No / Agents which increase intracellular cyclic adenosine monophosphate (cAMP) may have an antagonistic effect on pro-inflammatory molecule production so that inhibitors of the cAMP degrading phosphodiesterases have been identified as promising drugs in chronic inflammatory disorders. Although many such inhibitors have been developed, their introduction in the clinic has been hampered by their narrow therapeutic window with side effects such as nausea and emesis occurring at sub-therapeutic levels. The latest generation of inhibitors selective for phosphodiesterase 4 (PDE4), such as apremilast and roflumilast, seems to have an improved therapeutic index. While roflumilast has been approved for the treatment of exacerbated chronic obstructive pulmonary disease (COPD), apremilast shows promising activity in dermatological and rheumatological conditions. Studies in psoriasis and psoriatic arthritis have demonstrated clinical activity of apremilast. Efficacy in psoriasis is probably equivalent to methotrexate but less than that of monoclonal antibody inhibitors of tumour necrosis factor (TNFi). Similarly, in psoriatic arthritis efficacy is less than that of TNF inhibitors. PDE4 inhibitors hold the promise to broaden the portfolio of anti-inflammatory therapeutic approaches in a range of chronic inflammatory diseases which may include granulomatous skin diseases, some subtypes of chronic eczema and probably cutaneous lupus erythematosus. In this review, the authors highlight the mode of action of PDE4 inhibitors on skin and joint inflammatory responses and discuss their future role in clinical practice. Current developments in the field including the development of topical applications and the development of PDE4 inhibitors which specifically target the subform PDE4B will be discussed.

McMaster University MASTER OF SCIENCE (2019) Hamilton, Ontario (Medical Sciences) TITLE: Modulation of cyclic adenosine monophosphate for potentiation of long-acting β2-agonist and glucocorticoids in human airway epithelial cells AUTHOR: Yechan Kim, B.HSc. (McMaster University) SUPERVISOR: Dr. Jeremy Alexander Hirota NUMBER OF PAGES: xiv, 81 / In Canada, asthma is the third most common chronic disease resulting in 250 premature deaths annually and related healthcare expenses exceeding $2.1 billion/year. It is estimated that around 50-80% of asthma exacerbations are due to viral infections. Despite an advanced understanding on how to treat and manage the symptoms of asthma, current therapy is sub-optimal in 35-50% of moderate-severe asthmatics around the world resulting in lung inflammation, persistent impairment of lung function, and increased risk of mortality. Combination of long-acting β2 agonists (LABA) for bronchodilation and glucocorticoids (GCS) to control lung inflammation represent the dominant strategy for the management of asthma. Increasing intracellular cyclic adenosine monophosphate (cAMP) beyond existing combination LABA/GCS are likely to be beneficial for the management of difficult to control asthmatics that are hypo-responsive to mainstay therapy. In human airway epithelial cells (HAEC), cAMP is either exported by transporters or broken down by enzymes, such as phosphodiesterase 4 (PDE4). We have demonstrated that HAEC express ATP Binding Cassette Transporter C4 (ABCC4), an extracellular cAMP transporter. We also show that ABCC4 and PDE4 inhibition can potentiate LABA/GCS anti-inflammatory responses in a human epithelial cell line in a cAMP-dependent mechanism validating the pursuit of novel ABCC4 inhibitors as a cAMP elevating agent for asthma. / Thesis / Master of Science in Medical Sciences (MSMS) / Asthma is a common chronic lung disease characterized by narrow and inflamed airways that cause breathing difficulties. Current management includes the combination of bronchodilators, to relax the airway, and steroids, to decrease inflammation. Unfortunately, this combination therapy is suboptimal in 35-50% of users, increasing the risk of asthma attacks, hospitalization rate, and health care costs. Recently, there have been studies theorizing that we can improve the therapy’s ability to decrease inflammation by increasing cAMP, an important molecule for biological activities. We tested this claim by blocking the breakdown and export of cAMP to increase its levels and measured inflammatory cytokines, molecules that direct the action of immune cells. Our results show that in a model of viral infection, administering the combination therapy while increasing cAMP levels can further decrease inflammatory cytokines prompting further investigation for its potential implication in the clinic.

