Modulators of calpain activity: inhibitors and activators as potential drugs.

Introduction: Calpains are intracellular Ca2+-dependent cysteine proteases with 15 known members in the enzyme family. They act as regulatory enzymes, their cleavage modifying the function of their substrates. As their substrates have important roles in many physiological processes, adequate function of calpains is mandatory for normal cellular functions. The adverse operation of them is often related to diseases (e.g. neurodegenerative disorders, cancer, type 2 diabetes mellitus, or limb-girdle muscular dystrophy type 2A).Areas covered: Herein, the authors give an overview of calpains, their structure as well as their physiological and pathological functions. The authors further consider the challenges in calpain inhibitor and activator drug discovery and summarize examples of good candidates. New and applicable strategies are also discussed.Expert opinion: Calpain enzymes are attractive targets for inhibitor or activator design and development. The authors believe this area of research is of high potential, although it has many challenges. For one, the selective and targeted inhibition or activation of calpains is needed. Furthermore, uncontrolled calpain activation may cause more serious side effects and so caution is needed when designing novel therapeutics.