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Background & Aim Promethera is a biopharma company focused on the research, development and commercialization of stem cell-based therapies and technologies for acute and chronic liver diseases. Our lead clinical program, an allogenic human liver derived mesenchymal stem cell product derived from our patented cell technology platform HepaStem, is currently being used in Phase IIa clinical trials for ACLF (acute on chronic liver failure) with the company also preparing clinical trials for NASH. Non-alcoholic steatohepatitis (NASH), a severe form of non-alcoholic liver diseases (NAFLD), is one of the prominent liver diseases worldwide. There is currently no approved drug for its treatment and liver transplantation is the only therapeutic approach for advanced NASH. Mesenchymal stem cells (MSCs) are promising candidates to modulate the pro-inflammatory and pro-fibrogenic environment of chronic liver because of their immunomodulatory properties. Recent data obtained in preclinical models of early and advanced stage NASH provided significant evidences to open new phase I/II clinical studies in NASH. Methods, Results & Conclusion The dosing for this indication is likely to be in the order of 100 million cells per infusion. Large numbers of cells thus need to be manufactured and using standard cell culture techniques would make it too expensive and labour intensive. A standard expansion protocol in flasks or cell factories is an open process, and therefore run in expensive clean rooms to avoid the risk of contamination. We have explored several state-of-the art-bioreactor systems, and various types of microcarriers in stirred tanks from different manufacturers. We have tested these systems to optimize the complete workflow of HepaStem culture, including stem cell isolation from livers and expansion up to the scale of many clinical doses. Quality control and comparability studies were performed to verify that the characteristics of HepaStem cells harvested from the different procedures were maintained. We have built a production platform, almost entirely in closed system, that can provide the large numbers of clinical doses that would be needed for the treatment of NASH. This platform functions with a strong reduction of human labour and it also modular and flexible to anticipate growing demand. In parallel we have developed serum-free and xenofree culture methods to be able to abandon the use of animal-derived products, for the related risks and because animal sera become scarce and expensive.

Acetylcholinesterase inhibitors (AChEIs) are used for the treatment of Alzheimer's disease (AD). The increase in ACh levels ameliorates the symptoms of the disease. Tacrine is the first clinically approved drug as AChEI used in the treatment of AD. In this paper, we synthesized new tacrine analogs to act on catalytic and peripheral sites of AChE. Their inhibitory activity was evaluated. All novel compounds except 7a showed promising results toward AChE. Two compounds, 10b and 11b, are more potent than tacrine. Furthermore, molecular-modeling studies were performed for these two compounds to rationalize the obtained pharmacological activity. Moreover, various drug-likeness properties of the new compounds were predicted.

Developing a new drug is expensive: the cost of going from bench to bedside is about $US1 billion. Therefore, the repurposing of an approved drug is potentially rewarding because it expands the drug's existing therapeutic profile and preempts additional development costs. As the safety profile of a repurposed drug is already well known, any new investigations could then focus on its efficacy and other therapeutic benefits. Recombinant erythropoietin (EPO) is a potential candidate for repurposing because the results of numerous studies have shown that systemic and topical EPO is therapeutically beneficial when it is administered to healthy and diabetic animals with acute and chronic skin wounds and burns. Moreover, the molecular mechanisms of EPO's actions have been elucidated: EPO acts on those nonhematopoietic cells which are involved in the innate immune response where it promotes cellular proliferation and differentiation, exerts its cytoprotective actions, and inhibits apoptosis. In this review, the mechanism of EPO's action in skin wound healing is reviewed, and its potential for treating acute and chronic skin wounds and stimulating tissue regeneration in diabetic patients is discussed.

Coronary stenting represents the standard of care for percutaneous revascularization of symptomatic coronary artery disease. However, despite progress in the evolution of intravascular stents, clinical adverse events such as restenosis and stent thrombosis still represent the “achilles heel” of this ground-breaking technology. Of particular note was the association of these adverse events with the material, the polymer coating, and the active drug of currently approved drug eluting stents. Consequently, modifications were made to the design, coating, and the choice of drugs, eventually, resulting in (fully) biodegradable drug-eluting stents. Such stents offer the appealing concept of a temporary vascular scaffold and are currently under extensive preclinical and clinical investigation. However, biodegradable stents must demonstrate efficacy and safety in larger randomized clinical trials in real-world scenarios, which are currently on the horizon.

Diabetes Mellitus is a chronic metabolic disease affecting wide range of people across the globe. In India the rate of subjects being suffered from diabetes is continuously increasing. So, the development of drugs for its effective treatment is essential. Thereby, various attempts have been made to discover newer drugs, to reduce the rate of anti diabetic occurrence. Anti-diabetic drugs were found to treat diabetes mellitus by lowering glucose levels in the blood. Both the use antidiabetic drugs as well as the changes in lifestyle and proper diet can significantly affect the severity of diabetes mellitus and also reduces the symptoms and occurrence of the disease. Researches in the past few years on diabetes mellitus showed that this disease is spreading at a very faster rate, thereby; various attempts have been made to treat it efficaciously. Development and approval of antidiabetic drugs is quite necessary. There are different classes of anti-diabetic drugs reported to treat diabetes. The objective of the present review is to explore Invokana as a newly approved antidiabetic drug for the effective treatment of type 2 diabetes. This review focuses mainly on the various aspects of diabetes mellitus and its treatment perspectives. From the various clinical studies done on Invokana, it was concluded that and Invokana was found to be very effective for the efficacious therapy of diabetes mellitus.

There has been a substantial surge of 'targeted agents' in contemporary anticancer drug armamentarium and some of these agents have revolutionized the outcome of cancer patients. However, on contrary to the nomenclature, not all new targeted agents are selected based on presence of target molecules on the cancer cells. Drugs are typically approved based on demonstration of benefit in randomized controlled trials with regards to efficacy outcomes although both the 'benefits' and 'outcomes' are defined inconsistently. Surrogates that are not validated properly are often used as endpoints. Furthermore, new anticancer drugs are frequently associated with increased inconvenience to the patients and/or to the society due to added toxicity and cost. In this perspective article, emphasis is given to the above problems focusing on room for improvement in anticancer drug development. An illustration of a recently approved drug to treat advanced breast cancer, everolimus and a previously revoked drug bevacizumab is given.

