Challenges and limitations of the therapeutic application of protein kinase inhibitors

AspectNeurodegenerative disordersPsychiatric disorders
Disease complexity- Heterogeneity of neurodegenerative diseases (e.g., sporadic vs familial forms).
- Multiple pathways contribute to disease progression, requiring combination therapies.
- Psychiatric disorders have highly complex and poorly defined molecular underpinnings.
- Symptoms and etiologies overlap among disorders (e.g., bipolar disorder, schizophrenia, depression).
Blood-brain barrier (BBB)- PKIs must effectively cross the BBB, which limits many candidate drugs.
- Chronic neurodegenerative diseases require sustained drug delivery, raising concerns about toxicity and drug stability.
- PKIs face similar BBB challenges but are typically needed for short to intermediate-term treatments, unlike the chronic therapies required for neurodegeneration.
Off-target effects- Kinases are involved in numerous signaling pathways, leading to potential toxicity from off-target inhibition (e.g., cardiovascular, immune effects).- Psychiatric patients may be more susceptible to side effects such as mood instability or cognitive impairment due to off-target effects.
Patient-specific variability- Genetic mutations (e.g., LRRK2 in Parkinson’s) exist in a subset of patients, complicating treatment generalizability.- Lack of reliable biomarkers hampers patient stratification and target validation for kinase inhibitors.
Long-term safety- Long treatment durations required for neurodegeneration amplify safety concerns (e.g., hepatotoxicity, immune suppression).- Long-term safety studies are needed, especially for disorders requiring continuous maintenance therapy (e.g., bipolar disorder).

PKIs: protein kinase inhibitors; LRRK2: leucine-rich repeat kinase 2

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