It is currently known that erythrocytes are the major source of sphingosine 1-phosphate (S1P)
in the body. S1P acts both extracellularly as a cellular mediator and intracellularly as an important second
messenger molecule. Its effects are mediated by interaction with five specific types of G proteincoupled
S1P receptor. Fingolimod, is a recognized modulator of S1P receptors, and is the first orally active
disease-modifying therapy that has been approved for the treatment of multiple sclerosis. Magnetic
resonance imaging data suggest that fingolimod may be effective in multiple sclerosis by preventing
blood-brain barrier disruption and brain atrophy. Fingolimod might also possess S1P receptorindependent
effects and exerts both anti-inflammatory and neuroprotective effects.
In the therapeutic management of epilepsy, there are a great number of antiepileptic drugs, but there is
still a need for others that are more effective and safer. S1P and its receptors might represent a suitable
novel target also in light of their involvement in neuroinflammation, a well-known process underlying
seizures and epileptogenesis. The objective of this manuscript is to review the biological role of S1P
and its receptors, focusing on their expression, effects and possible involvement in epilepsy; furthermore,
we summarize the possible anti-seizure properties of fingolimod and discuss its possible usefulness
in epilepsy treatment. We conclude that fingolimod, being already commercially available, might
be easily tested for its possible therapeutic effectiveness in epileptic patients, both after a more comprehensive
evaluation of the real potential of this drug and following a clear evaluation of the potential role
of its main targets, including the S1P signaling pathway in epilepsy.
Keywords: Central nervous system diseases, epilepsy, epileptogenesis, fingolimod, neurodegeneration, neuroinflammation,
seizures, sphingosine 1-phosphate (S1P) signaling.
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