sphingosine-1-phosphate and Multiple-Sclerosis--Relapsing-Remitting

The sphingosine-1-phosphate (S1P) regulates diverse biological functions including cell proliferation, endothelial cell chemotaxis, angiogenesis, immune cell trafficking, mitogenesis, heart rate. The first-in-class S1P1,3-5-R pan-agonist fingolimod (FTY720) was approved by the FDA and EMEA for the treatment of relapsing-remitting multiple sclerosis, though the most common adverse effect is bradycardia which occurs in the early stage of treatment and resolves within the first 24 h despite continuing treatment. The underlying mechanism of the cardiovascular effects is the activation of G-protein-gated inwardly rectifying potassium (GIRK) channel by the S1P1-R. Several second generation S1P1-R agonists with distinct selectivity, pharmacokinetics and safety profile from FTY720 are under development for the treatment of autoimmune and chronic inflammatory diseases.. This review provides a summary of the patent literature from 2013 up to November 2015 on the S1P1-R agonist molecules and their relevant biological/pharmacological properties.. The molecules reviewed are S1P1-R agonists with a promising clinical outlook in particular in inflammation and autoimmune diseases. Clinical and preclinical studies of second generation S1P1-R agonists have been generating interesting results and may finally provide pharmacological agents with improved therapeutic profile than FTY720, particularly in terms of cardiovascular and pulmonary liabilities.

Topics: Animals; Autoimmune Diseases; Drug Design; Fingolimod Hydrochloride; Humans; Immunosuppressive Agents; Inflammation; Lysophospholipids; Multiple Sclerosis, Relapsing-Remitting; Patents as Topic; Receptors, Lysosphingolipid; Sphingosine

Fingolimod is a sphingosine 1-phosphate (S1P) receptor modulator approved to treat relapsing-remitting multiple sclerosis (MS). Initiation of treatment with fingolimod has been found to produce transient bradycardia and/or slowing of atrioventricular impulse conduction in a small proportion of patients. This effect is thought to be due to the interaction of fingolimod with S1P receptors on the surface membrane of atrial myocytes causing a vagomimetic effect, similar to the action of acetylcholine on muscarinic receptors. As a precaution, patients are under electrocardiogram (ECG) monitoring for 6 h after receiving their first dose. Fingolimod is contraindicated in patients with overt or concealed cardiac diseases. However, the Fingolimod Initiation and caRdiac Safety Trial (FIRST), which was designed specifically to investigate the cardiac profile of fingolimod, did not show an increased risk of clinically relevant cardiac events with fingolimod. This review examines the electrophysiology and pathophysiology of cardiac impulse formation in the context of fingolimod. It concludes that these vagomimetic effects should be considered benign and should not prevent the effective use of fingolimod in the treatment of patients with MS.

Topics: Animals; Atrioventricular Block; Bradycardia; Electrocardiography; Fingolimod Hydrochloride; Humans; Immunosuppressive Agents; Lysophospholipids; Multiple Sclerosis, Relapsing-Remitting; Propylene Glycols; Receptors, Lysosphingolipid; Sphingosine

Fingolimod is the first oral agent approved in the USA for the treatment of relapsing forms of multiple sclerosis. Fingolimod is a sphingosine 1-phosphate receptor modulator that binds to sphingosine 1-phosphate receptors on lymphocytes, resulting in a downregulation of the receptor and a reversible sequestration of lymphocytes in lymphoid tissue. Effector memory T cells are not sequestered so that immune surveillance may be minimally affected. Two large-scale Phase III clinical trials have demonstrated the efficacy of fingolimod compared with placebo and intramuscular interferon β-1a in relapsing-remitting multiple sclerosis. Due to its mechanism of action, fingolimod administration may be associated with first-dose bradycardia and macular edema. Therefore, patients should be observed for 6 h at the time of their first dose and undergo ophthalmologic evaluation prior to treatment initiation and at 3-4 months after initiation.

Topics: Administration, Oral; Clinical Trials, Phase II as Topic; Clinical Trials, Phase III as Topic; Fingolimod Hydrochloride; Humans; Immunosuppressive Agents; Interferon beta-1a; Interferon-beta; Lymphocytes; Lysophospholipids; Multiple Sclerosis, Relapsing-Remitting; Propylene Glycols; Receptors, Lysosphingolipid; Sphingosine

Sphingosine 1-phosphate (S1P) is a bioactive lipid that has both physiological and pathophysiological roles. It regulates cellular processes such as proliferation, migration, survival and differentiation and affects all organ systems. S1P not only activates S1P-specific receptors to initiate cellular signalling pathways but also directly regulates specific intracellular target proteins. The therapeutic opportunities surrounding S1P signalling are numerous and exemplified by the recent approval of FTY720 (a sphingosine analogue, Gilenya™) for the treatment of relapsing multiple sclerosis. A major focus of research is to develop small-molecule antagonists/agonists/inhibitors that are specific to the different S1P receptor subtypes and the enzymes that regulate S1P levels. This review describes fundamental aspects of S1P biology with an emphasis on the translational potential of intervention therapeutics.

