Pharmaceuticals

18 pages, 390 KB

Open AccessReview

Progressive Sensorineural Hearing Loss Following Cisplatin Chemotherapy: Mechanisms Underlying Cochlear Retention and Long-Term Ototoxicity

by Antonio Ruggiero, Pasqualina Maria Picciotti, Stefano Mastrangelo, Alberto Romano, Dario Talloa, Jacopo Galli and Giorgio Attinà

Pharmaceuticals 2026, 19(5), 779; https://doi.org/10.3390/ph19050779 (registering DOI) - 15 May 2026

Abstract

Cisplatin-induced ototoxicity is a permanent, bilateral sensorineural hearing loss occurring in up to 80% of treated patients. Its defining and clinically challenging feature is the progressive worsening of auditory function that continues well after chemotherapy has ended, a trajectory that cannot be explained [...] Read more.

Cisplatin-induced ototoxicity is a permanent, bilateral sensorineural hearing loss occurring in up to 80% of treated patients. Its defining and clinically challenging feature is the progressive worsening of auditory function that continues well after chemotherapy has ended, a trajectory that cannot be explained by cumulative dose alone. This article is a comprehensive review of the present research studies on mechanisms that are responsible for this post-treatment progression. The cochlea, unlike other organs, appears to be unable to eliminate platinum (the active divalent metal ion released from cisplatin and responsible for its cytotoxic and ototoxic effects): traces of it can be found in human temporal bone tissue even more than 18 months after last infusion, and bone might serve as a long-term systemic reservoir. Within the inner ear, platinum accumulates preferentially in the stria vascularis, impairing endocochlear potential and outer hair cell function. Retained platinum sustains cascading effects including sustained NOX3-dependent oxidative stress, mitochondrial dysfunction, ongoing genotoxic injury to non-regenerative cells, and the early loss of ribbon synapses that precipitates delayed spiral ganglion neurodegeneration. Pharmacogenetic variability in platinum transport and antioxidant metabolism further modulates individual susceptibility. These findings support lifelong audiological surveillance and provide a basis for designing strategies that can protect hearing without compromising the essential anticancer efficacy of cisplatin therapy. Full article

(This article belongs to the Section Pharmacology)

36 pages, 761 KB

Open AccessArticle

Interpretable QSAR, External PubChem Validation, and Coordination-Aware Docking Enable Tiered Prioritization of Carbonic Anhydrase I Inhibitors

by Alaa M. Elsayad and Khaled A. Elsayad

Pharmaceuticals 2026, 19(5), 778; https://doi.org/10.3390/ph19050778 (registering DOI) - 15 May 2026

Abstract

Background/Objectives: Carbonic anhydrase I (CAI) is a zinc-dependent metalloenzyme whose inhibitor discovery requires both effective navigation of chemical space and explicit evaluation of coordination-credible binding hypotheses. We aimed to develop an interpretable and reproducible QSAR-to-structure workflow for CAI inhibitor discovery. The workflow links [...] Read more.

Background/Objectives: Carbonic anhydrase I (CAI) is a zinc-dependent metalloenzyme whose inhibitor discovery requires both effective navigation of chemical space and explicit evaluation of coordination-credible binding hypotheses. We aimed to develop an interpretable and reproducible QSAR-to-structure workflow for CAI inhibitor discovery. The workflow links potency prediction with zinc-site plausibility and early developability to support decision-oriented prioritization of new CAI inhibitor candidates. Methods: CAI inhibitors were retrieved from ChEMBL (CHEMBL261) and modeled as pK_i = 9 – log₁₀(K_i[nM]). AlvaDesc v3.0.8 generated 4224 2D descriptors, which were reduced using train-only preprocessing, variance filtering, correlation pruning, and bagged-tree ranking to a top-100 panel. Five regressors (elastic net, CART, bagging, GB, and XGB) were benchmarked on a held-out test set. Potent ChEMBL seeds (K_i ≤ 10 nM) were used for a 90% 2D similarity PubChem expansion. Predicted hits were then externally validated using independently available PubChem CAI K_i records. Ten novel candidates lacking CAI K_i data were docked to CAI (PDB: 1AZM) via SwissDock AutoDock Vina in neutral and relevant anionic states, with pose selection constrained by a Zn-donor filter (Zn-N/O ≤2.6 Å). SwissADME was used to profile physicochemical space, alerts, and absorption/distribution proxies. Results: The bagging model showed the best test generalization (R² = 0.646; RMSE = 0.61; MAE = 0.45). PFI and SHAP converged on sulfur/heteroatom connectivity and polar–lipophilic organization as dominant potency drivers. PubChem expansion yielded 25,315 analogs and 233 candidates at predicted pK_i ≥ 8.0; external validation on 145 CAI-measured hits gave R² = 0.358 (RMSE = 0.456; MAE = 0.320). Across 20 ligand/protomer docking runs, 12 produced canonical Zn-anchored poses (10 Zn-N; 2 Zn-O). SwissADME indicated consensus logP values from −0.65 to 3.21, 0/10 PAINS alerts, and predominantly favorable drug-likeness (8/10 with zero Lipinski violations), supporting tiered advancement. Conclusions: Integrating interpretable QSAR, external PubChem validation, coordination-aware docking, and SwissADME yields a practical triage framework for CAI inhibitor discovery. The resulting tiered shortlist identifies two Zn-N-anchored N-alkyl sulfamides (CIDs 103935964 and 112684680) and one Zn-O-anchored carboxylate control (CID 122367674) as highest-priority computational hypotheses for staged biochemical evaluation. Full article

(This article belongs to the Section Medicinal Chemistry)

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22 pages, 1418 KB

Open AccessArticle

MSC-Derived Apoptotic Vesicles Restore Bone Marrow Niche Homeostasis in Postmenopausal Osteoporosis by miRNA-Mediated Suppression of MAPK and NF-κB Signaling Nodes

by Zhiwen Tu, Haolin Wu, Youxi Jiang, Xinxin Li, Zhiqing Huang, Songtao Shi and Ruibao Ren

Pharmaceuticals 2026, 19(5), 777; https://doi.org/10.3390/ph19050777 (registering DOI) - 15 May 2026

Abstract

Background: Postmenopausal osteoporosis is associated with cellular senescence and the accumulation of the senescence-associated secretory phenotype (SASP). While mesenchymal stem cell (MSC)-derived exosomes show tissue repair potential, the efficacy and mechanisms of MSC-derived apoptotic vesicles (apoVs) remain unclear. This study compared MSC-apoVs [...] Read more.

