Pub Date : 2026-10-13DOI: 10.1016/j.pharmthera.2026.109131
Nam V Truong, Julianna N Quinn, Mark Returan, Jun Wang
Sinoatrial node dysfunction (SND) is a major cause of bradyarrhythmia, chronotropic incompetence, tachy-brady syndrome, and a common indication for permanent pacemaker implantation, particularly in older adults. Although SND has diverse etiologies, this review focuses on aging-associated intrinsic SND, while considering other common causes where they inform differential diagnosis, arrhythmogenic mechanisms, or therapeutic development. Although current medical interventions provide effective rhythm support, they do not correct the molecular and tissue-level processes that drive sinoatrial node (SAN) degeneration. The review integrates current knowledge of SAN biology with mechanisms underlying SND, including fibrosis, ion-channel and calcium-clock remodeling, mitochondrial dysfunction, cellular senescence, impaired β-adrenergic signaling, genetic susceptibility, and epigenetic or epitranscriptomic regulation. We further discuss how these mechanisms contribute to impaired impulse generation, SAN exit block, reduced chronotropic reserve, and increased susceptibility to atrial arrhythmia. We discuss approaches for studying the molecular and cellular mechanisms and evaluating therapeutic strategies using emerging animal models, human pluripotent stem cell-derived SAN-like pacemaker cells, organoids, assembloids, and single-cell and spatial omics platforms. Finally, we highlight translational opportunities, including senescence-directed, metabolic, antifibrotic, autonomic, gene-based, regenerative, and biological pacing strategies. A mechanism-guided classification of SND may support future precision therapies that complement conventional pacing by linking dominant rhythm phenotypes to targetable biological drivers, molecular and functional pharmacodynamic markers, and human-relevant models of pacemaker failure.
{"title":"Sinoatrial node dysfunction: molecular mechanisms, arrhythmogenesis, and translational pathways toward precision therapy.","authors":"Nam V Truong, Julianna N Quinn, Mark Returan, Jun Wang","doi":"10.1016/j.pharmthera.2026.109131","DOIUrl":"10.1016/j.pharmthera.2026.109131","url":null,"abstract":"<p><p>Sinoatrial node dysfunction (SND) is a major cause of bradyarrhythmia, chronotropic incompetence, tachy-brady syndrome, and a common indication for permanent pacemaker implantation, particularly in older adults. Although SND has diverse etiologies, this review focuses on aging-associated intrinsic SND, while considering other common causes where they inform differential diagnosis, arrhythmogenic mechanisms, or therapeutic development. Although current medical interventions provide effective rhythm support, they do not correct the molecular and tissue-level processes that drive sinoatrial node (SAN) degeneration. The review integrates current knowledge of SAN biology with mechanisms underlying SND, including fibrosis, ion-channel and calcium-clock remodeling, mitochondrial dysfunction, cellular senescence, impaired β-adrenergic signaling, genetic susceptibility, and epigenetic or epitranscriptomic regulation. We further discuss how these mechanisms contribute to impaired impulse generation, SAN exit block, reduced chronotropic reserve, and increased susceptibility to atrial arrhythmia. We discuss approaches for studying the molecular and cellular mechanisms and evaluating therapeutic strategies using emerging animal models, human pluripotent stem cell-derived SAN-like pacemaker cells, organoids, assembloids, and single-cell and spatial omics platforms. Finally, we highlight translational opportunities, including senescence-directed, metabolic, antifibrotic, autonomic, gene-based, regenerative, and biological pacing strategies. A mechanism-guided classification of SND may support future precision therapies that complement conventional pacing by linking dominant rhythm phenotypes to targetable biological drivers, molecular and functional pharmacodynamic markers, and human-relevant models of pacemaker failure.</p>","PeriodicalId":402,"journal":{"name":"Pharmacology & Therapeutics","volume":" ","pages":"109131"},"PeriodicalIF":13.5,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2026-02-01DOI: 10.1016/j.pharmthera.2026.108991
Yumin Wang , Yan Wang , Qingzhu Gao , Yonglin Zhu , Yulin Li , Zhe-Sheng Chen , Junjing Zhang , Geng Zhang , Hongquan Wang
Therapeutic resistance remains a major challenge in cancer management. The cyclic GMP–AMP synthase (cGAS)–stimulator of interferon genes (STING) pathway senses cytosolic DNA and triggers innate immune responses. Cancer cells frequently acquire drug resistance by inhibiting cGAS-STING signaling, leading to growing interest in small-molecule agonists that reactivate this pathway to counter resistance. In this review, we summarize recent molecular and cellular findings explaining how cancer cells suppress cGAS-STING through epigenetic regulation, post-translational modifications (PTMs), and altered metabolic pathways. We also evaluate recent studies on cGAS-STING agonists aimed at restoring sensitivity to chemotherapy, immunotherapy, and targeted cancer therapies to inform new strategies to pharmacologically reactivate cGAS-STING signaling pathway to reverse existing therapeutic barriers.
