Bromocriptine

Macrophage CREBZF Orchestrates Inflammatory Response to Potentiate Insulin Resistance and Type 2 Diabetes

Chronic adipose tissue inflammation accompanied by macrophage accumulation and activation is implicated in the pathogenesis of insulin resistance and type 2 diabetes in humans. The transcriptional coregulator CREBZF is a key factor in hepatic metabolism, yet its role in modulating adipose tissue inflammation and type 2 diabetes remains elusive. The present study demonstrates that overnutrition-induced CREBZF links adipose tissue macrophage (ATM) proinflammatory activation to insulin resistance. CREBZF deficiency in macrophages, not in neutrophils, attenuates macrophage infiltration in adipose, proinflammatory activation, and hyperglycemia in diet-induced insulin-resistant mice. The coculture assays show that macrophage CREBZF deficiency improves insulin sensitivity in primary adipocytes and adipose tissue. Mechanistically, CREBZF competitively inhibits the binding of IκBα to p65, resulting in enhanced NF-κB activity. In addition, bromocriptine is identified as a small molecule inhibitor of CREBZF in macrophages, which suppresses the proinflammatory phenotype and improves metabolic dysfunction. Furthermore, CREBZF is highly expressed in ATM of obese humans and mice, which is positively correlated with proinflammatory genes and insulin resistance in humans. This study identifies a previously unknown role of CREBZF coupling ATM activation to systemic insulin resistance and type 2 diabetes.

Effects of acute administration of DA agonists on locomotor activity: MPTP versus neonatal intracerebroventricular 6-OHDA treatment

The effects of several dopamine (DA) receptor agonists upon locomotor activity on adult MPTP-treated mice and postnatal 6-hydroxydopamine- (6-OHDA-) treated rats were assessed in ten experiments. C57 BL/6 mice were administered 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP, 2 x 40 mg/kg, s.c., 24-hr interval between injections) at 5-months-age, while 1-day-old male Wistar rat pups were given intracisternal 6-OHDA (50 mg, once following desipramine, 25 mg/kg). MPTP-treated mice were tested 4-5 weeks following MPTP injections whereas neonatal 6-OHDA rats were tested at 3-months-age. Locomotor activity was measured in respective activity test chambers following acute administration of DA receptor agonists. In MPTP-treated mice, apomorphine failed to elevate locomotor activity but instead further exacerbated (1.0 and 3.0 mg/kg, s.c.) the hypokinesia of these animals while inducing marked increases in control mice. Cabergoline (0.3 mg/kg, s.c.) and bromocriptine (3.0 mg/kg, s.c.) caused dose-specific elevations of locomotion in MPTP and control mice but suppressed activity at the highest doses. Quinpirole (0.2 mg/kg) and 7-hydroxydipropylaminotetralin (7-OH-DPAT; 300 nmole/kg) increased locomotion in hypokinesic MPTP-treated mice; in control mice, activity was elevated by quinpirole (0.2 and 0.7 mg/kg) and 7-OH-DPAT (100 and 300 nmole/kg), while higher doses suppressed activity. Neither SKF 38393 (1-phenyl-2,3,4,5-tetrahydro-1H-3-benzazepine-7,8-diol) nor FCE 23884 [4-(9,10-didehydro-6-methylergolin-8 beta-yl) methyl-piperazine-2,6-dione] affected locomotor activity. Apomorphine (0.3, 1.0 and 2.0 mg/kg), bromocriptine (3.0 mg/kg) and cabergoline (1.0 mg/kg) stimulated locomotion in sham-operated rats, and to a greater extent in the 6-OHDA-treated rats. Higher dose cabergoline (3.0 mg/kg) induced increased activity of similar extent in sham controls and 6-OHDA treated rats. Activity-enhancing effects of quinpirole (0.2, 0.7 and 2.1 mg/kg) in sham rats were attenuated in 6-OHDA treated rats. Both SKF 38393 (10 mg/kg) and FCE 23884 (0.3 and 1.0 mg/kg) induced locomotor activity increases in 6-OHDA, but not sham, rats. Finally, 7-OH-DPAT (1200 mg/kg) enhanced activity in 6-OHDA rats vs. shams. The effects of the DA agonists are discussed with regard to the putative antihypokinesic effects in MPTP mice and DA-receptor supersensitivity effects in neonatal 6-OHDA rats, pertaining to their more-or-less selective subreceptor profiles.