Background: Postmenopausal osteoporosis is associated with cellular senescence and the accumulation of the senescence-associated secretory phenotype (SASP). While mesenchymal stem cell (MSC)-derived exosomes show tissue repair potential, the efficacy and mechanisms of MSC-derived apoptotic vesicles (apoVs) remain unclear. This study compared MSC-apoVs and exosomes in postmenopausal osteoporosis and investigated the underlying epigenetic mechanisms. Methods: Therapeutic efficacy was evaluated in an ovariectomized (OVX) mouse model and senescent human bone marrow mesenchymal stem cells (hBMMSCs). Small RNA sequencing identified differential microRNA (miRNA) cargos between vesicle types. SASP-related cytokine expression (IL-6, TNF-α, MCP-1) and pathway activation were assessed by RT-qPCR, ELISA, and Western blot. Results: MSC-apoV treatment attenuated bone loss in OVX mice and reduced SASP expression in senescent hBMMSCs to a greater extent than exosomes. Small RNA sequencing revealed that apoVs were enriched with a specific miRNA cluster, including hsa-let-7b-5p, hsa-miR-92a-3p, and hsa-miR-98-5p. Bioinformatic analyses identified BRAF and CRKL as downstream targets of this miRNA cluster, supported by reduced protein levels after apoV treatment. Subsequent molecular assays showed that apoV treatment inhibited the phosphorylation of both the MAPK (p38 and JNK) and NF-κB (p65) signaling pathways, which correlated with reduced local inflammation in the bone marrow microenvironment and preserved osteogenic differentiation capacity. Conclusions: MSC-apoVs attenuate postmenopausal osteoporosis more effectively than exosomes. This enhanced efficacy is associated with the delivery of an enriched miRNA cluster that inhibits MAPK and NF-κB signaling, together with suppression of BRAF and CRKL protein expression. ApoVs may represent a cell-free therapeutic strategy for age-related bone loss. Full article

(This article belongs to the Section Biopharmaceuticals)

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28 pages, 6281 KB

Open AccessSystematic Review

Effectiveness and Safety of Liuwei Dihuang as an Adjunctive Therapy for Cognitive Impairment: A Systematic Review, Meta-Analysis, and Network Pharmacology Analysis

by Jihyun Hwang, Mi Hye Kim, Jeongrim Bak, Jong-Min Yun and Jungtae Leem

Pharmaceuticals 2026, 19(5), 776; https://doi.org/10.3390/ph19050776 (registering DOI) - 15 May 2026

Abstract

Background/Objectives: Liuwei Dihuang (LWDH) is a classical plant-derived herbal formula widely used for cognitive decline. This study aimed to evaluate its efficacy and safety in cognitive disorders and to explore its potential pharmacological mechanisms using network pharmacology. Methods: We searched 11 [...] Read more.

Background/Objectives: Liuwei Dihuang (LWDH) is a classical plant-derived herbal formula widely used for cognitive decline. This study aimed to evaluate its efficacy and safety in cognitive disorders and to explore its potential pharmacological mechanisms using network pharmacology. Methods: We searched 11 databases through November 2024 for randomized controlled trials comparing LWDH plus conventional therapy with conventional therapy alone in cognitive disorders. Meta-analysis was performed for clinical outcomes, and herb–compound–target and disease-target datasets were integrated to identify core molecular modules. Results: Twelve randomized controlled trials involving 1137 participants were included. Adjunctive LWDH was associated with improvements in Mini-Mental State Examination scores (MD = 2.34, 95% CI 0.88–3.79), activities of daily living, and quality of life. However, substantial heterogeneity and methodological limitations, including unclear randomization and blinding, were observed across studies, indicating a potential risk of bias. Fewer adverse events were reported in the LWDH plus conventional treatment group, although reporting quality was limited. The overall risk of bias was judged as “some concerns”. Network pharmacology analysis identified a broad set of overlapping genes between LWDH-associated targets and cognitive disorder-related genes, which were further refined through filtering procedures. Subsequent analyses suggested associations with pathways related to neurodegeneration, apoptosis, and central nervous system function; however, these findings are exploratory and based on in silico predictions. Conclusions: LWDH may be associated with potential adjunctive benefits in cognitive disorders. However, given the methodological limitations and clinical heterogeneity of the included studies, the findings should be interpreted with caution. The proposed pharmacological mechanisms are exploratory and require further validation. Well-designed randomized controlled trials are needed to establish more robust evidence. Full article

(This article belongs to the Special Issue Plant-Derived Products in the Treatment of Internal Diseases: 2nd Edition)

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32 pages, 1963 KB

Open AccessArticle

Anti-Inflammatory Evaluation of Pyrazino[2,1-b]quinazoline-3,6-dione Derivatives Inspired by Fiscalin B

by Márcia S. Martins, Madalena M. M. Pinto, Isabel F. Almeida, Maria T. Cruz and Emília Sousa

Pharmaceuticals 2026, 19(5), 775; https://doi.org/10.3390/ph19050775 (registering DOI) - 15 May 2026

Abstract

Background/Objectives: Chronic inflammatory skin diseases are frequently associated with pruritus, in which the neurokinin-1 receptor (NK₁R) and its ligand substance P (SP) play a central role. The development of compounds combining anti-inflammatory and antipruritic effects represents a promising therapeutic strategy. This [...] Read more.

Background/Objectives: Chronic inflammatory skin diseases are frequently associated with pruritus, in which the neurokinin-1 receptor (NK₁R) and its ligand substance P (SP) play a central role. The development of compounds combining anti-inflammatory and antipruritic effects represents a promising therapeutic strategy. This study aims to identify fiscalin B derivatives as anti-inflammatory agents with high affinity to NK₁R using an integrated in silico and in vitro approach. Methods: A library of fiscalin B derivatives was screened through molecular docking against NK₁R to identify high-affinity ligands. Selected compounds were further evaluated using in silico ADMET and toxicity predictions. In vitro assays were conducted in HaCaT keratinocytes, RAW264.7 macrophages, and NIH/3T3 fibroblasts to assess cytotoxicity, nitric oxide production, inflammatory proteins expression, and cell migration. Results: Docking studies identified several derivatives with predicted binding affinities comparable to or exceeding those of aprepitant, a well-established NK₁R antagonist. Several compounds, particularly 2, 3, 4, 6, and 7, reduced lipopolysaccharide-induced nitric oxide production to 41–51% without relevant cytotoxicity. This effect was associated with reduced iNOS protein levels, suggesting modulation of inflammatory pathways rather than direct nitric oxide scavenging. Most compounds showed positive safety profiles, although in silico analysis indicated limited biodegradability and potential aquatic toxicity. Conclusions: The fiscalin B derivatives, 2, 3, and 4, demonstrate potential as anti-inflammatory agents, in vitro, and as NK₁R high affinity ligands, in silico. These findings support their potential as lead compounds for topical therapies for inflammatory skin disorders associated with pruritus, although further optimization and validation are required. Full article