Drug-induced liver injury (DILI) is one of the leading causes of the termination of drug development programs. Consequently, identifying the risk of DILI in humans for drug candidates during the early stages of the development process would greatly reduce the drug attrition rate in the pharmaceutical industry but would require the implementation of new research and development strategies. In this regard, several in silico models have been proposed as alternative means in prioritizing drug candidates. Because the accuracy and utility of a predictive model rests largely on how to annotate the potential of a drug to cause DILI in a reliable and consistent way, the Food and Drug Administration-approved drug labeling was given prominence. Out of 387 drugs annotated, 197 drugs were used to develop a quantitative structure-activity relationship (QSAR) model and the model was subsequently challenged by the left of drugs serving as an external validation set with an overall prediction accuracy of 68.9%. The performance of the model was further assessed by the use of 2 additional independent validation sets, and the 3 validation data sets have a total of 483 unique drugs. We observed that the QSAR model's performance varied for drugs with different therapeutic uses; however, it achieved a better estimated accuracy (73.6%) as well as negative predictive value (77.0%) when focusing only on these therapeutic categories with high prediction confidence. Thus, the model's applicability domain was defined. Taken collectively, the developed QSAR model has the potential utility to prioritize compound's risk for DILI in humans, particularly for the high-confidence therapeutic subgroups like analgesics, antibacterial agents, and antihistamines.

Summary What is known and Objective Prescribing sulfonamide-containing medications for patients with sulfonamide allergy continues to complicate medical decisions. We examined the cautionary recommendations in the approved drug monographs and primary literature, and formulated an evidence-based grading of cautionary recommendations for sulfonamide allergy and cross-reactivity among sulfonamide-containing medications. Methods Drug monographs were collected from six countries and three drug compendia. Two reviewers independently extracted the data from the contraindication, warning and/or precaution sections of drug monographs. Evidence for cross-reactivity was examined in the primary literature and compared with drug monograph recommendations. Consequently, medications were categorized based on the strength of recommendation and level of evidence by consensus. Results and Discussion We identified wide variability in cautionary recommendations ranging from no warning or precaution to contraindication among the sources reviewed. The recommendations were located mainly in the contraindication section of monographs for France (65·2%), United Kingdom (51·9%), Italy (50·0%), South Korea (43·5%), United States (38·2%) and Canada (37·0%), whereas in drug compendia, the recommendations were found in the precaution section for Martindale (51·4%) and Micromedex-Drugdex (33·3%), and contraindication and precaution section for the American Hospital Formulary Service Drug Information 2010 (30·8%). Evidence from the primary literature varied with recommendation included in drug monographs. Evidence-based categorization was carried out for 16 medications. Two sulfonamide-moiety-containing drugs were considered safe, six non-sulfonylarylamines required precaution, and eight medications from all three sulfonamide chemical classes were considered mostly unsafe. What is new and Conclusion There are significant discrepancies in cautionary recommendations included in drug-labels and drug compendia. Statements concerning cross-reactive hypersensitivity with other sulfonamides generally suggest theoretical possibilities. The consensus evidence-based grading instrument developed may be useful for deriving cautionary recommendations for sulfonamide-allergic patients.

Aim: To characterize concordance between clinically relevant drug–drug interactions (DDIs) related to CYP2C19, CYP2D6 and CYP2C9 and their analogous gene–drug interactions (GDIs) in US FDA-approved drug labeling. Methods: We selected prototypical CYP2C19, CYP2D6 and CYP2C9 inhibitors and abstracted all respective interacting drugs via a tertiary resource used in the clinical setting. We then selected only CYP2C19, CYP2D6 and CYP2C9 metabolism-related DDIs requiring enhanced clinical monitoring, dose adjustment or use of alternative drugs. Labeling and management strategies on DDIs and GDIs were compared. Results: Among the drug labels with DDI information, 73% of them describe the analogous GDI. Of the 65 drug labels, 43 and 17% had specific management recommendations for DDIs and GDIs, respectively. In general, GDI management recommendations were concordant with DDI management recommendations in terms of specific dose adjustments or use of alternative drugs. Conclusion: The FDA has recognized genetic differences in drug metabolism where clinically relevant DDIs trigger dose adjustment or use of alternative drugs.

Hepatocellular carcinoma (HCC) remains a major global health problem and Calabria in the south of Italy is not an exception. Sorafenib is the first and only Food and Drug Administration approved drug for the treatment of advanced HCC and it is currently under intensive monitoring by the Health Authorities in Italy Agenzia Italiana del Farmaco. This general report has been developed with the aim of briefly reviewing the data found in the reports of adverse reactions (ADRs) collected in Calabria in 2012 for sorafenib treated patients. Extrapolated data have highlighted some differences between the adverse drug reactions reported in patients younger or older than 70 years and other important differences with the current approved leaflet. Several limitations might be present in data analysis form spontaneous reporting, however, the relevance of reporting ADRs (dermatitis, asthenia, vomiting, etc.) for the early identification of drug related signals has to be underlined.

Aim: The study aims to investigate the prevalence of off-label prescribing in the general paediatric ward at a major teaching hospital in Tasmania, Australia. Method: The drug charts and medical records from two groups of 150 consecutive paediatric patients, admitted 6 months apart in July 2009 and January 2010, were studied retrospectively. Patients were required to spend at least one night in hospital and be aged less than 12 years. Each prescribed drug was compared with the approved product information to determine if the usage was off-label. Data concerning documented informed consent and adverse drug reactions were also recorded. Results: Three hundred patients were prescribed a total of 887 medicines. Of these, 31.8% were off-label and 57.3% of children received an off-label medication. There was no significant seasonal variation in patient characteristics or prescriptions. Drugs were most commonly off-label due to their dosage or frequency of administration. Of the 106 different drugs used, the use of 51 was off-label on at least one occasion, and for 30 drugs their use was off-label on more than 75% of occasions. The drugs most commonly used off-label were oxycodone, salbutamol and paracetamol. No informed consent documentationwas identified, and two of five recorded adverse drug reactionswere associated with off-label drug use. Conclusion: Off-label use of medicines occurred frequently in paediatric inpatients. The available evidence often supported off-label medication use. An improved system for the revision of approved drug information and an Australian guideline for paediatric prescribing are needed.

Gefitinib, an EGFR tyrosine kinase inhibitor, is used as FDA approved drug in breast cancer and non-small cell lung cancer treatment. However, this drug has certain side effects and complications for which the underlying molecular mechanisms are not well understood. By systems biology based in silico analysis, we identified off-targets of gefitinib that might explain side effects of this drugs. The crystal structure of EGFR-gefitinib complex was used for binding pocket similarity searches on a druggable proteome database (Sc-PDB) by using IsoMIF Finder. The top 128 hits of putative off-targets were validated by reverse docking approach. The results showed that identified off-targets have efficient binding with gefitinib. The identified human specific off-targets were confirmed and further analyzed for their links with biological process and clinical disease pathways using retrospective studies and literature mining, respectively. Noticeably, many of the identified off-targets in this study were reported in previous high-throughput screenings. Interestingly, the present study reveals that gefitinib may have positive effects in reducing brain and bone metastasis, and may be useful in defining novel gefitinib based treatment regime. We propose that a system wide approach could be useful during new drug development and to minimize side effect of the prospective drug.

