Frontiers in Pharmacology

"Revealing the structure of pharmacobehavioral space through motion sequencing" by Wiltschko et al. (2020) has been highly influential in behavioral phenotyping research. In a cohort of nearly 700 mice, the authors demonstrated that Motion Sequencing (MoSeq) could distinguish behavioral effects across a large and diverse set of neuroactive and psychoactive compounds. A central conclusion of the study is that MoSeq syllable features substantially outperform more traditional scalar behavioral features in treatment classification tasks. Although this comparison is not emphasized outside the Results section, the reported advantage corresponds to an increase in classification performance exceeding 50% relative to scalar feature representations. While reproducing parts of the analysis using the publicly available dataset, we found that much of this apparent performance difference can be attributed to differences in preprocessing, classifier selection, and hyperparameter optimization. Under alternative, but comparably standard, analytical choices, the performance gap between scalar features and MoSeq syllables was reduced to approximately 11%. Furthermore, in our reanalysis, the performance advantage of MoSeq syllables became statistically significant primarily in highly dense pharmacobehavioral spaces. These findings do not contradict the utility of MoSeq syllables. Rather, they suggest that the magnitude and generality of their advantage over simpler scalar features may depend strongly on analytical methodology and dataset structure. This distinction is practically relevant, as scalar feature approaches are substantially less computationally demanding and often easier to interpret biologically. Consequently, for laboratories with limited computational resources or for studies focused on specific treatment effects, conventional scalar representations may provide a competitive and more accessible alternative. Our findings highlight the importance of analytical standardization and reproducibility in comparative behavioral representation studies.

Volume-regulated anion channels (VRACs), formed by leucine-rich repeat-containing 8 (LRRC8) proteins, are ubiquitously expressed chloride channels essential for cell volume regulation and implicated in diverse physiological and pathological processes. Small-molecule VRAC inhibitors have been reported to modulate paracrine signaling, proliferation, differentiation, migration, and apoptosis, and have been patented for potential therapeutic applications in stroke, cardiovascular and metabolic diseases, and cancer. However, growing evidence indicates that many commonly used VRAC blockers exert substantial off-target effects and frequently fail to reproduce phenotypes observed after deletion of the essential VRAC subunit LRRC8A. Here, we systematically compared effects of several widely used pharmacological VRAC inhibitors with outcomes of molecular downregulation of LRRC8A in limiting proliferation of malignant glioblastoma cells derived from surgical specimens. NIH/3T3 fibroblasts served as a non-malignant control. In serum-containing media, structurally diverse VRAC blockers (DCPIB, DIDS, carbenoxolone, phloretin, and bromadiolone) reduced proliferation in a non-uniform manner, with potencies that did not correlate with reported VRAC affinities and varied markedly among cell lines. Radiotracer-based measurements of VRAC activity indicated that these discrepancies were largely attributable to binding of inhibitors to serum albumin. When experiments were repeated under serum-free conditions, all inhibitors except DIDS and phloretin induced extensive death of both malignant and non-malignant cells, confirmed by microscopy and LDH release assays. This cytotoxicity was accompanied by a marked reduction in intracellular ATP levels, consistent with previously reported mitochondrial uncoupling effects. In contrast, LRRC8A knockdown reduced proliferation without substantial cell death. Together, these findings demonstrate that most commercially available VRAC blockers limit proliferation and viability predominantly through VRAC-independent mechanisms. Under standard culture conditions, serum albumin masks much of their intrinsic cytotoxicity. These results underscore the need for rigorous molecular controls in pharmacological studies and provide basis for developing more selective and less toxic VRAC-targeting agents.