(This article belongs to the Section Medicinal Chemistry)

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16 pages, 2765 KB

Open AccessArticle

Biological Sex Influences the Pharmacokinetics and Organ Dosimetry of ¹⁷⁷Lu-DOTATATE: A Systematic Preclinical Evaluation

by Xiangsheng Kong, Peishang Li, Zhiqian Wang, Chenchen Cai, Mingjie Zhang, Chunmiao Qu, Chunlei Jin, Hongzhang Zhang, Yeqing Dong, Kai Lv and Fei Han

Pharmaceuticals 2026, 19(5), 774; https://doi.org/10.3390/ph19050774 (registering DOI) - 15 May 2026

Abstract

Background/Objectives: While ¹⁷⁷Lu-DOTATATE has demonstrated clinical efficacy in peptide receptor radionuclide therapy (PRRT) for neuroendocrine tumors (NETs), current dosing regimens do not account for potential sex-based pharmacokinetic differences. Our study systematically characterizes sex-dependent pharmacokinetic variations of ¹⁷⁷Lu-DOTATATE in preclinical models to [...] Read more.

Background/Objectives: While ¹⁷⁷Lu-DOTATATE has demonstrated clinical efficacy in peptide receptor radionuclide therapy (PRRT) for neuroendocrine tumors (NETs), current dosing regimens do not account for potential sex-based pharmacokinetic differences. Our study systematically characterizes sex-dependent pharmacokinetic variations of ¹⁷⁷Lu-DOTATATE in preclinical models to provide the first preclinical evidence base informing future sex-stratified clinical investigations. Methods: Sex-stratified pharmacokinetic and biodistribution studies were conducted in male and female SD rats following intravenous administration of ¹⁷⁷Lu-DOTATATE at multiple dose levels: 2.86, 5.71, and 11.43 mCi/kg. Metabolic stability and renal excretion patterns were characterized. Safety assessments included acute toxicity, vascular irritation, hemolysis, and allergenicity testing. Therapeutic efficacy was evaluated exclusively in female AR42J xenograft-bearing CB-17 SCID mice. Results: Significant sex-dependent pharmacokinetic differences were observed at high (11.43 mCi/kg) and low (2.86 mCi/kg) dose levels, with females exhibiting 30–40% higher AUC and C_max values compared to males (p < 0.05). Both sexes demonstrated preferential accumulation in SSTR-expressing tissues, particularly the pancreas (females: 10.87 ± 2.51% ID/g; males: 9.10 ± 0.76% ID/g) and adrenal glands, with rapid clearance from non-target organs. Radio-HPLC analysis confirmed high metabolic stability with no detectable radiolabeled metabolites, and over 90% of radioactivity was recovered through renal excretion. Safety assessments demonstrated excellent tolerability across dose levels. In female xenograft models, treatment achieved tumor growth inhibition of 92.35–96.44% and 100% survival rate versus 10% in controls, though mid/high doses caused weight loss. Conclusions: Our study provides systematic preclinical evidence of sex-dependent pharmacokinetic differences in ¹⁷⁷Lu-DOTATATE, with females demonstrating significantly higher systemic exposure than males at specific dose levels. These findings establish the systematic preclinical evidence base for sex-dependent pharmacokinetic differences in ¹⁷⁷Lu-DOTATATE, providing a scientific rationale for incorporating sex as a stratification variable in future dosimetry-guided clinical studies. Full article

(This article belongs to the Section Pharmacology)

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19 pages, 18707 KB

Open AccessArticle

Investigation of the Effects of Saffron on Neuroprotection and Circadian Rhythm in an In Vitro Parkinson’s Model

by Ayse Aksoy, Duygu Deniz Usta and Atiye Seda Yar

Pharmaceuticals 2026, 19(5), 773; https://doi.org/10.3390/ph19050773 (registering DOI) - 15 May 2026

Abstract

Background/Objectives: Parkinson’s disease (PD) is a progressive neurodegenerative disorder characterized by dopaminergic neuronal loss, oxidative stress, and mitochondrial dysfunction. Although levodopa (L-Dopa) remains the main symptomatic treatment, prolonged administration can lead to adverse effects. Safranal, a bioactive constituent of Crocus sativus, has [...] Read more.

Background/Objectives: Parkinson’s disease (PD) is a progressive neurodegenerative disorder characterized by dopaminergic neuronal loss, oxidative stress, and mitochondrial dysfunction. Although levodopa (L-Dopa) remains the main symptomatic treatment, prolonged administration can lead to adverse effects. Safranal, a bioactive constituent of Crocus sativus, has antioxidant and anti-apoptotic properties. This study evaluated the neuroprotective potential of L-Dopa and safranal, individually and in combination, in an in vitro cell-culture PD model. Methods: SH-SY5Y human neuroblastoma cells were treated with 6-hydroxydopamine (6-OHDA, 50 µM) to induce cytotoxicity. Cells were pretreated with L-Dopa (5–500 µM) and safranal (1–500 µM and 1–5 mM) for 4 or 24 h. Cell viability was assessed using 3-(4, 5-dimethylthiazol-2-yl)2,5-diphenyl-tetrazolium bromide (MTT) and lactate dehydrogenase (LDH) assays. Mitochondrial membrane potential (MMP), caspase-3/7 activity, and autophagy markers were also evaluated. Synergy was analyzed using Combination Index (CI) analysis. Furthermore, mRNA levels of circadian rhythm associated genes were also evaluated. Results: 6-OHDA significantly impaired cell viability and mitochondrial function. Pretreatment with low doses of L-Dopa and safranal partially improved cell viability and reduced apoptosis and showed a tendency to decrease autophagy-associated marker levels. Higher L-Dopa concentrations caused mild cytotoxicity, while high-dose safranal exhibited pronounced concentration-dependent toxicity. CI analysis confirmed synergistic interaction between both drugs in mitigating 6-OHDA-induced toxicity. Combined treatment markedly improved cell survival preserved mitochondrial function, and reduced caspase-3/7 activity compared with monotherapy. A significant increase in the mRNA levels of Per1, Clock, Bmal1 and Cry1 genes was observed in groups treated with L-Dopa and safranal together. Conclusions: L-Dopa and safranal exerted concentration-dependent neuroprotective effects in SH-SY5Y cells. Their combination enhanced cytoprotection, which was associated with modulation of mitochondrial function, oxidative stress, apoptosis, and autophagy-related responses. Full article

(This article belongs to the Section Pharmacology)

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19 pages, 3160 KB

Open AccessArticle

Lipidomics-Based Investigation of the Effects of Ginsenoside FI on Free Fatty Acid-Induced Metabolism in HepG2 Cells

by Jie Zhou, Dai-Feng Su, Yu-Xin Chi, Quan-Cheng Chen, Yu-Xin Huang, Shu-Xian Chen, Shuang Liu, Jin-Hao Liu and Wei-Yun Zhang

Pharmaceuticals 2026, 19(5), 772; https://doi.org/10.3390/ph19050772 (registering DOI) - 15 May 2026

Abstract

Objective: This study investigated the effects of ginsenoside F1 on lipid metabolism using cell-based assays combined with lipidomics. Methods: The optimal non-cytotoxic concentration of ginsenoside F1 was determined by the CCK-8 assay. A hyperlipidemic cell model was established by inducing HepG2 cells with [...] Read more.