Developing biopharmaceutical therapies is a scientifically complex endeavor, requiring from ten to fifteen years of effort with successive rounds of increasingly greater investment capital in a risk-intensive landscape. With failure rates at 88%, and an all-attempts-averaged investment of over $2B per approved drug, discussions of what leads to success and/or failure are pervasive. In this milieu, the BIEM (Bioenterprise Innovation Expertise Model) model was developed so that the status of a bioenterprise could quickly be assessed. Assessing the BIEM model, 20 biopharmaceuticals venture capitalists with 30 years average biotechnology industry experience, all having board experience, most having served as board chairs, and 80% having been CEO’s and/or presidents, rated the innovation expertise disciplines of BIEM 2.0 as to their importance in the scientific discovery through market-ready product innovation phase of biopharmaceutical development. Despite a small sample size, statistically significant insights were produced, verifying the BIEM model. The most important innovation expertise disciplines were intellectual property, science, regulatory expertise, and venture capital, in that order. Further, the strongest correlations linked regulatory expertise and science, and equally so, intellectual property and venture capital. Additional insights with respect to the profiles of the biopharmaceutical venture capitalists themselves is also presented.

Purpose The pharmaceutical industry is one of the most tightly regulated sectors, and it is essential to know each country׳s legal framework to understand the regulation, approval, and marketing of medicinal products for human use. This article describes the main statutes and procedures governing medicinal products for human use in Portugal and the role of the country׳s National Medicines and Health Products Authority ( Autoridade Nacional do Medicamento e Produtos de Saude, I.P. ; INFARMED). Methods From the most recently available data, an update of requests and approvals concerning marketing authorizations, variations, pricing, and reimbursements is provided. Data were sourced from the INFARMED website, Infomed (database of medicinal products for human use), and periodic reports issued by national authorities. Organic laws, acts, and law decrees published in the government gazette ( Diario da Republica ) are cited and reproduced as required. Findings In 2015 Portugal ranked fifth in the European System of Medicines Evaluation in terms of the number of completed procedures as a reference member state. Approximately 80% of all approved drug applications in Portugal in 2015 were for generic drugs, mostly pertaining to the nervous system. In Portugal, INFARMED monitors drug quality, safety profile, and efficacy in all stages of the drug life cycle, ensuring patients' safety. Implications The Portuguese market for medicinal products for human use has been appreciably changed by the advent of generic drugs. There is an increased trend for new request applications for biological and biotechnological substances.

Background The disposition of a pharmaceutical compound within an organism, i.e. its Absorption, Distribution, Metabolism, Excretion, Toxicity (ADMET) properties and adverse effects, critically affects late stage failure of drug candidates and has led to the withdrawal of approved drugs. Computational methods are effective approaches to reduce the number of safety issues by analyzing possible links between chemical structures and ADMET or adverse effects, but this is limited by the size, quality, and heterogeneity of the data available from individual sources. Thus, large, clean and integrated databases of approved drug data, associated with fast and efficient predictive tools are desirable early in the drug discovery process. Description We have built a relational database (IDAAPM) to integrate available approved drug data such as drug approval information, ADMET and adverse effects, chemical structures and molecular descriptors, targets, bioactivity and related references. The database has been coupled with a searchable web interface and modern data analytics platform (KNIME) to allow data access, data transformation, initial analysis and further predictive modeling. Data were extracted from FDA resources and supplemented from other publicly available databases. Currently, the database contains information regarding about 19,226 FDA approval applications for 31,815 products (small molecules and biologics) with their approval history, 2505 active ingredients, together with as many ADMET properties, 1629 molecular structures, 2.5 million adverse effects and 36,963 experimental drug-target bioactivity data. Conclusion IDAAPM is a unique resource that, in a single relational database, provides detailed information on FDA approved drugs including their ADMET properties and adverse effects, the corresponding targets with bioactivity data, coupled with a data analytics platform. It can be used to perform basic to complex drug-target ADMET or adverse effects analysis and predictive modeling. IDAAPM is freely accessible at http://idaapm.helsinki.fi and can be exploited through a KNIME workflow connected to the database.Graphical abstractFDA approved drug data integration for predictive modeling Electronic supplementary material The online version of this article (doi:10.1186/s13321-016-0141-7) contains supplementary material, which is available to authorized users.

Purpose: The translation of nonclinical oncology studies is a subject of continuous debate. We propose that translational oncology studies need to optimize both pharmacokinetic (drug exposure) and pharmacodynamic (xenograft model) aspects. While improvements in pharmacodynamic translatability can be obtained by choosing cell lines or patient-derived xenograft models closer to the clinical indication, significant ambiguity and variability exists when optimizing the pharmacokinetic translation of small molecule and biotherapeutic agents. Experimental Design and Results: In this work, we propose a pharmacokinetic-based strategy to select nonclinical doses for approved drug molecules. We define a clinically relevant dose (CRD) as the dosing regimen in mice that most closely approximates the relevant pharmacokinetic metric in humans. Such metrics include area under the time–concentration curve and maximal or minimal concentrations within the dosing interval. The methodology is applied to six drugs, including targeted agents and chemotherapeutics, small and large molecules (erlotinib, dasatinib, vismodegib, trastuzumab, irinotecan, and capecitabine). The resulting efficacy response at the CRD is compared with clinical responses. Conclusions: We conclude that nonclinical studies designed with the appropriate CRDs of approved drug molecules will maximize the translatability of efficacy results, which is critical when testing approved and investigational agents in combination. Clin Cancer Res; 23(4); 1080–90. ©2016 AACR.

People who inject drugs (PWID) and other individuals with opioid use disorders have a dramatically higher prevalence of hepatitis C virus (HCV) infection than the general population. The availability of novel direct acting antivirals (DAAs) for the treatment of HCV infection with very high efficacy, improved tolerability and shortened treatment durations have led to global efforts to ramp up treatment for all HCV-infected individuals to prevent or delay complications of the disease. Individuals with opioid use disorders, including those on medication-assisted therapy such as methadone or buprenorphine, are a key demographic group that can benefit from HCV treatment given their high HCV prevalence; however, pharmacokinetic and pharmacodynamic drug interactions could blunt their utility.We performed a comprehensive literature review of published and unpublished data from PubMed database, relevant conference abstracts/proceedings and FDA approved drug package inserts, to review the pharmacokinetic (PK) profile and drug interactions between currently approved HCV DAAs and methadone and buprenorphine.The paper highlights specific drug combinations which result in altered opioid drug levels including telaprevir/methadone, daclatasvir/buprenorphine, and Abbvie 3D combination regimen (paritaprevir, ritonavir, ombitasvir and dasabuvir)/buprenorphine. However, concurrent pharmacodynamics assessments did not reveal significant signs and symptoms of opioid withdrawal or toxicity that would preclude concurrent administration.