{"title":"Pharmacological activation of cGAS-STING pathway to reverse cancer drug resistance","authors":"Yumin Wang , Yan Wang , Qingzhu Gao , Yonglin Zhu , Yulin Li , Zhe-Sheng Chen , Junjing Zhang , Geng Zhang , Hongquan Wang","doi":"10.1016/j.pharmthera.2026.108991","DOIUrl":"10.1016/j.pharmthera.2026.108991","url":null,"abstract":"<div><div>Therapeutic resistance remains a major challenge in cancer management. The cyclic GMP–AMP synthase (cGAS)–stimulator of interferon genes (STING) pathway senses cytosolic DNA and triggers innate immune responses. Cancer cells frequently acquire drug resistance by inhibiting cGAS-STING signaling, leading to growing interest in small-molecule agonists that reactivate this pathway to counter resistance. In this review, we summarize recent molecular and cellular findings explaining how cancer cells suppress cGAS-STING through epigenetic regulation, post-translational modifications (PTMs), and altered metabolic pathways. We also evaluate recent studies on cGAS-STING agonists aimed at restoring sensitivity to chemotherapy, immunotherapy, and targeted cancer therapies to inform new strategies to pharmacologically reactivate cGAS-STING signaling pathway to reverse existing therapeutic barriers.</div></div>","PeriodicalId":402,"journal":{"name":"Pharmacology & Therapeutics","volume":"280 ","pages":"Article 108991"},"PeriodicalIF":12.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146102576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-01-19DOI: 10.1016/j.pharmthera.2026.108983
Dan Li , Ana L. Manzano-Covarrubias , Kelly B.I. Douglas , Karim Rafie , Martina Schmidt
Chronic obstructive pulmonary disease (COPD) and asthma are two major obstructive lung disorders characterized by persistent airway inflammation that leads to progressive lung function decline. Although both chronic in nature, the inflammatory profiles that characterize these diseases differ significantly: COPD is predominantly driven by neutrophilic inflammation, whereas allergic asthma, a major subtype of asthma disease, is traditionally associated with eosinophilic and T helper 2 (Th2)-mediated responses. This review explores first the mechanisms underlying chronic inflammation in COPD and asthma, emphasizing thereafter the impact of bacterial and viral infections in exacerbating inflammatory responses and accelerating lung damage. Current therapeutic approaches, including the use of corticosteroids, bronchodilators, and biologics, are evaluated, highlighting their mechanisms of actions and limitations. Finally, the review focuses on novel therapeutic targets that have emerged from recent advances in (airway) inflammation research. The roles of key signaling pathways such as those involving Nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB), C-X-C motif chemokine receptor 2 (CXCR2), toll-like receptors (TLRs), tumor necrosis factor (TNF) signaling, P2X purinoceptor 4 (P2X4 receptor), and the NOD-, LRR-, and pyrin domain-containing protein 3 (NLRP3) inflammasome in sustaining chronic inflammation are discussed. Understanding these pathways offers insights into the potential for development of more targeted and effective treatments. By offering a comprehensive overview of both established and (potential) novel approaches, this review aims to promote the identification and development of therapeutic strategies that could revolutionize the options for effective treatment of chronic inflammation in obstructive lung disorders.