The therapeutic potential of bromocriptine in neuropsychological rehabilitation of patients with acquired brain damage

1. Activation of neuropsychological rehabilitation by pharmacological agents is a promising therapeutic strategy. 2. Reports of single cases and case series claim improvement of akinetic mutism, non-fluent aphasia, apathy, attentional and other neuropsychiatric disturbances after treatment with bromocriptine, a D2 dopamine receptor agonist. 3. A critical review of published reports and own experiences discusses the results in the light of pharmacological and neurobiological considerations. 4. Dopaminergic stimulation after certain kinds of brain damage might influence neuronal recovery and/or substitute dopaminergical linked functions after destruction of the corresponding neurons. 5. Although controlled clinical studies are very difficult to design and such evidence is still lacking, preliminary recommendations are given with regard to differential indications, drug regime and evaluation criteria.

A randomized trial of bromocriptine for cocaine users presenting to the emergency department

OBJECTIVE

To determine the practicality of treating heavy cocaine users with bromocriptine in an outpatient setting to reduce cocaine use and increase entry into drug treatment.

DESIGN

Double-blind, randomized, placebo-controlled trial.

SETTING

VA Medical Center emergency department.

PARTICIPANTS

Twenty-nine men presenting for minor medical complaints who used cocaine at least four times per week for the previous month.

INTERVENTION

Subjects received either bromocriptine, 1.25 mg, or placebo three times per day for two weeks.

MEASUREMENTS AND MAIN RESULTS

On three follow-up visits, subjects were tested for cocaine metabolites and surveyed about their drug use and symptoms. Eight of 14 subjects randomized to the bromocriptine group appeared for follow-up evaluation and seven enrolled in drug treatment. Three of these patients tested negative for cocaine at all three visits. Ten of 15 control patients appeared for follow-up visits and five enrolled in drug treatment. None of the control patients tested negative for cocaine for all three visits. There was no major side effect.

CONCLUSION

Bromocriptine can be administered safely to heavy cocaine users in an emergency department setting. The question of whether bromocriptine will reduce the use of cocaine or promote entry into drug treatment deserves further research.

Dopamine agonists prevent duodenal ulcer relapse. A comparative study with famotidine and cimetidine

The present study investigated both the healing rate (after four weeks) and the relapse rate (during six months) following treatment with the dopamine-like drugs bromocriptine (2.5 mg twice daily), amantadine (100 mg nocte), or with the H2 blockers cimetidine (800 mg nocte), and famotidine (40 mg nocte) in 124 patients with endoscopically proven duodenal ulcer (DU). The ulcer was completely healed in 27 (amantadine), 26 (bromocriptine), 23 (cimetidine), and in 24 (famotidine) patients. Relapse was noted in 34.7% (cimetidine) and 25% (famotidine) versus 11.7% (amantadine) and 7.7% (bromocriptine) DU patients. No significant difference was found in initial healing rates. However, the relapse rate in the cimetidine-treated group was significantly higher than in all the other test groups. Additional comparisons between all the treatment categories showed a significantly lower relapse rate with the dopamine-like agents. These important new results indicate that dopamine-like compounds are equally effective as H2 blockers in inducing DU healing and may offer a promising advantage over H2 blockers concerning their efficacy in preventing ulcer relapse in DU patients.

Bromocriptine for "negative" schizophrenia

The hypothesis that the pathophysiology of negative symptoms in schizophrenia may involve relative hypoactivity of central dopaminergic neurotransmission prompts the exploration of dopamine agonist strategies in the treatment of this condition. Although the use of dopamine agonists in otherwise unmedicated schizophrenic patients often leads to the exacerbation of psychosis, trials of dopamine agonists in combination with neuroleptic agents warrant investigation. We therefore report on open clinical experience involving six patients with chronic negative symptoms of schizophrenia, maintained on neuroleptic medication, who appeared to have favorable responses to the addition of moderate doses of bromocriptine (10 to 20 mg/d orally in divided doses). One particular factor that makes these trials potentially informative is that five of the six patients had failed to respond to standard treatments with anticholinergic antiparkinsonian medication before the bromocriptine trial, making it unlikely that the bromocriptine had its effect purely by counteracting neuroleptic-induced akinesia. A trial of bromocriptine under these circumstances has never been reported. A second unique feature of this report concerns the lengthy period of follow-up. Adjunctive bromocriptine was continued for a total of 27 patient-years in the six individuals, with maintenance of favorable course and minimal incidence of psychotic exacerbation.

