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Abstract
<p class="first" id="P1">G protein-coupled receptors (GPCRs) are the most intensively
studied drug
targets, largely due to their substantial involvement in human pathophysiology
and their pharmacological tractability. Here, we report the first analysis of
all GPCR drugs and agents in clinical trials. This reveals the current trends
across molecule types, drug targets and therapeutic indications, including
showing that 481 drugs (~34% of all drugs approved by the FDA) act at 107
unique GPCR targets. Approximately 320 agents are currently in clinical trials,
of which ~36% target 64 potentially novel GPCR targets without an
approved drug, and the number of biological drugs, allosteric modulators and
biased agonists has grown. The major disease indications for GPCR modulators
show a shift towards diabetes, obesity, and Alzheimer’s disease, while
other central nervous system disorders remain highly represented. The 227 (57%)
non-olfactory GPCRs that are yet to be explored in clinical trials have broad
untapped therapeutic potential, particularly in genetic and immune system
disorders. Finally, we provide an interactive online resource to analyse and
infer trends in GPCR drug discovery.
</p>
The heterotrimeric guanine nucleotide-binding proteins (G proteins) are signal transducers that communicate signals from many hormones, neurotransmitters, chemokines, and autocrine and paracrine factors. The extracellular signals are received by members of a large superfamily of receptors with seven membrane-spanning regions that activate the G proteins, which route the signals to several distinct intracellular signaling pathways. These pathways interact with one another to form a network that regulates metabolic enzymes, ion channels, transporters, and other components of the cellular machinery controlling a broad range of cellular processes, including transcription, motility, contractility, and secretion. These cellular processes in turn regulate systemic functions such as embryonic development, gonadal development, learning and memory, and organismal homeostasis.
At present, the legendary magic bullet, i.e., a drug with high potency and selectivity toward a specific biological target, shares the spotlight with an emerging and alternative polypharmacology approach. Polypharmacology suggests that more effective drugs can be developed by specifically modulating multiple targets. It is generally thought that complex diseases such as cancer and central nervous system diseases may require complex therapeutic approaches. In this respect, a drug that "hits" multiple sensitive nodes belonging to a network of interacting targets offers the potential for higher efficacy and may limit drawbacks generally arising from the use of a single-target drug or a combination of multiple drugs. In this review, we will compare advantages and disadvantages of multitarget versus combination therapies, discuss potential drug promiscuity arising from off-target effects, comment on drug repurposing, and introduce approaches to the computational design of multitarget drugs.
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