Review Articles

Studies of human genetics have been used to identify promising drug targets, and might also inform safety assessment in the drug discovery process. In their Review, Ward and co-authors from industry discuss how genetic studies of rare and complex human diseases can be used to predict potential on- and off-target effects associated with modulating a given target. They also outline suggested best practices for incorporating human genetic data into safety assessments during drug development.

Tumour suppressor gene TP53 is frequently mutated in cancer, and therapeutic strategies to restore the functionality of p53 in tumours have been pursued for decades without success. This Review discusses the promising approaches towards p53-based therapy that have emerged in recent years.

Replication stress is a cause of genome instability in cancer cells. This Review discusses strategies to increase replicative stress by inhibiting the checkpoint kinases that coordinate DNA damage response and cell cycle, as well as combination strategies with other targeted therapies.

The exploitation of cytokines for therapeutic use has been limited by their pleiotropic activity, which has contributed to dose-limiting toxicity and lack of efficacy. Here, Garcia and colleagues discuss how recent insights from structural biology, protein engineering and receptor pharmacology have unveiled strategies to overcome cytokine pleiotropy and enable the design of new and improved cytokine-based therapeutics.

The rational discovery of covalent drugs depends on an expanding toolset of techniques. Here, Daniel Nomura and colleagues highlight covalent drugs that have achieved success over the past decade and discuss the tools and strategies that facilitate their discovery, describing two complementary approaches, namely, ligand-first and electrophile-first strategies.

Peptide and protein drugs have proven successful in the treatment of a wide range of diseases, but their use can be limited by their inherent short-life and need for parenteral administration. Here, Kurtzhals et al. discuss how fatty acid derivatization can be applied to address these issues and optimize the pharmacological properties of peptide and protein drugs, highlighting associated considerations and future directions.

This Review provides an update on the application of small-molecule drugs in immuno-oncology, discussing current development of small molecules designed to stimulate the antitumour immune response directly and indirectly, and the rapidly increasing efforts towards the discovery of small molecules that target T cell checkpoints.

Macrophages can promote tumorigenesis and enhance the antitumour response. This Review discusses the molecular mechanisms underlying the reprogramming of macrophages in the tumour microenvironment and provides an overview of macrophage-targeted therapies for the treatment of cancer.

The potential of therapeutically targeting RNA structures with small molecules is being increasingly recognized. Here, Disney and colleagues review strategies to identify, validate and optimize small-molecule RNA binders. Examples of existing RNA-targeted small molecules, as well as challenges and future directions in the field, are discussed.

Antibody function is dependent on avidity — the accumulated strength of multiple affinity interactions between the antibody, antigen, cell surface receptors and other antibodies. In this Review, Oostindie et al. discuss the role of avidity in eliciting antibody functional responses and review the current engineering strategies for manipulating avidity interactions in antibody-based therapies.

Monoclonal antibodies (mAbs) are appealing as potential therapeutics and prophylactics for viral infections. This Review describes advances in antibody discovery and engineering that have led to the development of mAbs that target viruses such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), respiratory syncytial virus and Ebola virus, and also considers the implications for vaccine development.

Multiple sclerosis (MS) is an immune-mediated neurological disorder featuring central nervous system demyelination. Increasing understanding of the complex pathophysiology of this disease has led to considerable expansion of the MS therapeutic toolbox over the past 20 years, but substantial limitations remain. In this Review, Sven Meuth and colleagues highlight promising non-classical targets for MS that could provide fruitful avenues for future therapies.

Aberrations in efferocytosis are associated with numerous inflammatory pathologies, including atherosclerosis, cancer and infections. Here, Mehrotra and Ravichandran discuss the mechanisms of efferocytosis and the role of this physiological process in disease, and assess strategies and agents for therapeutic intervention.

The widespread clinical translation and commercialization of cell-based therapies are hampered by challenges related to cell source, viability, potency, safety and scalability. Here, Veiseh and colleagues overview progress in the development of cell-based therapeutics and discuss how biological engineering approaches — including genome editing, synthetic biology and the use of biomaterials — are beginning to address key challenges in the field.

System-wide methods to monitor protein activity are still underused in drug discovery. This Review discusses the potential of proteomics and chemoproteomics approaches for target identification, validation and identification of safety hazards.

This Review summarizes the basic mechanisms that regulate natural killer cells and the various drugs, cytokines and antibodies that are currently being developed to stimulate natural killer cell responses in cancer treatment.

Natural products derived from bacteria are an important source of potential new drug compounds, such as antibiotics and anticancer agents, but how to efficiently mine this resource remains a challenge. In their Review, Hemmerling and Piel discuss newly developed computational tools and strategies to access biosynthetic novelty in bacterial genomes. They consider the opportunities and challenges associated with different bacterial sources, including cultivated, ecology-based and previously untapped bacterial ‘dark matter’.

Immune checkpoint inhibitors (ICIs) have dramatically improved the treatment of many tumours, but only a subset of patients respond when ICIs are used as standalone immunotherapeutic interventions. Here, Galluzzi and colleagues discuss the potential of harnessing clinical agents that target oncogene and non-oncogene addiction to enhance ICI sensitivity by converting immunologically ‘cold’ tumours into ‘hot’ lesions.

The past decade has witnessed rapid growth in the field of extracellular vesicle (EV) research, and the potential of harnessing EVs in the treatment and diagnosis of diseases is now well recognized. Here, Cheng and Hill provide an overview of the physiological and pathological roles of EVs, discuss how they could be therapeutically exploited and consider the associated challenges.

Advances in oligonucleotide design and delivery platforms have enabled the recent approval of several oligonucleotide-based therapies. Here, Goga and Stoffel discuss applications of RNA-silencing oligonucleotide therapeutics in metabolic diseases, recent developments in the field, ongoing challenges and possible future directions.