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BackgroundElobixibat is an oral treatment candidate for chronic constipation with a novel mechanism of action via inhibition of the ileal bile acid transporter. We performed this randomized, double-blind, placebo-controlled, dose-finding phase IIb study in Japanese patients with chronic constipation to determine the optimal clinical dose of elobixibat.MethodsJapanese patients with chronic constipation were randomized to receive elobixibat (5, 10, or 15 mg) or placebo once daily for 2 weeks. The primary efficacy endpoint was the change from baseline in frequency of spontaneous bowel movements at Week 1 of treatment. Secondary endpoints and adverse events were also examined.ResultsAmong 226 patients who provided informed consent, 163 patients were randomized and included in the full analysis set. In the 10- and 15-mg groups, frequency of spontaneous bowel movements (±standard deviation) were significantly higher than baseline (5.7 ± 4.2 and 5.6 ± 3.5 times per week, respectively, compared with 2.6 ± 2.9 times per week in the placebo group [P = 0.0005, P = 0.0001, respectively]). Subgroup analysis indicated that elobixibat was equally effective in patients with or without constipation-predominant irritable bowel syndrome. Common adverse events included mild abdominal pain and diarrhea in the elobixibat groups; no serious or severe adverse events occurred. Elobixibat was well tolerated at once-daily oral doses up to 15 mg for 2 weeks.ConclusionsOur study results suggest that 10 mg of elobixibat is a clinically optimal dose for Japanese patients with chronic constipation.Clinical trial registration numberJapicCTI-142608.

Plasmodium falciparum, a human malaria parasite, invades an erythrocyte during one stage of its life cycle. In an infected erythrocyte, the P. falciparum organism develops a membrane structure called the parasitophorus vacuolar membrane. The parasitophorus vacuolar membrane extends into the host cell cytoplasm and forms a complex membrane structure, thus called the tubovesicular membrane network (reviewed in Refs. 1-3). These membrane systems outside the P. falciparum cell are important for the transport of various nutrients such as glucose, phospholipids, and amino acids and for extrusion of antimalarial agents so as to maintain suitable circumstances for them (3-6). In addition to the formation of such intraerythrocytic membrane systems, P. falciparum cells also transport some proteins such as erythrocyte membrane protein-1 of P. falciparum (PfEMP1) 1 and PfEMP3 to the erythrocyte plasma membrane, which results in the formation of a knob-like structure on the surfaces of the infected erythrocytes. These proteins are responsible for protection against immunological attack and attachment of infected erythrocyte to endothelial cells, one of the crucial steps for cerebral malaria (1-3, 7-11). Importantly, the extraparasite protein transport process can not rely upon the endogenous transport machinery in the host cells, because mature erythrocytes are completely devoid of machinery for protein trafficking. Thus, the malaria parasite must transport proteins through the plasma membrane and the membrane structure in the cytoplasm of the host cells by means of their own mechanism, although the molecular pathway for the transport of proteins through the parasite plasma membrane is less understood.It has been shown that the transport of some proteins from malaria parasites is sensitive to BFA (12-16), which is a well known macrolide antibiotic produced by fungi that blocks eukaryotic protein trafficking processes, especially transport from the endoplasmic reticulum to the Golgi apparatus by inhibiting the activities of ADP-ribosylation factors and guanine nucleotide exchange factors (17). These results suggest that the transport pathway from the endoplasmic reticulum to the Golgi apparatus is involved in the targeting of parasite

Abstract. To construct a non-clinical database for drug-induced QT interval prolongation, the electrophysiological effects of 11 positive and 10 negative compounds on action potentials (AP) in guinea-pig papillary muscles were investigated in a multi-site study according to a standard protocol. Compounds with a selective inhibitory effect on the rapidly activated delayed rectifier potassium current (I Kr ) prolonged action potential duration at 90% repolarization (APD 90 ) in a concentration-dependent manner, those showing Ca 2+ current (I Ca ) inhibition shortened APD 30 , and those showing Na + current (I Na ) inhibition decreased action potential amplitude (APA) and V max . Some of the mixed ion-channel blockers showed a bell-shaped concentration-response curve for APD 90 , probably due to their blockade of I Na and / or I Ca , sometimes leading to a falsenegative result in the assay. In contrast, all positive compounds except for terfenadine and all negative compounds with I Kr -blocking activity prolonged APD 30-90 regardless of their I Na -and / or I Ca -blocking activities, suggesting that APD 30-90 is a useful parameter for evaluating the I Krblocking activity of test compounds. Furthermore, the assay is highly informative regarding the modulation of cardiac ion channels by test compounds. Therefore, when APD 90 and APD 30-90 are both measured, the action potential assay can be considered a useful method for assessing the risk of QT interval prolongation in humans in non-clinical safety pharmacology studies. Supplementary material (Appendix): available only at http://dx

Background In two phase 3 trials, elobixibat, a locally acting ileal bile acid transporter inhibitor, resolved constipation and was well tolerated in Japanese patients with chronic constipation. We analyzed the efficacy, safety, and impact on quality of life (QOL) of elobixibat in patients with symptomatically more severe constipation in the two phase 3 trials. Methods This post hoc analysis of elobixibat treatment outcomes included data from a 2‐week, randomized, placebo‐controlled, phase 3 trial (10 mg/d), and a 52‐week, open‐label trial (5‐15 mg/d) in subgroups with severe constipation defined as ≤2 spontaneous bowel movements (SBMs) and ≤3 Bristol Stool Form Scale score during the second week of the 2‐week run‐in period. We also analyzed the rates of abdominal pain, diarrhea, and QOL in subgroups according to sex, presence of constipation‐predominant irritable bowel syndrome (IBS‐C) and side effects. Key Results In patients with severe constipation, there was significant improvement in the 10 mg elobixibat group compared to the placebo group in change in SBMs from baseline at week 1 (primary endpoint) of the 2‐week trial. The differences between groups were reduced in patients with more severe constipation. Increasing the dose to 15 mg was effective for more severe constipation in improving the number of SBMs per week in the 52‐week trial. Overall, elobixibat was well tolerated and improved QOL scores, irrespective of gender, presence of IBS‐C or side effects. Conclusions & Inferences Elobixibat is effective for symptomatically severe constipation, is well tolerated and improves QOL, irrespective of potentially confounding patient characteristics.

Elobixibat induces bowel movements faster than sennoside through a different mechanism. Elobixibat locally inhibits IBAT in the ileal lumen, leading to elevated fecal BAs in the colon and induced mild GMCs during defecation.

G-quadruplex (G4) is the non-canonical secondary structure of DNA and RNA formed by guanine-rich sequences. G4-forming sequences are abundantly located in telomeric regions and in the promoter and untranslated regions (UTR) of cancer-related genes, such as RAS and MYC. Extensive research has suggested that G4 is a potential molecular target for cancer therapy. Here, we reviewed G4 ligands as photosensitizers for cancer photodynamic therapy (PDT), which is a minimally invasive therapeutic approach. The photosensitizers, such as porphyrins, were found to be highly toxic against cancer cells via the generation of reactive oxidative species (ROS) upon photo-irradiation. Several porphyrin derivatives and analogs, such as phthalocyanines, which can generate ROS upon photo-irradiation, have been reported to act as G4 ligands. Therefore, they have been implicated as promising photosensitizers that can selectively break down cancer-related DNA and RNA forming G4. In this review, we majorly focused on the potential application of G4 ligands as photosensitizers, which would provide a novel strategy for PDT, especially molecularly targeted PDT (mtPDT).