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Reverse Pharmacology-A Paradigm Shift for Drug Discovery and Development

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Reverse Pharmacology-A Paradigm Shift for Drug Discovery and Development Current Research in Drug Discovery Original Research Paper Reverse Pharmacology-A Paradigm Shift for Drug Discovery and Development Ashok D.B. Vaidya Kasturba Health Society, Advanced Centre of Reverse Pharmacology (ICMR) 17, Khandubhai Desai Road, Vile Parle (West), Mumbai, 400 056, India Department of Pharmaceutical Sciences, Saurashtra University, India Article history Abstract: The current scenario of drug discovery and development is Received: 06-11-2014 facing a model perturbation, despite significant advances in genomics, Revised: 28-11-2014 proteomics, metabolomics, combinatorial chemistry and high through put Accepted: 05-12-2014 assays. There is an urgent need of a paradigm shift in approaches to drug discovery. Natural products of Ayurveda offer a vast potential for novel Corresponding Author: phytomolecules with clinical activity. In India, Ayurveda is availed of by Ashok D.B. Vaidya Kasturba Health Society, more than 70% of the population. There has been a renaissance in scientific Advanced Centre of Reverse exploration of medicinal plants with therapeutic activity. New methods have Pharmacology (ICMR) 17, been proposed and developed for such exploration. Ayurvedic Khandubhai Desai Road, Vile Pharmacoepidemiology, Observational therapeutics and Reverse Parle (West), Pharmacology paths have led to significant hits, leads and drug candidates for Mumbai, 400 056, India several diseases. The active phyto-molecules will also provide novel Email: [email protected] scaffolds for medicinal chemists to enhance efficacy and reduce toxicity. Several plants have shown promise Viz. Mucuna pruriens for Parkinson’s disease, Nycthanthes arbor-tritis for malaria and Phyllanthus amarus for hepatitis. This approach of Reverse Pharmacology has also been adopted globally by several groups. A plea is made to look at the therapeutic activity of natural products for a revolution in drug discovery and development. Keywords: Reverse Pharmacology, Ayurveda, Drug Discovery and Development Introduction development. We must and can refocus on the novel biodynamic effects of natural products in human as A life-long pursuit in the domain of drug discovery starting points for drug discovery. and development, from the New Chemical Entities Gilbert (1993) cited Sir Austin Bradford Hill, the (NCE) and medicinal plants, obviously led to a serious pioneer of Medical Statistics and clinical drug trial, “All introspection on the ruling paradigms and conventional scientific work is incomplete-whether it be observational approaches, followed globally, by the pharmaceutical or experimental. All scientific work is liable to be upset industry. The experience of conducting phase 1, 2 and 3 or modified by advancing knowledge. That does not studies on more than a dozen drug candidates, confer upon us a freedom to ignore the knowledge we discovered at CIBA-Geigy Research Centre at Mumbai, already have or postpone the action that it appears to provided a ringside view of the failures and success of the game. Unlike the human studies with NCEs, the demand at a given time.” It is in the emphasis on not ‘to medicinal plants from Ayurveda had the benefit of their ignore the knowledge we already have that the path of human safety and therapeutic activity in Ayurveda. This Reverse Pharmacology (RP) finds a rationale as a new fact led to a fresh exploration of the history of modern paradigm. Clinical anecdotes, robustly documented, medicine. It was realized that human observations on constitute the knowledge we have and cannot be several natural products had ignited the curiosity of neglected. Clinical Pharmacology can become a investigators. Understanding the mechanisms of the discovery discipline and not a mere handmaid to the plant actions opened up the paths for the medicinal pharmaceutical as a conduit to new drug registrations. chemistry and screening of NCEs based on the Bradford Hill listed the criteria of causality which can be phytomolecules. It was then felt that a paradigm shift applied to novel bedside pharmacodynamic and toxic was needed in the approaches in new drug discovery and effects to understand and pursue the phenomena at other © 2014 The Ashok D.B. Vaidya. This open access article is distributed under a Creative Commons Attribution (CC-BY) 3.0 license. Ashok D.B. Vaidya / Current Research in Drug Discovery 2014, 1 (2): 39.44 DOI: 10.3844/crddsp.2014.39.44 levels of biological organization. The nine view-points has drifted and a crisis is imminent, Reverse proposed by Hill (1965) are: (1) Strength of association, Pharmacology from the traditional medicine is emerging (2) Temporal relationship, (3) Consistency, (4) as a model revolution. This paradigm change may not Theoretical plausibility, (5) Coherence, (6) Specificity in appear too impressive but offers the path to tap the the causes, (7) Dose response relationship, (8) therapeutic wisdom of millennia for the discovery of Experimental evidence and (9) Analogy 