Topics: Animals; Gene Expression Regulation; Humans; Intracellular Space; Lysophospholipids; Membrane Proteins; Multiple Sclerosis, Relapsing-Remitting; Phosphoric Monoester Hydrolases; Phosphotransferases (Alcohol Group Acceptor); Receptors, Lysosphingolipid; Sphingosine; Translational Research, Biomedical

FTY720 (fingolimod, Novartis) is a promising investigational drug for relapsing forms of multiple sclerosis (MS), an autoimmune and neurodegenerative disorder of the central nervous system. It is currently under FDA review in the United States, and could represent the first approved oral treatment for MS. Extensive, ongoing clinical trials in Phase II/III have supported both the efficacy and safety of FTY720. FTY720 itself is not bioactive, but when phosphorylated (FTY720-P) by sphingosine kinase 2, it becomes active through modulation of 4 of the 5 known G protein-coupled sphingosine 1-phosphate (S1P) receptors. The mechanism of action (MOA) is thought to be immunological, where FTY720 alters lymphocyte trafficking via S1P1. However, MOA for FTY720 in MS may also involve a direct, neurological action within the central nervous system in view of documented S1P receptor-mediated signaling influences in the brain, and this review considers observations that support an emerging neurological MOA.

Topics: Animals; Drugs, Investigational; Fingolimod Hydrochloride; Humans; Immunosuppressive Agents; Lysophospholipids; Multiple Sclerosis, Relapsing-Remitting; Neuroglia; Phosphorylation; Prodrugs; Propylene Glycols; Protein Isoforms; Receptors, Lysosphingolipid; Signal Transduction; Sphingosine

Sphingosine-1-phosphate (S1P(1)) receptor agonists such as Fingolimod (FTY-720) are a novel class of immunomodulators that have clinical utility in the treatment of remitting relapsing multiples sclerosis. This class of compound act by inducing peripheral lymphopenia. Using an integrated pharmacokinetic/pharmacodynamic (PK-PD) approach based on an in vivo rat model, novel S1P(1) agonists were identified with a predicted more rapid rate of reversibility of lymphocyte reduction in human compared to Fingolimod. The in vivo potency of 15 compounds based on PK-PD modelling of the rat lymphocyte reduction model was correlated with in vitro measures of potency at the S1P(1) receptor using β arrestin recruitment and G-protein signalling. A structurally novel S1P(1) agonist was identified and predictions of human pharmacokinetics and clinical dose are presented.

Topics: Animals; Arrestin; Fingolimod Hydrochloride; GTP-Binding Proteins; Lymphocytes; Lysophospholipids; Male; Multiple Sclerosis, Relapsing-Remitting; Propylene Glycols; Rats; Rats, Inbred Strains; Signal Transduction; Sphingosine

Sphingosine 1-phosphate (S1P) is a pleiotropic mediator that is critically involved in the development of an inflammatory response in various pathological conditions. We hypothesize that during the course of multiple sclerosis (MS) development, chronic inflammation will result in the alteration of S1P levels in blood and cerebrospinal fluid (CSF). We evaluated S1P concentrations in blood and CSF obtained from 66 subjects, including 40 patients diagnosed with MS and 26 subjects of a control group that included patients diagnosed with idiopathic cephalgia and idiopathic (Bell's) facial nerve palsy. HPLC techniques were used to determine S1P levels. We found that S1P concentrations in blood of the MS subject group (361.7+/-150.7 nM) did not differ from those of the control group (371.9+/-142.5 nM). However, S1P concentrations in CSF of the MS group were significantly higher (p<0.01) compared to the control group (2.2+/-2.7 versus 0.69+/-1.1 nM). The increase of S1P concentration in CSF of MS subjects suggests that this bioactive lipid is involved in chronic inflammation associated with MS and it may be useful to study S1P in a number of neurodegenerative diseases to provide better understanding of the mechanisms governing their development.

Topics: Adult; Female; Humans; Lysophospholipids; Male; Multiple Sclerosis, Relapsing-Remitting; Sphingosine

Topics: Animals; Autoantigens; Cell Movement; Central Nervous System; Down-Regulation; Fingolimod Hydrochloride; Humans; Immunosuppressive Agents; Lymph Nodes; Lysophospholipids; Multiple Sclerosis; Multiple Sclerosis, Relapsing-Remitting; Propylene Glycols; Sphingosine; T-Lymphocytes