Die Herzinsuffizienz ist trotz zahlreicher Therapiemöglichkeiten immer noch eine der häufigsten chronischen Erkrankung und Todesursachen in westlichen Industrienationen. Eine zentrale Rolle in der Regulation der effizienten Herzkontraktion nimmt die zyklisches Adenosin-3’,5’-monophophat(cAMP)-Signalkaskade ein, wobei Veränderungen in der Kompartimentierung des sekundären Botenstoffes bisher nicht vollständig verstanden sind. Ziel dieser Studie war es deshalb Regulationsmechanismen des lokalen cAMP-Pools der Mikrodomäne der ATP-abhängigen Calciumpumpe 2a des sarkoplasmatischen und endoplasmatischen Retikulums (SERCA2a) in kardialen Mausmyozyten unter den pathologischen Rahmenbedingungen der Herzinsuffizienz zu untersuchen. Hierfür wurde ein post-Myokardinfarkt Mausmodell an einer transgene Mauslinie verwendet, die einen cAMP-abhängigen auf Förster-Resonanz-Energietransfer(FRET)-basierenden Biosensor, lokalisiert in der SERCA2a-Mikrodomäne, in vivo exprimiert. Mit Hilfe von Echtzeit-FRET-Messungen an frisch isolierten, lebenden Kardiomyozyten wurden die Beiträge der am Herzen relevanten Phosphodiesterase(PDE)-Familien zur Begrenzung des lokalen cAMP-Pools in der SERCA2a-Domäne 12 Wochen nach Myokardinfarkt gemessen und mit einer Kontrollgruppe (Sham) verglichen. Hierbei zeigte sich, dass in der Mikrodomäne sowohl unter Ruhebedingungen, als auch nach β-adrenerger Vorstimulation, eine signifikante Aktivitätsminderung der PDE4, verglichen mit der Sham-Gruppe, nachweisbar ist. Da dies mit Veränderungen im lokalen cAMP-Pool der die SERCA2a reguliert einhergeht, bietet diese Studie also eine interessante Grundlage für die weitere Untersuchung der im Krankheitsfall auftretenden Funktionsabweichungen.

Introduktion: Psoriasis är en autoimmun hudsjukdom som orsakar fjällande, erytematösa plack på huden. Sjukdomen orsakas av genetiska och miljömässiga faktorer och den är kopplad till andra sjukdomar som psoriasisartrit. Immunceller i kroppen spelar en viktig roll i bildandet av psoriasis, så som T-celler och olika cytokiner, inklusive interleukin-23 (IL-23), IL-12, IL-6 och tyrosine kinase 2 (TYK2). Dessa inflammatoriska faktorer leder till överdriven tillväxt av keratinocyter i huden och bidrar till bildandet av psoriasis. Plackpsoriasis är den vanligaste typen av psoriasis där den uppträder symmetriskt i kroppen. Den kan orsaka torra fjäll och smärtsamma sprickor vilket försämrar patientens livskvalitet. Forskning pågår fortfarande i strävan efter nya läkemedel medbättre effekt och färre biverkningar. Det finns olika orala behandlingar som riktar sig mot immunmolekyler i kroppen och hämmar deras verkan för att lindra symptomen på plackpsoriasis. Apremilast, en oral fosfodiesteras 4 (PDE4) hämmare, har visat en god terapeutisk effekt och säkerhet medan deucravacitinib är en ny oral selektiv TYK2-hämmare som har en god effekt och bra säkerhetsprofil. Syfte: Syftet var att hitta och analysera kliniska studier för att ta reda på om oral behandling med deucravacitinib har bättre effekt och säkerhet än apremilast vid behandling av patienter med medelsvår till svår plackpsoriasis. Metod: Databasen PubMed användes för att hitta fem vetenskapliga artiklar som undersökte effekt och säkerhet på de två läkemedlen i fråga. Studierna analyserades och utifrån analyserna drogs slutaster som besvarar syftet med arbetet. Resultat: De två första studierna hade till syfte att jämföra deucravacitinib med apremilast genom en så kallad ”head to head”. De visade en signifikant överlägsenhet av deucravacitinib över apremilast för att uppnå 75 % förbättring av Psoriasis Area and Severity Index (PASI 75) och Static Physician's Global Assessment score of 0 (clear) or 1 (almost clear) (sPGA 0/1) samt en bra säkerhetsprofil. Medan den tredje och fjärde studien visade att apremilast hade en överlägsen terapeutisk effekt jämfört med placebo. Patienterna nådde PASI 75 och sPGA-värden signifikant med en bra säkerhetsprofil. När det gäller den femte studien så jämförde den deucravacitinib med placebo. Dess resultat