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Emerging Targets in Diseases with High Unmet Need: Alzheimer’s Disease, Lung Cancer, Dyslipidemia, Type 2 Diabetes, and COPD

Published by: CHI Insight Pharma Reports

Published: Jun. 1, 2006 - 125 Pages



Table of Contents


Chapter 1. Background: Targets and Target-Based Drug Discovery and Development

1.1. What Is a Drug Target?

1.2. The Target Validation Problem


Sidebar: Q&A with Dr. Neil W. Gibson, Chief Scientific Officer of OSI Pharmaceuticals, on Target Validation


1.3. Target Validation and Falling Productivity of Pharmaceutical Research and Development

1.4. A More Realistic View of Target Validation

1.5. Approaches to Improving the Productivity of Target Evaluation and of Drug Discovery


Dealing with Multiple Molecular “Causes” of Disease by Hitting More than One Target

Whole-Pathway Approaches

Biology-Driven Drug Discovery


1.6. Special Issues with Complex Diseases with High Unmet Medical Need


Biomarkers, Targets, and Patient Stratification

Animal Models and Complex Diseases




Chapter 2. Alzheimer’s Disease

2.1. Pathobiology and Mechanistic Studies of Alzheimer’s Disease


Neurotransmitters and Alzheimer's Drugs

The Amyloid Hypothesis

Apolipoprotein E and Alzheimer’s Disease

Mechanistic Studies of Tau and Alpha Synuclein in Alzheimer’s Disease


2.2. Prospects for Biomarkers in Detection of Presymptomatic and Early-Stage Alzheimer’s Disease and in Monitoring Therapy

2.3. Selected Emerging Targets in Alzheimer’s Disease


Neural Nicotinic Receptors

Beta-Amyloid

Beta-Secretase and Gamma-Secretase

Sidebar: Q&A with Dr. Adrian N. Hobden, President of Myriad Pharmaceuticals, Inc., on the Challenges of Developing the Novel-Acting Agent Flurizan for Alzheimer’s Disease

Somatostatin Receptors and Metabolism of Beta-Amyloid

The Tau Pathway

Apolipoprotein E


2.4. Outlook




Chapter 3. Lung Cancer

3.1. Types of Lung Cancer

3.2. Current Diagnosis of Lung Cancer

3.3. Current Therapies for Lung Cancer

3.4. Signaling Pathways and Strategies for Targeted Therapies in Non-Small-Cell Lung Cancer

3.5. Selected Emerging Targets in Lung Cancer


Epidermal Growth Factor Receptor

K-Ras

B-Raf

Mitogen-Activated Protein Kinase Kinase

Vascular Endothelial Growth Factor Receptor

Aromatose

Hedgehog Signaling Pathway


3.6. Outlook




Chapter 4. Dyslipidemia

4.1. Statins: Their Benefits and Their Limitations

4.2. Mechanistic Issues in Atherogenic Dyslipidemia


Anti-Atherogenic Effects of High-Density Lipoprotein

Metabolic Syndrome, High-Density Lipoprotein, and Triglycerides


4.3. Selected Emerging Targets in Dyslipidemia


Cholesteryl Ester Transfer Protein

Targeting High-Density Lipoprotein with Mimetics

Peroxisome Proliferator-Activated Receptors Alpha and Delta

Liver X Receptor


4.4. Outlook




Chapter 5. Type 2 Diabetes

5.1. Current Therapies

5.2. Difficulties in Drug Discovery in Type 2 Diabetes

5.3. Selected Emerging Targets in Type 2 Diabetes


Dipeptidyl Peptidase-IV

Simultaneous Targeting of PPAR-Alpha and PPAR-Beta

Cannabinoid-1 Receptor

S6 Kinase 1

11 Beta-Hydroxysteroid Dehydrogenase Type 1

Recombinant Adiponectin

Matrix Metalloproteinases


5.4. Outlook




Chapter 6. Chronic Obstructive Pulmonary Disease

6.1. Introduction


Chronic Bronchitis

Emphysema


6.2. Current Treatments

6.3. Animal Models in COPD

6.4. Selected Emerging Targets for COPD


Proteinases (Matrix Metalloproteinases and Neutrophil Elastase)

Phosphodiesterase-4

Oxidant/Antioxidant Balance

Leukotriene B4

CXC Chemokines

Tumor Necrosis Factor-Alpha


6.5. Outlook




Chapter 7. General Conclusions

7.1. Biology-Driven versus Technology-Driven Drug Discovery

7.2. Multitargeted Drugs and Combination Therapies

7.3. Biomarkers, Diagnostics, and Disease Stratification




Chapter 8. Company Profiles

8.1. Alzheimer’s Disease


Axonyx

Elan

Myriad Genetics

Neurochem

Targacept


8.2. Lung Cancer


AstraZeneca

Curis

Genentech

Onyx Pharmaceuticals

OSI Pharmaceuticals

Pfizer

Wyeth


8.3. Dyslipidemia


Avant Immunotherapeutics, Inc.