Hypoxia-inducible factor prolyl hydroxylase (HIF-PH) inhibitors are widely used for the treatment of renal anemia; however, their effects on intraocular vascular endothelial growth factor (VEGF) expression remain unclear. In this study, we examined the effects of all five HIF-PH inhibitors --roxadustat, daprodustat, vadadustat, enarodustat, and molidustat--on Vegfa expression in the retina in mice. C57BL/6J mice were orally administered each inhibitor. Six hours after administration, the kidney, retina, and liver were collected, and transcription levels were quantified by real-time quantitative reverse transcription PCR. Renal Epo transcription was significantly increased by molidustat (P < 0.01), roxadustat (P < 0.01), and enarodustat (P < 0.05). Retinal Vegfa transcription was significantly increased by four inhibitors (P < 0.01), with molidustat showing no significant effect. In the liver, Vegfa transcription was increased by daprodustat (P < 0.05) and vadadustat (P < 0.01). Furthermore, renal Epo and retinal Vegfa transcription levels showed a moderate positive correlation with a marginal trend toward statistical significance (r = 0.37, P = 0.08). These findings indicate that HIF-PH inhibitors differentially regulate hypoxia-responsive genes across tissues and suggest that retinal VEGF upregulation should be considered when evaluating the safety of these agents.

Several potentially potent anticancer drugs have been identified by in vitro evaluation, such as Andrographolide. These compounds show strong anticancer activity in vitro, but struggle to reach effective concentrations in the bloodstream when taken orally because they dissolve poorly in water or break down rapidly in the body. Bioenhancers, which are compounds that have potential to improve drug stability in the body, offer an alternative solution to overcome this limitation. Naringin and Quercetin have been identified as candidate bioenhancers, and have been hypothesized to potentially slow rapid first pass metabolism of poorly bioavailable drugs. Our work focuses on testing Naringin and Quercetin because they are flavonoids with therapeutic potential, due to their anti-inflammatory and antioxidant properties. Data from the hepatic microsomal assays performed on Naringin and Quercetin suggest moderate to proficient periods of stability in the body, with Naringin having 91.86% remaining, while Quercetin had 74.84% remaining. When administered alongside Andrographolide, a drug known to rapidly degrade in the body, Naringin raised its metabolic stability from 38.93% to 80.77% and on the other hand, Quercetin raised Andrographolide metabolic stability from 38.93% to 86.70%. In addition, plasma protein binding assays show the percentage of compounds available at the target site where Naringin was observed to be 49.32% bound and Quercetin found to be 50.14% bound, implying 50.68% of Naringin, and 49.86% of Quercetin available at the target site, respectively. This preliminary study explores whether Quercetin and Naringin could act as bioenhancers by remaining stable and available in plasma and by slowing the metabolism of poorly bioavailable drugs such as Andrographolide.

IL-4Ra is a key regulatory receptor for type 2 inflammatory responses, signal transduce from IL-4 and IL-13 through binding with IL-13Ra or the gamma c chain to activate the downstream JAK1-STAT6 pathway. IL-4Ra is currently the most successful "golden target" in the field of allergic disease therapeutics. Its representative monoclonal antibody drug, dupilumab, through the dual blockade mechanism of IL-4/IL-13 has pioneered a new era of precision therapy for type 2 inflammation. In our manuscript, we employed large-scale deep learning-based computational design methods to de novo design mini-protein antagonists specific for both human and mouse IL-4Ra. The binding affinity was improved from 22.1 nM to 569 pM through partial diffusion. The design accuracy and binding specificity were verified through X-ray crystallography and biochemical studies. In vitro IL4/IL13 signal blockade assays revealed that de novo designed monomeric mini-protein antagonist exhibited comparable blockade ability to bivalent dupilumab. In vivo pharmacokinetic half-life studies demonstrated that fusion to an HSA-binding domain extended the half-life of the mini-protein antagonist from 2.7 hours to 60.6 hours. The IL-4Ra mini-protein antagonist had excellent expression levels, solubility and thermal stability. The IL4/IL13 signal blockade ability remained unchanged even after being heating to 95 degrees. In conclusion, through large-scale cluster computing and deep learning-based de novo design, we developed well-performed IL-4Ra mini-protein antagonist, and demonstrates certain potential for drug development.

