks

Literatureandexperimentalpriori;:

・80%InhibitionofHWBaIstraininmonocy慷derivedmacrophages(io・6H1

‘AssumeexPOsuretargetsimilartoinvitro

activity?target

Translational肋rkflow

HypothesesbyStage

・DoesthestructuresuggestN3MEpropertieswhichconsistentwith"druggable”agents?

・isthecompound”active。intherangeofconcentraUonswhich

wouldbe

trough瞻concent怕Uon~

100—500ng/mL.

・Hetabolized

primadlybyCYP3A4;minor

metabolismby“P1A2andcYp2C19.・Enzymeinductionreducestheexposure

foIlowingchronicadministraUon.・ProteinbiridIng一95%;F

9-13hr

pharmacologically

achievable?

・Isthereevidenceofsynergywith

thevariousexperimentalagentsandmarketedanUrotrovirals?

・WhatistheQSARbetweenCCR5

andNKlreceptors?

60"6S%;HaIf-life:

・Moderatevariabili~inClearanceandVolume

0fdistribuUon

・Staged

first-orderinput

explainsabsomuon

・Isthe

monkey

the

areasonable

l‘a1I‘|2

——斗

presumedNKlr

mechanism(s)ofaction?

mode}for

・Canthe

extrapolated

SW/monkeymodelbe

tothehumanP“PD

behavior(neourocogn砌ve,

antirotroviral,etc)?

・Can

theSIv/monkeymodeIbe

tothehumanHⅣ

disease?

extrapolated

・Canactivitybedemonstratedat

thedoseandduraUonoftherapynegotiatedwithFDA?・Doesthe

.S..1.m....u..1.a...U...o..n....M...o..d...e..1..R...e..s..u...1.t.s.:

・Therapeuticwindowlikelysusceptibleto

・Inductionmay

variationin

response

suggestiveofresD0nder/non-responderpartitiongiventhe

。small・Is

interactions,adherence

bemanageable

・ARV/doselikelyexceedsofCINVdose

samplesize?

thePK/PDadequatelydefinedsuchthatdoseextrapolaUoncanbemadereliably?

・isthereSU仟icientcorrelaUon

betweenQSAPaandtherankingsuggestaback-up

apropt口nc,

・IsthereatherapeuticresponseforNeuroAIDSbasedonthe

aprepitantPhaseIbtrialthatcanbetargetedfromearlier

compoundtocriteriato

T■_M

(preclinical)data?

^啊■-●岫:一●■一一_I■_

CINV=chemotherapy-inducednauseaandvomitingSIV=simianimmunodeficiencyvirusARV=antiretroviral

Figure

3An

example

ofquantitative

pharmacologicalprinciplesapplied

totranslationalresearch:

Relationshipswithaprepitantfrominvitrodata,invivodatainanimals,andinvivodatainCINVpatientsused

to

predictHIV-infectedpatientresponseandNeuroAIDsdiseaseprogression.

・1088・

new

vision[J].Nr,w,1J

Med,2005;353:162l一1623.

and

12

ZerllouniEA,Al、rir瞩B.Climcalawards:aframework1.0rRes,2006;148:4—5.

tramlafionalscienoe

晰AK.Transitional

ogy,1999;116:1285.Opm

research:whati8

it[jJ?Gastroen咖l—

13

rationalresearchagenda[J].Traml

R舶eⅡR,MonzoM,0’B憎teA,砑以.TramlafionalOl'lCOg.

enomics:towardrationaltherapeutic

Kai∞rJ.Biomedicine.N】时funds

down’hom嘴’f撕transla.

d础ion-making[J].Curr

fional陀Bearch[J].science,2006;314:237.

14

DauphineeD,MartinJB.BreakirlgdowntIlethe

Oneol,20吆;14:171一179.