Dosage patents are one way to extend the market exclusivity of an approved drug beyond the lifetime of the patent that protects the drug as such. Dosage patents may help to compensate the applicant for the long period where the active pharmaceutical ingredient as such is already under patent prosecution, but not on the market yet, due to lengthy development and approval procedures. This situation erodes part of the time the drug is marketed under patent protection. Dosage patents filed at a later date can provide remedy for this problem. Examples of successful and unsuccesful attempts, and the reasons for the respective outcomes, are provided in this article.

Enzymes are proteins that catalyze almost every chemical reaction in living systems, achieving rate enhancements of up to 21 orders of magnitude relative to the uncatalyzed reactions. However, despite a century of intense investigation, the biophysical basis of the enormous catalytic power of enzymes is not completely understood. Enzymes are not only central to living systems, but also to many industrial processes such as the production of food, textiles, detergents, pharmaceuticals and other chemicals where environmentally friendly, green methods are of ever increasing importance. Because of their central role for life, enzymes are key drug targets and enzyme inhibition is a central strategy in the design of new drugs. Acetylsalicylic acid, azidothymidine, acyclovir, allopurinol, chloramphenicol, exemestane, fosfomycin, isoniazid, methotrexate, profens, proguanil, statins, thiouracil and warfarin are but a small subset of approved drug substances that are used in the clinic to treat, among others, pain, fever, inflammation, malaria, cancer, HIV, bacterial and viral infections, rheumatoid arthritis, osteoarthritis and heart disease, through the inhibition of key enzymes.

Cocrystals, a long known but understudied class of crystalline solids, have attracted interest from crystal engineers and pharmaceutical scientists in the past decade and are now an integral part of the preformulation stage of drug development. This is largely because cocrystals that contain a drug molecule, pharmaceutical cocrystals, can modify physicochemical properties without the need for covalent modification of the drug molecule. This review presents a brief history of cocrystals before addressing recent advances in design, discovery and development of pharmaceutical cocrystals that have occurred since an earlier review published in 2004. We address four aspects of cocrystals: nomenclature; design using hydrogen-bonded supramolecular synthons; methods of discovery and synthesis; development of pharmaceutical cocrystals as drug products. Cocrystals can be classified into molecular cocrystals (MCCs) that contain only neutral components (coformers) and ionic cocrystals (ICCs), which are comprised of at least one ionic coformer that is a salt. That cocrystals, especially ICCs, offer much greater diversity in terms of composition and properties than single component crystal forms and are amenable to design makes them of continuing interest. Seven recent case studies that illustrate how pharmaceutical cocrystals can improve physicochemical properties and clinical performance of drug substances, including a recently approved drug product based upon an ICC, are presented.

Combinatorial therapeutic approaches are an imperative to improve cancer treatment, because it is critical to impede compensatory signaling mechanisms that can engender drug resistance to individual targeted drugs. Currently approved drug combinations result largely from empirical clinical experience and cover only a small fraction of a vast therapeutic space. Here we present a computational network biology approach, based on pathway cross-talk inhibition, to discover new synergistic drug combinations for breast cancer treatment. In silico analysis identified 390 novel anticancer drug pairs belonging to 10 drug classes that are likely to diminish pathway cross-talk and display synergistic antitumor effects. Ten novel drug combinations were validated experimentally, and seven of these exhibited synergy in human breast cancer cell lines. In particular, we found that one novel combination, pairing the estrogen response modifier raloxifene with the c-Met/VEGFR2 kinase inhibitor cabozantinib, dramatically potentiated the drugs' individual antitumor effects in a mouse model of breast cancer. When compared with high-throughput combinatorial studies without computational prioritization, our approach offers a significant advance capable of uncovering broad-spectrum utility across many cancer types. Cancer Res; 77(2); 459–69. ©2016 AACR.

There are no currently approved drug therapies to assist in the recovery from aphasia. However, there is suggestive evidence from the animal literature that behavioral training, coupled with pharmacotherapy, can enhance recovery from motor stroke. Most of the pharmacologic interventions used in these studies involved sympathomimetic drugs, although other mechanisms were used as well, such enhancement in cholinergic signaling. A number of studies have been performed using human patients with aphasia. These studies are also suggestive of enhancement in recovery when sympathomimetic drugs are used in conjunction with speech and language therapy. There are also data to support cholinesterase inhibitors memantine and piracetam. In addition, other drugs, such as barbiturates, antipsychotics, and anticonvulsants, may slow recovery. Although more work is needed, these studies, which are critically reviewed herein, suggest that thoughtful use of pharmacologic agents in conjunction with speech and language therapy can enhance recovery from aphasic stroke.

The development of copper-drug complexes (CDCs) is hindered due to their very poor aqueous solubility. Diethyldithiocarbamate (DDC) is the primary metabolite of disulfiram, an approved drug for alcoholism that is being repurposed for cancer. The anticancer activity of DDC is dependent on complexation with copper to form copper bis-diethyldithiocarbamate (Cu(DDC)(2)), a highly insoluble complex that has not been possible to develop for indications requiring parenteral administration. We have resolved this issue by synthesizing Cu(DDC)(2) inside liposomes. DDC crosses the liposomal lipid bilayer, reacting with the entrapped copper; a reaction that can be observed through a colour change as the solution goes from a light blue to dark brown. This method is successfully applied to other CDCs including the anti-parasitic drug clioquinol, the natural product quercetin and the novel targeted agent CX-5461. Our method provides a simple, transformative solution enabling, for the first time, the development of CDCs as viable candidate anticancer drugs; drugs that would represent a brand new class of therapeutics for cancer patients.

