Role of polyamines and their antimetabolites in clinical medicine.

Polyamine research, which began with a clinical observation more than 300 years ago, has progressed for several decades as pure basic research, sometimes considered as an academic triviality. The role of polyamines in clinical medicine is coming of age. The fruits of polyamine research are just now entering into the realm of practical application and in a very multidisciplinary manner. Basic research on polyamine metabolism and the elucidation of their physiologic functions has involved many academically interesting, even revolutionary, aspects, but the imagination of biochemists and cell biologists may no longer be sufficient to discover the best ways to translate the results of this basic research into clinical practice. It is almost certain that polyamine antimetabolites will soon find their place among the drug regimens used for the treatment of human malignancies and, possibly, also of hyperproliferative skin diseases. The elucidation of the role of polyamines in cell differentiation may offer fundamental applications regarding the regulation of cell cycle events. The discovery of the antiparasitic properties of polyamine antimetabolites may have a major impact on the well-being of millions of people in the developing world. The potential application of polyamine research in microbial and viral diseases is an area in which investigational insight is just beginning. Finally, the clinical chemistry of extracellular polyamines, although initially disappointing, has not yet been explored in depth and may offer applications useful for the diagnosis or follow-up of a variety of common diseases.