Cited by 197Sphingolipid Metabolism and SignalingLysosomal Storage Disorders ResearchMultiple Sclerosis Research Studies

Targeting sphingosine-1-phosphate signaling in immune-mediated diseases: beyond multiple sclerosis

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Pérez-Jeldres, Tamara, Alvarez-Lobos, Manuel, Rivera-Nieves, Jesús·2021·Drugs

Abstract

Sphingosine-1-phosphate (S1P) is a bioactive lipid metabolite that exerts its actions by engaging 5 G-protein-coupled receptors (S1PR1-S1PR5). S1P receptors are involved in several cellular and physiological events, including lymphocyte/hematopoietic cell trafficking. An S1P gradient (low in tissues, high in blood), maintained by synthetic and degradative enzymes, regulates lymphocyte trafficking. Because lymphocytes live long (which is critical for adaptive immunity) and recirculate thousands of times, the S1P-S1PR pathway is involved in the pathogenesis of immune-mediated diseases. The S1PR1 modulators lead to receptor internalization, subsequent ubiquitination, and proteasome degradation, which renders lymphocytes incapable of following the S1P gradient and prevents their access to inflammation sites. These drugs might also block lymphocyte egress from lymph nodes by inhibiting transendothelial migration. Targeting S1PRs as a therapeutic strategy was first employed for multiple sclerosis (MS), and four S1P modulators (fingolimod, siponimod, ozanimod, and ponesimod) are currently approved for its treatment. New S1PR modulators are under clinical development for MS, and their uses are being evaluated to treat other immune-mediated diseases, including inflammatory bowel disease (IBD), rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and psoriasis. A clinical trial in patients with COVID-19 treated with ozanimod is ongoing. Ozanimod and etrasimod have shown promising results in IBD; while in phase 2 clinical trials, ponesimod has shown improvement in 77% of the patients with psoriasis. Cenerimod and amiselimod have been tested in SLE patients. Fingolimod, etrasimod, and IMMH001 have shown efficacy in RA preclinical studies. Concerns relating to S1PR modulators are leukopenia, anemia, transaminase elevation, macular edema, teratogenicity, pulmonary disorders, infections, and cardiovascular events. Furthermore, S1PR modulators exhibit different pharmacokinetics; a well-established first-dose event associated with S1PR modulators can be mitigated by gradual up-titration. In conclusion, S1P modulators represent a novel and promising therapeutic strategy for immune-mediated diseases.

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  • S1P is involved in HDL function and neuroinflammation through regulation of gene expression in the nucleus and alteration in the functioning of various immune cells.

    “The signaling lipid S1P is involved in high-density lipoprotein (HDL) function (44) and neuroinflammation through the regulation of gene expression in the nucleus and alteration in the functioning of various immune cells (45).”

    From Nuclear SphK2/S1P signaling is a key regulator of ApoE production and Aβ uptake in astrocytes (2024) · cites this paper as [45]

    The Intracellular Targets of S1P section (page unavailable) describes S1P’s effects on nuclear gene transcription, and the S1P Receptors section describes its effects on several immune-cell types. The cited paper does not clearly establish that these mechanisms specifically drive neuroinflammation. HDL function is attached to citation 44, not this source’s citation 45. (LLM, conf=0.82)

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Cited by

Sorted by citations

Authors
Pérez-Jeldres, T., Alvarez-Lobos, M., & Rivera-Nieves, J.
Affiliations
Pontificia Universidad Católica de Chile (CL)
Venue
Drugs
Published
2021-05-13
Volume
81
Issue
9
Pages
985-1002
ISSN
  • 0012-6667 (ISSN-L)
  • 1179-1950
OpenAlex
W3162784420
Cited by
197
References
1
Citations by year
2026: 34 · 2025: 42 · 2024: 43 · 2023: 38 · 2022: 33 · 2021: 7
FWCI
3.25
Type
journal article
Language
en
Open access
Locations
  • Drugs (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Universidad de Chile (submittedVersion, cc-by-nc-nd)
Funders
  • U.S. Department of Veterans Affairs (I01 BX001051)
  • National Institutes of Health
  • National Institute of Allergy and Infectious Diseases (R21AI149636)
  • National Institute of Diabetes and Digestive and Kidney Diseases (R01DK108670, P30DK120515)
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Sphingolipid Metabolism and Signaling
  • Health Sciences › Medicine › Physiology › Lysosomal Storage Disorders Research
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Multiple Sclerosis Research Studies
Keywords
sphingosine-1-phosphate, S1P receptor modulators, S1PR1, lymphocyte migration, multiple sclerosis, fingolimod, siponimod, ozanimod, ponesimod, etrasimod, inflammatory bowel disease, rheumatoid arthritis, systemic lupus erythematosus, psoriasis, COVID-19 pandemic, adverse drug reactions, first-dose effect, pharmacokinetics
MeSH terms
Animals, Pharmaceutical Preparations, Humans, Immune System Diseases, Lysophospholipids, Multiple Sclerosis, Sphingosine, Signal Transduction

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