Progress in developing new treatments for urothelial carcinoma (UC) has been stagnant for more than 20 years. A paradigm shift is needed to advance treatment for UC. For patients with advanced disease and in whom chemotherapy regimens have failed, a variety of single-agent or combination therapies, including molecularly targeted agents, have yielded modest response rates and poor survival durations.1,2 Although immunotherapy portends new promise, vinflunine is the only approved drug in Europe (European Medicines Agency) for progressive UC after platinum-based therapy, and the US Food and Drug Administration has not approved any agent.3 Advancements in genomic profiling of UC, mainly through The Cancer Genome Atlas (TCGA) project, recently made exceptional steps forward to uncover pertinent information on the underlying UC biology and potentially druggable pathways.4 The strategy to molecularly characterize patients who had achieved an extreme response to targeted drugs recently helped investigators to put known relevant alterations into the context of a clinical benefit from those compounds.5-7 This paradigm might best apply to anti-angiogenics, for which a proportion of approximately 5% to 10% complete or sustained responders has been reported for therapies including pazopanib.8,9

International audience; Molecular signaling pathways have been long used to demonstrate interactions among upstream causal molecules and downstream biological effects. They show the signal flow between cell compartments, the majority of which are represented as cartoons. These are often drawn manually by scanning through the literature, which is time-consuming, static, and non-interoperable. Moreover, these pathways are often devoid of context (condition and tissue) and biased toward certain disease conditions. Mining the scientific literature creates new possibilities to retrieve pathway information at higher contextual resolution and specificity. To address this challenge, we have created a pathway terminology system by combining signaling pathways and biological events to ensure a broad coverage of the entire pathway knowledge domain. This terminology was applied to mining biomedical papers and patents about neurodegenerative diseases with focus on Alzheimer's disease. We demonstrate the power of our approach by mapping literature-derived signaling pathways onto their corresponding anatomical regions in the human brain under healthy and Alzheimer's disease states. We demonstrate how this knowledge resource can be used to identify a putative mechanism explaining the mode-of-action of the approved drug Rasagiline, and show how this resource can be used for fingerprinting patents to support the discovery of pathway knowledge for Alzheimer's disease. Finally, we propose that based on next-generation cause-and-effect pathway models, a dedicated inventory of computer-processable pathway models specific to neurodegenerative diseases can be established, which hopefully accelerates context-specific enrichment analysis of experimental data with higher resolution and richer annotations.

Fragment based drug design has emerged as an effective alternative to high throughput screening for the identification of lead compounds in drug discovery in the past fifteen years. Fragment based screening and optimization methods have achieved credible success in many drug discovery projects with one approved drug and many more compounds in clinical trials. The fragment based drug design starts with the identification of fragments or low molecular weight compounds that generally bind with weak affinity to the target of interest. The fragments that form high quality interactions are then optimized to lead compounds with high affinity and selectivity. The weak affinity of fragments for their target requires the use of biophysical techniques such as nuclear magnetic resonance, X-ray crystallography or surface plasmon resonance to identify hits. These techniques are very sensitive and some of them provide detailed protein fragment interaction information that is important for fragment to lead optimization. Despite the huge advances in technology in the past years, experimental methods of fragment screening suffer several challenges such as low throughput, high cost of instruments and experiments, high protein and fragment concentration requirements. To address challenges posed by experimental screening approaches, computational methods were developed that play an important role in fragment library design, fragment screening and optimization of initial fragment hits. The computational approaches of fragment screening and optimization are most useful when they are used in combination with experimental approaches. The use of virtual fragment based screening in combination with experimental methods has fostered the application of fragment based drug design to important biological targets including protein-protein interactions and membrane proteins such as GPCRs. This review provides an overview of experimental and computational screening approaches used in fragment based drug discovery with an emphasis on recent successes achieved in discovering potent lead molecules using these approaches.

The notion of personalized medicine has developed from the application of the discipline of pharmacogenetics to clinical medicine. Although the clinical relevance of genetically-determined inter-individual differences in pharmacokinetics is poorly understood, and the genotype-phenotype association data on clinical outcomes often inconsistent, officially approved drug labels frequently include pharmacogenetic information concerning the safety and/or efficacy of a number of drugs and refer to the availability of the pharmacogenetic test concerned. Regulatory authorities differ in their approach to these issues. Evidence emerging subsequently has generally revealed the pharmacogenetic information included in the label to be premature. Revised drugs labels, together with a flurry of other collateral activities, have raised public expectations of personalized medicine, promoted as ‘the right drug at the right dose the first time.’ These expectations place the prescribing physician in a dilemma and at risk of litigation, especially when evidence-based information on genotype-related dosing schedules is to all intent and purposes non-existent and guidelines, intended to improve the clinical utility of available pharmacogenetic information or tests, distance themselves from any responsibility. Lack of efficacy or an adverse drug reaction is frequently related to non-genetic factors. Phenoconversion, arising from drug interactions, poses another often neglected challenge to any potential success of personalized medicine by mimicking genetically-determined enzyme deficiency. A more realistic promotion of personalized medicine should acknowledge current limitations and emphasize that pharmacogenetic testing can only improve the likelihood of diminishing a specific toxic effect or increasing the likelihood of a beneficial effect and that application of pharmacogenetics to clinical medicine cannot adequately predict drug response in individual patients.

The unprecedented progress in aging research has revealed that rapamycin, a clinically approved drug, is actually an anti-aging agent, which potentially could be employed to delay age-related diseases, thus extending healthy life span. The possibility of preventing diseases by staying young is remarkable in itself. At the same time this advance could save Medicare as we know it. Here I discuss how anti-aging interventions could solve otherwise intractable political problems without tax increases or curtailment of health care benefits.

Transthyretin (TTR) is one of the many proteins that are known to misfold and aggregate (i.e., undergo amyloidogenesis) in vivo. The process of TTR amyloidogenesis causes nervous system and/or heart pathology. While several of these maladies are associated with mutations that destabilize the TTR native quaternary and/or tertiary structure, wild type TTR amyloidogenesis also leads to the degeneration of post-mitotic tissue. Over the past twenty years, much has been learned about the factors that influence the propensity of TTR to aggregate. This biophysical information led to the development of a therapeutic strategy, termed “kinetic stabilization”, to prevent TTR amyloidogenesis. This strategy afforded the drug, tafamidis (trade name: Vyndaqel®), which was recently approved by the European Medicines Agency for the treatment of Transthyretin Familial Amyloid Polyneuropathy (TTR-FAP), a common familial TTR amyloid disease. Tafamidis is the first, and currently the only, medication approved to treat TTR-FAP. Here we review the biophysical basis for the kinetic stabilization strategy and the structure-based drug design effort that led to this first-in-class pharmacologic agent.