Objective: This study investigated the effects of ginsenoside F1 on lipid metabolism using cell-based assays combined with lipidomics. Methods: The optimal non-cytotoxic concentration of ginsenoside F1 was determined by the CCK-8 assay. A hyperlipidemic cell model was established by inducing HepG2 cells with free fatty acids (FFAs). Model cells were treated with ginsenoside F1 (0.2 µM, 0.8 µM, and 3.2 µM) or simvastatin (3.2 µM, positive control) for 24 h. Intracellular lipid accumulation was determined by measuring absorbance at 510 nm, together with quantification of total cholesterol (TC) and triglyceride (TG) contents. Untargeted lipidomics was employed to explore alterations in the lipid profile and identify relevant metabolic pathways. Results: Compared with the model group, lipid deposition, total cholesterol, and triglycerides were significantly reduced by ginsenoside F1 (p < 0.05). A total of 110 differential metabolites, mainly phosphatidylinositol and phosphatidylcholines, were identified by lipidomics, with glycerophospholipid and ether lipid metabolism highlighted as the key regulated pathways. Potential roles of targets including Akt1, PPARG, and EGFR, as well as pathways related to cancer and lipid metabolism, were further indicated by network pharmacology and molecular docking. Conclusions: FFA-induced lipid disorders in HepG2 cells were alleviated by ginsenoside F1, potentially through the regulation of glycerophospholipid metabolism. Full article

(This article belongs to the Section Pharmacology)

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25 pages, 413 KB

Open AccessArticle

Disproportionality and Case-Based Evidence for a Possible Association Between Fluoroquinolones and Kounis Syndrome

by Milena Cmiljanić, Miloš Milosavljević, Filip Jovčić, Mladen Pavlović and Srdjan Stefanović

Pharmaceuticals 2026, 19(5), 771; https://doi.org/10.3390/ph19050771 (registering DOI) - 14 May 2026

Abstract

Background/Objectives: Drug-induced hypersensitivity and cardiotoxicity are important yet often underrecognized clinical concerns, and fluoroquinolones are widely used antibiotics with well-documented safety issues. Given the limited systematic evidence and underreporting in pharmacovigilance databases, this study explored a potential association between fluoroquinolones and Kounis [...] Read more.

Background/Objectives: Drug-induced hypersensitivity and cardiotoxicity are important yet often underrecognized clinical concerns, and fluoroquinolones are widely used antibiotics with well-documented safety issues. Given the limited systematic evidence and underreporting in pharmacovigilance databases, this study explored a potential association between fluoroquinolones and Kounis syndrome (KS) and the possibility of a class-related effect. Methods: This retrospective descriptive study analyzed individual case safety reports from VigiBase, complemented by published case reports to capture additional cases not recorded in the database. All fluoroquinolones reported as suspected drugs in KS cases were included, and a systematic search of major literature databases was undertaken to identify further case-level evidence. Quantitative data were explored using VigiLyze, while qualitative clinical data were extracted for case characterization. Literature cases underwent Naranjo assessment, and the overall body of evidence was evaluated using a qualitative Bradford Hill framework. Results: A descriptive disproportionality signal for fluoroquinolones was identified in VigiBase (IC₀₂₅ = 1.3). Seventeen cases of fluoroquinolone-associated KS were identified across VigiBase and the published literature, all originating from unsolicited sources. Most cases involved ciprofloxacin and levofloxacin, whereas other fluoroquinolones were only rarely reported. Across cases, a consistent clinical pattern was observed, including a clear temporal relationship between drug exposure, allergic manifestations, and acute coronary events, compatible with hypersensitivity-mediated coronary involvement. Conclusions: KS cases associated with several fluoroquinolones were identified in pharmacovigilance data and the published literature, with the most consistent evidence observed for ciprofloxacin and levofloxacin. Although a class effect was not confirmed, a potential association cannot be excluded. These findings should be interpreted as hypothesis-generating, and further research is required to clarify underlying mechanisms, drug-specific risks, and clinical relevance. Full article

(This article belongs to the Section Pharmacology)

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26 pages, 4825 KB

Open AccessArticle

Physical Exercise Enhances Melatonin Effect in D-Galactose/Aluminum Chloride-Induced Alzheimer’s Disease of Ovariectomized Rats: Irisin Induction Associated with Upregulation of PPAR-γ/IGF-1/BDNF and Decreasing TNF-α/p38-MAPK/NLRP3/GFAP Pathway

by Ghada A. Badawi, Rawan S. Shaaban, Jawza A. Almutairi, Thanaa A. El-Masry, Hala F. Zaki and Sherehan M. Ibrahim

Pharmaceuticals 2026, 19(5), 770; https://doi.org/10.3390/ph19050770 (registering DOI) - 14 May 2026

Abstract

Background: Postmenopausal women are at high risk of Alzheimer’s disease (AD) incidence and progression. Irisin, an exercise-induced myokine, has neuroprotective and antiaging effects against AD, especially in menopausal women suffering from insulin resistance (IR). For the first time, the novel role of [...] Read more.