{"title":"Therapeutic potential of targeting novel signaling pathways in regulating chronic inflammation in obstructive lung disorders","authors":"Dan Li , Ana L. Manzano-Covarrubias , Kelly B.I. Douglas , Karim Rafie , Martina Schmidt","doi":"10.1016/j.pharmthera.2026.108983","DOIUrl":"10.1016/j.pharmthera.2026.108983","url":null,"abstract":"<div><div>Chronic obstructive pulmonary disease (COPD) and asthma are two major obstructive lung disorders characterized by persistent airway inflammation that leads to progressive lung function decline. Although both chronic in nature, the inflammatory profiles that characterize these diseases differ significantly: COPD is predominantly driven by neutrophilic inflammation, whereas allergic asthma, a major subtype of asthma disease, is traditionally associated with eosinophilic and T helper 2 (Th2)-mediated responses. This review explores first the mechanisms underlying chronic inflammation in COPD and asthma, emphasizing thereafter the impact of bacterial and viral infections in exacerbating inflammatory responses and accelerating lung damage. Current therapeutic approaches, including the use of corticosteroids, bronchodilators, and biologics, are evaluated, highlighting their mechanisms of actions and limitations. Finally, the review focuses on novel therapeutic targets that have emerged from recent advances in (airway) inflammation research. The roles of key signaling pathways such as those involving Nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB), C-X-C motif chemokine receptor 2 (CXCR2), toll-like receptors (TLRs), tumor necrosis factor (TNF) signaling, P2X purinoceptor 4 (P2X4 receptor), and the NOD-, LRR-, and pyrin domain-containing protein 3 (NLRP3) inflammasome in sustaining chronic inflammation are discussed. Understanding these pathways offers insights into the potential for development of more targeted and effective treatments. By offering a comprehensive overview of both established and (potential) novel approaches, this review aims to promote the identification and development of therapeutic strategies that could revolutionize the options for effective treatment of chronic inflammation in obstructive lung disorders.</div></div>","PeriodicalId":402,"journal":{"name":"Pharmacology & Therapeutics","volume":"279 ","pages":"Article 108983"},"PeriodicalIF":12.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146000573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-01-05DOI: 10.1016/j.pharmthera.2025.108973
Ricardo Caballero, Juan Tamargo, Eva Delpón
Sodium-glucose cotransporter 2 inhibitors (SGLT2i) represent the cornerstone of therapy in patients with type 2 diabetes (T2D), heart failure (HF), or chronic kidney disease (CKD). These patients present a high risk of cardiac arrhythmias, particularly when these comorbidities coexist. In experimental models, SGLT2i exert antiarrhythmic effects and clinical studies and meta-analyses strongly suggest that they reduce new-onset and recurrences of atrial fibrillation in patients with HF or CKD irrespective of the diabetic status. Although some trials and meta-analyses suggest that SGLT2i could decrease the risk of ventricular arrhythmias and sudden cardiac arrest, the evidence is weak, and their potential remains to be confirmed. Thus, clinical evidence so far should be considered as hypothesis-generating. Although the exact mechanism underlying their antiarrhythmic effects remains uncertain and much research is needed, multiple direct cardiac and extracardiac effects may be involved. They improve cardiac electrical (via changes in ion channels and transporters; maintenance of Na+ and Ca2+ homeostasis), structural (reduce hypertrophy, fibrosis, inflammation, and epicardial fat; improve mitochondrial function and energetic metabolism), and autonomic (reduce sympathetic hyperactivity) remodelling. Indirect extracardiac effects related to an improvement in cardiovascular risk factors and haemodynamics, together with their protective renal and vascular effects, may also play a role. This narrative review summarises the experimental and clinical evidence of their antiarrhythmic effects, potential underlying mechanisms, limitations of present evidence, and gaps of knowledge that should be filled before SGLT2i can be recommended for the prevention and treatment of arrhythmias in patients for whom these drugs are indicated.