Pharmaceutical companies in Japan often provide a unique document called the Guidance for Proper Usage (GPU) to medical oncologists, in order to promote the proper use of an approved drug. The aim of the study was to examine the content of and current trends in the efficacy and safety data provided in GPU documents, in order to understand what pharmaceutical companies regard as important information for an oncologist to ensure proper usage of oncology drugs in Japan. Furthermore, this study analysed the influence of route of administration (oral or injection), drug class (cytotoxic or other), type of malignancy (haematological or solid malignancy) and the period of GPU publication (before and after April 2004) on the content of the GPU document. For the 103 oncology drugs approved for use in Japan, 59 GPU documents, covering 50 drugs, were distributed to medical oncologists and were compared by multivariate analysis over two consecutive time periods, from October 1994 to March 2004 and April 2004 to December 2010. For each document, we determined the total number of pages and the proportion of pages that provided drug and toxicity information and the results of registration trials, including postmarketing surveillance. The median number of pages in the GPUs was 48 (range, 11–98). The proportion of pages providing toxicity information, drug information (e.g. warnings, contraindications, instructions, and directions for indications and usage, dosage and administration) and the results of registration trials were 30%, 26% and 11%, respectively. After April 2004, the publication of GPU documents doubled, and the proportion of pages discussing the results of registration trials significantly increased (p = 0.002). The proportions of pages discussing toxicity information and the results of registration trials in molecular-targeted drugs were significantly greater than those for other types of drugs (p < 0.001 and p = 0.008, respectively), while the proportion of pages discussing drug information was significantly lower (p = 0.001). The number and length of GPU publications distributed by pharmaceutical companies in Japan has increased since 2004. Significant changes in content have included a reduction in the amount of information about drug administration and an increase in information on the results of pharmaceutical company-sponsored registrational trials. A further study is warranted to evaluate how often oncologists actually access GPU documents and what type of information could be most useful in medical practice in Japan.

Current approved drug treatments for Alzheimer disease (AD) include cholinesterase inhibitors (donepezil, rivastigmine, galantamine) and the NMDA receptor antagonist memantine. These drugs provide symptomatic relief but poorly affect the progression of the disease. Drug discovery has been directed, in the last 10 years, to develop ‘disease modifying drugs’ hopefully able to counteract the progression of AD. Because in a chronic, slow progressing pathological process, such as AD, an early start of treatment enhances the chance of success, it is crucial to have biomarkers for early detection of AD-related brain dysfunction, usable before clinical onset. Reliable early biomarkers need therefore to be prospectively tested for predictive accuracy, with specific cut off values validated in clinical practice. Disease modifying drugs developed so far include drugs to reduce β amyloid (Aβ) production, drugs to prevent Aβ aggregation, drugs to promote Aβ clearance, drugs targeting tau phosphorylation and assembly and other approaches. Unfortunately none of these drugs has demonstrated efficacy in phase 3 studies. The failure of clinical trials with disease modifying drugs raises a number of questions, spanning from methodological flaws to fundamental understanding of AD pathophysiology and biology. Recently, new diagnostic criteria applicable to presymptomatic stages of AD have been published. These new criteria may impact on drug development, such that future trials on disease modifying drugs will include populations susceptible to AD, before clinical onset. Specific problems with completed trials and hopes with ongoing trials are discussed in this review.

Objective Barbados has a strong base in the practice of folklore botanical medicines. Consistent with the rest of the Caribbean region, the practice is criticized due to lack of evidence on the efficacy and safety testing. The objectives of this review article are i) to categorize and identify plants by their possible indications and their scientific classification and ii) to determine if the chemical constituents of the plants will be able to provide some insight into their possible uses in folklore medicine based on existing scientific research on their chemical constituents and also by their classification. Method A review of the folklore botanical medicines of Barbados was done. Plants were primarily grouped based on their use to treat particular communicable and non-communicable diseases. Plants were then secondarily grouped based on their families. The chemical profiles of the plants were then compared to established drug compounds currently approved for the conventional treatment of illnesses and also to established phytochemicals. Results The extensive literature review identified phytochemical compounds in particular plants used in Barbadian folklore medicine. Sixty-six per cent of reputed medicinal plants contain pharmacologically active phytochemicals; fifty-one per cent of these medicinal plants contain phytochemicals with activities consistent with their reported use. Conclusion Folklore botanical medicine is well grounded on investigation of the scientific rationale. The research showed that fifty-one per cent of the identified medicinal plants have chemical compounds which have been identified to be responsible for its associated medicinal activity. To a lesser extent, approved drug compounds from drug regulatory bodies with similar chemical structure to the bioactive compounds in the plants proved to validate the use of some of these plants to treat illnesses.

Daptomycin is the first approved drug from a new class of antimicrobials, the cyclic lipopeptides, and is a very important antimicrobial agent in current clinical practice. Currently, there are no "green" analytical methods described in the literature to analyze the typical pharmaceutical dosage form of daptomycin. Thus, the aim of this work was to validate an environment-friendly spectrophotometric method in the UV region, for the analysis of daptomycin as a lyophilized powder. Water was used as diluent and the analyses were carried out on a spectrophotometer at 221 nm. The method met all validation requirements of the ICH guidelines, over a concentration range of 6-21 µg mL-1. A Student's t-test demonstrated that the proposed method was comparable to an HPLC method previously validated. Thus, the validated spectrophotometric method could quantify daptomycin in a powder form for injectable solutions, while being an economical, rapid, and "green" alternative for routine analysis in quality control. resumo A daptomicina é o primeiro membro aprovado de uma nova classe de antimicrobianos, os lipopeptídeos cíclicos, e é muito importante para a prática clínica atualmente. Não existem métodos analíticos "verdes" descritos na literatura para a análise da daptomicina na forma farmacêutica. Desta forma, o objetivo deste trabalho foi a validação de método espectrofotométrico na região do UV ambientalmente favorável para análise da daptomicina em pó liofilizado. A água foi escolhida como diluente e as análises foram realizadas em 221 nm. O método atendeu a todas as exigências de validação dos guias do ICH, na faixa de 6-21 µg mL-1. Teste t de Student mostrou que o método proposto é intercambiável com método de HPLC previamente validado. Assim, o método espectrofotométrico validado é capaz de quantificar a daptomicina em pó para solução injetável e é uma opção econômica, rápida e "verde" para análises de rotina do controle de qualidade deste fármaco.

The collection, detection and monitoring of information such as side effects, adverse effects, warnings, precautions of pharmaceutical products is a challenging task. With the advent of user forums, online reviews have become a significant source of information about products. In this work, we aim to utilize pharmaceutical drugs reviews by patients on various health communities to identify frequently occurring issues. We compare these issues with food and drug administration (FDA) approved drug labels for possible improvements. We focus on Oncological drugs and develop a scalable system for mapping of interventions against indication and the respective symptoms from patient comments. Using these mappings, our system is able to compare different sections of FDA labels for recommendations. We use SVM based framework for sentiment analysis to give an overall rating to the drugs. We further incorporate aspect based sentiment analysis for finding the orientation of drug reviews for specific targets.

