Translatability: What does it mean in drug discovery?

Matthew Tudor, Jeffery Hermes, Jing Li (Screening & Protein Science, Merck Research Laboratories,USA), Drug Discovery Today, Available online 26 March 2016, ISSN 1359-6446, doi:10.1016/j.drudis.2016.03.010.

We can develop multiple disease-relevant in vitro and in vivo models as a means of further validation of the initial target hypothesis, and pursue decisive experiments that will enable early no-go calls to be made on targets. However, such surrogate assays can reach the wrong conclusion because they will have imperfect predictivity of the results of a well-designed Phase II clinical trial. Disease relevant assays can serve as ‘gate-keepers’ to inform the probability of the translatability but always have to be interpreted as suggestive rather than definitive.

Friedreich’s ataxia (FA), an autosomal-recessive disease, is caused by a trinucleotide GAA repeat expansion which leads to the reduction of FXN protein expression. The protein function is not entirely understood. Attempts to correct putative FXN mutation sequelae by reversing mitochondrial dysfunction, such as by using ion chelators and antioxidants, are broadly reported. Such symptomatic intervention can be viewed as spreading of bets in addition to direct FXN protein intervention, but the odds are clearly against such nonspecific approaches because of the unknown FXN biology. The more certain bet is on what human genetics is telling us: that restoration of FXN protein levels would be effective. To that end, efforts to improve the rate of transcriptional read-through or splicing would be expected to have higher chances of significantly impacting the clinical state.