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Crystal Structures of Human Orexin 2 Receptor Bound to the Subtype-Selective Antagonist EMPA. Structure 2018; 26:7-19.e5. [DOI: 10.1016/j.str.2017.11.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 09/02/2017] [Accepted: 11/08/2017] [Indexed: 11/16/2022]
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Couvineau A, Dayot S, Nicole P, Gratio V, Rebours V, Couvelard A, Voisin T. The Anti-tumoral Properties of Orexin/Hypocretin Hypothalamic Neuropeptides: An Unexpected Therapeutic Role. Front Endocrinol (Lausanne) 2018; 9:573. [PMID: 30319552 PMCID: PMC6170602 DOI: 10.3389/fendo.2018.00573] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 09/10/2018] [Indexed: 02/05/2023] Open
Abstract
Orexins (OxA and OxB) also termed hypocretins are hypothalamic neuropeptides involved in central nervous system (CNS) to control the sleep/wake process which is mediated by two G protein-coupled receptor subtypes, OX1R, and OX2R. Beside these central effects, orexins also play a role in various peripheral organs such as the intestine, pancreas, adrenal glands, kidney, adipose tissue and reproductive tract.In the past few years, an unexpected anti-tumoral role of orexins mediated by a new signaling pathway involving the presence of two immunoreceptor tyrosine-based inhibitory motifs (ITIM) in both orexin receptors subtypes, the recruitment of the phosphotyrosine phosphatase SHP2 and the induction of mitochondrial apoptosis has been elucidated. In the present review, we will discuss the anti-tumoral effect of orexin/OXR system in colon, pancreas, prostate and other cancers, and its interest as a possible therapeutic target.
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Thompson MD, Sakurai T, Rainero I, Maj MC, Kukkonen JP. Orexin Receptor Multimerization versus Functional Interactions: Neuropharmacological Implications for Opioid and Cannabinoid Signalling and Pharmacogenetics. Pharmaceuticals (Basel) 2017; 10:ph10040079. [PMID: 28991183 PMCID: PMC5748636 DOI: 10.3390/ph10040079] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 09/29/2017] [Accepted: 09/29/2017] [Indexed: 12/17/2022] Open
Abstract
Orexins/hypocretins are neuropeptides formed by proteolytic cleavage of a precursor peptide, which are produced by neurons found in the lateral hypothalamus. The G protein-coupled receptors (GPCRs) for these ligands, the OX₁ and OX₂ orexin receptors, are more widely expressed throughout the central nervous system. The orexin/hypocretin system has been implicated in many pathways, and its dysregulation is under investigation in a number of diseases. Disorders in which orexinergic mechanisms are being investigated include narcolepsy, idiopathic sleep disorders, cluster headache and migraine. Human narcolepsy has been associated with orexin deficiency; however, it has only rarely been attributed to mutations in the gene encoding the precursor peptide. While gene variations within the canine OX₂ gene hcrtr2 have been directly linked with narcolepsy, the majority of human orexin receptor variants are weakly associated with diseases (the idiopathic sleep disorders, cluster headache and polydipsia-hyponatremia in schizophrenia) or are of potential pharmacogenetic significance. Evidence for functional interactions and/or heterodimerization between wild-type and variant orexin receptors and opioid and cannabinoid receptors is discussed in the context of its relevance to depression and epilepsy.
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Affiliation(s)
- Miles D Thompson
- Department of Pediatrics, University of California, San Diego 92093, CA, USA.
| | - Takeshi Sakurai
- Department of Molecular Neuroscience and Integrative Physiology, Faculty of Medicine, Kanazawa University, Kanazawa 920-8620, Japan.
| | - Innocenzo Rainero
- Department of Neuroscience, University of Turin, Torino 10124, Italy.
| | - Mary C Maj
- Department of Biochemistry, School of Medicine, Saint George's University, Saint George's 11739, Grenada.
| | - Jyrki P Kukkonen
- Biochemistry and Cell Biology, Department of Veterinary Biosciences, University of Helsinki, Helsinki 11739, Finland.
- Department of Physiology, Institute of Biomedicine, Biomedicum Helsinki, University of Helsinki, Helsinki 00100, Finland.
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Roth T, Black J, Cluydts R, Charef P, Cavallaro M, Kramer F, Zammit G, Walsh J. Dual Orexin Receptor Antagonist, Almorexant, in Elderly Patients With Primary Insomnia: A Randomized, Controlled Study. Sleep 2017; 40:2740595. [PMID: 28364509 DOI: 10.1093/sleep/zsw034] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective Sleep laboratory study to determine the dose-related efficacy and safety of almorexant in elderly patients with primary chronic insomnia. Methods Patients aged ≥65 years with primary insomnia were enrolled into a prospective, randomized, double-blind, placebo-controlled, multicenter dose-finding study with a five-period, five-way Latin square cross-over design. Patients were randomized to one of 10 unique sequences of two-night treatment with oral almorexant 25, 50, 100, or 200 mg capsules, or matching placebo. The primary efficacy endpoint was polysomnography (PSG)-determined mean wake time after sleep onset (WASO). Secondary and exploratory efficacy endpoints were also assessed. Results 112 patients were randomized (mean [SD] age 72.1 [5.0] years; 69.9% female). Significant, dose-related improvements (reductions) in mean WASO were observed with almorexant. Least-squares mean (95% CI) treatment effects in the almorexant 200, 100, 50, and 25 mg dose groups versus placebo were -46.5 minutes (-53.0, -39.9; p < .0001), -31.4 minutes (-38.0, -24.9; p < .0001), -19.2 minutes (-25.7, -12.6; p < .0001), and -10.4 minutes (-17.0, -3.9; p = .0018), respectively. Mean total sleep time was significantly increased with each almorexant dose (mean increases versus placebo ranged 55.1-14.3 minutes; p < .0001 for each dose). Latency to persistent sleep was statistically significantly reduced only with almorexant 200 mg versus placebo (mean [95% CI] treatment effect -10.2 minutes, [-15.4, -5.0]; p = .0001). No unexpected safety concerns were identified. Adverse events were similar between all almorexant dose groups and placebo. Conclusions Two-night oral administration of almorexant was effective and well tolerated in treating primary insomnia in elderly patients.
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Affiliation(s)
- Thomas Roth
- Thomas Roth Sleep Disorders and Research Center, Detroit, MI
| | - Jed Black
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland.,Center for Sleep Research and Medicine, Stanford, CA
| | | | - Pascal Charef
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland.,Multidisciplinary Sleep Disorders Centre, University Hospital Antwerp, Antwerp, Belgium
| | | | | | | | - James Walsh
- Sleep Medicine and Research Center, St. Luke's Hospital, Chesterfield, MO
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Herring WJ, Connor KM, Snyder E, Snavely DB, Zhang Y, Hutzelmann J, Matzura-Wolfe D, Benca RM, Krystal AD, Walsh JK, Lines C, Roth T, Michelson D. Suvorexant in Elderly Patients with Insomnia: Pooled Analyses of Data from Phase III Randomized Controlled Clinical Trials. Am J Geriatr Psychiatry 2017; 25:791-802. [PMID: 28427826 DOI: 10.1016/j.jagp.2017.03.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 03/06/2017] [Accepted: 03/06/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Suvorexant is an orexin receptor antagonist approved for treating insomnia at doses of 10-20 mg. Previously reported phase III results showed that suvorexant was effective and well-tolerated in a combined-age population (elderly and nonelderly adults). The present analysis evaluated the clinical profile of suvorexant specifically in the elderly. METHODS Prespecified subgroup analyses of pooled 3-month data from two (efficacy) and three (safety) randomized, double-blind, placebo-controlled, parallel-group trials. In each trial, elderly (≥65 years) patients with insomnia were randomized to suvorexant 30 mg, suvorexant 15 mg, and placebo. By design, fewer patients were randomized to 15 mg. Patient-reported and polysomnographic (subset of patients) sleep maintenance and onset endpoints were measured. RESULTS Suvorexant 30 mg (N = 319) was effective compared with placebo (N = 318) on patient-reported and polysomnographic sleep maintenance, and onset endpoints at Night 1 (polysomnographic endpoints)/Week 1 (patient-reported endpoints), Month 1, and Month 3. Suvorexant 15 mg (N = 202 treated) was also effective across these measures, although the onset effect was less evident at later time points. The percentages of patients discontinuing because of adverse events over 3 months were 6.4% for 30 mg (N = 627 treated), 3.5% for 15 mg (N = 202 treated), and 5.5% for placebo (N = 469 treated). Somnolence was the most common adverse event (8.8% for 30 mg, 5.4% for 15 mg, 3.2% for placebo). CONCLUSION Suvorexant generally improved sleep maintenance and onset over 3 months of nightly treatment and was well-tolerated in elderly patients with insomnia (clinicaltrials.gov; NCT01097616, NCT01097629, NCT01021813).
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Affiliation(s)
| | | | | | | | | | | | | | - Ruth M Benca
- Department of Psychiatry and Human Behavior, School of Medicine, University of California-Irvine, Irvine, CA
| | - Andrew D Krystal
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - James K Walsh
- Sleep Medicine and Research Center, St. Luke's Hospital, St. Louis, MO
| | | | - Thomas Roth
- Henry Ford Hospital Sleep Center, Detroit, MI
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Connor KM, Ceesay P, Hutzelmann J, Snavely D, Krystal AD, Trivedi MH, Thase M, Lines C, Herring WJ, Michelson D. Phase II Proof-of-Concept Trial of the Orexin Receptor Antagonist Filorexant (MK-6096) in Patients with Major Depressive Disorder. Int J Neuropsychopharmacol 2017; 20:613-618. [PMID: 28582570 PMCID: PMC5570043 DOI: 10.1093/ijnp/pyx033] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 06/01/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We evaluated the orexin receptor antagonist filorexant (MK-6096) for treatment augmentation in patients with major depressive disorder. METHODS We conducted a 6-week, double-blind, placebo-controlled, parallel-group, Phase II, proof-of-concept study. Patients with major depressive disorder (partial responders to ongoing antidepressant therapy) were randomized 1:1 to once-daily oral filorexant 10 mg or matching placebo. RESULTS Due to enrollment challenges, the study was terminated early, resulting in insufficient statistical power to detect a prespecified treatment difference; of 326 patients planned, 129 (40%) were randomized and 128 took treatment. There was no statistically significant difference in the primary endpoint of change from baseline to week 6 in Montgomery Asberg Depression Rating Scale total score; the estimated treatment difference for filorexant-placebo was -0.7 (with negative values favoring filorexant) (P=.679). The most common adverse events were somnolence and suicidal ideation. CONCLUSIONS The interpretation of the results is limited by the enrollment, which was less than originally planned, but the available data do not suggest efficacy of orexin receptor antagonism with filorexant for the treatment of depression. (Clinical Trial Registry: clinicaltrials.gov: NCT01554176).