Since the beginnings of cancer chemotherapy in the 1940s, oncologists have treated patients with drugs based on the organ or tissue where their tumors originated. Colon cancer requires different drug regimens than lung, breast, or skin cancer. But in May, the U.S. Food and Drug Administration for the first time allowed the use of an existing approved drug, Keytruda, to treat any solid tumor bearing a specific genetic marker. Now, another drug, larotrectinib, looks likely to become the second approved tissue-agnostic drug by next year, and others are making their way through clinical trials. "It9s a sign of the times," says Alice Shaw, director of thoracic oncology at Massachusetts General Hospital in Boston. "The molecular biology of the tumor is really leading the way over the tissue of origin."

We use the format of a hypothetical case study to review issues related to pharmaceutical product approval and physician prescribing practices. In this case, a new FDA-approved drug is recommended for a patient who subsequently experiences an adverse event that may or may not be related to the prescription. This case raises a number of ethical and legal considerations physicians routinely face when deciding whether to recommend such drugs for their patients. Despite the need for ongoing observation by the regulatory apparatus, physicians should be cognizant of the limitations of the drug approval system and the post-approval prescription drug surveillance system. We discuss physicians' ethical obligations when faced with a newly approved drug, including seeking out independent sources of learning, reporting adverse effects, and notifying patients about limitations in available knowledge about therapeutic recommendations.

Since the introduction of the monomeric orally bioavailable anti-arthritic gold compound auranofin in 1985, and the success of the platinum-based anti-cancer drugs, there has been a great deal of interest in the use of gold compounds for cancer therapy. However this early promise has not materialized into an approved drug in spite of extensive and innovative efforts in gold chemistry. Therefore, in the light of this lack of success, the strategies for the biological evaluation of potential gold-based anti-cancer drugs are discussed. It is proposed that the biological testing strategy should be multi-faceted incorporating an understanding of the molecular properties of the compounds under investigation related to their behaviour in a biological environment, an evaluation of their comparative in vitro potency against tumor cells, ascertaining the biochemical mechanism of action and target identification to aid in medicinal chemistry design, evaluation of in vivo activity in relevant tumor models, and an understanding of their toxicological and pharmacokinetic properties. This strategy will be exemplified with work on Au(III) cyclometallated complexes in which an integrated approach to the search for new metal-based anticancer drugs was adopted, incorporating in vitro screening, in vivo human tumor xenograft models, and mechanistic studies. The importance of mechanistic studies which have led to the identification of new molecular targets for gold drugs, and in vivo evaluation are emphasized.

A novel method for simultaneously visualizing beneft and risk over time is presented. The underlying model represents a subject’s beneft-risk state at a given time as one of fve discrete clinical states, one being premature study withdrawal. The new graphic uses colors to represent each subject’s changing state over the course of the clinical trial. The user can quickly grasp how a treatment affects subjects in aggregate, then further examine how individuals are affected. It is possible to tell whether the benefcial and harmful outcomes are correlated. The method is particularly appropriate for treatments that provide only symptomatic relief. An approved drug for chronic pain is presented as a worked example.

The introduction of new topical drugs based on new chemical entities has become a rare event. Instead, pharmaceutical companies have been focused on reformulating existing drugs resulting in an ever-growing number of topical drug products for every approved drug substance. In light of this trend, soon reformulations may not be as rewarding to their sponsors as they are today unless they offer a substantial improvement over other formulations of the same drug substance and the same indication, namely improved efficacy over existing drugs, reduced side effects, unique drug combinations, or applicability for new indications. This article reviews and compares topical drug delivery systems currently under active research that are designed to offer such advantages in the coming years. The reviewed delivery systems are: liposomes, niosomes, transferosomes, ethosomes, solid lipid nanoparticles, nanostructured lipid carriers, cyclodextrin, and sol-gel microcapsules. Among all the topical drug delivery systems currently undergoing active research, only the sol-gel microencapsulation is at clinical stages.

Drug-induced liver injury (DILI) is a leading cause of drugs failing during clinical trials and being withdrawn from the market. Comparative analysis of drugs based on their DILI potential is an effective approach to discover key DILI mechanisms and risk factors. However, assessing the DILI potential of a drug is a challenge with no existing consensus methods. We proposed a systematic classification scheme using FDA-approved drug labeling to assess the DILI potential of drugs, which yielded a benchmark dataset with 287 drugs representing a wide range of therapeutic categories and daily dosage amounts. The method is transparent and reproducible with a potential to serve as a common practice to study the DILI of marketed drugs for supporting drug discovery and biomarker development.

Bacterial RNA polymerase (RNAP) is the least popular target for antibiotics, and currently Rifampicin is only an approved drug for clinical use. However, RNAP is essential for bacterial growth and survival, and it can be a promising target for antimicrobial agents. Thus, we decided to search new antimicrobial agents for RNAP by virtual screening. When virtual screenings are performed, certain compounds repeatedly appears on hits covering a wide range of targets (frequently hitters). Also, the performance of hit generation is important factor in success of the virtual screening. Since we previously developed the optimized docking scores, we examined our scoring methods with rigorous removals of frequent hitters. We used two complex structures for RNAP, and also used two unrelated structures as negative controls to remove frequent hitters. Finally, we selected seven high-scored candidates from hits, and two of them showed the inhibition of Gram-positive bacteria by paper disk agar diffusion assay in vivo.

Erlotinib is an approved drug for the treatment of advanced pancreatic cancer; however, its survival benefit is small and its cost is high, and the decision to use the drug may often be personalized according to the patient's background. A 72-year-old Asian man in good general condition chose gemcitabine monotherapy over combination therapy with gemcitabine plus erlotinib because the survival benefit of the latter was small. The cost of the drug did not appear to affect this decision. This report details the process of decision making with respect to whether a patient receives targeted therapy, and suggests that the use of molecular-targeted drugs must be personalized from many perspectives, including the patient's social situation.