{"title":"SGLT2 inhibitors: Do they have antiarrhythmic properties?","authors":"Ricardo Caballero, Juan Tamargo, Eva Delpón","doi":"10.1016/j.pharmthera.2025.108973","DOIUrl":"10.1016/j.pharmthera.2025.108973","url":null,"abstract":"<div><div>Sodium-glucose cotransporter 2 inhibitors (SGLT2i) represent the cornerstone of therapy in patients with type 2 diabetes (T2D), heart failure (HF), or chronic kidney disease (CKD). These patients present a high risk of cardiac arrhythmias, particularly when these comorbidities coexist. In experimental models, SGLT2i exert antiarrhythmic effects and clinical studies and meta-analyses strongly suggest that they reduce new-onset and recurrences of atrial fibrillation in patients with HF or CKD irrespective of the diabetic status. Although some trials and meta-analyses suggest that SGLT2i could decrease the risk of ventricular arrhythmias and sudden cardiac arrest, the evidence is weak, and their potential remains to be confirmed. Thus, clinical evidence so far should be considered as hypothesis-generating. Although the exact mechanism underlying their antiarrhythmic effects remains uncertain and much research is needed, multiple direct cardiac and extracardiac effects may be involved. They improve cardiac electrical (via changes in ion channels and transporters; maintenance of Na<sup>+</sup> and Ca<sup>2+</sup> homeostasis), structural (reduce hypertrophy, fibrosis, inflammation, and epicardial fat; improve mitochondrial function and energetic metabolism), and autonomic (reduce sympathetic hyperactivity) remodelling. Indirect extracardiac effects related to an improvement in cardiovascular risk factors and haemodynamics, together with their protective renal and vascular effects, may also play a role. This narrative review summarises the experimental and clinical evidence of their antiarrhythmic effects, potential underlying mechanisms, limitations of present evidence, and gaps of knowledge that should be filled before SGLT2i can be recommended for the prevention and treatment of arrhythmias in patients for whom these drugs are indicated.</div></div>","PeriodicalId":402,"journal":{"name":"Pharmacology & Therapeutics","volume":"279 ","pages":"Article 108973"},"PeriodicalIF":12.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145902500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-01-12DOI: 10.1016/j.pharmthera.2026.108982
Inês Costa , Daniel José Barbosa , Fernando Remião , Maria Emília Sousa , Renata Silva
Neurodegenerative diseases, including Alzheimer's disease, Parkinson's disease, amyotrophic lateral sclerosis, and multiple sclerosis, are characterized by the progressive breakdown and eventual loss of synapses and neurons, primarily driven by the accumulation of pathologically altered proteins within the brain and spinal cord. These diseases have complex and multifactorial etiologies, involving a broad spectrum of pathophysiological mechanisms, many of which remain incompletely understood. Nonetheless, several key pathways are consistently implicated across these conditions, including oxidative stress, mitochondrial dysfunction, neuroinflammation, and apoptosis. Given their rising prevalence and the persistent lack of effective disease-modifying therapies, the development of novel therapeutic strategies capable of targeting multiple pathophysiological processes is of critical importance for delaying or halting disease progression. In this context, marine natural compounds have emerged as promising candidates for counteracting neurodegeneration, owing to their ability to modulate key pathophysiological hallmarks of distinct neurodegenerative diseases. Derived from a wide range of marine organisms – including algae, sponges, fungi, and cyanobacteria - these bioactive molecules possess unique chemical structures and exhibit a broad spectrum of neuroprotective effects. Many have demonstrated potent antioxidant, anti-apoptotic, and mitochondrial-stabilizing activities in preclinical models. This review highlights recent advances in the discovery and characterization of marine-derived compounds with therapeutic potential in neurodegenerative diseases, contextualizing their pathologic mechanisms.