Mechanisms of action of atypical antipsychotic drugs. Implications for novel therapeutic strategies for schizophrenia

The mechanisms which contribute to the actions of atypical antipsychotic drugs, such as clozapine and the putative atypical agents remoxipride and raclopride, are reviewed. Examination of available preclinical and clinical data leads to two hypotheses concerning the mode of action of atypical antipsychotic drugs. The first hypothesis is that antagonism of the dopamine D2 receptor is both necessary and sufficient for the atypical profile, but that interaction with subtypes of the D2 receptor differentiates typical from atypical antipsychotic drugs. The second hypothesis has been previously advanced, and suggests that a relatively high ratio of serotonin 5-HT2:dopamine D2 receptor antagonism may subserve the atypical profile. It seems likely that the atypical antipsychotic drug profile may be achieved in more than one way.

Acute effects of direct dopamine agonists in the mouse behavioral despair test

All the dopamine agonists (apomorphine, dipropylamino-5,6-dihydroxytetrahydronaphtalene, piribedil, bromocriptine, CBM 36-733) tested in the 'behavioral despair' test performed in mice had a dose-dependent anti-immobility effect, with the exception of the D-1 dopamine agonist, SKF 38393. This effect occurred at doses that reduced locomotor activity and decreased colonic temperature. A profound hypothermia of the same amplitude resulted from the immersion in water of the control and apomorphine (Apo)-treated mice. The anti-immobility effect of dopamine agonists depends on the stimulation of central dopamine receptors; this effect was antagonized more easily by haloperidol than by domperidone, and dipropylamino-5,6-dihydroxytetrahydronaphtalene was more effective than amino-5,6-dihydroxytetrahydronaphtalene. Their high sensitivity to sulpiride make it likely that the receptors involved correspond to the D-4 subtype. Blockade of dopamine receptors by haloperidol for about 5 days induced a slight hypersensitivity to the Apo effects. In contrast, tolerance to Apo occurred after administration of Apo, 5 mg/kg s.c., 24 and 16 h before testing. These data might reflect the potential antidepressant activity of direct dopamine agonists.

Pharmacological adjuncts in the treatment of opioid and cocaine addicts

Addiction consists of a complex neuropharmacologic behavioral cycle. The positive reinforcement of the drug and the negative reinforcement of withdrawal serve to drive the behavior of obtaining and ingesting the drug. The pharmacological adjuncts that are available today work by interfering with one or another part of the cycle. The alpha 2-adrenergic agonists, such as clonidine and guanabenz, act to block noradrenergic activity in the locus coeruleus and therefore block the negative reinforcement of opioid withdrawal. Naltrexone, on the other hand, works by preventing the positive reinforcement of administered opioids by preventing them from binding to the opioid receptor. In the case of cocaine addiction, most of the adjuncts currently in use focus on decreasing the severity of the immediate withdrawal symptoms. These agents potentiate dopaminergic transmission and in so doing tend to counter the dopamine depletion effect of prolonged cocaine use. Bromocriptine is the best known and probably the most effective member of this class. It may be that neuroleptics or naltrexone will prove to decrease reinforcement of cocaine use. However, the hazards of long-term neuroleptic use make it unlikely that they will be widely used for this purpose. Desipramine and perhaps other antidepressants may have a special role in treating cocaine addiction: They may prove to have some long-term prophylactic value and prevent relapse in recovering addicts. This ability may stem from the antidepressant action or it may involve a more specific action on dopaminergic transmission. These pharmacological agents may be very effective for certain purposes, such as relieving withdrawal symptoms. However, since they only act on one part of the addiction cycle, they can never be considered complete treatment by themselves. Of course, the use of all of these agents requires the voluntary cooperation of the patient. Therefore, the basis of the treatment of addictive illness continues to be the peer group and other types of interpersonal interactions. However, these pharmacological adjuncts may serve to make treatment easier, shorter and less expensive, and they may improve overall success rates. Consequently, they are of great value in the present and they can serve as models for the development of more effective agents in the future.