{"title":"Nonsteroidal Mineralocorticoid Receptor Antagonists in Heart Failure: Mechanistic Basis, Clinical Evidence, and Therapeutic Integration.","authors":"Rami A Al-Horani, Navneet Goyal","doi":"10.3390/ddc5020033","DOIUrl":"10.3390/ddc5020033","url":null,"abstract":"<p><p>The therapeutic landscape for heart failure (HF), particularly in patients with mildly reduced (HFmrEF) and preserved ejection fraction (HFpEF), has historically been characterized by limited effective disease-modifying options. The recent approval of nonsteroidal mineralocorticoid receptor antagonists (nsMRAs), specifically finerenone, represents a major paradigm shift. This review synthesizes contemporary evidence, including the landmark FINEARTS-HF trial, which demonstrated significant reductions in cardiovascular death and heart failure hospitalizations in patients with left ventricular ejection fraction (LVEF) ≥ 40%. These findings contrast with the neutral overall results and subgroup limitations observed with steroidal MRAs such as spironolactone in the TOPCAT trial. Mechanistic distinctions, cardiorenal benefits, and emerging metabolic effects of finerenone are explored alongside its complementary role with sodium-glucose cotransporter-2 (SGLT2) inhibitors. Practical considerations for implementation, including patient selection, dosing, monitoring, and combination therapy strategies, are discussed. Overall, nsMRAs establish a new foundation for the management of HFmrEF and HFpEF and represent a critical advancement in contemporary heart failure therapeutics.</p>","PeriodicalId":520982,"journal":{"name":"Drugs and drug candidates","volume":"5 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13268565/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148268056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Cancer Metabolism and Its Historical & Molecular Foundations: An Overview.","authors":"Rami A Al-Horani","doi":"10.3390/ddc5010017","DOIUrl":"10.3390/ddc5010017","url":null,"abstract":"<p><p>Cancer metabolism is a cornerstone of tumor biology, characterized by profound alterations in cellular energy production and biosynthetic pathways that drive malignancy. The seminal discovery of the \"Warburg effect\", the preference of cancer cells for aerobic glycolysis even under oxygen-rich conditions, provided the first major insight into this field. Historically, this observation was attributed to defective mitochondria, but modern research has revealed a far more complex picture of metabolic reprogramming that is actively driven by oncogenes, tumor suppressor genes, and the tumor microenvironment (TME). This review advances a unifying framework for understanding cancer metabolism as a dynamic ecosystem defined by three interconnected adaptations: metabolic plasticity, oncometabolite-driven epigenetic remodeling, and immune-metabolic crosstalk. These adaptations extend beyond glycolysis to encompass glutamine metabolism, lipid synthesis, amino acid utilization, and mitochondrial dynamics, all coordinated to fuel rapid proliferation, promote survival, and enable metastasis. By examining the drivers, consequences, and therapeutic barriers within this framework, we highlight emerging strategies for precision intervention. Although understanding the mechanistic basis of these pathways has unveiled new therapeutic avenues, clinical translation has been limited by metabolic redundancy, microenvironmental buffering, and patient heterogeneity. Strategies such as metabolic inhibitors, dietary interventions, and immuno-metabolic combinations offer promising prospects for disrupting tumor growth when guided by biomarker-driven patient selection and emerging technologies, including spatial metabolomics and AI-driven network modeling.</p>","PeriodicalId":520982,"journal":{"name":"Drugs and drug candidates","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13002032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147501628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Suzetrigine: A Novel Non-Opioid Analgesic for Acute Pain Management-A Review.","authors":"Meaghan Jones, Aryanna Demery, Rami A Al-Horani","doi":"10.3390/ddc4030032","DOIUrl":"10.3390/ddc4030032","url":null,"abstract":"<p><p>Suzetrigine represents a groundbreaking advancement in acute pain management as the first FDA-approved selective Na<sub>v</sub>1.8 inhibitor. This comprehensive review synthesizes data from clinical trials, pharmacological studies, and prescribing information to evaluate its mechanism, efficacy, safety, and clinical implications. With demonstrated superiority over placebo in pivotal trials (SPID48: 29.3-48.4; <i>p</i> < 0.0001) and a favorable safety profile devoid of opioid-like addiction risks, suzetrigine offers a much-needed alternative in the opioid crisis era. However, its modest effect size compared to full-dose opioids, CYP3A-mediated drug interactions, and limited long-term data warrant judicious use. This article provides a balanced perspective on suzetrigine's role in modern pain management protocols.</p>","PeriodicalId":520982,"journal":{"name":"Drugs and drug candidates","volume":"4 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12337992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144839966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Current Therapies and Potential Strategies for Uveal Melanoma.","authors":"Sarah Scoles, Sanjay Ganesh, Kaori H Yamada","doi":"10.3390/ddc4020014","DOIUrl":"10.3390/ddc4020014","url":null,"abstract":"<p><strong>Background/objectives: </strong>Uveal melanoma (UM) is a rare but deadly ocular cancer. This review summarizes the characteristics of uveal melanoma and current therapeutic options for primary uveal melanoma and metastatic uveal melanoma, and introduces recent development of therapeutic strategies in preclinical animal studies and clinical trials.</p><p><strong>Methods: </strong>The literature search was conducted to identify relevant articles for UM studies. It was performed using PubMed for articles in English until March 2025. Information on clinical trials was also obtained from ClinicalTrial.gov.</p><p><strong>Results: </strong>Uveal melanoma originates from melanocytes, similar to skin melanoma. However, uveal melanoma has different mutations from skin melanoma. Thus, chemotherapy and immunotherapy, which are effective for skin melanoma, are ineffective for uveal melanoma. Current therapies for UM include radiation therapy, surgical resection, liver-directed therapies, and recently FDA-approved tebentafusp. Although a wide variety of available and newly developed therapies have been tested in clinical trials for UM, tebentafusp is the only FDA-approved therapy for metastatic UM. Given the excessive expression of vascular endothelial growth factor (VEGF) in UM patients with metastatic diseases, anti-VEGF strategies are being tested in clinical trials and pre-clinical animal models.</p><p><strong>Conclusions: </strong>This review summarizes an overview of current therapies and the development of therapeutic strategies in clinical trials and pre-clinical animal models. Despite successful control of primary tumors, 50% of UM patients still experience metastasis in the liver. Although tebentafusp improves the overall survival (OS) of a certain population of UM patients, robust strategies for preventing UM metastasis represent a critical unmet need. Further investigations of the heterogeneity of UM cells and mechanisms of UM metastasis are needed in the future.</p>","PeriodicalId":520982,"journal":{"name":"Drugs and drug candidates","volume":"4 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12928755/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147287063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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