Favipiravir (FPV) is an RdRp inhibitor developed and licensed in Japan for influenza but which has shown promising in-vitro activity against a range of RNA viruses. A physiologically-based pharmacokinetic model was developed for oral FPV and its metabolite M1 in order to optimise the dose regimen against plasma concentration targets for a number of viral pathogens. The model was validated using clinical data and was able to capture the variability in plasma concentrations for a population of individuals. FPV doses predicted to cause in-vivo exposures exceeding in-vitro IC90 targets against influenza, Ebola, Lassa fever, CCHF, SFTS, Andes virus and SARS-CoV-2, lie within the window of observed safe dosing, with SARS-CoV-2 requiring predicted doses of 2400 mg twice daily due to lower in-vitro potency. Simulations showed that a loading dose on day one of treatment should allow plasma targets to be exceeded on day one. Simulations of chronic kidney disease (CKD) showed no change to FPV plasma concentration in individuals with CKD3 and CKD5 compared to healthy individuals. Clinical data suggested active renal efflux of M1 which led to a predicted 2.2 and 11.5 fold increase in the maximum plasma concentrations of M1 in individuals with CKD3 and CKD5 respectively in comparison with healthy individuals.

Schizophrenia is a debilitating neuropsychiatric disease that lacks effective treatments for many symptom domains including negative, cognitive and sleep disturbances. Lack of clear disease etiology has hampered the development of new, effective treatments for the unmet needs of people with schizophrenia. Large scale human genetics have identified rare loss of function mutations that substantially increase risk of developing schizophrenia, including in GRIA3, the gene that encodes the GluA3 receptor subunit of the AMPA receptor (AMPAR). Several drug discovery programs have been aimed at developing AMPAR positive allosteric modulators (PAMs) as a novel treatment for schizophrenia. Despite intense drug discovery efforts, there are no FDA approved AMPAR PAMs. We therefore hypothesized that selectively targeting GluA3, the AMPAR subunit implicated by human genetics, could yield a safer and more effective AMPAR PAM for the potential treatment of schizophrenia. Using a combination of medicinal chemistry, in vitro, and in vivo studies, we discovered BRD3290, a GluA3-preferring AMPAR PAM with reasonable potency in heterologous cells, as well as favorable tolerability and brain exposure. Peripheral administration of BRD3290 engaged an established AMPAR PAM target engagement biomarker but did not improve performance of wildtype mice in the novel object recognition task (NOR), in contrast to the nonselective AMPAR PAM PF-4778574, which improved mouse NOR. These findings suggest that the GluA3 selectivity profile of BRD3290 was insufficient to enhance cognitive function in this mouse NOR paradigm. This work highlights the challenges of AMPAR subtype-selective modulation and provides molecular insights into the ability to develop subtype-selective AMPAR PAMs. Graphical Abstract O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=110 SRC="FIGDIR/small/740780v1_ufig1.gif" ALT="Figure 1"> View larger version (28K): org.highwire.dtl.DTLVardef@1c14b74org.highwire.dtl.DTLVardef@140b2b3org.highwire.dtl.DTLVardef@942636org.highwire.dtl.DTLVardef@58bc24_HPS_FORMAT_FIGEXP M_FIG C_FIG

Intestinal insect cells are integral to pharmacokinetic research, unfortunately they do not serve as cell models for more advanced studies comparable to transport studies typically conducted in mammalian models. To overcome this limitation, in this study, we developed a Caco-2 cell line that has been genetically modified to mimic insect-like characteristics, providing a robust insectified screening platform to monitor transport processes of xenobiotics. This platform consists of Wild Type (Pgpwild type) cells, an Pgp Knockout (PgpKO) line to eliminate endogenous background interference, and species-specific P-gp rescue lines. These rescue lines allow for the stable expression of human (Hs Pgp), cotton bollworm (Ha Pgp), and malaria mosquito (Ag Pgp) homologs, enabling a direct comparative analysis of efflux kinetics across different pesticide target and non-target biological systems. Functional validation using the substrate Digoxin confirmed high P-gp dependency within the platform. Methyl-parathion, an organophospate insecticide, was recognised and transported by both insect and human Pgps. This is consistent with the low mammalian selectivity of the compound. In contrast, Triflumezopyrim exhibited a high efflux ratio that remained remarkably stable even in the absence of MDR1, indicating that the uptake and pharmacokinetics of this compound are not Pgp-dependent. By successfully differentiating between transporter-specific and independent pathways these cell lines can serve as a high-fidelity screening tool for predicting novel pesticide selectivity and possibly validating the potential role of transporters in resistance. The system can be expanded and exploit also other transporters.