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Affiliation(s)
- Kathryn M Connor
- Merck & Co., Inc., Kenilworth, New Jersey (Dr. Connor, Dr. Ceesay, Ms. Hutzelmann, Mr. Snavely, Dr. Lines, Dr. Herring, and Dr. Michelson); Duke University Hospital, Durham, North Carolina (Dr. Krystal); University of Texas Southwestern Medical Center, Dallas, Texas (Dr. Trivedi); University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania (Dr. Thase)
| | - Paulette Ceesay
- Merck & Co., Inc., Kenilworth, New Jersey (Dr. Connor, Dr. Ceesay, Ms. Hutzelmann, Mr. Snavely, Dr. Lines, Dr. Herring, and Dr. Michelson); Duke University Hospital, Durham, North Carolina (Dr. Krystal); University of Texas Southwestern Medical Center, Dallas, Texas (Dr. Trivedi); University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania (Dr. Thase)
| | - Jill Hutzelmann
- Merck & Co., Inc., Kenilworth, New Jersey (Dr. Connor, Dr. Ceesay, Ms. Hutzelmann, Mr. Snavely, Dr. Lines, Dr. Herring, and Dr. Michelson); Duke University Hospital, Durham, North Carolina (Dr. Krystal); University of Texas Southwestern Medical Center, Dallas, Texas (Dr. Trivedi); University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania (Dr. Thase)
| | - Duane Snavely
- Merck & Co., Inc., Kenilworth, New Jersey (Dr. Connor, Dr. Ceesay, Ms. Hutzelmann, Mr. Snavely, Dr. Lines, Dr. Herring, and Dr. Michelson); Duke University Hospital, Durham, North Carolina (Dr. Krystal); University of Texas Southwestern Medical Center, Dallas, Texas (Dr. Trivedi); University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania (Dr. Thase)
| | - Andrew D Krystal
- Merck & Co., Inc., Kenilworth, New Jersey (Dr. Connor, Dr. Ceesay, Ms. Hutzelmann, Mr. Snavely, Dr. Lines, Dr. Herring, and Dr. Michelson); Duke University Hospital, Durham, North Carolina (Dr. Krystal); University of Texas Southwestern Medical Center, Dallas, Texas (Dr. Trivedi); University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania (Dr. Thase)
| | - Madhukar H Trivedi
- Merck & Co., Inc., Kenilworth, New Jersey (Dr. Connor, Dr. Ceesay, Ms. Hutzelmann, Mr. Snavely, Dr. Lines, Dr. Herring, and Dr. Michelson); Duke University Hospital, Durham, North Carolina (Dr. Krystal); University of Texas Southwestern Medical Center, Dallas, Texas (Dr. Trivedi); University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania (Dr. Thase)
| | - Michael Thase
- Merck & Co., Inc., Kenilworth, New Jersey (Dr. Connor, Dr. Ceesay, Ms. Hutzelmann, Mr. Snavely, Dr. Lines, Dr. Herring, and Dr. Michelson); Duke University Hospital, Durham, North Carolina (Dr. Krystal); University of Texas Southwestern Medical Center, Dallas, Texas (Dr. Trivedi); University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania (Dr. Thase)
| | - Christopher Lines
- Merck & Co., Inc., Kenilworth, New Jersey (Dr. Connor, Dr. Ceesay, Ms. Hutzelmann, Mr. Snavely, Dr. Lines, Dr. Herring, and Dr. Michelson); Duke University Hospital, Durham, North Carolina (Dr. Krystal); University of Texas Southwestern Medical Center, Dallas, Texas (Dr. Trivedi); University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania (Dr. Thase)
| | - W Joseph Herring
- Merck & Co., Inc., Kenilworth, New Jersey (Dr. Connor, Dr. Ceesay, Ms. Hutzelmann, Mr. Snavely, Dr. Lines, Dr. Herring, and Dr. Michelson); Duke University Hospital, Durham, North Carolina (Dr. Krystal); University of Texas Southwestern Medical Center, Dallas, Texas (Dr. Trivedi); University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania (Dr. Thase)
| | - David Michelson
- Merck & Co., Inc., Kenilworth, New Jersey (Dr. Connor, Dr. Ceesay, Ms. Hutzelmann, Mr. Snavely, Dr. Lines, Dr. Herring, and Dr. Michelson); Duke University Hospital, Durham, North Carolina (Dr. Krystal); University of Texas Southwestern Medical Center, Dallas, Texas (Dr. Trivedi); University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania (Dr. Thase)
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Herring WJ, Connor KM, Snyder E, Snavely DB, Zhang Y, Hutzelmann J, Matzura-Wolfe D, Benca RM, Krystal AD, Walsh JK, Lines C, Roth T, Michelson D. Clinical profile of suvorexant for the treatment of insomnia over 3 months in women and men: subgroup analysis of pooled phase-3 data. Psychopharmacology (Berl) 2017; 234:1703-1711. [PMID: 28265715 DOI: 10.1007/s00213-017-4573-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 02/13/2017] [Indexed: 11/28/2022]
Abstract
RATIONALE Sex-related differences in the clinical profiles of some insomnia medications have been previously reported. OBJECTIVE To evaluate the clinical profile of suvorexant, a novel orexin receptor antagonist approved for treating insomnia at doses up to 20 mg, by sex subgroups. METHODS Efficacy analyses by sex were based on pooled data from two similar phase 3, randomized, double-blind, placebo-controlled, 3-month trials in elderly (≥65 years) and non-elderly (18-64 years) insomnia patients. Two age-adjusted (non-elderly/elderly) dose regimes of 40/30 and 20/15 mg were evaluated, with fewer patients assigned to 20/15 mg. Efficacy was assessed by patient-reported outcomes (N = 1264 women, 707 men) and by polysomnography endpoints in ~75% of patients. Safety analyses by sex (N = 1744 women, 1065 men) included pooled data from the two 3-month trials plus 3-month data from a safety trial of 40/30 mg. RESULTS The sex subgroup efficacy analyses mirrored the improvements seen for suvorexant 40/30 and 20/15 mg over placebo on patient-reported outcomes and polysomnography sleep maintenance and onset endpoints in the primary analyses; 95% CIs excluded zero in favor of suvorexant for most endpoints in both sexes, and similar efficacy was observed between sexes (95% CIs overlapped). Suvorexant was well-tolerated in women and men, although women in all treatment groups (including placebo) reported more adverse events than men. The most frequent adverse event was somnolence (women: 11.1% for 40/30 mg, 8.5% for 20/15 mg, 2.3% for placebo; men: 10.1% for 40/30 mg, 3.4% for 20/15 mg, 4.2% for placebo). CONCLUSION Suvorexant was generally effective and well-tolerated in both women and men with insomnia. ClinicalTrials.gov trial registration numbers: NCT01097616, NCT01097629, NCT01021813.
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Affiliation(s)
- W Joseph Herring
- Merck & Co., Inc., Kenilworth, NJ, USA. .,Merck & Co., Inc., UG 4C-13, PO Box 1000, North Wales, PA, 19454-1099, USA.
| | | | | | | | | | | | | | - Ruth M Benca
- Department of Psychiatry and Human Behavior, University of California-Irvine, Irvine, CA, USA
| | - Andrew D Krystal
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - James K Walsh
- Sleep Medicine and Research Center, St., Luke's Hospital, St. Louis, MO, USA
| | | | - Thomas Roth
- Henry Ford Hospital Sleep Center, Detroit, MI, USA
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Yao L, Ramirez AD, Roecker AJ, Fox SV, Uslaner JM, Smith SM, Hodgson R, Coleman PJ, Renger JJ, Winrow CJ, Gotter AL. The dual orexin receptor antagonist, DORA-22, lowers histamine levels in the lateral hypothalamus and prefrontal cortex without lowering hippocampal acetylcholine. J Neurochem 2017; 142:204-214. [PMID: 28444767 DOI: 10.1111/jnc.14055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 04/18/2017] [Accepted: 04/18/2017] [Indexed: 11/27/2022]
Abstract
Chronic insomnia is defined as a persistent difficulty with sleep initiation maintenance or non-restorative sleep. The therapeutic standard of care for this condition is treatment with gamma-aminobutyric acid (GABA)A receptor modulators, which promote sleep but are associated with a panoply of side effects, including cognitive and memory impairment. Dual orexin receptor antagonists (DORAs) have recently emerged as an alternative therapeutic approach that acts via a distinct and more selective wake-attenuating mechanism with the potential to be associated with milder side effects. Given their distinct mechanism of action, the current work tested the hypothesis that DORAs and GABAA receptor modulators differentially regulate neurochemical pathways associated with differences in sleep architecture and cognitive performance induced by these pharmacological mechanisms. Our findings showed that DORA-22 suppresses the release of the wake neurotransmitter histamine in the lateral hypothalamus, prefrontal cortex, and hippocampus with no significant alterations in acetylcholine levels. In contrast, eszopiclone, commonly used as a GABAA modulator, inhibited acetylcholine secretion across brain regions with variable effects on histamine release depending on the extent of wakefulness induction. In normal waking rats, eszopiclone only transiently suppressed histamine secretion, whereas this suppression was more obvious under caffeine-induced wakefulness. Compared with the GABAA modulator eszopiclone, DORA-22 elicits a neurotransmitter profile consistent with wake reduction that does not impinge on neurotransmitter levels associated with cognition and rapid eye movement sleep.
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Affiliation(s)
- Lihang Yao
- Department of Neuroscience, Merck Research Laboratories, West Point, Pennsylvania, USA
| | - Andres D Ramirez
- Department of Neuroscience, Merck Research Laboratories, West Point, Pennsylvania, USA
| | - Anthony J Roecker
- Department of Medicinal Chemistry, Merck Research Laboratories, West Point, Pennsylvania, USA
| | - Steven V Fox
- Department of In Vivo Pharmacology, Merck Research Laboratories, West Point, Pennsylvania, USA
| | - Jason M Uslaner
- Department of Neuroscience, Merck Research Laboratories, West Point, Pennsylvania, USA
| | - Sean M Smith
- Department of Neuroscience, Merck Research Laboratories, West Point, Pennsylvania, USA
| | - Robert Hodgson
- Department of In Vivo Pharmacology, Merck Research Laboratories, West Point, Pennsylvania, USA
| | - Paul J Coleman
- Department of Medicinal Chemistry, Merck Research Laboratories, West Point, Pennsylvania, USA
| | - John J Renger
- Department of Neuroscience, Merck Research Laboratories, West Point, Pennsylvania, USA
| | - Christopher J Winrow
- Department of Neuroscience, Merck Research Laboratories, West Point, Pennsylvania, USA
| | - Anthony L Gotter
- Department of Neuroscience, Merck Research Laboratories, West Point, Pennsylvania, USA
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Black J, Pillar G, Hedner J, Polo O, Berkani O, Mangialaio S, Hmissi A, Zammit G, Hajak G. Efficacy and safety of almorexant in adult chronic insomnia: a randomized placebo-controlled trial with an active reference. Sleep Med 2017; 36:86-94. [PMID: 28735928 DOI: 10.1016/j.sleep.2017.05.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 05/02/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND OBJECTIVES The orally active dual OX1R and OX2R antagonist, almorexant, targets the orexin system for the treatment of primary insomnia. This clinical trial assessed the effect of almorexant on sleep maintenance and other sleep endpoints, and its safety and tolerability in adults. PATIENTS AND METHODS Prospective, randomized, double-blind, placebo-controlled, active referenced trial in male and female adults aged 18-64 years with chronic, primary insomnia. Patients were randomized 1:1:1:1 to receive placebo, almorexant 100 mg, almorexant 200 mg, or zolpidem 10 mg (active reference) for 16 days. Primary efficacy assessments were objective (polysomnography-measured) and subjective (patient-recorded) wake time after sleep onset (WASO). Further sleep variables were also evaluated. RESULTS From 709 randomized patients, 707 (mean age 45.4 years; 61.7% female) received treatment and 663 (93.8%) completed the study. A significant decrease versus placebo in median objective WASO was observed with almorexant 200 mg at the start and end of randomized treatment (-26.8 min and -19.5 min, respectively; both p < 0.0001); subjective WASO also decreased over the two-week treatment period (p = 0.0006). Objective and subjective total sleep time (TST) were increased with almorexant 200 mg (p < 0.0001). Almorexant 200 mg significantly reduced objective and subjective latency to persistent sleep and latency to sleep onset at initiation of therapy, and provided longer duration of sleep stages with no suppression of slow-wave sleep. No impaired next-day performance, rebound insomnia, or withdrawal effects were observed. Adverse events were similar with almorexant and placebo. CONCLUSION Almorexant reduced time to sleep onset and maintained sleep without residual effects on next-day performance or safety concerns. This study provides further support for the role of the endogenous orexin system in insomnia disorder. CLINICALTRIALS. GOV REGISTRATION NCT00608985.
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Affiliation(s)
- Jed Black
- Center for Sleep Research and Medicine, Stanford, USA.
| | | | - Jan Hedner
- Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Olli Polo
- Unesta Research Center, Tampere, Finland and University of Turku, Turku, Finland
| | - Ouali Berkani
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | | | - Abdel Hmissi
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | | | - Goran Hajak
- University of Regensburg, Germany and Social Foundation, Bamberg, Germany
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Coborn JE, DePorter DP, Mavanji V, Sinton CM, Kotz CM, Billington CJ, Teske JA. Role of orexin-A in the ventrolateral preoptic area on components of total energy expenditure. Int J Obes (Lond) 2017; 41:1256-1262. [PMID: 28392556 DOI: 10.1038/ijo.2017.92] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 03/20/2017] [Accepted: 03/26/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Identifying whether components of total energy expenditure (EE) are affected by orexin receptor (OXR1 and OXR2) stimulation or antagonism with dual orexin receptor antagonists (DORAs) has relevance for obesity treatment. Orexin receptor stimulation reduces weight gain by increasing total EE and EE during spontaneous physical activity (SPA). OBJECTIVE The purpose of this study was to determine if a DORA (TCS-1102) in the ventrolateral preoptic area (VLPO) reduced orexin-A-induced arousal, SPA, total EE and EE during sleep, rest, wake and SPA and whether the DORA alone reduced total EE and its components. We hypothesized that: (1) a DORA would reduce orexin-A induced increases in arousal, SPA, components of total EE, reductions in sleep and the EE during sleep and (2) the DORA alone would reduce baseline (non-stimulated) SPA and total EE. SUBJECTS/METHODS Sleep, wakefulness, SPA and EE were determined after microinjection of the DORA (TCS-1102) and orexin-A in the VLPO of male Sprague-Dawley rats with a unilateral cannula targeted towards the VLPO. Individual components of total EE were determined based on time-stamped data. RESULTS The DORA reduced orexin-A-induced increases in arousal, SPA, total EE and EE during SPA, wake, rest and sleep 1 h post injection (P<0.05). Orexin-A significantly reduced sleep and significantly increased EE during sleep 1 h post injection (P<0.05). Furthermore, the DORA alone significantly reduced total EE, EE during sleep (NREM and REM) and resting EE 2 h post injection (P<0.05). CONCLUSIONS These data suggest that orexin-A reduces weight gain by stimulating total EE through increases in EE during SPA, rest and sleep. Residual effects of the DORA alone include decreases in total EE and EE during sleep and rest, which may promote weight gain.