3. While studying new drugs. Rabindranath Tagore has rightly said, “What the bedside drug-induced novel finding we can apply is huge is not great. And pride is not everlasting.” these criteria to Ayurvedic Pharmacology as suggested by Vaidya et al . (2003) However we must not forget he The Wisdom of Ayurveda caution expressed by Doll (1992), “None of these nine India, the world’s largest democracy has a live and viewpoints can bring indisputable evidence for or against a cause and effect hypothesis …. What they can do, with vibrant traditional system of medicine-Ayurveda. greater or less strength, is to help answer the Around 70% of India’s 1.25 billion population uses fundamental question-is there any other way of Ayurveda for their healthcare. There is a separate explaining the set of facts before us, is there any other Department of AYUSH, under the Ministry of Health answer equally, or more, likely than cause and effect?” and Family Welfare of the Government of India. The Vaidya (2011) suggested that observational therapeutics department has the education, services and research in in Ayurveda can provide such identified hits for new Ayurveda, Yoga, Unani, Siddha and Homeopathy. There drug discovery through RP. are more than 400 undergraduate and 100 postgraduate colleges of these systems. The registered trained Direct Pharmacology Path for Drug physicians if these systems are more than 7.5 million. Discovery The vast live experience in these systems offers opportunities for drug discoveries. Figure 1 shows the For many years, the pharmaceutical new drug discovery was dominated by ‘medicine-naïve chemists’ spectrum of remedies used in Ayurveda. to fulfil the expectations of ‘chemistry-naïve doctors’. There are more than 9000 manufacturers of Now-a-days the ruling paradigm is based on genomics, Ayurvedic drugs in India. The traditional knowledge proteomics and metabolomics. These new kids on the digital library (CSIR) has a database of thousands of block are often both medicine-naive and chemistry- Ayurvedic formulations. Millions of Indians consume naive! No wonder the attrition rate of the new drug hundreds of plants or formulations as self-medication or candidates is so high. The average costs of new drug as home culinary items. Despite the widespread use of discovery are stated to be around $ 1.3 billion. The Ayurvedic plants, in India, there is not any appropriate non-specific OECD guideline for toxicity studies, documentation of the responses and reactions to these commercial clinical trials by contract research organizations and the lack of physician involvement in drugs. The classical Ayurvedic texts and teachers explain new drugs are some of the reasons for the present the drug effects in terms of Ayurvedic Drvyagunas- debacle in drug discovery. The developing nations are properties of the materials- as per their epistemology. frightened away from the domain by the costly and Reverse Pharmacology would investigate the drug long process of getting a new drug on the market. The actions in terms of the modern pharmacology. 0.01 % market yield from the baseline of 100% NCEs The poet-saint Dave (1998) stated once, “There are makes one wonder for the need of a paradigm shift in two paths to discover botanical drugs. One is the ancient drug discovery process. traditional path of understanding the Guna-dharmas and then carry out the experiments in bedside therapeutics. A Paradigm Shift in Drug Discovery The second path lies in the modern laboratory approach. Kuhn (1962) wrote, “The historian of science may be It is very essential to synergize both the paths, bereft of tempted to exclaim that when paradigms change, the stark commercial interest with a reverence for the herbs world itself changes with them.” In our proposal of as our partners in the healing art.” Vaidya and Vaidya ‘bedside to the bench’, we expect that the clinical ward (2006) described that Lokmanya Tilak, the father of to evolve from a service-teaching unit to a clinical Indian independence movement, had said, “Ayurvidya is research milieu. The entrenched paradigm of normal an active and open ended interface of Ayurveda with the science, over a period, fails to deliver results and advancing modern sciences, especially life sciences.” discoveries as in the earlier times. Then a model drift sets in, which can lead to model crisis. The crisis Recently, in India, a significant renaissance is taking precipitates a revolution in the model, leading to a place by a multi-pronged research in Ayurveda. The paradigm change. The entire cycle is called the Kuhn diverse paths for natural products Research and cycle. As the model of drug discovery and development Development (R and D) are shown in the Fig. 2. 40 Ashok D.B. Vaidya / Current Research in Drug Discovery 2014, 1 (2): 39.44 DOI: 10.3844/crddsp.2014.39.44 Fig. 1. Spectrum of ayurvedic remedies Fig. 2. R and D paths for natural products efficacy and safety and human pharmacology and phase Reverse Pharmacology 2 studies for dose-finding, (3) the experimental domain The definition of reverse pharmacology is as involves well-planned experimental and clinical follows.
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