Background: Subtype-selectivity predictions are scored against measured selectivity and judged against an assumed noise ceiling. We asked what an 2-adrenergic benchmark rewards and which controls change its interpretation. Research design and methods: On a frozen benchmark of 586 paired 2A/2C compounds we evaluated Glide SP docking, CNN rescoring, ligand-only fingerprint models, receptor descriptors and pose contacts, with dopamine D3/D2 as comparator, applying five controls: a measured ceiling, a cluster-identity null, a nonselective reference, a same-receptor floor and a trivial-descriptor baseline. Results: Five descriptors from SMILES reached Spearman 0.645, 72% of the measured ceiling, against 0.071 for Glide SP and 0.188 for CNN rescoring; receptor properties and pose contacts reduced to size under control, while a non-size signal of 0.258 survived. Measured rather than propagated noise raised that ceiling from 0.704 to 0.897; cluster identity alone reached R2 0.499 on D3/D2 and none on 2; a nonselective reference received +1.43 to +4.79 kcal/mol where zero is expected; and a same-receptor floor reached 1.77-fold against 1.88-fold across subtypes. Conclusions: Such benchmarks reward molecular size first; a method must exceed 0.645 before its score indicates structural reasoning. The controls are inexpensive; conclusions rest on two receptor pairs, a three-pair floor and static structures.

Immune checkpoint blockade (ICB) therapy has revolutionized cancer treatment, though it is still effective in only about 20-40% of patients. To increase the efficacy of ICB therapy, combinations of ICB antibodies such as anti-PD1 and anticoagulants (e.g., thrombin inhibitors) have been studied in preclinical mouse models and clinical trials. We developed a Bliss-type analysis to quantify the synergy between anti-PD1 and dabigatran etexilate using published tumor growth data from a mouse model. We then developed a minimal mechanistic computational model to quantitatively study the synergy between anti-PD1 and the thrombin inhibitor dabigatran etexilate in a published study (Metelli et al.) of a preclinical mouse model of colon cancer. Our model included tumor cells, CD8+ T cells, and the pleiotropic cytokine TGF{beta}, whose production in platelets is influenced by thrombin, and described a potential mechanism of interplay among these components in the tumor microenvironment. We performed nonlinear mixed-effects modeling to capture mouse-to-mouse variation in tumor growth under different treatment conditions. The estimated parameter values pointed to several underlying mechanisms of synergy, including increased expansion of CD8+ T cells in the tumor microenvironment in the presence of anti-PD1 and dabigatran etexilate. These predictions can be further validated in future experiments. Thus, the combination of longitudinal tumor growth data, mechanistic population dynamics modeling, and nonlinear mixed-effects modeling can be used to study synergy between ICB and other drugs in controlling tumor growth.

Serotonin (5-HT) is a monoamine which regulates not only central functions but also various peripheral functions. Peripheral 5-HT is primarily derived from the gut, and its synthesis and secretion are regulated by enterochromaffin cells. Stimulation of enterochromaffin cells by food factors may regulate mental functions via the gut-brain axis. We studied whether oleuropein, an olive-derived polyphenol, regulates central functions by stimulating 5-HT secretion from enterochromaffin cells. In QGP-1 cells, which are enterochromaffin-like cells, 10 {micro}M oleuropein stimulated 5-HT secretion via Ca2+ influx through T-type and L-type voltage-dependent Ca2+ channels. Hydroxytyrosol, a metabolite of oleuropein, also promoted 5-HT secretion via the same mechanism. Furthermore, oleuropein stimulated 5-HT secretion from isolated mouse colon via voltage-dependent Ca2+ channels. Finally, oral administration of 200 mg/kg oleuropein acutely increased the depression-like behavior in the mice, which was inhibited by the prior administration of ramosetron, a 5-HT3 receptor antagonist. These findings suggest that oleuropein is a potent stimulant of gut 5-HT secretion, and show that food factors may act to regulate mental function via the secretion of gut 5-HT.