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Affiliation(s)
- J E Coborn
- Department of Nutritional Sciences, University of Arizona, Tucson, AZ, USA
| | - D P DePorter
- Department of Nutritional Sciences, University of Arizona, Tucson, AZ, USA
| | - V Mavanji
- Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - C M Sinton
- Arizona Respiratory Center, University of Arizona, Tucson, AZ, USA
| | - C M Kotz
- Minneapolis VA Health Care System, Minneapolis, MN, USA.,Geriatric Research Education and Clinical Center, Minneapolis, MN, USA.,Minnesota Obesity Center, Saint Paul, MN, USA.,Department of Food Science and Nutrition, University of Minnesota, Saint Paul, MN, USA
| | - C J Billington
- Minneapolis VA Health Care System, Minneapolis, MN, USA.,Minnesota Obesity Center, Saint Paul, MN, USA.,Department of Food Science and Nutrition, University of Minnesota, Saint Paul, MN, USA.,Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - J A Teske
- Department of Nutritional Sciences, University of Arizona, Tucson, AZ, USA.,Minneapolis VA Health Care System, Minneapolis, MN, USA.,Minnesota Obesity Center, Saint Paul, MN, USA.,Department of Food Science and Nutrition, University of Minnesota, Saint Paul, MN, USA
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Sauchelli S, Jiménez-Murcia S, Fernández-García JC, Garrido-Sánchez L, Tinahones FJ, Casanueva FF, Baños RM, Botella C, Crujeiras AB, de la Torre R, Fernández-Real JM, Frühbeck G, Granero R, Ortega FJ, Rodríguez A, Zipfel S, Giel KE, Menchón JM, Fernández-Aranda F. Interaction Between Orexin-A and Sleep Quality in Females in Extreme Weight Conditions. EUROPEAN EATING DISORDERS REVIEW 2016; 24:510-517. [DOI: 10.1002/erv.2484] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/15/2016] [Accepted: 09/16/2016] [Indexed: 12/22/2022]
Affiliation(s)
- Sarah Sauchelli
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN); Instituto de Salud Carlos III; Madrid Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN); Instituto de Salud Carlos III; Madrid Spain
- Department of Clinical Sciences, School of Medicine; University of Barcelona; Barcelona Spain
| | - Jose C. Fernández-García
- CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN); Instituto de Salud Carlos III; Madrid Spain
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga (IBIMA); Hospital Clínico Virgen de la Victoria; Malaga Spain
| | - Lourdes Garrido-Sánchez
- CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN); Instituto de Salud Carlos III; Madrid Spain
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga (IBIMA); Hospital Clínico Virgen de la Victoria; Malaga Spain
| | - Francisco J. Tinahones
- CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN); Instituto de Salud Carlos III; Madrid Spain
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga (IBIMA); Hospital Clínico Virgen de la Victoria; Malaga Spain
| | - Felipe F. Casanueva
- CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN); Instituto de Salud Carlos III; Madrid Spain
- Department of Medicine, Endocrinology Division, Santiago de Compostela University; Complejo Hospitalario Universitario; Santiago de Compostela Spain
| | - Rosa M. Baños
- CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN); Instituto de Salud Carlos III; Madrid Spain
- Department of Psychological, Personality, Evaluation and Treatment; University of Valencia; Valencia Spain
| | - Cristina Botella
- CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN); Instituto de Salud Carlos III; Madrid Spain
- Department of Basic Psychology, Clinic and Psychobiology; University Jaume I; Castelló Spain
| | - Ana B. Crujeiras
- CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN); Instituto de Salud Carlos III; Madrid Spain
- Department of Medicine, Endocrinology Division, Santiago de Compostela University; Complejo Hospitalario Universitario; Santiago de Compostela Spain
| | - Rafael de la Torre
- CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN); Instituto de Salud Carlos III; Madrid Spain
- Integrated Pharmacology and Systems Neurosciences Research Group, Neuroscience Research Program Organization IMIM; Hospital del Mar Medical Research Institute; Barcelona Spain
- Department of Health and Experimental Sciences; Universitat Pompeu Fabra; Barcelona Spain
| | - Jose M. Fernández-Real
- CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN); Instituto de Salud Carlos III; Madrid Spain
- Department of Diabetes, Endocrinology and Nutrition, Institu d'Investigació, Biomèdica de Girona (IdIBGi); Hospital Dr Josep Trueta; Girona Spain
| | - Gema Frühbeck
- CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN); Instituto de Salud Carlos III; Madrid Spain
- Metabolic Research Laboratory, Clínica Universidad de Navarra; University of Navarra-IdiSNA; Pamplona Spain
| | - Roser Granero
- CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN); Instituto de Salud Carlos III; Madrid Spain
- Department of Psychobiology and Methodology; Autonomous University of Barcelona; Barcelona Spain
| | - Francisco J. Ortega
- CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN); Instituto de Salud Carlos III; Madrid Spain
- Department of Diabetes, Endocrinology and Nutrition, Institu d'Investigació, Biomèdica de Girona (IdIBGi); Hospital Dr Josep Trueta; Girona Spain
| | - Amaia Rodríguez
- CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN); Instituto de Salud Carlos III; Madrid Spain
- Metabolic Research Laboratory, Clínica Universidad de Navarra; University of Navarra-IdiSNA; Pamplona Spain
| | - Stephan Zipfel
- Department of Psychosomatic Medicine; University of Tübingen; Tübingen Germany
| | - Katrin E. Giel
- Department of Psychosomatic Medicine; University of Tübingen; Tübingen Germany
| | - Jose M. Menchón
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
- Department of Clinical Sciences, School of Medicine; University of Barcelona; Barcelona Spain
- CIBER Salud Mental (CIBERSAM); ISCIII; Barcelona Spain
| | - Fernando Fernández-Aranda
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN); Instituto de Salud Carlos III; Madrid Spain
- Department of Clinical Sciences, School of Medicine; University of Barcelona; Barcelona Spain
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Tsuneki H, Sasaoka T, Sakurai T. Sleep Control, GPCRs, and Glucose Metabolism. Trends Endocrinol Metab 2016; 27:633-642. [PMID: 27461005 DOI: 10.1016/j.tem.2016.06.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 06/29/2016] [Accepted: 06/29/2016] [Indexed: 12/29/2022]
Abstract
Modern lifestyles prolong daily activities into the nighttime, disrupting circadian rhythms, which may cause sleep disturbances. Sleep disturbances have been implicated in the dysregulation of blood glucose levels and reported to increase the risk of type 2 diabetes (T2D) and diabetic complications. Sleep disorders are treated using anti-insomnia drugs that target ionotropic and G protein-coupled receptors (GPCRs), including γ-aminobutyric acid (GABA) agonists, melatonin agonists, and orexin receptor antagonists. A deeper understanding of the effects of these medications on glucose metabolism and their underlying mechanisms of action is crucial for the treatment of diabetic patients with sleep disorders. In this review we focus on the beneficial impact of sleep on glucose metabolism and suggest a possible strategy for therapeutic intervention against sleep-related metabolic disorders.
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Affiliation(s)
- Hiroshi Tsuneki
- Department of Clinical Pharmacology, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan
| | - Toshiyasu Sasaoka
- Department of Clinical Pharmacology, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan.
| | - Takeshi Sakurai
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan.
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Connor KM, Mahoney E, Jackson S, Hutzelmann J, Zhao X, Jia N, Snyder E, Snavely D, Michelson D, Roth T, Herring WJ. A Phase II Dose-Ranging Study Evaluating the Efficacy and Safety of the Orexin Receptor Antagonist Filorexant (MK-6096) in Patients with Primary Insomnia. Int J Neuropsychopharmacol 2016; 19:pyw022. [PMID: 26979830 PMCID: PMC5006195 DOI: 10.1093/ijnp/pyw022] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 03/02/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Filorexant (MK-6096) is an orexin receptor antagonist; here, we evaluate the efficacy of filorexant in the treatment of insomnia in adults. METHODS A double-blind, placebo-controlled, randomized, two 4-week-period, adaptive crossover polysomnography study was conducted at 51 sites worldwide. Patients (18 to <65 years) with insomnia received 1 of 4 doses of oral filorexant (2.5, 5, 10, 20mg) once daily at bedtime during one period and matching placebo in the other period in 1 of 8 possible treatment sequences. Polysomnography was performed on night 1 and end of week 4 of each period. The primary endpoint was sleep efficiency at night 1 and end of week 4. Secondary endpoints included wakefulness after persistent sleep onset and latency to onset of persistent sleep. RESULTS A total of 324 patients received study treatment, 315 received ≥1 dose of placebo, and 318 ≥1 dose of filorexant (2.5mg, n=79; 5mg, n=78; 10mg, n=80; 20mg, n=81). All filorexant doses (2.5/5/10/20mg) were significantly superior to placebo in improving sleep among patients with insomnia as measured by sleep efficiency and wakefulness after persistent sleep onset on night 1 and end of week 4. The 2 higher filorexant doses (10/20mg) were also significantly more effective than placebo in improving sleep onset as measured by latency to onset of persistent sleep at night 1 and end of week 4. Filorexant was generally well tolerated. CONCLUSIONS Orexin receptor antagonism by filorexant significantly improved sleep efficiency in nonelderly patients with insomnia. Dose-related improvements in sleep onset and maintenance outcomes were also observed with filorexant.
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Affiliation(s)
- Kathryn M Connor
- Merck & Co., Inc., Kenilworth, NJ (Dr Connor, Ms Mahoney, Ms Jackson, Ms Hutzelmann, Dr Zhao, Dr Jia, Dr Snyder, Mr Snavely, Dr Michelson, and Dr Herring); Henry Ford Hospital, Detroit, MI (Dr Roth).Current affiliations: Biogen, Cambridge, MA (E.M.). Janssen Pharmaceutical Research and Development, Raritan, NJ (X.Z.). Eli Lilly and Company, Indianapolis, IN (N.J.)
| | - Erin Mahoney
- Merck & Co., Inc., Kenilworth, NJ (Dr Connor, Ms Mahoney, Ms Jackson, Ms Hutzelmann, Dr Zhao, Dr Jia, Dr Snyder, Mr Snavely, Dr Michelson, and Dr Herring); Henry Ford Hospital, Detroit, MI (Dr Roth).Current affiliations: Biogen, Cambridge, MA (E.M.). Janssen Pharmaceutical Research and Development, Raritan, NJ (X.Z.). Eli Lilly and Company, Indianapolis, IN (N.J.)
| | - Saheeda Jackson
- Merck & Co., Inc., Kenilworth, NJ (Dr Connor, Ms Mahoney, Ms Jackson, Ms Hutzelmann, Dr Zhao, Dr Jia, Dr Snyder, Mr Snavely, Dr Michelson, and Dr Herring); Henry Ford Hospital, Detroit, MI (Dr Roth).Current affiliations: Biogen, Cambridge, MA (E.M.). Janssen Pharmaceutical Research and Development, Raritan, NJ (X.Z.). Eli Lilly and Company, Indianapolis, IN (N.J.)
| | - Jill Hutzelmann
- Merck & Co., Inc., Kenilworth, NJ (Dr Connor, Ms Mahoney, Ms Jackson, Ms Hutzelmann, Dr Zhao, Dr Jia, Dr Snyder, Mr Snavely, Dr Michelson, and Dr Herring); Henry Ford Hospital, Detroit, MI (Dr Roth).Current affiliations: Biogen, Cambridge, MA (E.M.). Janssen Pharmaceutical Research and Development, Raritan, NJ (X.Z.). Eli Lilly and Company, Indianapolis, IN (N.J.)
| | - Xin Zhao
- Merck & Co., Inc., Kenilworth, NJ (Dr Connor, Ms Mahoney, Ms Jackson, Ms Hutzelmann, Dr Zhao, Dr Jia, Dr Snyder, Mr Snavely, Dr Michelson, and Dr Herring); Henry Ford Hospital, Detroit, MI (Dr Roth).Current affiliations: Biogen, Cambridge, MA (E.M.). Janssen Pharmaceutical Research and Development, Raritan, NJ (X.Z.). Eli Lilly and Company, Indianapolis, IN (N.J.)
| | - Nan Jia
- Merck & Co., Inc., Kenilworth, NJ (Dr Connor, Ms Mahoney, Ms Jackson, Ms Hutzelmann, Dr Zhao, Dr Jia, Dr Snyder, Mr Snavely, Dr Michelson, and Dr Herring); Henry Ford Hospital, Detroit, MI (Dr Roth).Current affiliations: Biogen, Cambridge, MA (E.M.). Janssen Pharmaceutical Research and Development, Raritan, NJ (X.Z.). Eli Lilly and Company, Indianapolis, IN (N.J.)
| | - Ellen Snyder
- Merck & Co., Inc., Kenilworth, NJ (Dr Connor, Ms Mahoney, Ms Jackson, Ms Hutzelmann, Dr Zhao, Dr Jia, Dr Snyder, Mr Snavely, Dr Michelson, and Dr Herring); Henry Ford Hospital, Detroit, MI (Dr Roth).Current affiliations: Biogen, Cambridge, MA (E.M.). Janssen Pharmaceutical Research and Development, Raritan, NJ (X.Z.). Eli Lilly and Company, Indianapolis, IN (N.J.)
| | - Duane Snavely
- Merck & Co., Inc., Kenilworth, NJ (Dr Connor, Ms Mahoney, Ms Jackson, Ms Hutzelmann, Dr Zhao, Dr Jia, Dr Snyder, Mr Snavely, Dr Michelson, and Dr Herring); Henry Ford Hospital, Detroit, MI (Dr Roth).Current affiliations: Biogen, Cambridge, MA (E.M.). Janssen Pharmaceutical Research and Development, Raritan, NJ (X.Z.). Eli Lilly and Company, Indianapolis, IN (N.J.)
| | - David Michelson
- Merck & Co., Inc., Kenilworth, NJ (Dr Connor, Ms Mahoney, Ms Jackson, Ms Hutzelmann, Dr Zhao, Dr Jia, Dr Snyder, Mr Snavely, Dr Michelson, and Dr Herring); Henry Ford Hospital, Detroit, MI (Dr Roth).Current affiliations: Biogen, Cambridge, MA (E.M.). Janssen Pharmaceutical Research and Development, Raritan, NJ (X.Z.). Eli Lilly and Company, Indianapolis, IN (N.J.)
| | - Thomas Roth
- Merck & Co., Inc., Kenilworth, NJ (Dr Connor, Ms Mahoney, Ms Jackson, Ms Hutzelmann, Dr Zhao, Dr Jia, Dr Snyder, Mr Snavely, Dr Michelson, and Dr Herring); Henry Ford Hospital, Detroit, MI (Dr Roth).Current affiliations: Biogen, Cambridge, MA (E.M.). Janssen Pharmaceutical Research and Development, Raritan, NJ (X.Z.). Eli Lilly and Company, Indianapolis, IN (N.J.)
| | - W Joseph Herring
- Merck & Co., Inc., Kenilworth, NJ (Dr Connor, Ms Mahoney, Ms Jackson, Ms Hutzelmann, Dr Zhao, Dr Jia, Dr Snyder, Mr Snavely, Dr Michelson, and Dr Herring); Henry Ford Hospital, Detroit, MI (Dr Roth).Current affiliations: Biogen, Cambridge, MA (E.M.). Janssen Pharmaceutical Research and Development, Raritan, NJ (X.Z.). Eli Lilly and Company, Indianapolis, IN (N.J.)
