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Boleto G, Avouac J, Allanore Y. The role of antifibrotic therapies in the treatment of systemic sclerosis-associated interstitial lung disease. Ther Adv Musculoskelet Dis 2022; 14:1759720X211066686. [PMID: 35111241 PMCID: PMC8801639 DOI: 10.1177/1759720x211066686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 11/15/2021] [Indexed: 01/09/2023] Open
Abstract
Systemic sclerosis (SSc) is a rare autoimmune condition with complex pathogenesis characterized by a heterogeneous presentation and different disease courses. Fibrosis of multiple organs including the lungs favored by inflammation and vasculopathy is the hallmark of SSc. SSc-associated interstitial lung disease (SSc-ILD) is common and can be associated with poor outcomes, this complication being the leading cause of death in recent series. Because of its huge heterogeneity, SSc-ILD management can be very challenging. Immunosuppressive therapy has long been used to prevent SSc-ILD progression with modest effects in clinical trials. However, thanks to a better understating of SSc pathogenesis, innovative therapies including antifibrotics are increasingly being developed. The achievement of the Safety and Efficacy of Nintedanib in Systemic SClerosIS (SENSCIS) trial has led to the approval by drug agencies of the first antifibrotic drug for SSc-ILD. In parallel, other antifibrotics are being investigated as possible beneficial therapies in SSc-ILD. An important unmet need remains to clarify the positioning of the various strategies, such as the added value of combination of immunosuppressants and antifibrotic therapies in patients at high risk of progression. Indeed, irreversible lung injury or self-perpetuated progression highlights the concept of a window of opportunity in SSc-ILD patients. Herewith, we provide an overview of the most significant clinical trials with antifibrotic drugs developed in recent years for the management of SSc-ILD and a viewpoint about their positioning in treatment algorithms.
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Affiliation(s)
| | - Jérôme Avouac
- Department of Rheumatology, Université de Paris, Cochin Hospital, Paris, France; INSERM U1016, Institut Cochin, CNRS UMR8104, Paris, France
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Thomas BF. Interactions of Cannabinoids With Biochemical Substrates. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2017; 11:1178221817711418. [PMID: 28607542 PMCID: PMC5457144 DOI: 10.1177/1178221817711418] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 02/13/2017] [Indexed: 01/02/2023]
Abstract
Recent decades have seen much progress in the identification and characterization of cannabinoid receptors and the elucidation of the mechanisms by which derivatives of the Cannabis sativa plant bind to receptors and produce their physiological and psychological effects. The information generated in this process has enabled better understanding of the fundamental physiological and psychological processes controlled by the central and peripheral nervous systems and has fostered the development of natural and synthetic cannabinoids as therapeutic agents. A negative aspect of this decades-long effort is the proliferation of clandestinely synthesized analogs as recreational street drugs with dangerous effects. Currently, the interactions of cannabinoids with their biochemical substrates are extensively but inadequately understood, and the clinical application of derived and synthetic receptor ligands remains quite limited. The wide anatomical distribution and functional complexity of the cannabinoid system continue to indicate potential for both therapeutic and side effects, which offers challenges and opportunities for medicinal chemists involved in drug discovery and development.
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Affiliation(s)
- Brian F Thomas
- Analytical Chemistry and Pharmaceutics, RTI International, Research Triangle Park, NC, USA
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Borsook D, Moulton EA, Schmidt KF, Becerra LR. Neuroimaging revolutionizes therapeutic approaches to chronic pain. Mol Pain 2007; 3:25. [PMID: 17848191 PMCID: PMC2048498 DOI: 10.1186/1744-8069-3-25] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Accepted: 09/11/2007] [Indexed: 01/08/2023] Open
Abstract
An understanding of how the brain changes in chronic pain or responds to pharmacological or other therapeutic interventions has been significantly changed as a result of developments in neuroimaging of the CNS. These developments have occurred in 3 domains : (1) Anatomical Imaging which has demonstrated changes in brain volume in chronic pain; (2) Functional Imaging (fMRI) that has demonstrated an altered state in the brain in chronic pain conditions including back pain, neuropathic pain, and complex regional pain syndromes. In addition the response of the brain to drugs has provided new insights into how these may modify normal and abnormal circuits (phMRI or pharmacological MRI); (3) Chemical Imaging (Magnetic Resonance Spectroscopy or MRS) has helped our understanding of measures of chemical changes in chronic pain. Taken together these three domains have already changed the way in which we think of pain – it should now be considered an altered brain state in which there may be altered functional connections or systems and a state that has components of degenerative aspects of the CNS.
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Affiliation(s)
- David Borsook
- PAIN Group, Brain Imaging Center, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA
- Imaging Consortium for Drug Development, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA
- Program in Neuroscience Department of Psychiatry and Athinoula Martinos Center for Biomedical Engineering, Department of Radiology, Massachusetts Hospital, 149 13th Street, Charlestown, MA, 02129, USA
| | - Eric A Moulton
- PAIN Group, Brain Imaging Center, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA
| | - Karl F Schmidt
- PAIN Group, Brain Imaging Center, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA
- Imaging Consortium for Drug Development, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA
| | - Lino R Becerra
- PAIN Group, Brain Imaging Center, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA
- Imaging Consortium for Drug Development, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA
- Program in Neuroscience Department of Psychiatry and Athinoula Martinos Center for Biomedical Engineering, Department of Radiology, Massachusetts Hospital, 149 13th Street, Charlestown, MA, 02129, USA
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