{"title":"A dive into the untapped potential of marine compounds in counteracting neurodegeneration","authors":"Inês Costa , Daniel José Barbosa , Fernando Remião , Maria Emília Sousa , Renata Silva","doi":"10.1016/j.pharmthera.2026.108982","DOIUrl":"10.1016/j.pharmthera.2026.108982","url":null,"abstract":"<div><div>Neurodegenerative diseases, including Alzheimer's disease, Parkinson's disease, amyotrophic lateral sclerosis, and multiple sclerosis, are characterized by the progressive breakdown and eventual loss of synapses and neurons, primarily driven by the accumulation of pathologically altered proteins within the brain and spinal cord. These diseases have complex and multifactorial etiologies, involving a broad spectrum of pathophysiological mechanisms, many of which remain incompletely understood. Nonetheless, several key pathways are consistently implicated across these conditions, including oxidative stress, mitochondrial dysfunction, neuroinflammation, and apoptosis. Given their rising prevalence and the persistent lack of effective disease-modifying therapies, the development of novel therapeutic strategies capable of targeting multiple pathophysiological processes is of critical importance for delaying or halting disease progression. In this context, marine natural compounds have emerged as promising candidates for counteracting neurodegeneration, owing to their ability to modulate key pathophysiological hallmarks of distinct neurodegenerative diseases. Derived from a wide range of marine organisms – including algae, sponges, fungi, and cyanobacteria - these bioactive molecules possess unique chemical structures and exhibit a broad spectrum of neuroprotective effects. Many have demonstrated potent antioxidant, anti-apoptotic, and mitochondrial-stabilizing activities in preclinical models. This review highlights recent advances in the discovery and characterization of marine-derived compounds with therapeutic potential in neurodegenerative diseases, contextualizing their pathologic mechanisms.</div></div>","PeriodicalId":402,"journal":{"name":"Pharmacology & Therapeutics","volume":"279 ","pages":"Article 108982"},"PeriodicalIF":12.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145962077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-24DOI: 10.1016/j.pharmthera.2025.108972
Hao Zhang , Yilin Wu , Rui Zhao , Xuhan Hu , Xiaoou Sun
Cardiocerebrovascular disease (CCD) is a condition related to the heart and blood vessels affecting the cardiovascular system. The disease is caused by various pathogenic factors that damage the heart and brain tissues. CCD significantly threatens human health due to the increased incidence, disability, and mortality, but effective treatment options remain lacking. As precision medicine has taken center stage in recent years, the relationship between epigenetics and CCD has been increasingly studied. N6-methyladenosine (m6A) represents a dynamic and reversible methylation occurring on the sixth nitrogen atom of RNA adenine. This modification is essential in epigenetic regulation, involving the coordinated methyltransferase action, methylated reading proteins, and demethylases. Being a prevalent internal modification in eukaryotic messenger ribonucleic acid (mRNA), m6A is indispensable in numerous bioprocesses. m6A modification has been found to govern gene expression at the epigenetic, transcriptional, and post-transcriptional levels. This alteration can affect tumor development, regulate spermatogenesis and hematopoietic stem cell differentiation, thereby serving as a biomarker for CCD diagnosis and prognosis. Accordingly, we reviewed the function, mechanism, and value of m6A modification in CCD to present a fresh perspective for early diagnosis and clinical treatment.
{"title":"N6-methyladenosine (m6A) RNA methylation: a potential clinical therapeutic target in cardiocerebrovascular diseases","authors":"Hao Zhang , Yilin Wu , Rui Zhao , Xuhan Hu , Xiaoou Sun","doi":"10.1016/j.pharmthera.2025.108972","DOIUrl":"10.1016/j.pharmthera.2025.108972","url":null,"abstract":"<div><div>Cardiocerebrovascular disease (CCD) is a condition related to the heart and blood vessels affecting the cardiovascular system. The disease is caused by various pathogenic factors that damage the heart and brain tissues. CCD significantly threatens human health due to the increased incidence, disability, and mortality, but effective treatment options remain lacking. As precision medicine has taken center stage in recent years, the relationship between epigenetics and CCD has been increasingly studied. N6-methyladenosine (m6A) represents a dynamic and reversible methylation occurring on the sixth nitrogen atom of RNA adenine. This modification is essential in epigenetic regulation, involving the coordinated methyltransferase action, methylated reading proteins, and demethylases. Being a prevalent internal modification in eukaryotic messenger ribonucleic acid (mRNA), m6A is indispensable in numerous bioprocesses. m6A modification has been found to govern gene expression at the epigenetic, transcriptional, and post-transcriptional levels. This alteration can affect tumor development, regulate spermatogenesis and hematopoietic stem cell differentiation, thereby serving as a biomarker for CCD diagnosis and prognosis. Accordingly, we reviewed the function, mechanism, and value of m6A modification in CCD to present a fresh perspective for early diagnosis and clinical treatment.</div></div>","PeriodicalId":402,"journal":{"name":"Pharmacology & Therapeutics","volume":"278 ","pages":"Article 108972"},"PeriodicalIF":12.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145822826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-11-30DOI: 10.1016/j.pharmthera.2025.108962