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Heidmann B, Gatfield J, Roch C, Treiber A, Tortoioli S, Brotschi C, Williams JT, Bolli MH, Abele S, Sifferlen T, Jenck F, Boss C. Discovery of Highly Potent Dual Orexin Receptor Antagonists via a Scaffold-Hopping Approach. ChemMedChem 2016; 11:2132-2146. [DOI: 10.1002/cmdc.201600175] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 05/18/2016] [Indexed: 01/04/2023]
Affiliation(s)
- Bibia Heidmann
- Actelion Pharmaceuticals Ltd.; Drug Discovery and Preclinical Research & Development; Gewerbestrasse 16 4123 Allschwil Switzerland
| | - John Gatfield
- Actelion Pharmaceuticals Ltd.; Drug Discovery and Preclinical Research & Development; Gewerbestrasse 16 4123 Allschwil Switzerland
| | - Catherine Roch
- Actelion Pharmaceuticals Ltd.; Drug Discovery and Preclinical Research & Development; Gewerbestrasse 16 4123 Allschwil Switzerland
| | - Alexander Treiber
- Actelion Pharmaceuticals Ltd.; Drug Discovery and Preclinical Research & Development; Gewerbestrasse 16 4123 Allschwil Switzerland
| | - Simone Tortoioli
- Actelion Pharmaceuticals Ltd.; Drug Discovery and Preclinical Research & Development; Gewerbestrasse 16 4123 Allschwil Switzerland
| | - Christine Brotschi
- Actelion Pharmaceuticals Ltd.; Drug Discovery and Preclinical Research & Development; Gewerbestrasse 16 4123 Allschwil Switzerland
| | - Jodi T. Williams
- Actelion Pharmaceuticals Ltd.; Drug Discovery and Preclinical Research & Development; Gewerbestrasse 16 4123 Allschwil Switzerland
| | - Martin H. Bolli
- Actelion Pharmaceuticals Ltd.; Drug Discovery and Preclinical Research & Development; Gewerbestrasse 16 4123 Allschwil Switzerland
| | - Stefan Abele
- Actelion Pharmaceuticals Ltd.; Drug Discovery and Preclinical Research & Development; Gewerbestrasse 16 4123 Allschwil Switzerland
| | - Thierry Sifferlen
- Actelion Pharmaceuticals Ltd.; Drug Discovery and Preclinical Research & Development; Gewerbestrasse 16 4123 Allschwil Switzerland
| | - François Jenck
- Actelion Pharmaceuticals Ltd.; Drug Discovery and Preclinical Research & Development; Gewerbestrasse 16 4123 Allschwil Switzerland
| | - Christoph Boss
- Actelion Pharmaceuticals Ltd.; Drug Discovery and Preclinical Research & Development; Gewerbestrasse 16 4123 Allschwil Switzerland
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McDonald T, Liang HA, Sanoja R, Gotter AL, Kuduk SD, Coleman PJ, Smith KM, Winrow CJ, Renger JJ. Pharmacological evaluation of orexin receptor antagonists in preclinical animal models of pain. J Neurogenet 2016; 30:32-41. [DOI: 10.3109/01677063.2016.1171862] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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67
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Brown RM, Kim AK, Khoo SYS, Kim JH, Jupp B, Lawrence AJ. Orexin-1 receptor signalling in the prelimbic cortex and ventral tegmental area regulates cue-induced reinstatement of ethanol-seeking in iP rats. Addict Biol 2016; 21:603-12. [PMID: 25899624 DOI: 10.1111/adb.12251] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Orexins (hypocretins) are hypothalamic neuropeptides that innervate the entire neuraxis, including the prelimbic cortex and ventral tegmental area and have been implicated in ethanol-seeking behaviour. The present study aimed to use the orexin-1 (OX1 ) receptor antagonist SB-334867 to examine the role of prelimbic cortex and ventral tegmental area OX1 receptors in cue-induced reinstatement of ethanol-seeking. Ethanol-preferring rats (iP) rats were trained to self-administer ethanol (10 percent v/v, FR3) or sucrose (0.2-1 percent w/v, FR3) in the presence of reward-associated cues before being implanted with indwelling guide cannulae. Rats then underwent extinction training for 11 days. On test days, rats were given a microinjection of vehicle or SB-334867 (3 μg/side) and presented with reward-associated cues to precipitate reinstatement. Results show SB-334867 infused into the prelimbic cortex attenuated cue-induced reinstatement of ethanol-seeking, but not sucrose-seeking. OX1 antagonism in the ventral tegmental area also attenuated cue-induced reinstatement of ethanol-seeking. These findings suggest that OX1 receptors located in the prelimbic cortex and ventral tegmental area are part of a circuit driving cue-mediated ethanol-seeking behaviour.
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Affiliation(s)
- Robyn Mary Brown
- Florey Institute of Neuroscience and Mental Health; University of Melbourne; Australia
| | - Andrezza K. Kim
- Florey Institute of Neuroscience and Mental Health; University of Melbourne; Australia
- Departamento de Psicobiologia; Universidade Federal de São Paulo; Brazil
| | - Shaun Yon-Seng Khoo
- Florey Institute of Neuroscience and Mental Health; University of Melbourne; Australia
- School of Psychology; University of New South Wales; Australia
| | - Jee Hyun Kim
- Florey Institute of Neuroscience and Mental Health; University of Melbourne; Australia
| | - Bianca Jupp
- Florey Institute of Neuroscience and Mental Health; University of Melbourne; Australia
- Experimental Psychology; University of Cambridge; UK
| | - Andrew John Lawrence
- Florey Institute of Neuroscience and Mental Health; University of Melbourne; Australia
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Yin J, Babaoglu K, Brautigam CA, Clark L, Shao Z, Scheuermann TH, Harrell CM, Gotter AL, Roecker AJ, Winrow CJ, Renger JJ, Coleman PJ, Rosenbaum DM. Structure and ligand-binding mechanism of the human OX1 and OX2 orexin receptors. Nat Struct Mol Biol 2016; 23:293-9. [PMID: 26950369 DOI: 10.1038/nsmb.3183] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 02/02/2016] [Indexed: 01/10/2023]
Abstract
The orexin (also known as hypocretin) G protein-coupled receptors (GPCRs) regulate sleep and other behavioral functions in mammals, and are therapeutic targets for sleep and wake disorders. The human receptors hOX1R and hOX2R, which are 64% identical in sequence, have overlapping but distinct physiological functions and potential therapeutic profiles. We determined structures of hOX1R bound to the OX1R-selective antagonist SB-674042 and the dual antagonist suvorexant at 2.8-Å and 2.75-Å resolution, respectively, and used molecular modeling to illuminate mechanisms of antagonist subtype selectivity between hOX1R and hOX2R. The hOX1R structures also reveal a conserved amphipathic α-helix, in the extracellular N-terminal region, that interacts with orexin-A and is essential for high-potency neuropeptide activation at both receptors. The orexin-receptor crystal structures are valuable tools for the design and development of selective orexin-receptor antagonists and agonists.
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Affiliation(s)
- Jie Yin
- Department of Biophysics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Kerim Babaoglu
- Department of Structural Chemistry, Merck Research Laboratories, West Point, Pennsylvania, USA
| | - Chad A Brautigam
- Department of Biophysics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Lindsay Clark
- Department of Biophysics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Zhenhua Shao
- Department of Biophysics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Thomas H Scheuermann
- Department of Biophysics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Charles M Harrell
- Department of Neuroscience, Merck Research Laboratories, West Point, Pennsylvania, USA
| | - Anthony L Gotter
- Department of Neuroscience, Merck Research Laboratories, West Point, Pennsylvania, USA
| | - Anthony J Roecker
- Department of Medicinal Chemistry, Merck Research Laboratories, West Point, Pennsylvania, USA
| | - Christopher J Winrow
- Department of Neuroscience, Merck Research Laboratories, West Point, Pennsylvania, USA
| | - John J Renger
- Department of Neuroscience, Merck Research Laboratories, West Point, Pennsylvania, USA
| | - Paul J Coleman
- Department of Medicinal Chemistry, Merck Research Laboratories, West Point, Pennsylvania, USA
| | - Daniel M Rosenbaum
- Department of Biophysics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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69
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Tannenbaum PL, Tye SJ, Stevens J, Gotter AL, Fox SV, Savitz AT, Coleman PJ, Uslaner JM, Kuduk SD, Hargreaves R, Winrow CJ, Renger JJ. Inhibition of Orexin Signaling Promotes Sleep Yet Preserves Salient Arousability in Monkeys. Sleep 2016; 39:603-12. [PMID: 26943466 DOI: 10.5665/sleep.5536] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 10/04/2015] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES In addition to enhancing sleep onset and maintenance, a desirable insomnia therapeutic agent would preserve healthy sleep's ability to wake and respond to salient situations while maintaining sleep during irrelevant noise. Dual orexin receptor antagonists (DORAs) promote sleep by selectively inhibiting wake-promoting neuropeptide signaling, unlike global inhibition of central nervous system excitation by gamma-aminobutyric acid (GABA)-A receptor (GABAaR) modulators. We evaluated the effect of DORA versus GABAaR modulators on underlying sleep architecture, ability to waken to emotionally relevant stimuli versus neutral auditory cues, and performance on a sleepiness-sensitive cognitive task upon awakening. METHODS DORA-22 and GABAaR modulators (eszopiclone, diazepam) were evaluated in adult male rhesus monkeys (n = 34) with continuous polysomnography recordings in crossover studies of sleep architecture, arousability to a classically conditioned salient versus neutral acoustical stimulus, and psychomotor vigilance task (PVT) performance if awakened. RESULTS All compounds decreased wakefulness, but only DORA-22 sleep resembled unmedicated sleep in terms of underlying sleep architecture, preserved ability to awaken to salient-conditioned acoustic stimuli while maintaining sleep during neutral acoustic stimuli, and no congnitive impairment in PVT performance. Although GABAaR modulators induced lighter sleep, monkeys rarely woke to salient stimuli and PVT performance was impaired if monkeys were awakened. CONCLUSIONS In nonhuman primates, DORAs' targeted mechanism for promoting sleep protects the ability to selectively arouse to salient stimuli and perform attentional tasks unimpaired, suggesting meaningful differentiation between a hypnotic agent that works through antagonizing orexin wake signaling versus the sedative hypnotic effects of the GABAaR modulator mechanism of action.
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Affiliation(s)
- Pamela L Tannenbaum
- Department of Pharmacology, Merck Research Laboratories, Merck & Co., Inc., West Point, PA
| | - Spencer J Tye
- Department of Pharmacology, Merck Research Laboratories, Merck & Co., Inc., West Point, PA
| | - Joanne Stevens
- Department of Pharmacology, Merck Research Laboratories, Merck & Co., Inc., West Point, PA
| | - Anthony L Gotter
- Department of Neuroscience, Merck Research Laboratories, Merck & Co., Inc., West Point, PA
| | - Steven V Fox
- Department of Pharmacology, Merck Research Laboratories, Merck & Co., Inc., West Point, PA
| | - Alan T Savitz
- Department of Pharmacology, Merck Research Laboratories, Merck & Co., Inc., West Point, PA
| | - Paul J Coleman
- Department of Medicinal Chemistry, Merck Research Laboratories, Merck & Co., Inc., West Point, PA
| | - Jason M Uslaner
- Department of Pharmacology, Merck Research Laboratories, Merck & Co., Inc., West Point, PA
| | - Scott D Kuduk
- Department of Medicinal Chemistry, Merck Research Laboratories, Merck & Co., Inc., West Point, PA
| | - Richard Hargreaves
- Department of Neuroscience, Merck Research Laboratories, Merck & Co., Inc., West Point, PA
| | - Christopher J Winrow
- Department of Neuroscience, Merck Research Laboratories, Merck & Co., Inc., West Point, PA
| | - John J Renger
- Department of Neuroscience, Merck Research Laboratories, Merck & Co., Inc., West Point, PA
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Moorman DE, James MH, Kilroy EA, Aston-Jones G. Orexin/hypocretin neuron activation is correlated with alcohol seeking and preference in a topographically specific manner. Eur J Neurosci 2016; 43:710-20. [PMID: 26750264 DOI: 10.1111/ejn.13170] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 12/09/2015] [Accepted: 01/04/2016] [Indexed: 12/14/2022]
Abstract
Orexin (ORX) (also known as hypocretin) neurons are located exclusively in the posterior hypothalamus, and are involved in a wide range of behaviours, including motivation for drugs of abuse such as alcohol. Hypothalamic subregions contain functionally distinct populations of ORX neurons that may play different roles in regulating drug-motivated and alcohol-motivated behaviours. To investigate the role of ORX neurons in ethanol (EtOH) seeking, we measured Fos activation of ORX neurons in rats following three different measures of EtOH seeking and preference: (i) context-induced reinstatement, or ABA renewal; (ii) cue-induced reinstatement of extinguished responding for EtOH; and (iii) a home cage task in which preference for EtOH (vs. water) was measured in the absence of either reinforcer. We found significant activation of ORX neurons in multiple subregions across all three behavioural tests. Notably, ORX neuron activation in the lateral hypothalamus correlated with the degree of seeking in context reinstatement and the degree of preference in home cage preference testing. In addition, Fos activation in ORX neurons in the dorsomedial hypothalamic and perifornical areas was correlated with context and home cage seeking/preference, respectively. Surprisingly, we found no relationship between the degree of cue-induced reinstatement and ORX neuron activation in any region, despite robust activation overall during reinstatement. These results demonstrate a strong relationship between ORX neuron activation and EtOH seeking/preference, but one that is differentially expressed across ORX field subregions, depending on reinstatement modality.