Background and purposeAnthracyclines, such as doxorubicin (DOX), are associated with late-onset kidney dysfunction; however, the mechanisms underlying chronic tubular injury remain poorly understood. We investigated whether chronic low-dose DOX exposure induces persistent mitochondrial dysfunction in renal tubules and evaluated the therapeutic potential of activating the NAD-Sirtuin axis. Experimental ApproachC57BL/6 mice were repeatedly administered low-dose DOX with or without resveratrol (RSV) or nicotinamide mononucleotide (NMN), a sirtuin activator. Renal injury was assessed using neutrophil gelatinase-associated lipocalin (NGAL) staining. Integrated proteomic and RNA sequencing analyses were performed to identify molecular alterations. Mitochondrial morphology and function were evaluated using structured illumination microscopy (SIM) of Massons trichrome-stained paraffin sections and ex vivo Seahorse analysis of freshly isolated renal tubules. Key ResultsChronic DOX administration induced tubular injury, despite preserving serum creatinine levels. Multi-omics analyses consistently demonstrated the suppression of mitochondrial pathways, including oxidative phosphorylation, fatty acid oxidation, and mitochondrial gene expression. SIM revealed mitochondrial fragmentation in tubular epithelial cells, whereas the Seahorse assay showed impaired mitochondrial respiratory capacity in isolated renal tubules. DOX also increased tubular acetylated superoxide dismutase 2 (SOD2) levels and activated inflammatory pathways. Importantly, both RSV and NMN attenuated tubular injury, restored mitochondrial metabolic pathways, reduced SOD2 acetylation, improved mitochondrial morphology, and suppressed inflammatory responses. Conclusions and ImplicationsChronic low-dose DOX exposure induces subclinical renal tubular injury characterized by mitochondrial dysfunction and inflammation. The pharmacological activation of sirtuins confers reno-protective effects by preserving mitochondrial homeostasis. These findings identify mitochondrial dysfunction as a central therapeutic target in DOX-induced nephrotoxicity and support sirtuin modulation as a potential strategy for preventing chemotherapy-related chronic kidney injury. Bullet point summaryO_ST_ABSWhat is already knownC_ST_ABSO_LIDoxorubicin causes cardiotoxicity through mitochondrial dysfunction and oxidative stress. C_LIO_LIDoxorubicin-induced tubular injury and the associated late-onset kidney dysfunction are clinically proven. C_LI What does this study addO_LIChronic low-dose doxorubicin induces tubular mitochondrial dysfunction, as identified by integrated multi-omics analyses. C_LIO_LIResveratrol and NMN preserve mitochondrial integrity and suppress inflammatory responses in renal tubules. C_LI Clinical significanceO_LIMitochondrial dysfunction may represent an early therapeutic target in doxorubicin-associated nephrotoxicity. C_LIO_LIActivation of the NAD-Sirtuin axis could prevent chronic kidney injury in cancer survivors. C_LI

