Functional selectivity (FS) is the term used to describe the ability of drugs to differentially activate signaling cascades coupled to a single receptor subtype. Importantly, differences in the FS profile between drugs acting at the same receptor subtype may underlie differences in therapeutic efficacy and/or adverse effect liability. Paliperidone (PAL) is the 9‐OH metabolite of risperidone (RIS). Both drugs are effective at treating symptoms of schizophrenia and have similar receptor binding profiles. We compared the FS profiles of PAL and RIS for cellular signaling responses at human D2 receptors expressed in CHO or HEK cells. Relative to the reference ligand butaclamol, the relative efficacy of PAL was greater, not different or less than that of RIS, depending upon the response measured. For example, as inverse agonists at the adenylyl cyclase pathway, the relative efficacy of PAL was greater then RIS. However, for reduction of constitutive desensitization, PAL equaled RIS and for increasing receptor density, the relative efficacy of PAL was less than that of RIS. Thus, a small difference in molecular structure can produce pronounced differences in the FS profile of drugs. Moreover, these results suggest that the presence of 9‐OH group can alter the functional response of RIS at human D2 receptors and suggest that the actions of PAL and RIS in vivo may differ as well.
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