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Affiliation(s)
- David E Moorman
- Department of Neurosciences, Medical University of South Carolina, Charleston, SC, USA
| | - Morgan H James
- Department of Neurosciences, Medical University of South Carolina, Charleston, SC, USA
| | - Elisabeth A Kilroy
- Department of Neurosciences, Medical University of South Carolina, Charleston, SC, USA
| | - Gary Aston-Jones
- Department of Neurosciences, Medical University of South Carolina, Charleston, SC, USA
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71
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Cui D, Cabalu T, Yee KL, Small J, Li X, Liu B, Maciolek C, Smith S, Liu W, McCrea JB, Prueksaritanont T. In vitro and in vivo characterisation of the metabolism and disposition of suvorexant in humans. Xenobiotica 2016; 46:882-95. [PMID: 26864332 DOI: 10.3109/00498254.2015.1129565] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
1. Suvorexant (MK-4305, Belsomra®) is a first-in-class dual orexin receptor antagonist approved in the USA and Japan for the treatment of insomnia. The current studies describe suvorexant's absorption, disposition and potential for CYP-mediated drug interactions in humans. 2. Following single oral administration of [(14)C]suvorexant to healthy human subjects, 90% of the radioactivity was recovered (66% in faeces, 23% in urine), primarily as oxidative metabolites. 3. In plasma, suvorexant and M9 were predominant, accounting for 30 and 37% of the total radioactivity, respectively. Metabolite M17 became more prominent (approaching 10%) following multiple daily doses of unlabelled suvorexant. M9 and M17 are not expected to contribute to the pharmacological activity of suvorexant due to reduced orexin receptor binding affinity and limited brain penetration. 4. CYP3A was determined to be the predominant enzyme mediating suvorexant oxidation. In vitro, suvorexant demonstrated reversible inhibition of CYP3A4 and 2C19 (IC50 ∼ 4-5 μM), and weak time-dependent inhibition of CYP3A4 (KI = 12 μM, kinact = 0.14 min(-1)). Suvorexant was also a weak inducer of CYP3A4, 1A2 and 2B6. Given the low plasma concentrations at clinical doses, suvorexant was not anticipated to cause significant drug interactions via inhibition and/or induction of major CYPs in vivo.
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Affiliation(s)
- Donghui Cui
- a Department of Pharmacokinetics , Pharmacodynamics and Drug Metabolism, Merck & Co, Inc , West Point , PA , USA
| | - Tamara Cabalu
- a Department of Pharmacokinetics , Pharmacodynamics and Drug Metabolism, Merck & Co, Inc , West Point , PA , USA
| | - Ka Lai Yee
- a Department of Pharmacokinetics , Pharmacodynamics and Drug Metabolism, Merck & Co, Inc , West Point , PA , USA
| | - James Small
- b Structure Elucidation NMR Group, Process Chemistry, Merck & Co, Inc , West Point , PA , USA
| | - Xiaodong Li
- c Bristol-Myers Squibb, Full Development Statistics, Global Biometrics Science , Hopewell , NJ , USA , and
| | - Bo Liu
- a Department of Pharmacokinetics , Pharmacodynamics and Drug Metabolism, Merck & Co, Inc , West Point , PA , USA
| | - Cheri Maciolek
- a Department of Pharmacokinetics , Pharmacodynamics and Drug Metabolism, Merck & Co, Inc , West Point , PA , USA
| | - Sheri Smith
- a Department of Pharmacokinetics , Pharmacodynamics and Drug Metabolism, Merck & Co, Inc , West Point , PA , USA
| | - Wen Liu
- a Department of Pharmacokinetics , Pharmacodynamics and Drug Metabolism, Merck & Co, Inc , West Point , PA , USA
| | - Jacqueline B McCrea
- d Department of Clinical Pharmacology and Experimental Therapeutics (CPET) , Merck & Co, Inc , Kenilworth , NJ , USA
| | - Thomayant Prueksaritanont
- a Department of Pharmacokinetics , Pharmacodynamics and Drug Metabolism, Merck & Co, Inc , West Point , PA , USA
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72
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Lopez MF, Moorman DE, Aston-Jones G, Becker HC. The highly selective orexin/hypocretin 1 receptor antagonist GSK1059865 potently reduces ethanol drinking in ethanol dependent mice. Brain Res 2016; 1636:74-80. [PMID: 26851547 DOI: 10.1016/j.brainres.2016.01.049] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 01/20/2016] [Accepted: 01/27/2016] [Indexed: 01/01/2023]
Abstract
The orexin/hypocretin (ORX) system plays a major role in motivation for natural and drug rewards. In particular, a number of studies have shown that ORX signaling through the orexin 1 receptor (OX1R) regulates alcohol seeking and consumption. Despite the association between ORX signaling and motivation for alcohol, no study to date has investigated what role the ORX system plays in alcohol dependence, an understanding of which would have significant clinical relevance. This study was designed to evaluate the effect of the highly selective OX1R antagonist GSK1059865 on voluntary ethanol intake in ethanol-dependent and control non-dependent mice. Mice were subjected to a protocol in which they were evaluated for baseline ethanol intake and then exposed to intermittent ethanol or air exposure in inhalation chambers. Each cycle of chronic intermittent ethanol (CIE), or air, exposure was followed by a test of ethanol intake. Once the expected effect of increased voluntary ethanol intake was obtained in ethanol dependent mice, mice were tested for the effect of GSK1059865 on ethanol and sucrose intake. Treatment with GSK1059865 significantly decreased ethanol drinking in a dose-dependent manner in CIE-exposed mice. In contrast GSK1059865 decreased drinking in air-exposed mice only at the highest dose used. There was no effect of GSK1059865 on sucrose intake. Thus, ORX signaling through the OX1R, using a highly-selective antagonist, has a profound influence on high levels of alcohol drinking induced in a dependence paradigm, but limited or no influence on moderate alcohol drinking or sucrose drinking. These results indicate that the ORX system may be an important target system for treating disorders of compulsive reward seeking such as alcoholism and other addictions in which motivation is strongly elevated.
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Affiliation(s)
- Marcelo F Lopez
- Department of Neurosciences, Medical University of South Carolina, Charleston, SC 29425, United States; Charleston Alcohol Research Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, United States.
| | - David E Moorman
- Department of Neurosciences, Medical University of South Carolina, Charleston, SC 29425, United States.
| | - Gary Aston-Jones
- Department of Neurosciences, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Howard C Becker
- Department of Neurosciences, Medical University of South Carolina, Charleston, SC 29425, United States; Charleston Alcohol Research Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, United States; Department of Veterans Affairs, Ralph H. Johnson Medical Center, Charleston, SC 29425, United States
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73
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Urrestarazu E, Iriarte J. Clinical management of sleep disturbances in Alzheimer's disease: current and emerging strategies. Nat Sci Sleep 2016; 8:21-33. [PMID: 26834500 PMCID: PMC4716729 DOI: 10.2147/nss.s76706] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Sleep and circadian disorders in Alzheimer's disease (AD) are more frequent than in the general population and appear early in the course of the disease. Quality of sleep and quality of life are parallel in these patients, and such disorders also represent a heavy burden for caregivers. Although alterations in melatonin and hypocretins (orexins) seem to play a key role in the origin of these disturbances, the etiology of these disorders is multifactorial, including many factors such as environment, behavior, treatments, and comorbidities, among others. A comprehensive evaluation of sleep in each patient is essential in the design of the treatment that includes nonpharmacological and pharmacological approaches. One particularly interesting point is the possibility of a role of sleep disorders in the pathogenesis of AD, raising the possibility that treating the sleep disorder may alter the course of the disease. In this review, we present an update on the role of sleep disorders in AD, the bidirectional influence of sleep problems and AD, and treatment options. Behavioral measures, bright light therapy (BLT), melatonin, and other drugs are likely well known and correctly managed by the physicians in charge of these patients. In spite of the multiple treatments used, evidence of efficacy is scarce and more randomized double-blind placebo-controlled studies are needed. Future directions for treatment are the establishment of BLT protocols and the development of drugs with new mechanisms of action, especially hypocretin receptor antagonists, melatonin receptor agonists, and molecules that modulate the circadian clock.
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Affiliation(s)
- Elena Urrestarazu
- Sleep Unit, Clinical Neurophysiology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Jorge Iriarte
- Sleep Unit, Clinical Neurophysiology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
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74
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Abstract
Sleep and energy balance are essential for health. The two processes act in concert to regulate central and peripheral homeostasis. During sleep, energy is conserved due to suspended activity, movement, and sensory responses, and is redirected to restore and replenish proteins and their assemblies into cellular structures. During wakefulness, various energy-demanding activities lead to hunger. Thus, hunger promotes arousal, and subsequent feeding, followed by satiety that promotes sleep via changes in neuroendocrine or neuropeptide signals. These signals overlap with circuits of sleep-wakefulness, feeding, and energy expenditure. Here, we will briefly review the literature that describes the interplay between the circadian system, sleep-wake, and feeding-fasting cycles that are needed to maintain energy balance and a healthy metabolic profile. In doing so, we describe the neuroendocrine, hormonal/peptide signals that integrate sleep and feeding behavior with energy metabolism.
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Affiliation(s)
- Charu Shukla
- Department of Psychiatry, VA Boston Healthcare System, Harvard Medical School, West Roxbury, MA, USA
| | - Radhika Basheer
- Department of Psychiatry, VA Boston Healthcare System, Harvard Medical School, West Roxbury, MA, USA
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75
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Sutton EL. Profile of suvorexant in the management of insomnia. DRUG DESIGN DEVELOPMENT AND THERAPY 2015; 9:6035-42. [PMID: 26648692 PMCID: PMC4651361 DOI: 10.2147/dddt.s73224] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Suvorexant, approved in late 2014 in the United States and Japan for the treatment of insomnia characterized by difficulty achieving and/or maintaining sleep, is a dual orexin receptor antagonist and the first drug in its class to reach the market. Its development followed from the 1998 discovery of orexins (also called hypocretins), excitatory neuropeptides originating from neurons in the hypothalamus involved in regulation of sleep and wake, feeding behavior and energy regulation, motor activity, and reward-seeking behavior. Suvorexant objectively improves sleep, shortening the time to achieve persistent sleep and reducing wake after sleep onset, although at approved doses (≤20 mg) the benefit was subjectively assessed as modest. Its half-life of 12 hours is relatively long for a modern hypnotic; however, at approved doses (≤20 mg) next-day sedation and driving impairment were much less apparent than at higher doses. Suvorexant is metabolized by the hepatic CYP3A system and should be avoided in combination with strong CYP3A inhibitors. Drug levels are higher in women and obese people; hence, dosing should be conservative in obese women. Administration with food delays drug absorption and is not advised. No dose adjustment is needed for advanced age, renal impairment, or mild-to-moderate hepatic impairment. Suvorexant in contraindicated in narcolepsy and has not been studied in children. In alignment with the changes begun in 2013 in the labeling of other hypnotics, the United States Food and Drug Administration advises that the lowest dose effective to treat symptoms be used and that patients be advised of the possibility of next-day impairment in function, including driving. Infrequent but notable side effects included abnormal dreams, sleep paralysis, and suicidal ideation that were dose-related and reported to be mild. Given its mechanism of action, cataplexy and rapid eye movement (REM) sleep behavior disorder could potentially occur in some patients taking this medication.
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Affiliation(s)
- Eliza L Sutton
- Department of Medicine, University of Washington, Seattle, WA, USA
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76
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Sun H, Yee KL, Gill S, Liu W, Li X, Panebianco D, Mangin E, Morrison D, McCrea J, Wagner JA, Troyer MD. Psychomotor effects, pharmacokinetics and safety of the orexin receptor antagonist suvorexant administered in combination with alcohol in healthy subjects. J Psychopharmacol 2015; 29:1159-69. [PMID: 26464455 DOI: 10.1177/0269881115609015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A double-blind crossover study investigated psychomotor effects, pharmacokinetics, and safety of the orexin receptor antagonist suvorexant with and without alcohol. Healthy adults (n=31) were randomized to receive placebo or suvorexant (40 mg) plus placebo solution or alcohol (0.7 g/kg) in each of four treatments (single doses; morning administration). The US Food and Drug Administration approved suvorexant dose is 10 mg (up to 20 mg) daily. Pharmacodynamic effects were assessed using tests of digit vigilance (DVT; primary endpoint), choice reaction time, digit symbol substitution, numeric working memory, immediate/delayed word recall, body sway and subjective alertness. Suvorexant alone did not significantly affect DVT reaction time, but did impact some pharmacodynamic tests. Suvorexant with alcohol increased reaction time versus either alone (mean difference at 2 h: 44 ms versus suvorexant, p<0.001; 24 ms, versus alcohol, p<0.05) and had additive negative effects on tests of vigilance, working/episodic memory, postural stability and alertness. No effects of suvorexant alone or with alcohol were observed by 9 h. No important changes in pharmacokinetic parameters were observed upon co-administration. All treatments were generally well tolerated without serious adverse events. In conclusion, co-administration of 40 mg suvorexant and 0.7 g/kg alcohol had additive negative psychomotor effects. Patients are advised not to consume alcohol with suvorexant.
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Affiliation(s)
- Hong Sun
- Merck & Co., Inc., Kenilworth, NJ, USA
| | | | - Sean Gill
- Merck & Co., Inc., Kenilworth, NJ, USA
| | - Wen Liu
- Merck & Co., Inc., Kenilworth, NJ, USA
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77
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Roecker AJ, Mercer SP, Bergman JM, Gilbert KF, Kuduk SD, Harrell CM, Garson SL, Fox SV, Gotter AL, Tannenbaum PL, Prueksaritanont T, Cabalu TD, Cui D, Lemaire W, Winrow CJ, Renger JJ, Coleman PJ. Discovery of diazepane amide DORAs and 2-SORAs enabled by exploration of isosteric quinazoline replacements. Bioorg Med Chem Lett 2015; 25:4992-4999. [DOI: 10.1016/j.bmcl.2014.12.081] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 12/22/2014] [Accepted: 12/24/2014] [Indexed: 01/25/2023]
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78
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Gao XB, Hermes G. Neural plasticity in hypocretin neurons: the basis of hypocretinergic regulation of physiological and behavioral functions in animals. Front Syst Neurosci 2015; 9:142. [PMID: 26539086 PMCID: PMC4612503 DOI: 10.3389/fnsys.2015.00142] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 10/02/2015] [Indexed: 12/22/2022] Open
Abstract
The neuronal system that resides in the perifornical and lateral hypothalamus (Pf/LH) and synthesizes the neuropeptide hypocretin/orexin participates in critical brain functions across species from fish to human. The hypocretin system regulates neural activity responsible for daily functions (such as sleep/wake homeostasis, energy balance, appetite, etc.) and long-term behavioral changes (such as reward seeking and addiction, stress response, etc.) in animals. The most recent evidence suggests that the hypocretin system undergoes substantial plastic changes in response to both daily fluctuations (such as food intake and sleep-wake regulation) and long-term changes (such as cocaine seeking) in neuronal activity in the brain. The understanding of these changes in the hypocretin system is essential in addressing the role of the hypocretin system in normal physiological functions and pathological conditions in animals and humans. In this review, the evidence demonstrating that neural plasticity occurs in hypocretin-containing neurons in the Pf/LH will be presented and possible physiological, behavioral, and mental health implications of these findings will be discussed.