Tenuazonic acid (TeA) is one of the most frequently detected Alternaria mycotoxins in contaminated food. Despite its frequent occurrence, its immunomodulatory effects remain insufficiently characterized. Therefore, the present study investigated the impact of TeA on inflammatory signaling and cytokine regulation in monocytes and intestinal epithelial cell (IEC) models. NF-{kappa}B activity was assessed using a reporter gene assay in THP1-Lucia monocytes, while cytokine mRNA expression and protein secretion were quantified in Caco-2 and HCEC-1CT cells by qRT-PCR and ELISA, respectively. In THP-1 monocytes, TeA significantly suppressed lipopolysaccharide (LPS)-induced NF-{kappa}B activation in a concentration-dependent manner starting at 25 M, while cytotoxicity occurred only at concentrations [&ge;]100 M. In HCEC-1CT and differentiated Caco-2 cells, TeA increased IL-6, IL-8, and TNF- mRNA levels at non-cytotoxic concentrations ([&ge;]10 M). In Caco-2 cells, these transcriptional changes were accompanied by increased cytokine secretion, whereas HCEC-1CT cells showed only partial effects on the protein level after short-term exposure. Following prolonged incubation, TNF- secretion was increased and IL-6 and IL-8 secretion were slightly reduced. IL-10 remained unaffected under all conditions. Overall, TeA exerted cell type-dependent immunomodulatory effects characterized by immunoinhibitory activity in monocytes and pro-inflammatory responses in IECs, highlighting the complex immunotoxic potential of this Alternaria mycotoxin.

Background: Adverse drug withdrawal events (ADWEs) are a key safety concern during deprescribing but remain poorly explored in pharmacovigilance systems. Objectives: To identify and compare ADWE signals across drug classes, different drugs within drug classes, and across patient characteristics, countries, and over time. Methods: A case/non-case disproportionality analysis was conducted in FDA-FAERS and EMA-EudraVigilance pharmacovigilance databases, with stratification by age (adults: 18-64, older adults: [&ge;]65), sex (male/female), reporting time (2004-2023 in 5-year intervals), and country (for EMA data). Disproportionality analysis (quantitative signal detection) was used to detect signals between ADWEs and drugs using the proportional reporting rate (PRR[&ge;]2), reporting odds ratio (ROR>1), and information component (IC>0) with case count [&ge;]5. Results: Overall, 158,501 reports (FDA-FAERS 145,514; EMA-EudraVigilance 12,987) included drug-event pairs related to ADWEs. In FDA-FAERS, clobetasone (IC=5.58; PRR=79.18; ROR=176.90) showed the strongest ADWE signals, followed by hydromorphone (4.85; 29.94; 37.37), hydrocodone, and paroxetine. In EMA-EudraVigilance, ethyl loflazepate (IC=6.01; PRR=119.80; ROR=197.53), clobetasone (5.39; 102.73; 155.10), veralipride, and levomethadone had the strongest signals. Most drugs maintained positive ADWE signals in analysis stratified into adults and older adults. However, among the top 10 drugs (based on highest IC values), buprenorphine/naloxone, desvenlafaxine, and baclofen in FDA-FAERS (ICs 4.95-6.05) showed stronger signals in older adults. A sex-based difference was observed, with paroxetine, venlafaxine, and buprenorphine/naloxone showing a stronger positive signal in females in both databases, whereas several opioids had stronger signals in males versus females across both databases. Conclusion: This study suggests ADWE signals for some medications differ by age and sex, potentially indicating different risks for withdrawal effects.

We published recently that one of the main constituents of cannabis products, cannabidiol (CBD), is an efficacious negative allosteric modulator (NAM) of the mu opioid receptor (MOR1) (Bosquez-Berger et al., 2023). Here, we investigated how the presence of cannabidiol (CBD) is associated with fentanyl (FEN) binding across MOR1 conformations. We performed molecular dynamics simulations of systems containing FEN alone or FEN+CBD in three mouse MOR1 conformational backgrounds: active-like 5C1M, inactive-like 4DKL, and a modeled Morph50 intermediate between the 5C1M and 4DKL conformations. Three independently seeded 200 ns trajectories were analyzed per model and condition (18 trajectories total), with the trajectory treated as the independent unit. Across the matched 0-200 ns window, consensus CBD contacts and CBD-associated changes in FEN contacts were strongly state dependent. Corrected intracellular TM3 to TM6 analyses separated the expected active-like, intermediate, and inactive-like backgrounds but did not identify a CBD-associated shift that was consistent across both geometric definitions and all three replicates. Equal-weight replicate-composite density maps preserved both the shared ligand distributions and this between-trajectory variability. These descriptive results support receptor-state-dependent CBD, FEN, MOR1 interactions while emphasizing the limited inferential power of three trajectories per condition.

