4.3: Rush Delivery

Finding new medicines and cost-effective ways to manufacture them is only half the battle. An enormous challenge for pharmacologists is figuring out how to get drugs to the right place, a task known as drug delivery.

Ideally, a drug should enter the body, go directly to the diseased site while bypassing healthy tissue, do its job, and then disappear. Unfortunately, this rarely happens with the typical methods of delivering drugs: swallowing and injection. When swallowed, many medicines made of protein are never absorbed into the bloodstream because they are quickly chewed up by enzymes as they pass through the digestive system. If the drug does get to the blood from the intestines, it falls prey to liver enzymes. For doctors prescribing such drugs, this first-pass effect means that several doses of an oral drug are needed before enough makes it to the blood. Drug injections also cause problems, because they are expensive, difficult for patients to self-administer, and are unwieldy if the drug must be taken daily. Both methods of administration also result in fluctuating levels of the drug in the blood, which is inefficient and can be dangerous.

What to do? Pharmacologists can work around the first-pass effect by delivering medicines via the skin, nose, and lungs. Each of these methods bypasses the intestinal tract and can increase the amount of drug getting to the desired site of action in the body. Slow, steady drug delivery directly to the bloodstream—without stopping at the liver first—is the primary benefit of skin patches, which makes this form of drug delivery particularly useful when a chemical must be administered over a long period.

Hormones such as testosterone, progesterone, and estrogen are available as skin patches. These forms of medicines enter the blood via a meshwork of small arteries, veins, and capillaries in the skin. Researchers also have developed skin patches for a wide variety of other drugs. Some of these include Duragesic® (a prescription-only pain medicine), Transderm Scop® (a motion-sickness drug), and Transderm Nitro® (a blood vessel-widening drug used to treat chest pain associated with heart disease). Despite their advantages, however, skin patches have a significant drawback. Only very small drug molecules can get into the body through the skin.

Inhaling drugs through the nose or mouth is another way to rapidly deliver drugs and bypass the liver. Inhalers have been a mainstay of asthma therapy for years, and doctors prescribe nasal steroid drugs for allergy and sinus problems.

Researchers are investigating insulin powders that can be inhaled by people with diabetes who rely on insulin to control their blood sugar daily. This still-experimental technology stems from novel uses of chemistry and engineering to manufacture insulin particles of just the right size. Too large, and the insulin particles could lodge in the lungs; too small, and the particles will be exhaled. If clinical trials with inhaled insulin prove that it is safe and effective, then this therapy could make life much easier for people with diabetes.

Reading a Cell MAP

Scientists try hard to listen to the noisy, garbled "discussions" that take place inside and between cells. Less than a decade ago, scientists identified one very important cellular communication stream called MAP (mitogen-activated protein) kinase signaling. Today, molecular pharmacologists such as Melanie H. Cobb of the University of Texas Southwestern Medical Center at Dallas are studying how MAP kinase signaling pathways malfunction in unhealthy cells.

Kinases are enzymes that add phosphate groups (red-yellow structures) to proteins (green), assigning the proteins a code. In this reaction, an intermediate molecule called ATP (adenosine triphosphate) donates a phosphate group from itself, becoming ADP (adenosine diphosphate).

Some of the interactions between proteins in these pathways involve adding and taking away tiny molecular labels called phosphate groups. Kinases are the enzymes that add phosphate groups to proteins, and this process is called phosphorylation. Marking proteins in this way assigns the proteins a code, instructing the cell to do something, such as divide or grow. The body employs many, many signaling pathways involving hundreds of different kinase enzymes. Some of the important functions performed by MAP kinase pathways include instructing immature cells how to "grow up" to be specialized cell types like muscle cells, helping cells in the pancreas respond to the hormone insulin, and even telling cells how to die.

Since MAP kinase pathways are key to so many important cell processes, researchers consider them good targets for drugs. Clinical trials are under way to test various molecules that, in animal studies, can effectively lock up MAP kinase signaling when it's not wanted, for example, in cancer and in diseases involving an overactive immune system, such as arthritis. Researchers predict that if drugs to block MAP kinase signaling prove effective in people, they will likely be used in combination with other medicines that treat a variety of health conditions, since many diseases are probably caused by simultaneous errors in multiple signaling pathways.

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