GJ,SigmanCC,GreenwaldP.Cancerehemopreven-

walls:thou曲tson

3Keloff

scb【盯幽p

0f

mtegration[J].Acad

Med,2000;75:881—

fion:progress2088.4

and删∞lJJ.EIlr

886.15

HoWZ,CnaanA,“YH,d以.Su]粥taneePmodttlateshu.mallblood

immunoddlciencyvirusIeplicationin

humanpenpher.1

JCancer,1999;35:203l一

Hum瞄曲.Tmnsladonal

mediei∞andtIleNationalInsfitutesof

Healtllroadmap:steepgraclesandClnMed,2005;146:51—54.

to咖伽scun,鹄[J].J

Lab

monoeyte-&fivedmacmphag瞄[J].AIDSllesHumRet—

P麟一

rovimses,1996;12:195—198.

Mao

J.Transitionalpainresearch:晡dgingtllegapbetween

16Ho

WZ,hiJP,UY,甜af.ⅧV

basic卸delimcalre=e,lreh[J].Pain,2002;97:183—187.

BrownSC,ParkI)C.Theoreticalmodel80fcogniive

pressioninhumanilnnllme—618.

eells[J].眦B

in

enhanc∞substance

J,2002;16:616

agingand

imptcafiomfortranslationalresearchiIlmedicine[J].Gemntol—o西st,2003;43:57—67.

17场JP,HoWz,ZlumGX,税以.subs咖Pantagonist(CP-

96.345)inhibits

HIV-l酬ication

NailAead

humanmoflonuclo_.,alr

CI)阴,US

Foodand

DmgAdministration.IllnOvllIJonandstag-

On

pllagoc归[J].Proc

sci吣~,2001;98:3970—

substanceP

nation:Challenge锄dopportunity

medicinalproducts|S8

thecritical

p讪to

new

1.2004.

ZerhouniE.Nedicine.711leNIH302:63—72.

R0蛳[J].science,2003;

andopportu-

18叫鹪SD,Ho

levels19

3975.

in阱i瓶ectedmen[J].AIDs,200l;15:2043—2045.

J,PerkimD0,髓以.Stress-associated

WZ,Gettes

DR,甜以.Eh砷ed

EvansDL,Lef℃Ilmlm

I_osealzo

J.TtleNIHbudgetandthe缸tureofbiomedieal陀.

Engl

reduetiomofcvtoto菇cT

search[J].N

10

norignm鹤iII708.1l

JMed,2006;354:1665—1667.

20

船)吼l栅mtic

543—550.Barrett

lymphoc舾锄dnaturalkillereelsirI

HⅣi如lon[JJ.AmJPsycIlia何,1995;152:

c伽咖und

progression0fanti|etroviral

H,Marin砒E,Marin池F1VI.0bslacles

trans舢onal

research[J].Nat

Med,20Q5;ll:705—

JS.Faclimfing

agentsvia

modelllg卸dsimuladon[J].JNettroimmunePhar—

Ze由ourliEA.Translationaland

clillical∞ier妒time

for

llmcol。20I昕;2:58—71.

转化型研究中的定量药理学

摘要转化型研究一般是指将基础科学发现应用到治疗或预防疾病或损伤,其价值通常是基于探索或

品药物管理局的关键路径计划中的一个元素就是通

过定量药理学研究桥接基础与临床科学。美国宾夕法尼亚大学/费城儿童医院临床和转化型研究相对

发展可产生有效疗法的可能性。当今的制药工业已发展成为一个从事转化型研究的高度专业化行业,在美国国立卫生研究院的倡议及激励下,医学科研

队伍同样接受了这一模式。临床和转化型研究奖的

突出,两项研究和教育目标均依赖于定量药理学。美国国立卫生研究院所赞助的一项旨在探索神经激

肽l受体拮抗用于治疗神经性爱滋病的研究案例,

设立可以为能从事此类研究机构所需的多学科环境创造机会。临床和转化型研究奖的一个关键组成部分以及美国国立卫生研究院的工作路线图和美国食

正是用来说明运用定量药理进行转化型研究的范

例。


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