Valproic acid/sodium valproate (VPA) is a widely prescribed anticonvulsant and has also been used against certain tumor cells. It is a potent modulator of gene expression. Its ability to induce apoptosis has been well documented in HeLa cells. However, another form of cell death - mitotic catastrophe - has not yet been explored in VPA-treated HeLa cells. Here, we investigated the effects of VPA treatment on mitotic catastrophe characteristics, including morphological features and their frequencies, fluorescence intensity signals of caspase-2 and p53, and the expression and abundance of DNMT1 and DNMT3B. An increased frequency of mitotic catastrophe was observed not only morphologically, but also through enhanced induction of caspase-2, involvement of p53, at least under more drastic VPA treatment, but without a decrease in DNMT1 or DNMT3B levels. Additionally, enhancement of mitotic catastrophe coincided with a reduction in mitotic chromosome abnormalities. Increased DNMT3B expression following VPA action, may be favored by previously reported chromatin decondensation induced by this drug. Enhanced CpG methylation of specific DNA sites could thus be promoted. In conclusion, VPA was shown to trigger metabolic pathways linked to different forms of cell death in HeLa cells, supporting its oncosuppressive potential.

We propose two new tests to detect drug effects (DE) in trials of one to very few patients followed during two periods (before and after initiation of a treatment). Both methods use longitudinal natural history data to inform the estimation of each patient's DE. The first method uses a non linear mixed effect model (NLMEM) reflecting an expected natural history with a hypothetical drug effect, to estimate the Conditional Distribution of the Drug Effect (CDDE). The second method trains a Pareto Depth Analysis (PDA) algorithm, a machine learning based approach based on outlier detection, that we implement using data simulated under the NLMEM. We evaluated the two tests with a simulation study. We used data from the PROSPAX study in Autosomal Recessive Cerebellar Ataxias (ARCAs, to derive a NLMEM for the Scale for the Assessment and Rating of Ataxia score. The CDDE method provided controlled type I error and, in some scenarios, adequate corrected power, though sensitivity analyses showed vulnerability to misspecification. The PDA method demonstrated lower statistical power except with high score precision. These results highlight different strategies for quantifying treatment effects in ultra rare, patient' specific trials. They can inform methodological design for future ARCA precision therapies.

Background: Dietary supplements (DS) are extensively used in Pakistan, frequently in conjunction with prescription medicines. Pharmacists are well positioned for patient counsesling due to their accessibility. However, their ability to provide evidence-based counseling remains uncertain due to their varying knowledge and training, especially in low- and middle-income countries (LMICs), including Pakistan. The study assessed pharmacists' knowledge, attitudes, and practices (KAP) regarding DS counseling and identified gaps requiring intervention. Methods: A cross-sectional study was conducted among 256 registered pharmacists in Lahore, Pakistan. Data were collected using a validated, self-administered questionnaire assessing knowledge, attitudes, and counseling practices concerning dietary supplements over a period of six months i.e., July to December 2025. Statistical analyses were performed using SPSS version 27. A p-value of < 0.05 was considered statistically significant. Results: Mean age was 31.0 {+/-} 6.2 years, with male predominance (56.3%), Doctor of Pharmacy degree (75.0%), community pharmacy practice (62.5%), and 1-5 years of experience (48.4%). Mean knowledge score was 6.18 {+/-} 1.71, with most (76.6%) exhibiting moderate knowledge. Mean attitude score was 7.01 {+/-} 1.94, with 91.4% demonstrating positive attitudes. Mean practice score was 7.91 {+/-} 2.93, with 68% exhibiting good counseling practices. Knowledge scores were significantly higher among female pharmacists (6.96 {+/-} 1.52 vs. 5.57 {+/-} 1.61, p=0.001), urban residents (6.39 {+/-} 1.61 vs. 4.37 {+/-} 1.30, p<0.001), and clinical pharmacists (7.10 {+/-} 1.68, p=0.001). Conclusion: Pharmacists practicing in Lahore, Pakistan demonstrated positive attitudes but moderate knowledge and inconsistent counseling practices. Key gaps were identified in drug-supplement interaction knowledge and counseling practices. These findings underscore the need for organized education, continued training, and regulatory supervision to improve counseling practices of dietary supplements.