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Affiliation(s)
- Xiao-Bing Gao
- Section of Comparative Medicine, Yale University School of Medicine New Haven, CT, USA ; Program on Integrative Cell Signaling and Neurobiology of Metabolism (ICSNM), Yale University School of Medicine New Haven, CT, USA
| | - Gretchen Hermes
- Department of Psychiatry, Yale University School of Medicine New Haven, CT, USA
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79
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Rhyne DN, Anderson SL. Suvorexant in insomnia: efficacy, safety and place in therapy. Ther Adv Drug Saf 2015; 6:189-95. [PMID: 26478806 DOI: 10.1177/2042098615595359] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Insomnia is a highly prevalent disorder that can occur in conjunction with other medical or psychiatric conditions or can occur in the absence of a coexisting disorder. Regardless, treatment of insomnia is beneficial to the patient and may benefit comorbidities if they exist. Nonpharmacologic modalities such as sleep hygiene and stimulus controls are important mainstays of insomnia therapy, but may not be sufficient to treat the disorder. Dual orexin receptor antagonists (DORAs) are a new class of insomnia medication that target wakefulness-promoting neuropeptides to regulate the sleep-wake cycle. Suvorexant is the first DORA to be approved and has demonstrated efficacy at decreasing both time to sleep onset and increasing total sleep time compared with placebo. Suvorexant has a novel mechanism of action and may represent an alternative for patients who cannot tolerate or do not receive benefit from traditional sleep agents. Suvorexant is generally effective and well tolerated, but has not been compared head to head with traditional sleep agents and being only newly available, lacks a longer-term 'real-world' experience base.
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Affiliation(s)
- Danielle N Rhyne
- University of Colorado Anschutz Medical Campus, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Sarah L Anderson
- University of Colorado Anschutz Medical Campus, Skaggs School of Pharmacy and Pharmaceutical Sciences, Mail Stop C238, 80045 East Montview Blvd, Aurora, CO, USA
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80
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Abstract
The orexin-1 and orexin-2 receptors are two G protein-coupled receptors that bind the neuropeptides orexin-A and orexin-B. Dual antagonism of the receptors by small molecules is clinically efficacious in the treatment of insomnia, where the most advanced molecule suvorexant has recently been approved. The scope of this article is to review the small molecule orexin receptor antagonist patent literature between January 2012 and January 2014.
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81
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Abstract
INTRODUCTION The orexin (hypocretin) system is an evolutionarily conserved neuropeptide-G-protein-coupled receptor system, consisting of two neuropeptides the orexin-A and the orexin-B peptides as well as two receptors the orexin-1 and the orexin-2 receptors. The orexin system is crucially involved in the regulation of the circadian rhythm, states of wakefulness and arousal and the modulation of emotions and has attracted the interest of many researchers which resulted in an enormous amount of insight, mainly in the field of antagonists. Clinical proof of concept was obtained with dual orexin receptor antagonists in primary insomnia. Merck's suvorexant got FDA approval on 13 August 2014 for the treatment of insomnia. AREAS COVERED The patent applications from Thomson Reuters Integrity Database (covering 2010-August 2014) are summarized, analyzed and discussed in the review. EXPERT OPINION Intense patenting activities have been observed over the past 3 years in the field of orexin antagonists. Several compounds have been investigated in clinical trials mainly for the treatment of primary insomnia. The advantage of orexin antagonists, based on animal pharmacology results, is the promotion and maintenance of physiological sleep which should avoid hangover phenomena reported as side effects of approved treatments. Many other potential treatment options are mentioned for orexin antagonists of different selectivity profiles.
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Affiliation(s)
- Christoph Boss
- Drug Discovery and Preclinical Research, Actelion Pharmaceuticals Ltd , Gewerbestrasse 16, CH-4123 Allschwil/ BL , Switzerland
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82
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Bonaventure P, Shelton J, Yun S, Nepomuceno D, Sutton S, Aluisio L, Fraser I, Lord B, Shoblock J, Welty N, Chaplan SR, Aguilar Z, Halter R, Ndifor A, Koudriakova T, Rizzolio M, Letavic M, Carruthers NI, Lovenberg T, Dugovic C. Characterization of JNJ-42847922, a Selective Orexin-2 Receptor Antagonist, as a Clinical Candidate for the Treatment of Insomnia. J Pharmacol Exp Ther 2015; 354:471-82. [PMID: 26177655 DOI: 10.1124/jpet.115.225466] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 07/14/2015] [Indexed: 11/22/2022] Open
Abstract
Dual orexin receptor antagonists have been shown to promote sleep in various species, including humans. Emerging research indicates that selective orexin-2 receptor (OX2R) antagonists may offer specificity and a more adequate sleep profile by preserving normal sleep architecture. Here, we characterized JNJ-42847922 ([5-(4,6-dimethyl-pyrimidin-2-yl)-hexahydro-pyrrolo[3,4-c]pyrrol-2-yl]-(2-fluoro-6-[1,2,3]triazol-2-yl-phenyl)-methanone), a high-affinity/potent OX2R antagonist. JNJ-42847922 had an approximate 2-log selectivity ratio versus the human orexin-1 receptor. Ex vivo receptor binding studies demonstrated that JNJ-42847922 quickly occupied OX2R binding sites in the rat brain after oral administration and rapidly cleared from the brain. In rats, single oral administration of JNJ-42847922 (3-30 mg/kg) during the light phase dose dependently reduced the latency to non-rapid eye movement (NREM) sleep and prolonged NREM sleep time in the first 2 hours, whereas REM sleep was minimally affected. The reduced sleep onset and increased sleep duration were maintained upon 7-day repeated dosing (30 mg/kg) with JNJ-42847922, then all sleep parameters returned to baseline levels following discontinuation. Although the compound promoted sleep in wild-type mice, it had no effect in OX2R knockout mice, consistent with a specific OX2R-mediated sleep response. JNJ-42847922 did not increase dopamine release in rat nucleus accumbens or produce place preference in mice after subchronic conditioning, indicating that the compound lacks intrinsic motivational properties in contrast to zolpidem. In a single ascending dose study conducted in healthy subjects, JNJ-42847922 increased somnolence and displayed a favorable pharmacokinetic and safety profile for a sedative/hypnotic, thus emerging as a promising candidate for further clinical development for the treatment of insomnia.
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Affiliation(s)
| | | | - Sujin Yun
- Janssen Research & Development, LLC, San Diego, California
| | | | - Steven Sutton
- Janssen Research & Development, LLC, San Diego, California
| | - Leah Aluisio
- Janssen Research & Development, LLC, San Diego, California
| | - Ian Fraser
- Janssen Research & Development, LLC, San Diego, California
| | - Brian Lord
- Janssen Research & Development, LLC, San Diego, California
| | - James Shoblock
- Janssen Research & Development, LLC, San Diego, California
| | - Natalie Welty
- Janssen Research & Development, LLC, San Diego, California
| | | | | | - Robin Halter
- Janssen Research & Development, LLC, San Diego, California
| | - Anthony Ndifor
- Janssen Research & Development, LLC, San Diego, California
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83
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Letavic MA, Bonaventure P, Carruthers NI, Dugovic C, Koudriakova T, Lord B, Lovenberg TW, Ly KS, Mani NS, Nepomuceno D, Pippel DJ, Rizzolio M, Shelton JE, Shah CR, Shireman BT, Young LK, Yun S. Novel Octahydropyrrolo[3,4-c]pyrroles Are Selective Orexin-2 Antagonists: SAR Leading to a Clinical Candidate. J Med Chem 2015; 58:5620-36. [DOI: 10.1021/acs.jmedchem.5b00742] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Michael A. Letavic
- Janssen Pharmaceutical Research & Development, LLC, 3210 Merryfield Row, San Diego, California 92121, United States
| | - Pascal Bonaventure
- Janssen Pharmaceutical Research & Development, LLC, 3210 Merryfield Row, San Diego, California 92121, United States
| | - Nicholas I. Carruthers
- Janssen Pharmaceutical Research & Development, LLC, 3210 Merryfield Row, San Diego, California 92121, United States
| | - Christine Dugovic
- Janssen Pharmaceutical Research & Development, LLC, 3210 Merryfield Row, San Diego, California 92121, United States
| | - Tatiana Koudriakova
- Janssen Pharmaceutical Research & Development, LLC, 3210 Merryfield Row, San Diego, California 92121, United States
| | - Brian Lord
- Janssen Pharmaceutical Research & Development, LLC, 3210 Merryfield Row, San Diego, California 92121, United States
| | - Timothy W. Lovenberg
- Janssen Pharmaceutical Research & Development, LLC, 3210 Merryfield Row, San Diego, California 92121, United States
| | - Kiev S. Ly
- Janssen Pharmaceutical Research & Development, LLC, 3210 Merryfield Row, San Diego, California 92121, United States
| | - Neelakandha S. Mani
- Janssen Pharmaceutical Research & Development, LLC, 3210 Merryfield Row, San Diego, California 92121, United States
| | - Diane Nepomuceno
- Janssen Pharmaceutical Research & Development, LLC, 3210 Merryfield Row, San Diego, California 92121, United States
| | - Daniel J. Pippel
- Janssen Pharmaceutical Research & Development, LLC, 3210 Merryfield Row, San Diego, California 92121, United States
| | - Michele Rizzolio
- Janssen Pharmaceutical Research & Development, LLC, 3210 Merryfield Row, San Diego, California 92121, United States
| | - Jonathan E. Shelton
- Janssen Pharmaceutical Research & Development, LLC, 3210 Merryfield Row, San Diego, California 92121, United States
| | - Chandra R. Shah
- Janssen Pharmaceutical Research & Development, LLC, 3210 Merryfield Row, San Diego, California 92121, United States
| | - Brock T. Shireman
- Janssen Pharmaceutical Research & Development, LLC, 3210 Merryfield Row, San Diego, California 92121, United States
| | - Lana K. Young
- Janssen Pharmaceutical Research & Development, LLC, 3210 Merryfield Row, San Diego, California 92121, United States
| | - Sujin Yun
- Janssen Pharmaceutical Research & Development, LLC, 3210 Merryfield Row, San Diego, California 92121, United States
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84
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Morley JE. Sleep and the Nursing Home. J Am Med Dir Assoc 2015; 16:539-43. [DOI: 10.1016/j.jamda.2015.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 05/06/2015] [Indexed: 12/14/2022]
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85
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Lim MM, Szymusiak R. Neurobiology of Arousal and Sleep: Updates and Insights Into Neurological Disorders. CURRENT SLEEP MEDICINE REPORTS 2015. [DOI: 10.1007/s40675-015-0013-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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86
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Moustafa AA. On and Off switches in the brain. Front Behav Neurosci 2015; 9:114. [PMID: 25972796 PMCID: PMC4413777 DOI: 10.3389/fnbeh.2015.00114] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 04/17/2015] [Indexed: 12/01/2022] Open
Affiliation(s)
- Ahmed A Moustafa
- Department of Veterans Affairs East Organge, New Jersey, USA ; Marcs Institute for Brain and Behaviour and School of Social Sciences and Psychology, University of Western Sydney Sydney, NSW, Australia
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87
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Perrey DA, German NA, Decker AM, Thorn D, Li JX, Gilmour BP, Thomas BF, Harris DL, Runyon SP, Zhang Y. Effect of 1-substitution on tetrahydroisoquinolines as selective antagonists for the orexin-1 receptor. ACS Chem Neurosci 2015; 6:599-614. [PMID: 25643283 DOI: 10.1021/cn500330v] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Selective blockade of the orexin-1 receptor (OX1) has been suggested as a potential approach to drug addiction therapy because of its role in modulating the brain's reward system. We have recently reported a series of tetrahydroisoquinoline-based OX1 selective antagonists. Aimed at elucidating structure-activity relationship requirements in other regions of the molecule and further enhancing OX1 potency and selectivity, we have designed and synthesized a series of analogues bearing a variety of substituents at the 1-position of the tetrahydroisoquinoline. The results show that an optimally substituted benzyl group is required for activity at the OX1 receptor. Several compounds with improved potency and/or selectivity have been identified. When combined with structural modifications that were previously found to improve selectivity, we have identified compound 73 (RTIOX-251) with an apparent dissociation constant (Ke) of 16.1 nM at the OX1 receptor and >620-fold selectivity over the OX2 receptor. In vivo, compound 73 was shown to block the development of locomotor sensitization to cocaine in rats.
