Cinobufagin is a bufadienolide compound extracted from the dried venom secreted by the parotid glands of toads and one of the glycosides in the traditional Chinese medicine ChanSu, with potential antineoplastic activity. Cinobufagin has been shown to have clinical applications in cancer treatment as well as immunomodulatory and analgesic properties. Cinobufagin induces apoptosis of osteosarcoma cells through inactivation of Notch signaling. Cinobufagin induces autophagy-mediated cell death in human osteosarcoma U2OS cells through the ROS/JNK/p38 signaling pathway. Cinobufagin significantly relieved cancer pain in mice and raised their pain threshold, mainly upregulating the expression levels of beta-Endorphin and μ- opioid receptor in the hind paw tumor and adjacent tissue. In combination with gemcitabine-oxaliplatin cinobufagin was used in clinical trial for the treatment of locally advanced or metastatic gallbladder carcinoma.

INCB3284 or INCB-3284 Incyte’s internally developed, oral human CCR2 antagonist for the treatment of chronic inflammations. It is in Phase IIa trial of patients with rheumatoid arthritis (RA).

AMG-487 is a potent and selective orally bioavailable chemokine (C-X-C motif) receptor 3 (CXCR3) antagonist that displays dose- and time-dependent pharmacokinetics in human subjects after multiple oral dosing. AMG-487 is an 8-azaquinazolinone, it can prevent the chemokines I-IP-10 and I-ITAC from binding to CXCR3. The preclinical properties of AMG487 has been extensively studied. The compound displays a greater than 1000-fold selectivity for CXCR3 versus a panel of other receptors, including 11 chemokine receptors. The safety profile of AMG487, as assessed by various genotoxicity and cardiotoxicity assays, revealed no major concerns. The ability of AMG487 to inhibit inflammatory cell migration in vivo was confirmed in a mouse model of bleomycin-induced cellular recruitment, where AMG487 significantly reduced infiltration of macrophages and lymphocytes into the lungs in CXCR3-KO mice. In a mouse model for idiopathic pneumonia syndrome (IPS), AMG487 reduced recruitment of donor T cells to the lung after allogeneic stem cell transplantation, leading to improved survival rates. Likewise, reductions in inflammation, pannus formation, and cartilage damage were observed upon administering AMG487. The preclinical studies convincingly paved the way for clinical studies on two inflammation-related diseases: psoriasis and rheumatoid arthritis. In 2003, results of a Phase I trial on AMG487 were disclosed. The compound was assessed for safety and pharmacokinetics in 30 healthy males in a randomised, double blind, placebo-controlled dose-escalation study. Generally, the compound was well tolerated and adverse events were mild to moderate. Disappointingly, no significant differences in the endpoints (psoriasis severity index or physician global assessment scores) were seen between patient groups. AMG-487 progressed to Phase II clinical trials but has been withdrawn because of lack of efficacy.

Phenserine tartrate (phenserine), a phenylcarbamate analog of physostigmine, is a long-acting and centrally active inhibitor of acetylcholinesterase (AChE). In addition to being a potent inhibitor of AChE, it has been demonstrated that phenserine inhibits the formation of beta-APP, the source of neurotoxic beta-amyloid peptide which is a major component of the extraneuronal plaques that pathologically characterize Alzheimer’s disease (AD). Phenserine was developed as a potential therapy for AD by Axonyx, under license from the National Institutes of Health/National Institute on Aging. In March 2005, Axonyx suspended patient recruitment for the ongoing Phase III trials of phenserine, after the drug failed to meet the primary endpoints of the first of these trials.

Manoalide is a sesquiterpenoid isolated from the Indo-Pacific sponge Luffariella variabilis. It is a potent analgesic and anti-inflammatory agent. Manoalide acts by inhibiting PLA2. At low concentrations, manoalide also inhibited calcium channels with no effect on phosphoinositide metabolism. Manoalide was licensed to Allergan Pharmaceuticals and reached Phase II clinical trials as a topical anti-psoriatic, its development was however, discontinued due to formulation problems.

Daprodustat (DUVROQ) is a small molecule inhibitor of hypoxia-inducible factor prolyl hydroxylase (PHD) developed by GlaxoSmithKline for the treatment of anaemia in patients with chronic kidney disease (CKD). Inhibition of PHD prevents degradation of hypoxia-inducible factor (HIF), leading to the production of erythropoietin and subsequent induction of erythropoiesis. In June, daprodustat received its first approval in Japan for the treatment of renal anaemia.

