Review Articles in 2023

This Review discusses the mechanisms that regulate stabilization of hypoxia-inducible factors (HIFs), and the pharmacological strategies to activate or inhibit HIFs in diseases such as ischaemia, inflammation, cancer, retinal neovascularization and pulmonary hypertension.

The TAM tyrosine kinase receptors TYRO3, AXL and MERTK regulate tissue and immune homeostasis. This Review discusses how their aberrant signalling is linked to diseases such as cancer, fibrosis and viral infection, and surveys the therapeutic landscape of TAM receptor inhibitors in preclinical and clinical development.

A diverse range of systems have recently been developed to promote the degradation of extracellular and membrane protein targets by using bispecific antibodies, conjugates or small molecules to traffic targeted proteins to the lysosome. This article describes and categorizes systems for extracellular targeted protein degradation, including LYTACs, ATACs, AbTACs, PROTABs and KineTACs, and discusses their advantages and the challenges ahead to realizing their therapeutic potential.

The potential of harnessing tRNAs to treat genetic diseases has recently gained significant attention. Here, Coller and Ignatova provide an overview of the history and potential applications of tRNA-based therapies, summarize advances in tRNA cargo design and delivery strategies, and assess the challenges encountered in establishing tRNAs as effective and safe therapeutics.

Inflammasomes are central instigators of the inflammatory response to infection and tissue damage and key regulators in diverse diseases. Here, the authors describe signalling mechanisms that regulate the NLRP3 inflammasome pathways and recent progress in the development of inhibitors and agonists that are advancing into the clinic.

The recent success of mRNA vaccines has boosted the prospects for the development of a new class of designer medicines based on mRNA. This Review discusses the multiple design parameters that need to be carefully considered to create highly effective mRNA medicines.

Synapses are crucial nodes for communication between neurons and are frequently damaged or dysfunctional in a range of neurodegenerative diseases. In their Review, Dejanovic, Sheng and Hanson outline the current understanding of pathological mechanisms operating at the synapse. They discuss several synapse-targeted approaches in preclinical and clinical development, which could be particularly valuable in combination with other therapeutic strategies.

This Review discusses current research strategies to overcome resistance to CAR-T cell therapy in blood cancers, including optimization of CAR design, improvement of T cell function and persistence, modulation of the immunosuppressive tumour microenvironment and synergistic combination strategies.

T cell receptors (TCRs) enable the targeting of proteins selectively expressed by cancer cells, including neoantigens, cancer germline antigens and viral oncoproteins. This Review discusses the current cancer treatment landscape using TCRs and TCR-like molecules, including adoptive cell transfer of T cells expressing endogenous or engineered TCRs or TCR bispecific engagers.

New classes of antibiotic with activity against Gram-negative bacteria that are resistant to existing drugs are urgently needed, but have been very challenging to identify. This Review describes promising but as-yet-unrealized targets for antibacterial drugs against Gram-negative bacteria and highlights lessons learned from past drug discovery programmes.

CRISPR-based genome editing has the potential to treat many human genetic diseases, but achieving stable, efficient and safe in vivo delivery remains a challenge. This Review assesses current delivery systems for genome editors—focusing on adeno-associated viruses and lipid nanoparticles—and highlights data from recent clinical trials. Emerging delivery systems and ongoing challenges in the field are discussed.

Advances in computational omics technologies are enabling access to the hidden diversity of natural products, and artificial intelligence approaches are facilitating key steps in harnessing the therapeutic potential of such compounds, including biological activity prediction. This article discusses synergies between these fields to effectively identify drug candidates from the plethora of molecules produced by nature, and how to address the challenges in realizing the potential of these synergies.

In vivo gene supplementation using adeno-associated virus (AAV) vectors holds substantial promise for a range of neurological disorders. In this Review, the authors discuss ongoing clinical trials and growing knowledge on factors that affect translational success and safety. They outline approaches to increase efficacy and reduce potential toxicity, including optimization of the AAV vector, and consider new frontiers and unmet needs in the field.

Malaria case numbers are rising globally and there is a vital need for new medicines that overcome the emergence of drug resistance. This Review describes the current landscape of small-molecule antimalarial therapies and the methods used to discover them as well as perspectives on approaches to find new targets and treatments.

Duchenne muscular dystrophy is an inherited muscle-wasting disease caused by mutations that disrupt production of dystrophin protein. This Review discusses the plethora of therapeutic approaches being developed to restore dystrophin function, such as exon skipping, gene replacement, cell therapy and gene editing, and highlights recent clinical approvals.

Several forms of non-apoptotic cell death, such as necroptosis, pyroptosis, parthanatos and ferroptosis, are implicated in degenerative diseases, cancer and inflammation. This article describes the molecular pathways regulating these forms of cell death and gives an update on small-molecule inhibitors being developed to target these pathways.

Cytokines mediate a broad range of cellular functions, and the regulation of their activity is important both physiologically and pathologically. This Review explores the biology, signalling and regulation of cytokines and their receptors. Focusing on IL-2, engineering strategies and agents aimed at therapeutically redirecting and fine-tuning cytokine actions, particularly for applications in cancer and autoimmune disease, are assessed.

Increased understanding of the molecular mechanisms underlying type 2 chronic inflammatory diseases has facilitated the development of more targeted therapies for these conditions. Focusing on five major type 2 diseases, this Review provides an overview of the pathogenic drivers of type 2 inflammation, assesses agents that target them and considers emerging novel therapies and unmet needs.

Cancer therapy has changed substantially since the beginning of the century, with advances including kinase inhibitors and immunotherapies resulting in substantial improvements in treatment outcomes. This Review summarizes trends in the approval of oncology therapeutic products by the FDA since 2000 and discusses the implications for the future of anticancer drug development.

DNA-encoded library (DEL) technology is a powerful small-molecule discovery platform, offering many advantages over traditional screening methods. Here, Peterson and Liu provide an in-depth review of recent small molecules discovered through DELs, illustrating the versatility, efficiency and broad impact of this technology.