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Affiliation(s)
- David A. Perrey
- Research Triangle Institute, Research Triangle
Park, North Carolina 27709, United States
| | - Nadezhda A. German
- Research Triangle Institute, Research Triangle
Park, North Carolina 27709, United States
| | - Ann M. Decker
- Research Triangle Institute, Research Triangle
Park, North Carolina 27709, United States
| | - David Thorn
- Department
of Pharmacology and Toxicology, University at Buffalo, the State University of New York, Buffalo, New York 14214, United States
| | - Jun-Xu Li
- Department
of Pharmacology and Toxicology, University at Buffalo, the State University of New York, Buffalo, New York 14214, United States
| | - Brian P. Gilmour
- Research Triangle Institute, Research Triangle
Park, North Carolina 27709, United States
| | - Brian F. Thomas
- Research Triangle Institute, Research Triangle
Park, North Carolina 27709, United States
| | - Danni L. Harris
- Research Triangle Institute, Research Triangle
Park, North Carolina 27709, United States
| | - Scott P. Runyon
- Research Triangle Institute, Research Triangle
Park, North Carolina 27709, United States
| | - Yanan Zhang
- Research Triangle Institute, Research Triangle
Park, North Carolina 27709, United States
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Zeng Y, Yang J, Du J, Pu X, Yang X, Yang S, Yang T. Strategies of Functional Foods Promote Sleep in Human Being. ACTA ACUST UNITED AC 2015; 9:148-155. [PMID: 26005400 PMCID: PMC4440346 DOI: 10.2174/1574362410666150205165504] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Revised: 02/03/2015] [Accepted: 02/04/2015] [Indexed: 02/07/2023]
Abstract
Sleep is a vital segment of life, however, the mechanisms of diet promoting sleep are
unclear and are the focus of research. Insomnia is a general sleep disorder and functional foods are
known to play a key role in the prevention of insomnia. A number of studies have demonstrated that
major insomnia risk factors in human being are less functional foods in dietary. There are higher
functional components in functional foods promoting sleep, including tryptophan, GABA, calcium,
potassium, melatonin, pyridoxine, L-ornithine and hexadecanoic acid; but wake-promoting neurochemical
factors include serotonin, noradrenalin, acetylcholine, histamine, orexin and so on. The factors promoting sleep in human
being are the functional foods include barley grass powder, whole grains, maca, panax, Lingzhi, asparagus powder,
lettuce, cherry, kiwifruits, walnut, schisandra wine, and milk; Barley grass powder with higher GABA and calcium, as
well as potassium is the most ideal functional food promoting sleep, however, the sleep duration for modern humans is
associated with food structure of ancient humans. In this review, we put forward possible mechanisms of functional
components in foods promoting sleep. Although there is clear relevance between sleep and diet, their molecular
mechanisms need to be studied further.
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Affiliation(s)
- Yawen Zeng
- Biotechnology and Genetic Resources Institute, Yunnan Academy of Agricultural Sciences, Kunming 650205, P.R. China
| | - Jiazhen Yang
- Biotechnology and Genetic Resources Institute, Yunnan Academy of Agricultural Sciences, Kunming 650205, P.R. China; ; Kuming Tiankang Science & Technology Limited Company, Kunming 650231, P.R. China
| | - Juan Du
- Biotechnology and Genetic Resources Institute, Yunnan Academy of Agricultural Sciences, Kunming 650205, P.R. China
| | - Xiaoying Pu
- Biotechnology and Genetic Resources Institute, Yunnan Academy of Agricultural Sciences, Kunming 650205, P.R. China
| | - Xiaomen Yang
- Biotechnology and Genetic Resources Institute, Yunnan Academy of Agricultural Sciences, Kunming 650205, P.R. China
| | - Shuming Yang
- Biotechnology and Genetic Resources Institute, Yunnan Academy of Agricultural Sciences, Kunming 650205, P.R. China
| | - Tao Yang
- Biotechnology and Genetic Resources Institute, Yunnan Academy of Agricultural Sciences, Kunming 650205, P.R. China
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Doghramji PP. Integrating Modern Concepts of Insomnia and its Contemporary Treatment into Primary Care. Postgrad Med 2015; 126:82-101. [PMID: 25295652 DOI: 10.3810/pgm.2014.09.2802] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Suzuki R, Nozawa D, Futamura A, Nishikawa-Shimono R, Abe M, Hattori N, Ohta H, Araki Y, Kambe D, Ohmichi M, Tokura S, Aoki T, Ohtake N, Kawamoto H. Discovery and in vitro and in vivo profiles of N-ethyl-N-[2-[3-(5-fluoro-2-pyridinyl)-1H-pyrazol-1-yl]ethyl]-2-(2H-1,2,3-triazol-2-yl)-benzamide as a novel class of dual orexin receptor antagonist. Bioorg Med Chem 2015; 23:1260-75. [DOI: 10.1016/j.bmc.2015.01.044] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 01/23/2015] [Accepted: 01/23/2015] [Indexed: 12/11/2022]
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Abad VC, Guilleminault C. Pharmacological treatment of sleep disorders and its relationship with neuroplasticity. Curr Top Behav Neurosci 2015; 25:503-53. [PMID: 25585962 DOI: 10.1007/7854_2014_365] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Sleep and wakefulness are regulated by complex brain circuits located in the brain stem, thalamus, subthalamus, hypothalamus, basal forebrain, and cerebral cortex. Wakefulness and NREM and REM sleep are modulated by the interactions between neurotransmitters that promote arousal and neurotransmitters that promote sleep. Various lines of evidence suggest that sleep disorders may negatively affect neuronal plasticity and cognitive function. Pharmacological treatments may alleviate these effects but may also have adverse side effects by themselves. This chapter discusses the relationship between sleep disorders, pharmacological treatments, and brain plasticity, including the treatment of insomnia, hypersomnias such as narcolepsy, restless legs syndrome (RLS), obstructive sleep apnea (OSA), and parasomnias.
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Affiliation(s)
- Vivien C Abad
- Psychiatry and Behavioral Science-Division of Sleep Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
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92
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Crystal structure of the human OX2 orexin receptor bound to the insomnia drug suvorexant. Nature 2014; 519:247-50. [DOI: 10.1038/nature14035] [Citation(s) in RCA: 162] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 11/04/2014] [Indexed: 12/18/2022]
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Citrome L. Suvorexant for insomnia: a systematic review of the efficacy and safety profile for this newly approved hypnotic - what is the number needed to treat, number needed to harm and likelihood to be helped or harmed? Int J Clin Pract 2014; 68:1429-41. [PMID: 25231363 DOI: 10.1111/ijcp.12568] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To describe the efficacy and safety of suvorexant for the treatment of insomnia. DATA SOURCES The pivotal registration trials were accessed by querying http://www.ncbi.nlm.nih.gov/pubmed/ and http://www.clinicaltrials.gov for the search terms 'suvorexant' and 'MK4305'. Briefing documents from the US Food and Drug Administration Peripheral & Central Nervous System Drugs Advisory Committee and product labelling, provided additional information. STUDY SELECTION All available clinical reports of studies were identified. DATA EXTRACTION Descriptions of the principal results and calculation of number needed to treat (NNT) and number needed to harm (NNH) for relevant dichotomous outcomes were extracted from the available study reports and other sources of information. DATA SYNTHESIS Suvorexant (MK4305) is the first orexin receptor antagonist approved for the treatment of insomnia. This approval was based in part on a Phase 3 clinical development programme that included two similarly designed, 3-month, randomised, double-blind, placebo-controlled, parallel-group studies examining suvorexant 40 and 20 mg in non-elderly adults (age < 65 years) and 30 and 15 mg in elderly patients (age ≥ 65 years). Suvorexant was superior to placebo for sleep latency as assessed both objectively by polysomnography and subjectively by patient-estimated sleep latency; suvorexant was also superior to placebo for sleep maintenance, as assessed both objectively by polysomnography and subjectively by patient-estimated total sleep time. NNT vs. placebo for response as measured by a ≥ 6 point improvement on the Insomnia Severity Index at month 3 was 8 (95% CI 6-14) for both the higher and lower dose regimens. The most commonly encountered adverse event (incidence ≥ 5% and at least twice the rate of placebo) as identified in product labelling is somnolence, with NNH values vs. placebo of 13 (95% CI 11-18) for suvorexant 40 and 30 mg, and 28 (95% CI 17-82) for suvorexant 20 and 15 mg. The efficacy and tolerability profile of suvorexant is similar for those < 65 and ≥ 65 years of age. Rebound insomnia and withdrawal effects were not observed when suvorexant was discontinued after 3 months or after 12 months of nightly use. Because of concerns about dose-related, next-day effects, including sedation, the recommended dose range is 10-20 mg. CONCLUSIONS Suvorexant appears efficacious and relatively tolerable. Its different mechanism of action and potentially different safety and tolerability profile compared with currently available hypnotics represents a new option for the pharmacological treatment of insomnia.
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Affiliation(s)
- L Citrome
- New York Medical College, Valhalla, NY, USA
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94
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Gotter AL, Garson SL, Stevens J, Munden RL, Fox SV, Tannenbaum PL, Yao L, Kuduk SD, McDonald T, Uslaner JM, Tye SJ, Coleman PJ, Winrow CJ, Renger JJ. Differential sleep-promoting effects of dual orexin receptor antagonists and GABAA receptor modulators. BMC Neurosci 2014; 15:109. [PMID: 25242351 PMCID: PMC4261741 DOI: 10.1186/1471-2202-15-109] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 09/17/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The current standard of care for insomnia includes gamma-aminobutyric acid receptor A (GABAA) activators, which promote sleep as well as general central nervous system depression. Dual orexin receptor antagonists (DORAs) represent an alternative mechanism for insomnia treatment that induces somnolence by blocking the wake-promoting effects of orexin neuropeptides. The current study compares the role and interdependence of these two mechanisms on their ability to influence sleep architecture and quantitative electroencephalography (qEEG) spectral profiles across preclinical species. RESULTS Active-phase dosing of DORA-22 induced consistent effects on sleep architecture in mice, rats, dogs, and rhesus monkeys; attenuation of active wake was accompanied by increases in both non-rapid eye movement (NREM) and rapid eye movement (REM) sleep. Eszopiclone, a representative GABAA receptor modulator, promoted sleep in rats and rhesus monkeys that was marked by REM sleep suppression, but had inconsistent effects in mice and paradoxically promoted wakefulness in dogs. Active-phase treatment of rats with DORA-12 similarly promoted NREM and REM sleep to magnitudes nearly identical to those seen during normal resting-phase sleep following vehicle treatment, whereas eszopiclone suppressed REM even to levels below those seen during the active phase. The qEEG changes induced by DORA-12 in rats also resembled normal resting-phase patterns, whereas eszopiclone induced changes distinct from normal active- or inactive-phase spectra. Co-dosing experiments, as well as studies in transgenic rats lacking orexin neurons, indicated partial overlap in the mechanism of sleep promotion by orexin and GABA modulation with the exception of the REM suppression exclusive to GABAA receptor modulation. Following REM deprivation in mice, eszopiclone further suppressed REM sleep while DORA-22 facilitated recovery including increased REM sleep. CONCLUSION DORAs promote NREM and importantly REM sleep that is similar in proportion and magnitude to that seen during the normal resting phase across mammalian animal models. While limited overlap exists between therapeutic mechanisms, orexin signaling does not appear involved in the REM suppression exhibited by GABAA receptor modulators. The ability of DORAs to promote proportional NREM and REM sleep following sleep deprivation suggests that this mechanism may be effective in alleviating recovery from sleep disturbance.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - John J Renger
- Department of Neuroscience, Merck Research Laboratories, 770 Sumneytown Pike, PO Box 4, West Point, PA 19486-0004, USA.
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95
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Kukkonen JP, Leonard CS. Orexin/hypocretin receptor signalling cascades. Br J Pharmacol 2014; 171:314-31. [PMID: 23902572 DOI: 10.1111/bph.12324] [Citation(s) in RCA: 141] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 07/18/2013] [Accepted: 07/28/2013] [Indexed: 12/16/2022] Open
Abstract
Orexin (hypocretin) peptides and their two known G-protein-coupled receptors play essential roles in sleep-wake control and powerfully influence other systems regulating appetite/metabolism, stress and reward. Consequently, drugs that influence signalling by these receptors may provide novel therapeutic opportunities for treating sleep disorders, obesity and addiction. It is therefore critical to understand how these receptors operate, the nature of the signalling cascades they engage and their physiological targets. In this review, we evaluate what is currently known about orexin receptor signalling cascades, while a sister review (Leonard & Kukkonen, this issue) focuses on tissue-specific responses. The evidence suggests that orexin receptor signalling is multifaceted and is substantially more diverse than originally thought. Indeed, orexin receptors are able to couple to members of at least three G-protein families and possibly other proteins, through which they regulate non-selective cation channels, phospholipases, adenylyl cyclase, and protein and lipid kinases. In the central nervous system, orexin receptors produce neuroexcitation by postsynaptic depolarization via activation of non-selective cation channels, inhibition of K⁺ channels and activation of Na⁺/Ca²⁺ exchange, but they also can stimulate the release of neurotransmitters by presynaptic actions and modulate synaptic plasticity. Ca²⁺ signalling is also prominently influenced by these receptors, both via the classical phospholipase C-Ca²⁺ release pathway and via Ca²⁺ influx, mediated by several pathways. Upon longer-lasting stimulation, plastic effects are observed in some cell types, while others, especially cancer cells, are stimulated to die. Thus, orexin receptor signals appear highly tunable, depending on the milieu in which they are operating.
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Affiliation(s)
- J P Kukkonen
- Biochemistry and Cell Biology, Department of Veterinary Biosciences, University of Helsinki, Helsinki, Finland
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96
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Roecker AJ, Reger TS, Mattern MC, Mercer SP, Bergman JM, Schreier JD, Cube RV, Cox CD, Li D, Lemaire W, Bruno JG, Harrell CM, Garson SL, Gotter AL, Fox SV, Stevens J, Tannenbaum PL, Prueksaritanont T, Cabalu TD, Cui D, Stellabott J, Hartman GD, Young SD, Winrow CJ, Renger JJ, Coleman PJ. Discovery of MK-3697: a selective orexin 2 receptor antagonist (2-SORA) for the treatment of insomnia. Bioorg Med Chem Lett 2014; 24:4884-90. [PMID: 25248679 DOI: 10.1016/j.bmcl.2014.08.041] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 08/15/2014] [Accepted: 08/19/2014] [Indexed: 01/12/2023]
Abstract
Orexin receptor antagonists have demonstrated clinical utility for the treatment of insomnia. The majority of clinical efforts to date have focused on the development of dual orexin receptor antagonists (DORAs), small molecules that antagonize both the orexin 1 and orexin 2 receptors. Our group has recently disclosed medicinal chemistry efforts to identify highly potent, orally bioavailable selective orexin 2 receptor antagonists (2-SORAs) that possess acceptable profiles for clinical development. Herein we report additional SAR studies within the 'triaryl' amide 2-SORA series focused on improvements in compound stability in acidic media and time-dependent inhibition of CYP3A4. These studies resulted in the discovery of 2,5-disubstituted isonicotinamide 2-SORAs such as compound 24 that demonstrated improved stability and TDI profiles as well as excellent sleep efficacy across species.