Hengrui Liu , Yaqi Jiao , Peng-Chao Wang , Yingjie Chen , Maokai Xu , Xiaojuan Zhang , Xiaochun Zheng , Zhenshan Yang
Oxidative stress is now understood as a disturbance in the cellular redox balance, involving the accumulation of reactive oxygen, nitrogen, and other reactive species beyond the capacity of antioxidant defenses, with effects that range from essential redox signaling to harmful oxidative damage. Reactive oxygen and nitrogen species are generated from both endogenous metabolic processes and exogenous environmental factors. While controlled levels of oxidative stress contribute to cellular signaling and homeostasis, excessive oxidative damage can lead to pathological conditions, including cardiovascular diseases, diabetes, neurodegenerative disorders, inflammatory conditions, and cancer. To counteract oxidative damage, the body employs a complex antioxidant defense system, comprising endogenous enzymatic and non-enzymatic mechanisms, as well as exogenous dietary antioxidants. Therefore, understanding the regulatory pathways and mechanisms of antioxidants is essential for exploring their role in disease prevention, aging, and immune function. This review provides a comprehensive analysis of oxidative stress, its impact on cellular function, and its involvement in disease pathogenesis. Furthermore, it discusses current therapeutic intervention mechanisms, including dietary strategies, pharmacological antioxidants, and clinical trials evaluating antioxidant efficacy. Finally, emerging research directions, such as novel antioxidant compounds, gene therapy, and personalized antioxidant treatments, are highlighted as potential avenues for future exploration.
{"title":"Oxidative stress and antioxidant therapeutic mechanisms","authors":"Hengrui Liu , Yaqi Jiao , Peng-Chao Wang , Yingjie Chen , Maokai Xu , Xiaojuan Zhang , Xiaochun Zheng , Zhenshan Yang","doi":"10.1016/j.pharmthera.2025.108962","DOIUrl":"10.1016/j.pharmthera.2025.108962","url":null,"abstract":"<div><div>Oxidative stress is now understood as a disturbance in the cellular redox balance, involving the accumulation of reactive oxygen, nitrogen, and other reactive species beyond the capacity of antioxidant defenses, with effects that range from essential redox signaling to harmful oxidative damage. Reactive oxygen and nitrogen species are generated from both endogenous metabolic processes and exogenous environmental factors. While controlled levels of oxidative stress contribute to cellular signaling and homeostasis, excessive oxidative damage can lead to pathological conditions, including cardiovascular diseases, diabetes, neurodegenerative disorders, inflammatory conditions, and cancer. To counteract oxidative damage, the body employs a complex antioxidant defense system, comprising endogenous enzymatic and non-enzymatic mechanisms, as well as exogenous dietary antioxidants. Therefore, understanding the regulatory pathways and mechanisms of antioxidants is essential for exploring their role in disease prevention, aging, and immune function. This review provides a comprehensive analysis of oxidative stress, its impact on cellular function, and its involvement in disease pathogenesis. Furthermore, it discusses current therapeutic intervention mechanisms, including dietary strategies, pharmacological antioxidants, and clinical trials evaluating antioxidant efficacy. Finally, emerging research directions, such as novel antioxidant compounds, gene therapy, and personalized antioxidant treatments, are highlighted as potential avenues for future exploration.</div></div>","PeriodicalId":402,"journal":{"name":"Pharmacology & Therapeutics","volume":"278 ","pages":"Article 108962"},"PeriodicalIF":12.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145619571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-26DOI: 10.1016/j.pharmthera.2025.108971
Xinlong Zhang , Kaizong Huang , Zixin Wu , Rui Ding , Junming Han , Yuan Zhang , Yaping Lu , Yingmei Lu , Yanna Si
Sepsis-associated encephalopathy is a debilitating complication of systemic infection, marked by acute cognitive impairment and long-term neurological deficits in the absence of direct central nervous system (CNS) infection. Its pathogenesis involves a multifactorial interplay of neuroinflammation (e.g., cytokine storms), immune dysregulation, blood-brain barrier (BBB) disruption, metabolic derangements, and impaired neuronal repair. These mechanisms synergistically contribute to neuronal injury and persistent cognitive dysfunction. Emerging therapeutic strategies-such as targeted immunomodulators, BBB-stabilizing agents, and novel CNS-targeted drug delivery-aim to interrupt this cascade and improve outcomes. Concurrently, precision medicine approaches leverage molecular profiling to tailor interventions. However, current clinical management remains supportive, hindered by incomplete mechanistic understanding and a paucity of disease-modifying therapies. This review synthesizes recent advances in the pathophysiology of sepsis-associated encephalopathy, critically evaluates these mechanism-based therapeutic approaches, and highlights translational roadblocks in biomarker development and preclinical-to-clinical bridging. We also propose future directions to accelerate the development of targeted pharmacotherapies and personalized treatment paradigms for sepsis-associated encephalopathy.