Cytochrome P450 (CYP) enzymes play a key role in the metabolism of both xenobiotics and endogenous compounds, and the activity of some CYP isoforms are susceptible to induction and/or inhibition by certain chemicals. As CYP induction and inhibition can significantly alter the in vivo fate of xenobiotics i.e., levels of parent chemicals and/or metabolites, and thus toxicity, CYP induction/inhibition data is needed for regulatory chemical toxicity hazard assessment. Utilizing available human in vivo pharmaceutical data, a successful validation was previously conducted on the in vitro HepaRG CYP induction test method for measurement of induction of three key human CYP enzymes CYP1A1/1A2, 2B6 and 3A4. However, further validation data was required to demonstrate applicability of the test method to also accurately detect CYP induction mediated by industrial and pesticidal chemicals. Here we report on the supplementary validation of the HepaRG CYP enzyme induction test method carried out in two laboratories under the auspices of the EU Horizon2020-funded project "GOLIATH", to expand the chemical applicability domain beyond pharmaceutical chemicals. Successful transfer was demonstrated and reproducibility assessed for the original 10 selected proficiency pharmaceuticals, plus three reference inducers together with six additional non-pharmaceutical augmentation chemicals. The method and chemical selection were found to be reliable and relevant for the routine assessment of human CYP induction. For the augmentation chemicals being proposed as additional proficiency chemicals, the test method achieved a reasonable but not optimum reproducibility. Recommendations are proposed to improve the test methods specificity, reflecting the inherent uncertainty around borderline CYP inducing chemicals. Plain language summaryCytochrome P450 (CYP) enzymes help break down drugs and other chemicals in the body. Their activity can be increased (induced) or decreased (inhibited), which can change how toxic a chemical is and when it is excreted. Because of this, CYP data is important for chemical safety assessments. A laboratory-based method using HepaRG cells was previously validated to measure induction of key CYP enzymes (CYP1A1/1A2, CYP2B6 and CYP3A4) using pharmaceutical chemicals. This study aimed to show that it also works well for industrial and pesticidal chemicals. In the EU funded GOLIATH project, two laboratories tested 10 pharmaceutical and 6 non-pharmaceutical chemicals. The method showed good reliability overall and strong reproducibility for pharmaceuticals. For non-pharmaceutical chemicals, results were acceptable but less consistent. The study concludes that the method is useful for routine testing, but improvements are needed to increase accuracy and better handle chemicals that show weak or borderline CYP induction effects.

G protein-gated inwardly rectifying potassium (GIRK2) channels regulate neuronal excitability and are implicated in neurodevelopmental disorders. A rare KCNJ6 variant, G154C (hGIRK2G154C), was identified in a patient with mild Keppen-Lubinsky syndrome features, contrasting with severe phenotypes linked to other selectivity filter mutations. Here we combined molecular dynamics simulations and patch-clamp electrophysiology to characterize the hGIRK2G154C mutant, revealing a widened selectivity filter that resulted in loss of potassium selectivity, aberrant sodium permeation, and loss of inward rectification, indicating a severe gain-of-function phenotype. An in silico and electrophysiological drug screen identified FDA-approved compounds, including nefazodone and eletriptan, that potently inhibited GIRK2 and GIRK2G154C through distinct blocking mechanisms. These findings elucidate the structural and functional impact of the G154C mutation and highlight potential pharmacological tools and therapeutic candidates for the treatment of GIRK2 channelopathies.