Exelixis

GlaxoSmithKline

Ligand Pharmaceuticals

Pfizer


8.4. Type 2 Diabetes


Biovitrum

Bristol-Myers Squibb

Merck

Novartis

sanofi-aventis


8.5. Chronic Obstructive Pulmonary Disease


Aeolus Pharmaceuticals

ALTANA Pharma

Arriva

Dompé

Pfizer




References




Glossary




Company Index with Web Sites




List of Figures

Figure 3.1. The Ras Pathway and Tumor Drug Sensitivity

Figure 4.1. High-Density Lipoprotein and Cholesterol Efflux from the Arterial Wall

Figure 5.1. S6 Kinase 1 and Feedback Regulation of Insulin Signaling




List of Tables

Table 1.1. Major Types of Target Evaluation Technologies

Table 2.1. Selected Emerging Targets in Alzheimer’s Disease

Table 3.1. Types of Lung Cancer

Table 3.2. Selected Emerging Targets in Lung Cancer

Table 4.1. Accepted Modifiable Risk Factors for Coronary Heart Disease

Table 4.2. Selected Emerging Targets in Dyslipidemia

Table 5.1. Major Current Therapies for Type 2 Diabetes

Table 5.2. Selected Emerging Targets in Type 2 Diabetes

Table 6.1. Selected Emerging Targets in COPD

Abstract

Emerging Targets in Diseases with High Unmet Need: Alzheimer’s Disease, Lung Cancer, Dyslipidemia, Type 2 Diabetes, and COPD is a survey of emerging targets in these important diseases. The report assesses the issues in target-based drug discovery and development as well as several specific issues that are common to these and other complex diseases with high unmet medical need.

Comprehensive analysis includes the following:
  • Background discussion of the nature of each disease.
  • Mechanistic characterization of each disease, and major issues in diagnosis, stratification, and treatment of each disease.
  • Evaluation of leading emerging targets in terms of signaling pathways and therapeutic strategies.
Currently there are no mechanism-based drugs on the market for Alzheimer’s disease and COPD, and only one mechanism-based therapeutic approach is available for lung cancer. While mechanism-based therapy is available for type 2 diabetes and dyslipidemia, huge gaps in the therapeutic armamentarium result in inadequate treatment. Potentially, all of the diseases discussed in this report could be treated with combination therapies (and, in some cases, possibly by multitargeted agents) of mechanism-based drugs, if such drugs were developed.

Indication-specific highlights presented in this report include the following:

Lung Cancer
The activities of several companies developing inhibitors of signaling kinases of the Raf family, which includes B-Raf, are discussed and evaluated. One such inhibitor, sorafenib (Onyx/Bayer’s Nexavar) has recently been approved by the Food and Drug Administration (FDA) for renal cell carcinoma, and is also being developed for lung cancer. Companies are also developing inhibitors of MEK (mitogen-activated protein [MAP] kinase kinase) and of Ras

Alzheimers
The report chronicles efforts to identify and validate biomarkers of Alzheimer’s, as well as recent efforts to develop agents for in vivo imaging of amyloid plaque in animal models and in human subjects. Emerging drugs, such as Targacept’s selective small-molecule compounds that target the neural nicotinic receptors (NNRs), are also evaluated.

Dyslipidemia
An examination of the benefits and limitations of statins is presented, as well as new approaches to prevention and treatment of cardiovascular disease. Important activities in this area include efforts to target CETP. There are now three drug candidates in Phase II or Phase III clinical trials, including Pfizer’s torcetrapib, a small-molecule CETP inhibitor delivered in a fixed combination with the company’s atorvastatin.

Diabetes
Perhaps the greatest problem in discovering new drugs for type 2 diabetes is the lack of scientific understanding of the disease, and of metabolic syndrome, which usually precedes it. The report discusses the efforts of companies such as Metabolex, a biotechnology company whose mission is to discover and develop new diabetes drugs based on increased scientific understanding.

COPD
Many classes of drugs being developed for other inflammatory conditions might be applicable to COPD. However, in many cases, systemic and chronic administration of broad-spectrum anti-inflammatory drugs (such as those that target signal transduction pathways involved in inflammation) would have unacceptable side effects. Of drugs under development for COPD, PDE4 inhibitors (specifically, cilomast and roflumilast) may reach the market in 2006 or 2007, provided that they can overcome concern with potential side effects at regulatory agencies. If approved, they will be the first mechanism-specific drugs with the potential to affect the course of COPD.

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