{"title":"Sepsis-associated encephalopathy: Unraveling molecular mechanisms, emerging therapeutics, and translational frontiers","authors":"Xinlong Zhang , Kaizong Huang , Zixin Wu , Rui Ding , Junming Han , Yuan Zhang , Yaping Lu , Yingmei Lu , Yanna Si","doi":"10.1016/j.pharmthera.2025.108971","DOIUrl":"10.1016/j.pharmthera.2025.108971","url":null,"abstract":"<div><div>Sepsis-associated encephalopathy is a debilitating complication of systemic infection, marked by acute cognitive impairment and long-term neurological deficits in the absence of direct central nervous system (CNS) infection. Its pathogenesis involves a multifactorial interplay of neuroinflammation (e.g., cytokine storms), immune dysregulation, blood-brain barrier (BBB) disruption, metabolic derangements, and impaired neuronal repair. These mechanisms synergistically contribute to neuronal injury and persistent cognitive dysfunction. Emerging therapeutic strategies-such as targeted immunomodulators, BBB-stabilizing agents, and novel CNS-targeted drug delivery-aim to interrupt this cascade and improve outcomes. Concurrently, precision medicine approaches leverage molecular profiling to tailor interventions. However, current clinical management remains supportive, hindered by incomplete mechanistic understanding and a paucity of disease-modifying therapies. This review synthesizes recent advances in the pathophysiology of sepsis-associated encephalopathy, critically evaluates these mechanism-based therapeutic approaches, and highlights translational roadblocks in biomarker development and preclinical-to-clinical bridging. We also propose future directions to accelerate the development of targeted pharmacotherapies and personalized treatment paradigms for sepsis-associated encephalopathy.</div></div>","PeriodicalId":402,"journal":{"name":"Pharmacology & Therapeutics","volume":"278 ","pages":"Article 108971"},"PeriodicalIF":12.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145844789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-11-19DOI: 10.1016/j.pharmthera.2025.108958
Sebastiano A. Torrisi , Federica Geraci , Lidia Diolosà , Angelina De Luca , Luca Falzone , Filippo Drago , Massimo Libra , Gian Marco Leggio
In a relatively brief period, the mRNA COVID-19 vaccines have saved millions of lives and have considerably contributed to return to normality after the pandemic. More broadly, the development of RNA-based drugs represents a real paradigm shift with promising therapeutic applications. Besides their safety and efficacy, RNA-based drugs are essentially easy to design and manufactured and may therefore be cost effective. At the pharmacological level, the development of RNA-based drugs marks a breakthrough because these drugs can reach previously “undruggable” pharmacological targets. This clearly represents a step toward the possible establishment of personalized treatments for several difficult-to-treat diseases. This review provides an updated, critical, and comprehensive pharmacological analysis of the current RNA therapeutics landscape, including both approved RNA-based drugs and key investigational candidates. We summarize the state of clinical progress, highlighting pharmacological mechanisms, challenges in drug delivery, tolerability, and clinical outcomes. Our comprehensive overview emphasizes the versatility of RNA-based drugs, illustrating their therapeutic application across various diseases such as cancer, neurodegenerative, cardiovascular, metabolic, rare genetic, and infectious diseases. Also, we uniquely explore the concept of RNA-based drugs repurposing, which may leverage shared pathophysiological mechanisms across diseases to accelerate clinical impact.