Gepirone (brand name Travivo) is an investigational azapirone antidepressant and anxiolytic drug in development for the treatment of major depressive disorder but has yet to be marketed. Like other azapirones, it acts as a selective partial agonist of the 5-HT1A receptor. Gepirone has been under development in the U.S. in an extended release form (referred to as Gepirone ER). It has been rejected multiple times by the FDA during the drug approval process and Phase III studies evaluating its use in the treatment of MDD were prematurely terminated. These were the initial Phase III studies of gepirone ER in MDD, and the effective dose range had not been determined. In March 2016, the FDA reversed its decision and gave gepirone ER a positive review, clearing the way for the drug to finally gain market approval in the U.S. In addition to its antidepressant and anxiolytic properties, gepirone has been found to improve symptoms of sexual dysfunction in men and women, similarly to the marketed 5-HT1A receptor agonist flibanserin. The pro-sexual effects appear to be independent of its antidepressant and anxiolytic effects. Mechanism of action studies have demonstrated that gepirone possesses a much greater selectivity for 5-HT1A receptors over dopamine D2 receptors. Long-term studies have shown that gepirone has a differential action at presynaptic (agonist) and post-synaptic (partial agonist) 5-HT1A receptors. Treatment with gepirone ER desensitizes presynaptic 5-HT1A receptors, which decreases serotonin autoregulatory inhibition and enhances activation of postsynaptic 5-HT1A receptors. As a partial agonist gepirone ER acts as an agonist when endogenous serotonin is not present and as an antagonist when endogenous serotonin is present. Overall, gepirone ER increases serotonin production when insufficient amounts are present, and decreases serotonin production when excess amounts are present. Gepirone has been tested in Phase II clinical trial as antidepressant medication for pharmacotherapy for cocaine dependent subjects.

Omidenepag isopropyl, a prodrug, is hydrolyzed in the eye to the active form (Omidenepag) which functions as a selective, nonprostaglandin, prostanoid EP2 agonist, has been developed by Ube Industries and Santen Pharmaceutical as an ophthalmic solution (EYBELIS®) for the treatment of glaucoma and ocular hypertension. Omidenepag isopropyl increases the outfow of aqueous humor via both the uveoscleral outfow and the trabecular outfow pathways, resulting in potent and stable reduction in intraocular pressure (IOP). In September 2018, omidenepag isopropyl ophthalmic solution 0.002% was approved in Japan for the treatment of glaucoma and ocular hypertension. On September 22, 2022, the FDA approved Santen’s Omlonti (omidenepag isopropyl), for the reduction of elevated intraocular pressure in patients with open-angle glaucoma or ocular hypertension.

Mobocertinib (EXKIVITY™) is a first-in-class EGFR tyrosine kinase inhibitor being developed for the treatment of EGFR exon 20 insertion (EGFRex20ins) -positive non-small cell lung cancer (NSCLC). Mobocertinib is a kinase inhibitor of the epidermal growth factor receptor (EGFR) that irreversibly binds to and inhibits EGFR exon 20 insertion mutations at lower concentrations than wild type (WT) EGFR. Two pharmacologically-active metabolites (AP32960 and AP32914) with similar inhibitory profiles to mobocertinib have been identified in the plasma after oral administration of mobocertinib. In vitro, mobocertinib also inhibited the activity of other EGFR family members (HER2 and HER4) and one additional kinase (BLK) at clinically relevant concentrations (IC50 values <2 nM). Based on efficacy in patients whose disease had progressed on or after platinum-based therapy in a phase I/II trial, mobocertinib was recently granted accelerated approval in the USA in this indication. The drug is also being assessed for marketing approval in various other countries and territories including the EU and China.

p-cresol, also known as also 4-methylphenol, is a unique bacterial metabolite from protein fermentation that is not produced by human enzymes, this metabolites has been frequently used to assess the degree of proteolytic fermentation. Recently investigation showed that p-cresol measurements might help to predict cardiovascular disease risk in renal patients over a wide range of residual renal function, beyond traditional markers of glomerular filtration. In addition, there were studies, which revealed, that urinary p-cresol was elevated in young French children with autism spectrum disorder.