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      Recent clinical trends in Toll‐like receptor targeting therapeutics

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          Abstract

          Toll‐like receptors (TLRs) are germline‐encoded receptors that are central to innate and adaptive immune responses. Owing to their vital role in inflammation, TLRs are rational targets in clinics; thus, many ligands and biologics have been reported to overcome the progression of various inflammatory and malignant conditions and support the immune system. For each TLR, at least one, and often many, drug formulations are being evaluated. Ligands reported as stand‐alone drugs may also be reported based on their use in combinatorial therapeutics as adjuvants. Despite their profound efficacy in TLR‐modulation in preclinical studies, multiple drugs have been terminated at different stages of clinical trials. Here, TLR modulating drugs that have been evaluated in clinical trials are discussed, along with their mode of action, suggestive failure reasons, and ways to improve the clinical outcomes. This review presents recent advances in TLR‐targeting drugs and provides directions for more successful immune system manipulation.

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          Most cited references113

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          Toll-like receptors: critical proteins linking innate and acquired immunity.

          Recognition of pathogens is mediated by a set of germline-encoded receptors that are referred to as pattern-recognition receptors (PRRs). These receptors recognize conserved molecular patterns (pathogen-associated molecular patterns), which are shared by large groups of microorganisms. Toll-like receptors (TLRs) function as the PRRs in mammals and play an essential role in the recognition of microbial components. The TLRs may also recognize endogenous ligands induced during the inflammatory response. Similar cytoplasmic domains allow TLRs to use the same signaling molecules used by the interleukin 1 receptors (IL-1Rs): these include MyD88, IL-1R--associated protein kinase and tumor necrosis factor receptor--activated factor 6. However, evidence is accumulating that the signaling pathways associated with each TLR are not identical and may, therefore, result in different biological responses.
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            Recognition of single-stranded RNA viruses by Toll-like receptor 7.

            Viral infection of mammalian host results in the activation of innate immune responses. Toll-like receptors (TLRs) have been shown to mediate the recognition of many types of pathogens, including viruses. The genomes of viruses possess unique characteristics that are not found in mammalian genomes, such as high CpG content and double-stranded RNA. These genomic nucleic acids serve as molecular signatures associated with viral infections. Here we show that TLR7 recognizes the single-stranded RNA viruses, vesicular stomatitis virus and influenza virus. The recognition of these viruses by plasmacytoid dendritic cells and B cells through TLR7 results in their activation of costimulatory molecules and production of cytokines. Moreover, this recognition required intact endocytic pathways. Mice deficient in either the TLR7 or the TLR adaptor protein MyD88 demonstrated reduced responses to in vivo infection with vesicular stomatitis virus. These results demonstrate microbial ligand recognition by TLR7 and provide insights into the pathways used by the innate immune cells in the recognition of viral pathogens.
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              Activation of the IkappaB kinase complex by TRAF6 requires a dimeric ubiquitin-conjugating enzyme complex and a unique polyubiquitin chain.

              TRAF6 is a signal transducer in the NF-kappaB pathway that activates IkappaB kinase (IKK) in response to proinflammatory cytokines. We have purified a heterodimeric protein complex that links TRAF6 to IKK activation. Peptide mass fingerprinting analysis reveals that this complex is composed of the ubiquitin conjugating enzyme Ubc13 and the Ubc-like protein Uev1A. We find that TRAF6, a RING domain protein, functions together with Ubc13/Uev1A to catalyze the synthesis of unique polyubiquitin chains linked through lysine-63 (K63) of ubiquitin. Blockade of this polyubiquitin chain synthesis, but not inhibition of the proteasome, prevents the activation of IKK by TRAF6. These results unveil a new regulatory function for ubiquitin, in which IKK is activated through the assembly of K63-linked polyubiquitin chains.
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                Author and article information

                Contributors
                sangdunchoi@ajou.ac.kr
                Journal
                Med Res Rev
                Med Res Rev
                10.1002/(ISSN)1098-1128
                MED
                Medicinal Research Reviews
                John Wiley and Sons Inc. (Hoboken )
                0198-6325
                1098-1128
                18 November 2018
                May 2019
                : 39
                : 3 ( doiID: 10.1002/med.2019.39.issue-3 )
                : 1053-1090
                Affiliations
                [ 1 ] Department of Molecular Science and Technology Ajou University Suwon Korea
                [ 2 ] J2H Biotech Suwon Korea
                Author notes
                [*] [* ] Correspondence Sangdun Choi, PhD, Department of Molecular Science and Technology, Ajou University, Suwon 16499, Korea. Email: sangdunchoi@ 123456ajou.ac.kr

                Author information
                http://orcid.org/0000-0001-5920-7848
                Article
                MED21553
                10.1002/med.21553
                6587958
                30450666
                7cf597b1-eddb-48e4-a44b-598e73364d6a
                © 2018 The Authors. Medicinal Research Reviews Published by Wiley Periodicals, Inc.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 16 June 2018
                : 18 October 2018
                : 21 October 2018
                Page count
                Figures: 3, Tables: 10, Pages: 38, Words: 15464
                Funding
                Funded by: Commercialization Promotion Agency for R&D Outcomes funded by the Ministry of Science and ICT
                Award ID: 2018K000369
                Funded by: National Research Foundation of Korea
                Award ID: NRF‐2015R1A2A2A09001059
                Categories
                Review Article
                Review Articles
                Custom metadata
                2.0
                med21553
                May 2019
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.4 mode:remove_FC converted:21.06.2019

                adjuvant,clinical trial,drug,innate immunity,toll‐like receptor

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