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Certain classes of neuroactive steroids (NASs) are positive allosteric modulators (PAM) of synaptic and extrasynaptic GABA receptors. Herein, we report new SAR insights in a series of 5β-nor-19-pregnan-20-one analogues bearing substituted pyrazoles and triazoles at C-21, culminating in the discovery of 3α-hydroxy-3β-methyl-21-(4-cyano-1H-pyrazol-1'-yl)-19-nor-5β-pregnan-20-one (SAGE-217, 3), a potent GABA receptor modulator at both synaptic and extrasynaptic receptor subtypes, with excellent oral DMPK properties. Compound 3 has completed a phase 1 single ascending dose (SAD) and multiple ascending dose (MAD) clinical trial and is currently being studied in parallel phase 2 clinical trials for the treatment of postpartum depression (PPD), major depressive disorder (MDD), and essential tremor (ET).
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http://dx.doi.org/10.1021/acs.jmedchem.7b00846 | DOI Listing |
Neurosci Biobehav Rev
September 2025
Department of Psychiatry and Psychotherapy, University Regensburg, Universitätsstrasse 8493053 Regensburg, Germany. Electronic address:
Pain
September 2025
Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital (MGH), Harvard Medical School (HMS), Boston, MA, United States.
Previous studies suggest a dysregulation of the inhibitory γ-aminobutyric acid (GABA) and the excitatory glutamate/glutamine (Glx) neurotransmitter systems in people living with chronic pain. Here, we test this hypothesis in people with HIV (PWH) on stable antiretroviral therapy, either with or without neuropathic pain (PWHpain and PWHnopain, respectively), and people without HIV and pain (Ctrl). Fourteen PWHpain (age, mean ± SD: 59 ± 6.
View Article and Find Full Text PDFBiomolecules
August 2025
Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA.
Although opioids are effective in treating pain, they cause serious side effects. The use of regional anesthesia, although effective in the perioperative period, may not be suitable if mobility and lack of numbness is desired. Hence, there is a clear need for novel pain therapies.
View Article and Find Full Text PDFDrug Metab Dispos
August 2025
Department of Systems Pharmacology & Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center of Excellence in Environmental Toxicology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic addr
Aldo-keto reductases (AKRs) are a superfamily of NAD(P)(H)-dependent oxidoreductases (phase I enzymes) that reduce aldehydes and ketones to primary and secondary alcohols, respectively. Four percent of xenobiotic biotransformation has been attributed to AKRs, although this is likely an underestimate because this is based on their ability to act as carbonyl reductases. AKRs also have an emerging role in nitroreduction.
View Article and Find Full Text PDFFront Psychiatry
August 2025
Standardization of Computational Anatomy Techniques for Cognitive and Behavioral Sciences (SoCAT) Lab, Department of Psychiatry, Faculty of the Medicine, Ege University, Izmir, Türkiye.
Major depressive disorder (MDD) presents a significant global health challenge, characterized by a high prevalence and significant impact on quality of life. Traditional antidepressants fall short in terms of efficacy and onset speed, up to 60% of patients. This review delves into the new and emerging pharmacologic treatments for MDD, focusing on their mechanisms of action, clinical effectiveness, and potential to fill the gaps left by conventional therapies.
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