Background: Postmenopausal women are at high risk of Alzheimer’s disease (AD) incidence and progression. Irisin, an exercise-induced myokine, has neuroprotective and antiaging effects against AD, especially in menopausal women suffering from insulin resistance (IR). For the first time, the novel role of irisin induced by melatonin (MTN) or/and physical exercise (PHE) was investigated in the current ovariectomized (OVX)/AD rat model by modulating brain neuroinflammation and IR-related markers. Methods: Fifty female Wistar rats were divided into five groups, with one representing a sham group. AD was induced in the other four bilateral OVX rat groups by daily intraperitoneal injection of D-galactose/AlCl₃ (60 and 10 mg/kg, respectively) for 42 days. Group III–V: Animals were exposed to MTN (10 mg/kg/day; i.p.), PHE, and a combination of these, respectively, in the final 14 days of the experiment. Results: The OVX/AD rats showed significant deterioration in learning, memory, neurochemical, and histopathological examinations, while the MTN or/and PHE treatments significantly increased serum and brain irisin, improving memory in a Y-maze assessment. Thus, hippocampal histopathological alterations and IR-related markers decreased. In addition, suppressed hippocampal amyloid-beta protein expression and neuroinflammatory content of tumor necrosis factor-alpha (TNF-α), p38 mitogen-activated protein kinase (p38 MAPK), and NOD-like receptor protein-3 (NLRP3) were associated with an increase in peroxisome proliferator-activated receptor-gamma (PPAR-γ) protein expression and insulin-like growth factor-1 content in hippocampal tissues, collectively suppressing glial fibrillary acidic protein (GFAP) content, leading to an increase in brain-derived neurotrophic factor expression. Conclusions: Irisin induction may serve as a novel avenue in AD/menopause treatment and prevention via modulating the TNF-α/p38 MAPK/PPAR-γ/NLRP3/GFAP pathway. Full article

(This article belongs to the Special Issue Novel Therapeutic Strategies for Alzheimer’s Disease Treatment)

28 pages, 1814 KB

Open AccessReview

Hyperglycaemia-Induced Metabolic Stress Promotes EMT-Driven Therapeutic Resistance in Cancer: Evidence of a Deleterious Feed-Forward Cycle

by Rabia Zafar, Thanh Dat Pham, Lupeuea Vakafua, Teana Reed and Naisana Seyedasli

Pharmaceuticals 2026, 19(5), 769; https://doi.org/10.3390/ph19050769 (registering DOI) - 14 May 2026

Abstract

The phenotypic plasticity of epithelial cells along the epithelial–mesenchymal (E-M) axis, or epithelial–mesenchymal transition (EMT), is a critical aspect of tumour progression and therapeutic resistance. During EMT, epithelial cells gradually acquire mesenchymal traits, facilitating vital functions in embryogenesis, wound healing, fibrosis, and tumour [...] Read more.

The phenotypic plasticity of epithelial cells along the epithelial–mesenchymal (E-M) axis, or epithelial–mesenchymal transition (EMT), is a critical aspect of tumour progression and therapeutic resistance. During EMT, epithelial cells gradually acquire mesenchymal traits, facilitating vital functions in embryogenesis, wound healing, fibrosis, and tumour metastasis. This review article investigates the potential interplay between hyperglycaemia-induced metabolic stress and EMT in the context of therapeutic resistance. The study examines a complex, multifaceted network of molecular mechanisms regulating EMT, including specialised transcription factors and signalling pathways as well as growth factors, integrins, and matrix metalloproteinases in various epithelial carcinomas. Emerging findings have demonstrated the existence of EMT hybrid states along the continuum, possessing heightened metastatic potential and distinctive metabolic signatures that play critical roles in the development of therapeutic resistance in cancer cells. Hyperglycaemia has been particularly highlighted for its potential to promote EMT-driven therapeutic resistance through various interconnected mechanisms. Elevated glucose levels induce the increased production of reactive oxygen species (ROS), activation of EMT-promoting transcription factors, and a metabolic shift towards glycolysis. This hyperglycaemic stress involves upregulation of glucose transporters and glycolytic enzymes, creating feed-forward loops that support drug efflux mechanisms and help maintain the mesenchymal phenotype. Clinical data also indicate that hyperglycaemia in OSCC patients is associated with more advanced tumour stages, more extended hospital stays, less effective treatments, and higher rates of local recurrence and distant metastasis. Overall, these insights reveal a deleterious feed-forward loop in which hyperglycaemia promotes EMT-driven therapeutic resistance, with the strongest clinical evidence in oral squamous cell carcinoma (OSCC) and supportive data from pancreatic and breast cancers. Although glycaemic control represents a promising low-risk adjunctive approach, its clinical benefit remains to be validated in prospective interventional studies. Full article

(This article belongs to the Special Issue Epithelial Plasticity and Therapy Resistance in Cancer)

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27 pages, 1786 KB

Open AccessArticle

Antitumor Activity of Cannabinoids and Their Interaction with Chemotherapy: A Systematic Review and Meta-Analysis of Preclinical Evidence

by Ioana Creangă-Murariu, Ioana-Irina Rezuș, Roshanak Karami, Amir Makolli, Codrin Chifu, Anett Rancz, Zoltán Sipos, Péter Ferdinandy, Renáta Papp, Brigitta Teutsch, Bogdan-Ionel Tamba, Péter Hegyi and Stefania Bunduc

Pharmaceuticals 2026, 19(5), 768; https://doi.org/10.3390/ph19050768 (registering DOI) - 14 May 2026

Abstract

Background: Cannabinoids are studied as anticancer agents, but their effects vary across tumors, compounds, and experimental settings, underscoring the need to define consistent patterns. Our objective was to map cannabinoid efficacy across cancer preclinical models and identify tumor settings with the greatest [...] Read more.

Background: Cannabinoids are studied as anticancer agents, but their effects vary across tumors, compounds, and experimental settings, underscoring the need to define consistent patterns. Our objective was to map cannabinoid efficacy across cancer preclinical models and identify tumor settings with the greatest translational promise. Methods: The protocol was registered on PROSPERO (CRD42025543744); PubMed, Embase, and CENTRAL were searched on 4 April 2024 for in vitro and in vivo studies assessing cannabinoid antitumor effects alone or with chemotherapy versus vehicle or chemotherapy only. Random-effects models yielded pooled mean differences (MD) with 95% confidence intervals (CI). MDs of viable cells were calculated for in vitro assays and tumor volume (mm³) for in vivo studies. Reports of various compounds, cannabidiol (CBD), tetrahydrocannabinol (THC) or synthetic cannabinoids, were pooled. Results: We included 189 studies in the final analysis. In vitro, cannabinoids reduced cell viability modestly overall, with significant effects in glioblastoma (MD −18.77 [CI: −27.15; −10.39]) and a nonsignificant trend in breast cancer (MD −6.75 [CI: −13.90; 0.40]). For in vivo, monotherapy showed the most consistent efficacy in glioblastoma, significantly reducing tumor volume by MD −980.58 mm³; [CI: −1270.2; −690.88]. Addition to temozolomide produced a favorable but nonsignificant decrease of MD −220.65 mm³; [CI: −579.34; 138.03, vs. temozolomide]. In breast cancer, cannabinoids achieved smaller yet significant tumor reductions (MD −402.64 mm³); [CI: −671.84; −133.45]. Synthetic agents had the largest effect (MD −1295.19 mm³); [CI: −1664.33; −928.05] -CBD plus doxorubicin vs. doxorubicin). Lung cancer (MD −562.17 mm³); [CI: −693.99; −430.35] and prostate cancer (MD −1136.59 mm³); [95% CI: −1320.97; −952.21] also had a significant response, whereas colon, pancreatic, and hepatocellular carcinoma models showed inconsistent or null responses. Conclusions: Cannabinoids show promise as adjuncts in oncotherapy, particularly in glioblastoma and breast cancer, to enhance chemotherapy efficacy. These findings should be interpreted with caution given the high inter-study heterogeneity typical of preclinical research and should be considered hypothesis-generating, warranting further validation in standardized and clinically relevant models. Full article