{"title":"RNA-based drugs: current, imminent and possible therapeutic applications","authors":"Sebastiano A. Torrisi , Federica Geraci , Lidia Diolosà , Angelina De Luca , Luca Falzone , Filippo Drago , Massimo Libra , Gian Marco Leggio","doi":"10.1016/j.pharmthera.2025.108958","DOIUrl":"10.1016/j.pharmthera.2025.108958","url":null,"abstract":"<div><div>In a relatively brief period, the mRNA COVID-19 vaccines have saved millions of lives and have considerably contributed to return to normality after the pandemic. More broadly, the development of RNA-based drugs represents a real paradigm shift with promising therapeutic applications. Besides their safety and efficacy, RNA-based drugs are essentially easy to design and manufactured and may therefore be cost effective. At the pharmacological level, the development of RNA-based drugs marks a breakthrough because these drugs can reach previously “undruggable” pharmacological targets. This clearly represents a step toward the possible establishment of personalized treatments for several difficult-to-treat diseases. This review provides an updated, critical, and comprehensive pharmacological analysis of the current RNA therapeutics landscape, including both approved RNA-based drugs and key investigational candidates. We summarize the state of clinical progress, highlighting pharmacological mechanisms, challenges in drug delivery, tolerability, and clinical outcomes. Our comprehensive overview emphasizes the versatility of RNA-based drugs, illustrating their therapeutic application across various diseases such as cancer, neurodegenerative, cardiovascular, metabolic, rare genetic, and infectious diseases. Also, we uniquely explore the concept of RNA-based drugs repurposing, which may leverage shared pathophysiological mechanisms across diseases to accelerate clinical impact.</div></div>","PeriodicalId":402,"journal":{"name":"Pharmacology & Therapeutics","volume":"277 ","pages":"Article 108958"},"PeriodicalIF":12.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145553615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-10-27DOI: 10.1016/j.pharmthera.2025.108943
Eric A. Okrah , Claire Allan , Monika S. Doblin , Sarah J. Annesley
Cannabidiol (CBD) is one of the major active constituents among the several hundreds of compounds found in the cannabis plant. It is a non-psychoactive compound known for its anti-inflammatory, neuroprotective, antidepressant and anxiolytic effects. In preclinical studies it has shown to be effective, safe, and well-tolerated in mitigating the symptoms associated with Parkinson's disease (PD) and other neurodegenerative diseases. However, the mechanism of action is not fully characterised. CBD is postulated to exert its therapeutic effects through its interaction with the endocannabinoid system (ECS), and via interaction with a large array of non-cannabinoid receptors, neurotransmitters, and enzymes. These interactions are complex and are influenced by cell type, concentration and exposure time. The lack of specificity for a single receptor system makes CBD an intriguing therapeutic compound and enables it to influence multiple pathways. This broad interaction goes beyond its beneficial therapeutic effects and could lead to potential adverse effects. Detailed understanding of the versatility and complexity of how CBD exerts its effect is required so that the true potential as a therapeutic option can be realised.
{"title":"Cannabidiol and Parkinson's disease: Investigating receptor interactions and their therapeutic implications","authors":"Eric A. Okrah , Claire Allan , Monika S. Doblin , Sarah J. Annesley","doi":"10.1016/j.pharmthera.2025.108943","DOIUrl":"10.1016/j.pharmthera.2025.108943","url":null,"abstract":"<div><div>Cannabidiol (CBD) is one of the major active constituents among the several hundreds of compounds found in the cannabis plant. It is a non-psychoactive compound known for its anti-inflammatory, neuroprotective, antidepressant and anxiolytic effects. In preclinical studies it has shown to be effective, safe, and well-tolerated in mitigating the symptoms associated with Parkinson's disease (PD) and other neurodegenerative diseases. However, the mechanism of action is not fully characterised. CBD is postulated to exert its therapeutic effects through its interaction with the endocannabinoid system (ECS), and via interaction with a large array of non-cannabinoid receptors, neurotransmitters, and enzymes. These interactions are complex and are influenced by cell type, concentration and exposure time. The lack of specificity for a single receptor system makes CBD an intriguing therapeutic compound and enables it to influence multiple pathways. This broad interaction goes beyond its beneficial therapeutic effects and could lead to potential adverse effects. Detailed understanding of the versatility and complexity of how CBD exerts its effect is required so that the true potential as a therapeutic option can be realised.</div></div>","PeriodicalId":402,"journal":{"name":"Pharmacology & Therapeutics","volume":"277 ","pages":"Article 108943"},"PeriodicalIF":12.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145382728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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