Human pluripotent stem cell–derived models and drug screening in CNS precision medicine

• Published in: Annals of the New York Academy of Sciences Vol. 1471; no. 1; pp. 18 - 56
• Main Authors: Silva, M. Catarina, Haggarty, Stephen J.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.07.2020
• Subjects: Aging; Automation; Biomarkers; Cell culture; Cell differentiation; Cell Differentiation - drug effects; Central nervous system; Central Nervous System - drug effects; Central Nervous System - pathology; Central Nervous System Diseases - drug therapy; Central Nervous System Diseases - genetics; Central Nervous System Diseases - pathology; Drug development; Drug Discovery; Drug Evaluation, Preclinical; Drug metabolism; Drug screening; Etiology; Humans; human‐induced pluripotent stem cells; Induced Pluripotent Stem Cells - drug effects; Inhibitory postsynaptic potentials; Medicine; neurodegenerative disorders; Neurological diseases; Neurons - drug effects; neuroscience; Optimization; Pathophysiology; Phenotypes; Pluripotency; Precision Medicine; psychiatric disorders; screening; Stem cells; Target recognition; Therapeutic applications; Toxicity; Toxicity testing; screening; drug discovery; human-induced pluripotent stem cells; neurodegenerative disorders; neuroscience; psychiatric disorders
• ISSN: 0077-8923; 1749-6632
• DOI: 10.1111/nyas.14012

Development of effective therapeutics for neurological disorders has historically been challenging partly because of lack of accurate model systems in which to investigate disease etiology and test new therapeutics at the preclinical stage. Human stem cells, particularly patient‐derived induced pluripotent stem cells (iPSCs) upon differentiation, have the ability to recapitulate aspects of disease pathophysiology and are increasingly recognized as robust scalable systems for drug discovery. We review advances in deriving cellular models of human central nervous system (CNS) disorders using iPSCs along with strategies for investigating disease‐relevant phenotypes, translatable biomarkers, and therapeutic targets. Given their potential to identify novel therapeutic targets and leads, we focus on phenotype‐based, small‐molecule screens employing human stem cell–derived models. Integrated efforts to assemble patient iPSC‐derived cell models with deeply annotated clinicopathological data, along with molecular and drug‐response signatures, may aid in the stratification of patients, diagnostics, and clinical trial success, shifting translational science and precision medicine approaches. A number of remaining challenges, including the optimization of cost‐effective, large‐scale culture of iPSC‐derived cell types, incorporation of aging into neuronal models, as well as robustness and automation of phenotypic assays to support quantitative drug efficacy, toxicity, and metabolism testing workflows, are covered. Continued advancement of the field is expected to help fully humanize the process of CNS drug discovery. Human stem cells, particularly patient‐derived induced pluripotent stem cells (iPSCs) after differentiation, have the ability to recapitulate aspects of neurological disease pathophysiology and are increasingly used as robust scalable systems for drug discovery. We review advances in deriving cellular models of human central nervous system disorders using iPSCs along with strategies for investigating disease‐relevant phenotypes, translatable biomarkers, and therapeutic targets, and we focus on phenotype‐based, small‐molecule screens employing human stem cell‐derived models.