Emerging Therapeutic Approaches Multi-Targeting Receptor Tyrosine Kinases and G Protein-Coupled Receptors in Cardiovascular Disease

Advances in molecular biology and functional genomics have demonstrated that the “one gene-one phenotypeone drug” paradigm, that has dominated pharmaceutical industry and clinical pharmacology thinking, is too simplistic for management of complex polygenic traits. The traditional highly specific drugs with unique target have proven their clinical usefulness. However, they do not always display the required efficacy versus side-effect profile, in major part because polygenic traits are determined by redundant mechanisms. Simultaneously modulating multiple targets may enhance therapeutic efficacy in the treatment of a range of disorders. Multi-targeting can be achieved by the combination of different drugs having specific single target activity. This approach introduces potential problems with pharmacokinetic interactions, toxicity and patient compliance. High efficacy can be achieved, alternatively, by administering selectively nonselective drugs with complex pharmacological profiles directed towards various molecular targets and affording pleiotropic actions. Dual- or multiple-ligands can be discovered accidentally, but can also be rationally designed according to validated medicinal chemical approaches. The merits of multiple-target versus single-target approaches for cardiovascular disease traits are assessed in the present review. The main aim is to make evident the molecular biological basis of the possibility for targeting multiple sites and the subsequently emerging strategies for interventions with superior clinical value by harnessing receptor tyrosine kinases (RTKs) such as VEGFR, PDGFR, bFGFR, as well as G protein-coupled receptors (GPCRs). The premises for lead discovery in this new area and the challenges of medicinal chemistry behind the rational design of multitasked ligands are also discussed.