(This article belongs to the Section Pharmacology)

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17 pages, 1399 KB

Open AccessArticle

Interpretable Two-Stage Machine Learning for Early and Full Drug Release Prediction in PLGA Microspheres

by Younghun Song, Saroj Bashyal, Hyuk Jun Cho, Mi Ran Woo, Jong Oh Kim and Duhyeong Hwang

Pharmaceuticals 2026, 19(5), 767; https://doi.org/10.3390/ph19050767 (registering DOI) - 14 May 2026

Abstract

Background/Objectives: Poly(lactic-co-glycolic acid) (PLGA) microspheres are widely used in long-acting injectable (LAI) formulations because PLGA exhibits well-established biocompatibility and undergoes controlled hydrolytic degradation into metabolizable byproducts. However, optimization of microspheres typically requires time-consuming in vitro testing. Therefore, we developed a predictive machine learning [...] Read more.

Background/Objectives: Poly(lactic-co-glycolic acid) (PLGA) microspheres are widely used in long-acting injectable (LAI) formulations because PLGA exhibits well-established biocompatibility and undergoes controlled hydrolytic degradation into metabolizable byproducts. However, optimization of microspheres typically requires time-consuming in vitro testing. Therefore, we developed a predictive machine learning model for early-stage and full time-dependent release profiles of drug-loaded PLGA microspheres. Methods: Using a published dataset comprising 321 release profiles from 89 drugs, we first developed a classification model to identify slow-release behavior (≤20% release within 3 days) and subsequently integrated the predicted early-release probability into a regression model to estimate cumulative release over time. Results: Among tree-based ensemble models, XGBoost achieved the lowest mean absolute error (MAE = 0.126) and highest Pearson correlation coefficient (r = 0.831). SHapley Additive exPlanations (SHAP) analysis revealed that drug and polymer molecular weight, predictive slow-release probability, and polymer concentration substantially influence release behavior. We also assessed this framework with external datasets. Drug release data for olaparib-loaded PLGA microspheres were obtained in-house, whereas those for semaglutide-based microspheres were obtained from the published literature. In both datasets, this framework demonstrated low MAE values (0.096 and 0.068, respectively). Conclusions: This suggests that the proposed framework can predict in vitro drug release and support efficient optimization of PLGA-based LAI formulations. Full article

(This article belongs to the Section Pharmaceutical Technology)

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67 pages, 759 KB

Open AccessSystematic Review

Dosing Strategies for High-Alert Medications in Obese Pediatric Patients: A Systematic Review

by Yolanda Hernández-Gago, Pedro J. Alcalá Minagorre, José Germán Sánchez-Hernández, Belén Rodríguez Marrodán, Laura Hernández Sabater, Ana Cristina Rodríguez Negrín and Claudio-Alberto Rodríguez-Suárez

Pharmaceuticals 2026, 19(5), 766; https://doi.org/10.3390/ph19050766 (registering DOI) - 13 May 2026

Abstract

Background/Objective: Childhood obesity induces physiological changes that alter drug distribution and clearance; however, these patients are often excluded from clinical trials, creating a critical safety gap for high-alert medications (HAM). The Objective was to evaluate HAM dosing strategies and pharmacokinetic (PK) alterations [...] Read more.

Background/Objective: Childhood obesity induces physiological changes that alter drug distribution and clearance; however, these patients are often excluded from clinical trials, creating a critical safety gap for high-alert medications (HAM). The Objective was to evaluate HAM dosing strategies and pharmacokinetic (PK) alterations in overweight and obese pediatric patients. Methods: A systematic review was conducted and registered in PROSPERO (CRD42023452126). A search of MEDLINE, EMBASE, Web of Science, and Cochrane CENTRAL (1990–March 2026) identified studies reporting dosing strategies or PK of HAM in obese or overweight pediatric patients. Studies were included if they reported dosing recommendations or PK parameters. Eligible designs comprised prospective and retrospective, randomized and non-randomized, observational (cohort, case-control, and cross-sectional), case series, case reports, and narrative and systematic reviews. Study selection, data extraction, and quality assessment were conducted independently by two reviewers. Methodological quality was assessed using validated tools, and results were synthesized qualitatively. Results: Of 5801 records, 91 studies were included, providing evidence for only 27% of the evaluated HAM. Total body weight (TBW) appeared to be appropriate for insulin and vancomycin, although close monitoring was required. TBW-based dosing was associated with approximately 20% overexposure for enoxaparin, supporting the use of fat-free mass (FFM) or reduced dosing strategies. Increased clearance may justify higher doses for amlodipine and consideration of adult-equivalent dosing for metformin in adolescents. For gentamicin, FFM appeared to be the most appropriate descriptor, while adjusted body weight was used for valproic acid. In anesthetics and sedatives, reduced TBW-based dosing may be considered for propofol, whereas ideal body weight (IBW) or FFM were generally preferred for ketamine and dexmedetomidine. Analgesics such as fentanyl and morphine may require IBW- or FFM-based dosing, and maintenance dosing of paracetamol may require adjustment. Conclusions: Evidence remains limited and heterogeneous, with no standardized dosing approach. Model-informed strategies—such as population PK (PopPK) and physiologically based PK model (PBPK) approaches—may be useful for hypothesis generation and exploring PK variability; however, their clinical applicability is constrained by the limited and heterogeneous evidence base, and they should be considered exploratory. Full article

(This article belongs to the Special Issue Pediatric Drug Therapy: Safety, Efficacy, and Personalized Medicine)

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21 pages, 1370 KB

Open AccessSystematic Review

Iontophoresis-Based Topical Drug Delivery for Dermatologic Conditions: A Systematic Review

by Francesco Piscazzi, Francesco D’Oria, Maria Alejandra Ramirez and Marco Ardigò

Pharmaceuticals 2026, 19(5), 765; https://doi.org/10.3390/ph19050765 (registering DOI) - 13 May 2026

Abstract

Background/Objectives: The efficacy of topical therapies in dermatology is often limited by the barrier function of the stratum corneum, which restricts drug penetration. Iontophoresis is a non-invasive transdermal delivery technique that uses a low-intensity electrical current to enhance the transport of charged [...] Read more.