Two rare, severe seizure disorders, Lennox–Gastaut syndrome and Dravet syndrome, can now be treated with cannabidiol (Epidiolex), the first approved drug derived from marijuana.Cannabidiol does not contain the psychoactive component of marijuana and does not lead to physical dependence.Common advers

A group of 12 clinical commissioning groups in the north of England have won a legal battle to offer patients a choice to use off-label bevacizumab to treat wet age related macular degeneration, which they say will save the NHS millions of pounds. In November last year the drug companies Novartis and Bayer brought legal proceedings against the CCGs because they had decided to offer bevacizumab (Roche’s Avastin), which is not licensed for treatment of wet AMD, alongside ranibizumab (Lucentis, marketed by Novartis) and aflibercept (Bayer’s Eylea), which are approved by the UK National Institute for Health and Clinical Excellence for treating the condition in the NHS.1 The companies opposed the policy on four grounds: they said that the supply of bevacizumab was unlawful because it was not licensed for ophthalmic use; it undermined drug regulation; it undermined patients’ right to have a NICE approved drug; and the patient information sheet accompanying the policy was misleading. However, in the High Court Mrs Justice Whipple dismissed the application for judicial review on all grounds and found in favour of the CCG’s policy. She said that the companies’ arguments that the NHS could not consider bevacizumab unless Roche applied for a licence for …

Patients who search for a better treatment, an increased quality of life, or even a chance to preserve life itself may claim to have an interest in accessing investigational medicinal products (IMP), particularly when no validated treatment for their disease or condition exists. For many, awaiting the uncertain and time-consuming process of converting an IMP into an approved drug may not appear a realistic option, as prognoses may be grim and a dramatic outcome may seem hard to avert. Gaining access to an IMP, however, often proves to be a difficult enterprise with a highly uncertain outcome. In addition, the process of seeking access to IMP is surrounded by various ethical issues that will be explored in this article. This paper explores the ethical concerns in two potential tracks of seeking access to IMP for minors: on an individual basis, or collectively, as a patient organisation. In this discourse, several unique ethical and regulatory concerns related to the direct negotiation of access to IMP for minor patients are identified, with a focus on product safety, the recruitment of research subjects, the unnoticed entry of market mechanisms in the recruitment of research subjects, and the sidelining of third parties in the recruitment process. The paper concludes with a concise reflection on the way forward. The quest for access to investigational drugs is particularly relevant to paediatric practice, in which a significant share of the drugs prescribed has never been tested in children or labelled for use in the paediatric population.

Despite a move towards personalised medicine, attrition rates for new cancer drugs remain unacceptably high. The pharmaceutical industry has also shown a preference for well-studied targets and pathways, as evidenced by ‘me too' drugs. Together with the challenge of inadequate pre-clinical models, this indicates a need for novel, evidence-based therapeutic targets. Genome-wide association studies (GWAS) have identified over 450 robust genetic variants associated with increased cancer risk. Genes implicated through GWAS are often mutated somatically and therefore represent attractive therapeutic targets. Examples include the target of venetoclax in chronic lymphocytic leukaemia, BCL2. We exploit this principle more generally by integrating genetic associations for common cancers with drug target data and druggability using the canSAR drug discovery knowledgebase (https://cansar.icr.ac.uk). By harnessing the power of Big Data we aim to both identify opportunities for repurposing of existing drugs, and prioritise novel targets for cancer drug discovery. We mined the NHGRI-EBI Catalog of published GWAS for all cancer risk SNPs. We annotated candidate target genes through overlapping topologically associating domains (TADs), a more sensitive technique than previously published methods using linkage disequilibrium. We used canSAR to identify target genes for which there is no FDA-approved small molecule drug, and the resource Probe Miner to identify targets for which high-quality chemical probes exist. We also utilised canSAR's machine learning algorithms to assess the druggability of target genes by structure-, ligand-, precedence- and network-based approaches. We additionally analysed results from cancer drug databases to ascertain whether there is an enrichment of ‘drug target-indication pairs' at successive stages of the drug development pathway for which supporting evidence from GWAS exists: this indicates potential ‘stumbling blocks' that may present a risk for future drug development projects. 7 257 protein-coding genes mapped within TADs overlapping cancer risk SNPs. Of these, 98 were pre-existing targets for which there is an FDA-approved small molecule drug. For the remaining 7 159 genes we performed multi-faceted druggability analyses incorporating assessments of the 3D structure of the target and any protein complexes it exists in, chemical properties of known ligands of the target, and the target's position and role within the human interactome. We comprehensively rank our target-indication pairings by criteria including novelty relative to existing targets and predicted attrition risk. Mapping approved drug targets back to cancer GWAS signals enables identification of both novel drug targets and patient populations. Collectively our findings show the value of investigating germline cancer genetics as part of interdisciplinary, data-driven approaches to inform drug discovery. Citation Format: Elizabeth A. Coker, Ben Kinnersley, Amit Sud, Patrizio Di Micco, Bissan Al-Lazikani, Richard Houlston. Utilising genetic susceptibility and big data to inform novel cancer therapies [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 776.

The cost of drug development has skyrocketed to an estimated $2.6B for every FDA approved drug primarily due to failures from lack of efficacy or safety. This suggests that our current preclinical validation process has been insufficient in predicting therapeutic potential and toxicity in humans. While genetically engineered animal models have been highlighted as the gold standard for dissecting cancer mechanisms and evaluating novel drug targets in vivo, the cost and long lead time to develop them previously prevented their routine use in the oncology drug discovery process. Now, with the advent of CRISPR/Cas9 technology, the speed and precision in which genetically engineered mouse models can be created is unprecedented. When combined with inducible RNA inteference technology, we we can not only generate cancer de novo in a few weeks time, but also mimic drug therapy via RNAi in the same mice, giving us advanced capabilities to perform preclinical studies in vivo. Despite the utility of mouse models, the rat has historically been the major model species in many biomedical fields, notably toxicology and carcinogenicity testing; and for many scientists, the rat still remains the preferred rodent due to their larger size for surgical manipulation, repeat blood sampling, and their cognitive and physiological characteristics that more closely resemble humans than their mouse counterparts. Here, we take advantage of our two-step engineering approach and exploit the efficiency of CRISPR-based targeting to develop RNAi rat models that enable inducible and reversible gene silencing to simulate therapeutic regimes. We demonstrate that our approach allows us to rapidly generate RNAi rat models and mimic the function of the targeted small molecule inhibitors, such as BET inhibitors targeting Brd4. We compare our results to our Brd4 RNAi mice and demonstrate organism variances that provide valuable insight to cross-species differences. These results demonstrate that our high-throughput system currently used to generate RNAi mice is also applicable to the rat system and, by extension, other mammalian models. Inducible RNAi rat models will undoubtedly be powerful tools that can be used to model human cancers, to mimic the action of putative drugs, and to assess the potential of therapeutic targeting strategies in vivo prior to the costly drug development, ultimately guiding the development of safer and more effective drugs. Citation Format: Prem K. Premsrirut, Chia-Lin Wang, Yu-Ting Yang, Lukas E. Dow, Johannes Zuber, Scott W. Lowe. CRISPR/Cas9-based development of RNAi rat models for drug discovery [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 5106.