överensstämde med resultaten av de två första studierna. Diskussion: De fem artiklarna som analyserades var randomiserade kliniska studier på patienter med plackpsoriasis vilket gav tillförlitliga slutsatser. Det fanns felkällor så som det lilla antalet deltagare i den tredje och femte studien och bristen på tillräcklig etnisk mångfald. Vid jämförelse av PASI-värdena för de fem studierna så hade deucravacitinib bättre terapeutiska värden än apremilast. När det gäller säkerhetsprofilen så minskade kardiovaskulära biverkningar signifikant vid behandling med deucravacitinib. Slutsats: Deucravacitinib har en bättre effekt än apremilast samt bättre säkerhetsprofil vid behandling av patienter med medelsvår till svår plackpsoriasis

Cystic fibrosis (CF) is the most common genetic disease affecting Canadian newborns (1 in 3,850) and is caused by mutations in the CF transmembrane conductance regulator (CFTR) gene. This gene encodes for CFTR, a phosphorylation-dependent ion channel localized at the apical membrane. Phosphorylation of CFTR by the cyclic adenosine monophosphate (cAMP)-dependent enzyme protein kinase A activates its activity, facilitating the transport of chloride and bicarbonate ions across the epithelial membrane. CFTR contributes to ion and airway surface liquid regulation, crucial for maintaining host defenses. The inheritance of CFTR mutations leads to a variety of respiratory complications, including impaired mucociliary clearance, excessive mucus production, persistent airway infections, and heightened inflammation, ultimately causing lung damage. While there is currently no cure for CF, the development of CFTR modulators, targeting the defective CFTR protein directly, has significantly improved the quality of life for many CF patients. Despite these advancements, many patients remain unresponsive to current treatment options. It has been well-established that combination therapies outperform monotherapies, emphasizing the need for alternative or complementary therapeutic strategies for CF management. Furthermore, CFTR dysfunction extends beyond CF and has been implicated in other respiratory diseases, such as chronic obstructive pulmonary disease, which is primarily linked to tobacco smoke exposure. This Ph.D. thesis explores a complementary therapeutic approach, targeting proteins within the CFTR-containing macromolecular signaling complex to elevate intracellular cAMP levels, thereby enhancing CFTR function. We hypothesized that synergistic use of cAMP modulators, alongside CFTR modulators, will serve as an effective therapeutic strategy for CF and other respiratory diseases. Collectively, our studies highlight the potential of cAMP and CFTR modulation as a therapeutic strategy for improving the treatment of CF and other respiratory diseases, warranting further investigation, offering insights for future studies, and contributes to the ongoing pursuit of improved combination treatments. / Dissertation / Doctor of Philosophy (PhD) / Cystic fibrosis (CF) is the most common genetic condition affecting Canadian newborns, caused by inheritance of mutations in the CF transmembrane conductance regulator (CFTR) gene. These mutations result in respiratory issues, including breathlessness, excess mucus, and susceptibility to infections, causing lung damage and premature death. Despite progress in CF drug development, some patients remain unresponsive to existing drug combinations, highlighting the need for new combinations to improve the quality of life for all CF patients. CFTR function is also compromised in other respiratory diseases like chronic obstructive pulmonary disease, a lung disease that shares many characteristics with CF and is mainly caused by tobacco smoke exposure. This Ph.D. thesis explores the effectiveness of a new drug strategy targeting proteins interacting with CFTR. By investigating drugs to complement existing treatments, we aim to improve CFTR function. This research offers a promising strategy to improve treatment for CF and other respiratory diseases.