Background/Objectives: The efficacy of topical therapies in dermatology is often limited by the barrier function of the stratum corneum, which restricts drug penetration. Iontophoresis is a non-invasive transdermal delivery technique that uses a low-intensity electrical current to enhance the transport of charged and polar molecules across the skin. It has emerged as a strategy to improve local drug bioavailability while minimizing systemic exposure. We systematically reviewed the clinical evidence on the efficacy, safety, and pharmacologic performance of iontophoresis-assisted topical drug delivery in dermatologic diseases. Methods: This systematic review followed PRISMA guidelines and was prospectively registered in PROSPERO (CRD420251234877). PubMed, Embase, Web of Science, CENTRAL, and ClinicalTrials.gov were searched through 19 November 2025 without language restrictions. Records were screened against predefined eligibility criteria, and data were extracted on study design, participants, dermatologic indications, intervention/comparator, iontophoresis parameters, efficacy outcomes, and adverse events. The risk of bias was assessed using RoB 2 for randomized trials and the JBI checklist for non-randomized studies. Because of substantial clinical and methodological heterogeneity, the findings were synthesized narratively and no meta-analysis was performed. Results: Twenty-one studies published between 1990 and 2025 met the inclusion criteria, including 15 randomized and 6 non-randomized studies. Investigated conditions included psoriasis, eczema, melasma, post-inflammatory hyperpigmentation, herpes labialis, onychomycosis, chronic ulcers, systemic sclerosis-related digital ulcers, acne scarring, and actinic keratosis. Across studies, findings were mixed. The most consistent signals of benefit were observed in pigmentary disorders and infectious diseases, whereas results were more heterogeneous in inflammatory dermatoses and some studies did not show superiority over active comparators. Tolerability was generally favorable, with adverse events limited to mild, reversible local reactions such as erythema, tingling, burning, or transient irritation. No serious treatment-related adverse events were reported. Conclusions: Iontophoresis may represent a useful non-invasive delivery-enhancement strategy in selected dermatologic settings, particularly when topical efficacy is limited by anatomical or physicochemical barriers. However, heterogeneity in protocols, formulations, outcomes, and clinical indications limits direct comparison and does not support broad conclusions of efficacy across all dermatologic conditions. Larger, standardized trials are needed to clarify its therapeutic role, long-term efficacy, and indication-specific benefit. Full article

(This article belongs to the Special Issue Advances in Biotechnological Formulations for Skin Disorders: Delivery Strategies and Biocompatibility)

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19 pages, 1178 KB

Open AccessArticle

Differential Modulation of Spinal Angiotensin-Converting Enzymes Plays a Critical Role in the Development of Trigeminal Neuropathic Pain

by Jo-Young Son, Yu-Mi Kim, Song-Hee Kang, Jin-Sook Ju and Dong-Kuk Ahn

Pharmaceuticals 2026, 19(5), 764; https://doi.org/10.3390/ph19050764 (registering DOI) - 13 May 2026

Abstract

Background/Objectives: While the functions of angiotensin-converting enzyme (ACE) 1 and 2 are well established in peripheral tissues, the role of the spinal ACE1 and ACE2 pathways in the development of neuropathic pain remains unclear. This study examined the role of the spinal ACE1 [...] Read more.

Background/Objectives: While the functions of angiotensin-converting enzyme (ACE) 1 and 2 are well established in peripheral tissues, the role of the spinal ACE1 and ACE2 pathways in the development of neuropathic pain remains unclear. This study examined the role of the spinal ACE1 and ACE2 pathways in trigeminal neuropathic pain produced by inferior alveolar nerve (IAN) injury. Methods: The experiments were conducted using male Sprague-Dawley rats (6–8 weeks old, weighing 220–250 g). The left mandibular second molar was extracted, and a dental mini-implant was placed to induce IAN injury. IAN injury produced robust and long-lasting mechanical allodynia and markedly increased angiotensinogen (AGT) expression within the ipsilateral trigeminal subnucleus caudalis (iTSC). Results: Neuropathic mechanical allodynia was inhibited by intracisternally administered losartan (an angiotensin II type-1 receptor antagonist), but not by an angiotensin II type-2 receptor antagonist. Intracisternal treatment with captopril (an ACE1 inhibitor) and diminazene aceturate (an ACE2 activator) produced significant anti-allodynic effects. Intracisternally injected angiotensin-(1-7) reduced neuropathic mechanical allodynia, and this anti-allodynic effect was blocked by pretreatment with A779, a Mas receptor inhibitor. In naïve rats, the intracisternal administration of DX600 (an ACE2 inhibitor) resulted in mechanical allodynia, which was inhibited by intracisternal pretreatment with losartan. IAN injury led to upregulated ACE1 expression and downregulated ACE2 expression in the iTSC. Conclusions: Our findings indicate that IAN injury induces a polarized shift in the ACEs within the iTSC, characterized by increased ACE1 and decreased ACE2 expression. Their modulation may therefore offer a promising strategy for developing effective treatments for chronic pain. Full article

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25 pages, 4746 KB

Open AccessArticle

Development and Preclinical Safety Evaluation of an Injectable β-Caryophyllene Nanoemulsion

by Ana Bárbara Souza Viana, Natálya Gabriely Lobato-Santos, Andressa Ketelem Meireles Alberto, Abrahão Victor Tavares de Lima Teixeira dos Santos, Sergio Gabriell Leite Brito, Nayara Nilcia Dias Colares and José Carlos Tavares Carvalho

Pharmaceuticals 2026, 19(5), 763; https://doi.org/10.3390/ph19050763 (registering DOI) - 13 May 2026

Abstract

Background/Objectives: β-Caryophyllene is a plant-derived sesquiterpene with recognized therapeutic potential; however, high lipophilicity and low aqueous solubility limit its parenteral application. Nanoemulsion-based systems represent a rational strategy to address these challenges. This study aimed to develop and physicochemically characterize an injectable β-caryophyllene nanoemulsion [...] Read more.