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Affiliation(s)
- Anthony J Roecker
- Department of Medicinal Chemistry, Merck Research Laboratories, PO Box 4, 770 Sumneytown Pike, West Point, PA 19486, United States.
| | - Thomas S Reger
- Department of Medicinal Chemistry, Merck Research Laboratories, PO Box 4, 770 Sumneytown Pike, West Point, PA 19486, United States.
| | - M Christa Mattern
- Department of Medicinal Chemistry, Merck Research Laboratories, PO Box 4, 770 Sumneytown Pike, West Point, PA 19486, United States
| | - Swati P Mercer
- Department of Medicinal Chemistry, Merck Research Laboratories, PO Box 4, 770 Sumneytown Pike, West Point, PA 19486, United States
| | - Jeffrey M Bergman
- Department of Medicinal Chemistry, Merck Research Laboratories, PO Box 4, 770 Sumneytown Pike, West Point, PA 19486, United States
| | - John D Schreier
- Department of Medicinal Chemistry, Merck Research Laboratories, PO Box 4, 770 Sumneytown Pike, West Point, PA 19486, United States
| | - Rowena V Cube
- Department of Medicinal Chemistry, Merck Research Laboratories, PO Box 4, 770 Sumneytown Pike, West Point, PA 19486, United States
| | - Christopher D Cox
- Department of Medicinal Chemistry, Merck Research Laboratories, PO Box 4, 770 Sumneytown Pike, West Point, PA 19486, United States
| | - Dansu Li
- Department of Medicinal Chemistry, Merck Research Laboratories, PO Box 4, 770 Sumneytown Pike, West Point, PA 19486, United States
| | - Wei Lemaire
- Department of In Vitro Pharmacology, Merck Research Laboratories, PO Box 4, 770 Sumneytown Pike, West Point, PA 19486, United States
| | - Joseph G Bruno
- Department of In Vitro Pharmacology, Merck Research Laboratories, PO Box 4, 770 Sumneytown Pike, West Point, PA 19486, United States
| | - C Meacham Harrell
- Department of Neuroscience, Merck Research Laboratories, PO Box 4, 770 Sumneytown Pike, West Point, PA 19486, United States
| | - Susan L Garson
- Department of Neuroscience, Merck Research Laboratories, PO Box 4, 770 Sumneytown Pike, West Point, PA 19486, United States
| | - Anthony L Gotter
- Department of Neuroscience, Merck Research Laboratories, PO Box 4, 770 Sumneytown Pike, West Point, PA 19486, United States
| | - Steven V Fox
- Department of In Vivo Pharmacology, Merck Research Laboratories, PO Box 4, 770 Sumneytown Pike, West Point, PA 19486, United States
| | - Joanne Stevens
- Department of In Vivo Pharmacology, Merck Research Laboratories, PO Box 4, 770 Sumneytown Pike, West Point, PA 19486, United States
| | - Pamela L Tannenbaum
- Department of In Vivo Pharmacology, Merck Research Laboratories, PO Box 4, 770 Sumneytown Pike, West Point, PA 19486, United States
| | - Thomayant Prueksaritanont
- Department of Drug Metabolism, Merck Research Laboratories, PO Box 4, 770 Sumneytown Pike, West Point, PA 19486, United States
| | - Tamara D Cabalu
- Department of Drug Metabolism, Merck Research Laboratories, PO Box 4, 770 Sumneytown Pike, West Point, PA 19486, United States
| | - Donghui Cui
- Department of Drug Metabolism, Merck Research Laboratories, PO Box 4, 770 Sumneytown Pike, West Point, PA 19486, United States
| | - Joyce Stellabott
- Department of Basic Pharmaceutical Sciences, Merck Research Laboratories, PO Box 4, 770 Sumneytown Pike, West Point, PA 19486, United States
| | - George D Hartman
- Department of Medicinal Chemistry, Merck Research Laboratories, PO Box 4, 770 Sumneytown Pike, West Point, PA 19486, United States
| | - Steven D Young
- Department of Medicinal Chemistry, Merck Research Laboratories, PO Box 4, 770 Sumneytown Pike, West Point, PA 19486, United States
| | - Christopher J Winrow
- Department of Neuroscience, Merck Research Laboratories, PO Box 4, 770 Sumneytown Pike, West Point, PA 19486, United States
| | - John J Renger
- Department of Neuroscience, Merck Research Laboratories, PO Box 4, 770 Sumneytown Pike, West Point, PA 19486, United States
| | - Paul J Coleman
- Department of Medicinal Chemistry, Merck Research Laboratories, PO Box 4, 770 Sumneytown Pike, West Point, PA 19486, United States
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Tannenbaum PL, Stevens J, Binns J, Savitz AT, Garson SL, Fox SV, Coleman P, Kuduk SD, Gotter AL, Marino M, Tye SJ, Uslaner JM, Winrow CJ, Renger JJ. Orexin receptor antagonist-induced sleep does not impair the ability to wake in response to emotionally salient acoustic stimuli in dogs. Front Behav Neurosci 2014; 8:182. [PMID: 24904334 PMCID: PMC4032881 DOI: 10.3389/fnbeh.2014.00182] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 05/01/2014] [Indexed: 11/16/2022] Open
Abstract
The ability to awaken from sleep in response to important stimuli is a critical feature of normal sleep, as is maintaining sleep continuity in the presence of irrelevant background noise. Dual orexin receptor antagonists (DORAs) effectively promote sleep across species by targeting the evolutionarily conserved wake-promoting orexin signaling pathway. This study in dogs investigated whether DORA-induced sleep preserved the ability to awaken appropriately to salient acoustic stimuli but remain asleep when exposed to irrelevant stimuli. Sleep and wake in response to DORAs, vehicle, GABA-A receptor modulators (diazepam, eszopiclone and zolpidem) and antihistamine (diphenhydramine) administration were evaluated in telemetry-implanted adult dogs with continuous electrocorticogram, electromyogram (EMG), electrooculogram (EOG), and activity recordings. DORAs induced sleep, but GABA-A modulators and antihistamine induced paradoxical hyperarousal. Thus, salience gating studies were conducted during DORA-22 (0.3, 1, and 5 mg/kg; day and night) and vehicle nighttime sleep. The acoustic stimuli were either classically conditioned using food reward and positive attention (salient stimulus) or presented randomly (neutral stimulus). Once conditioned, the tones were presented at sleep times corresponding to maximal DORA-22 exposure. In response to the salient stimuli, dogs woke completely from vehicle and orexin-antagonized sleep across all sleep stages but rarely awoke to neutral stimuli. Notably, acute pharmacological antagonism of orexin receptors paired with emotionally salient anticipation produced wake, not cataplexy, in a species where genetic (chronic) loss of orexin receptor signaling leads to narcolepsy/cataplexy. DORA-induced sleep in the dog thereby retains the desired capacity to awaken to emotionally salient acoustic stimuli while preserving uninterrupted sleep in response to irrelevant stimuli.
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Affiliation(s)
- Pamela L Tannenbaum
- Department of In Vivo Pharmacology, Merck Research Laboratories West Point, PA, USA
| | - Joanne Stevens
- Department of In Vivo Pharmacology, Merck Research Laboratories West Point, PA, USA
| | - Jacquelyn Binns
- Department of In Vivo Pharmacology, Merck Research Laboratories West Point, PA, USA
| | - Alan T Savitz
- Department of In Vivo Pharmacology, Merck Research Laboratories West Point, PA, USA
| | - Susan L Garson
- Department of Neuroscience, Merck Research Laboratories West Point, PA, USA
| | - Steven V Fox
- Department of In Vivo Pharmacology, Merck Research Laboratories West Point, PA, USA
| | - Paul Coleman
- Department of Medicinal Chemistry, Merck Research Laboratories West Point, PA, USA
| | - Scott D Kuduk
- Department of Medicinal Chemistry, Merck Research Laboratories West Point, PA, USA
| | - Anthony L Gotter
- Department of Neuroscience, Merck Research Laboratories West Point, PA, USA
| | - Michael Marino
- Department of In Vivo Pharmacology, Merck Research Laboratories West Point, PA, USA
| | - Spencer J Tye
- Department of In Vivo Pharmacology, Merck Research Laboratories West Point, PA, USA
| | - Jason M Uslaner
- Department of In Vivo Pharmacology, Merck Research Laboratories West Point, PA, USA
| | | | - John J Renger
- Department of Neuroscience, Merck Research Laboratories West Point, PA, USA
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Thompson MD, Xhaard H, Sakurai T, Rainero I, Kukkonen JP. OX1 and OX2 orexin/hypocretin receptor pharmacogenetics. Front Neurosci 2014; 8:57. [PMID: 24834023 PMCID: PMC4018553 DOI: 10.3389/fnins.2014.00057] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Accepted: 03/12/2014] [Indexed: 01/01/2023] Open
Abstract
Orexin/hypocretin peptide mutations are rare in humans. Even though human narcolepsy is associated with orexin deficiency, this is only extremely rarely due to mutations in the gene coding prepro-orexin, the precursor for both orexin peptides. In contrast, coding and non-coding variants of the OX1 and OX2 orexin receptors have been identified in many human populations; sometimes, these have been associated with disease phenotype, although most confer a relatively low risk. In most cases, these studies have been based on a candidate gene hypothesis that predicts the involvement of orexins in the relevant pathophysiological processes. In the current review, the known human OX1/HCRTR1 and OX2/HCRTR2 genetic variants/polymorphisms as well as studies concerning their involvement in disorders such as narcolepsy, excessive daytime sleepiness, cluster headache, polydipsia-hyponatremia in schizophrenia, and affective disorders are discussed. In most cases, the functional cellular or pharmacological correlates of orexin variants have not been investigated—with the exception of the possible impact of an amino acid 10 Pro/Ser variant of OX2 on orexin potency—leaving conclusions on the nature of the receptor variant effects speculative. Nevertheless, we present perspectives that could shape the basis for further studies. The pharmacology and other properties of the orexin receptor variants are discussed in the context of GPCR signaling. Since orexinergic therapeutics are emerging, the impact of receptor variants on the affinity or potency of ligands deserves consideration. This perspective (pharmacogenetics) is also discussed in the review.
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Affiliation(s)
- Miles D Thompson
- University of Toronto Epilepsy Research Program, Department of Pharmacology, University of Toronto Toronto, ON, Canada
| | - Henri Xhaard
- Faculty of Pharmacy, Centre for Drug Research, University of Helsinki Helsinki, Finland
| | - Takeshi Sakurai
- Department of Molecular Neuroscience and Integrative Physiology, Faculty of Medicine, Kanazawa University Kanazawa, Japan
| | | | - Jyrki P Kukkonen
- Biochemistry and Cell Biology, Department of Veterinary Biosciences, University of Helsinki Helsinki, Finland
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Roecker AJ, Mercer SP, Harrell CM, Garson SL, Fox SV, Gotter AL, Prueksaritanont T, Cabalu TD, Cui D, Lemaire W, Winrow CJ, Renger JJ, Coleman PJ. Discovery of dual orexin receptor antagonists with rat sleep efficacy enabled by expansion of the acetonitrile-assisted/diphosgene-mediated 2,4-dichloropyrimidine synthesis. Bioorg Med Chem Lett 2014; 24:2079-85. [DOI: 10.1016/j.bmcl.2014.03.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 03/14/2014] [Accepted: 03/17/2014] [Indexed: 10/25/2022]
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Dingemanse J, Gehin M, Cruz HG, Hoever P. Formulation development for the orexin receptor antagonist almorexant: assessment in two clinical studies. Drug Des Devel Ther 2014; 8:397-403. [PMID: 24812492 PMCID: PMC4010641 DOI: 10.2147/dddt.s62118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Almorexant, a dual orexin receptor antagonist, was investigated for the treatment of insomnia. The following observations initiated further formulation development: the active pharmaceutical ingredient (API) was sticking to the apparatus used during tablet compression; almorexant has an absolute bioavailability of 11.2%; and almorexant modestly decreased the latency to persistent sleep by 10.4 minutes in patients. Two randomized crossover studies were performed to investigate the pharmacokinetics of several new formulations in healthy subjects. In study I, the old "sticky" tablet was compared to two new formulations developed to prevent sticking: a qualitatively similar tablet but with a larger API crystal size and a tablet with 30% more excipients as well as a larger API crystal size. This latter formulation was available in two strengths. The geometric mean ratios and 90% confidence interval of the area under the curve (AUC) were within the bioequivalence range of 0.80-1.25 for the different comparisons between formulations. In study II, 100 mg of the reference tablet was compared to 25 and 50 mg of a liquid-filled hard gelatin capsule developed to increase the bioavailability of almorexant. The geometric mean ratios of the maximum concentration and AUC comparing the new 25 and 50 mg capsule formulations to the reference tablet did not exceed 0.25 and 0.50, respectively, indicating that the new capsule formulation did not increase the maximum concentration of or the total exposure to almorexant. In conclusion, a new tablet was developed but formulation development aimed at increasing the bioavailability of almorexant failed.
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Affiliation(s)
- Jasper Dingemanse
- Department of Clinical Pharmacology, Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | - Martine Gehin
- Department of Clinical Pharmacology, Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | - Hans Gabriel Cruz
- Department of Clinical Pharmacology, Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | - Petra Hoever
- Department of Clinical Pharmacology, Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
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