Background/Objectives: β-Caryophyllene is a plant-derived sesquiterpene with recognized therapeutic potential; however, high lipophilicity and low aqueous solubility limit its parenteral application. Nanoemulsion-based systems represent a rational strategy to address these challenges. This study aimed to develop and physicochemically characterize an injectable β-caryophyllene nanoemulsion and to evaluate its preclinical safety following intramuscular administration. Methods: Five nanoemulsions (NBCP1–NBCP5) were prepared by low-energy emulsification using different hydrophilic–lipophilic balance (HLB) values and characterized in terms of particle size, polydispersity index, zeta potential, and encapsulation efficiency. The optimized formulation (NBCP1) was evaluated in a 14-day subacute intramuscular toxicity study in male Wistar rats (n = 5 per group) at doses of 5 and 15 mg/kg. Clinical observations, food and water intake, body weight, hematological and biochemical parameters, and histopathological analyses of muscle, liver, and kidney tissues were assessed. Results: NBCP1 exhibited favorable physicochemical properties, including a mean particle size of 102.39 nm, PDI of 0.27, zeta potential of −27.5 mV, and encapsulation efficiency of 97.16%, and remained stable under stress conditions. Repeated intramuscular administration did not induce behavioral alterations, changes in consumption patterns, or differences in body weight between the control and treated groups. Hematological and biochemical parameters remained within physiological ranges, and histopathological analysis revealed preserved tissue architecture without inflammatory or degenerative changes. Conclusions: The results support the suitability of NBCP1 as a stable nanoemulsion platform for the parenteral delivery of β-caryophyllene under the evaluated conditions. These findings address the limited information available on injectable formulations of this sesquiterpene and provide a foundation for future pharmacokinetic, longer-term safety, and efficacy studies. Full article

(This article belongs to the Special Issue Natural Products and Phytomedicines: From Chemical Profiling and Pharmacological Properties to Therapeutic Applications)

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26 pages, 6243 KB

Open AccessArticle

Liuweidihuang Pill Attenuates Early Bleomycin-Induced Pulmonary Fibrosis in Mice and Is Associated with Gut Microbiome

by Yang Zou, Rui-Tao Hu, Qun Yu, Pei-Li Rao, Hong-Yan Cui, Wen-Jing Wei, Xing Cai, Hou-Kai Li and Yun-Hui Shen

Pharmaceuticals 2026, 19(5), 762; https://doi.org/10.3390/ph19050762 (registering DOI) - 13 May 2026

Abstract

Background: Pulmonary fibrosis (PF) is a chronic, progressive lung disease with limited treatment options. Liuweidihuang pill (LDP), a classical formula for kidney-yin deficiency, has been reported to have anti-inflammatory and anti-oxidative activities, suggesting potential relevance to PF. Purpose: This study evaluated [...] Read more.

Background: Pulmonary fibrosis (PF) is a chronic, progressive lung disease with limited treatment options. Liuweidihuang pill (LDP), a classical formula for kidney-yin deficiency, has been reported to have anti-inflammatory and anti-oxidative activities, suggesting potential relevance to PF. Purpose: This study evaluated whether LDP attenuates bleomycin-induced PF in mice and whether gut microbiota remodeling may contribute to its protective effects. Methods: Mice received intratracheal bleomycin followed by LDP gavage. Lung pathology was assessed by hematoxylin–eosin (HE) and Masson staining. Inflammatory cytokines, hydroxyproline (HYP), and α-SMA were measured. LDP and LDP-containing serum were profiled by UPLC-MS. The gut microbiota was analyzed using 16S rDNA sequencing. To further explore whether microbiota-related changes were associated with the protective phenotype, fecal microbiota transplantation (FMT) and probiotic VSL#3 intervention were performed. In addition, LDP-containing serum was tested in a TGF-β1-induced EMT model in A549 cells. Results: LDP reduced lung index, inflammatory infiltration, interstitial fibrosis, α-SMA expression, HYP content, and pro-inflammatory cytokine levels in bleomycin-treated mice. These effects were accompanied by gut microbiota remodeling and transcriptomic changes related to inflammation, metabolism, and fibrosis. VSL#3 partially reproduced the protective phenotype, whereas FMT showed limited efficacy. LDP-containing serum had a limited inhibitory effect on EMT inhibited EMT in vitro, suggesting that systemic host responses may contribute to the in vivo effect. Conclusions: LDP attenuated early bleomycin-induced PF and was associated with reduced inflammation and gut microbiota remodeling. These findings suggest a possible role for microbiota–host interactions in LDP-associated protection; however, causal directionality, key active effectors, and protein-level pathway validation remain unresolved. Full article

(This article belongs to the Section Pharmacology)

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16 pages, 5044 KB

Open AccessArticle

Integrative In Silico Identification of TP53-Associated Drug Repurposing Candidates in Lung Adenocarcinoma

by Akile Tuncal and Rasime Kalkan

Pharmaceuticals 2026, 19(5), 761; https://doi.org/10.3390/ph19050761 (registering DOI) - 13 May 2026

Abstract

Background/Aim: Lung adenocarcinoma (LUAD) is the most common subtype of lung cancer and is characterized by high genetic heterogeneity and poor prognosis. TP53 is the most frequently mutated gene in LUAD and plays a critical role in tumor initiation, progression, and therapeutic resistance. [...] Read more.

Background/Aim: Lung adenocarcinoma (LUAD) is the most common subtype of lung cancer and is characterized by high genetic heterogeneity and poor prognosis. TP53 is the most frequently mutated gene in LUAD and plays a critical role in tumor initiation, progression, and therapeutic resistance. The present study aimed to prioritize TP53-associated drug repurposing candidates in LUAD using an integrative in silico approach. Materials and Methods: A total of 1309 TP53-associated compounds were retrieved from the Gene2Drug database. Drug sensitivity profiles of lung adenocarcinoma cell lines were evaluated using PRISM Repurposing Public 22Q2 viability data obtained from the DepMap platform. Candidate compounds were ranked according to Gene2Drug significance scores (p < 1 × 10⁻³), and compounds with concordant sensitivity patterns in PRISM data were prioritized. Results: LUAD cell lines showed the strongest sensitivity to atropine (p = 6.83 × 10⁻⁵). Additionally, LUAD cell lines displayed consistent sensitivity signals for dropropizine (p = 8.47 × 10⁻³), terazosin (p = 1.11 × 10⁻³), morantel (p = 9.05 × 10⁻³), netilmicin (p = 8.37 × 10⁻³), altretamine (p = 9.82 × 10⁻³), and perphenazine (p = 9.58 × 10⁻³). These findings indicate that several non-oncology drugs exhibit distinct and reproducible sensitivity profiles in LUAD cell lines. Conclusions: Based on TP53-associated drug sensitivity profiles, this in silico analysis identifies atropine among the prioritized candidates, showing the strongest TP53-associated sensitivity signal in LUAD cell lines. Although experimental validation is required, the integration of independent computational datasets provides a robust framework for candidate prioritization and our findings provide a rationale for further preclinical investigation of atropine and related compounds in LUAD. Full article

(This article belongs to the Special Issue Novel Anticancer Drug Development and Toxicity Reduction Strategies)

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