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Domi E, Barbier E, Augier E, Augier G, Gehlert D, Barchiesi R, Thorsell A, Holm L, Heilig M. Preclinical evaluation of the kappa-opioid receptor antagonist CERC-501 as a candidate therapeutic for alcohol use disorders. Neuropsychopharmacology 2018; 43:1805-1812. [PMID: 29463912 PMCID: PMC6046052 DOI: 10.1038/s41386-018-0015-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 12/22/2017] [Accepted: 01/09/2018] [Indexed: 12/12/2022]
Abstract
Prior work suggests a role of kappa-opioid signaling in the control of alcohol drinking, in particular when drinking is escalated due to alcohol-induced long-term neuroadaptations. Here, we examined the small molecule selective kappa antagonist CERC-501 in rat models of alcohol-related behaviors, with the objective to evaluate its potential as a candidate therapeutic for alcohol use disorders. We first tested the effect of CERC-501 on acute alcohol withdrawal-induced anxiety-like behavior. CERC-501 was then tested on basal as well as escalated alcohol self-administration induced by 20% alcohol intermittent access. Finally, we determined the effects of CERC-501 on relapse to alcohol seeking triggered by both stress and alcohol-associated cues. Control experiments were performed to confirm the specificity of CERC-501 effects on alcohol-related behaviors. CERC-501 reversed anxiety-like behavior induced by alcohol withdrawal. It did not affect basal alcohol self-administration but did dose-dependently suppress self-administration that had escalated following long-term intermittent access to alcohol. CERC-501 blocked relapse to alcohol seeking induced by stress, but not when relapse-like behavior was triggered by alcohol-associated cues. The effects of CERC-501 were observed in the absence of sedative side effects and were not due to effects on alcohol metabolism. Thus, in a broad battery of preclinical alcohol models, CERC-501 has an activity profile characteristic of anti-stress compounds. Combined with its demonstrated preclinical and clinical safety profile, these data support clinical development of CERC-501 for alcohol use disorders, in particular for patients with negatively reinforced, stress-driven alcohol seeking and use.
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Affiliation(s)
- E Domi
- 0000 0001 2162 9922grid.5640.7Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience, Linköping University, Linköping, Sweden
| | - E Barbier
- 0000 0001 2162 9922grid.5640.7Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience, Linköping University, Linköping, Sweden
| | - E Augier
- 0000 0001 2162 9922grid.5640.7Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience, Linköping University, Linköping, Sweden
| | - G Augier
- 0000 0001 2162 9922grid.5640.7Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience, Linköping University, Linköping, Sweden
| | - D Gehlert
- grid.504315.6Cerecor, Baltimore, MD (DG) and Matrix Pharmaceutical Consulting, Boulder, CO, United States
| | - R Barchiesi
- 0000 0001 2162 9922grid.5640.7Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience, Linköping University, Linköping, Sweden
| | - A Thorsell
- 0000 0001 2162 9922grid.5640.7Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience, Linköping University, Linköping, Sweden
| | - L Holm
- 0000 0001 2162 9922grid.5640.7Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience, Linköping University, Linköping, Sweden
| | - M Heilig
- Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience, Linköping University, Linköping, Sweden.
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Brousse G, Arnaud B, Vorspan F, Richard D, Dissard A, Dubois M, Pic D, Geneste J, Xavier L, Authier N, Sapin V, Llorca PM, De Chazeron I, Minet-Quinard R, Schmidt J. Alteration of glutamate/GABA balance during acute alcohol withdrawal in emergency department: a prospective analysis. Alcohol Alcohol 2012; 47:501-8. [PMID: 22791370 DOI: 10.1093/alcalc/ags078] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
AIMS Animal studies suggest that in alcohol withdrawal the balance of neurotransmitters gamma aminobutyric acid (GABA) and glutamate is altered. To test this in humans, we aimed to measure plasma levels of glutamate, GABA and glutamate/GABA ratio in alcoholic patients presenting with complicated AWS with the same values in non-alcohol abuser/dependent controls and to determine prognostic factors for severe withdrawal. METHODS 88 patients admitted to the emergency room for acute alcohol intoxication (DSM-IV) were prospectively included. Measurements of GABA and glutamate were performed on admission (Time 1, T1) and after 12 ± 2 h (T2). The experimental group (EG) was composed of 23 patients who presented at T2 with a severe AWS. The control group (CG) consisted of healthy subjects paired with the EG (gender and age). Logistic regression was performed in order to compare associated clinical and biological variables that could predict severe withdrawal. RESULTS The concentration of GABA in the EG at T1 was significantly lower than that in the CG. The concentration of glutamate in the EG at T1 was significantly higher than that in the CG. The glutamate/GABA ratio in the EG at T1 was significantly higher than the ratio in the CG. With a multivariate logistic regression model, glutamate level at admission remained the only criterion identified as a predictor of AWS at 12 h. CONCLUSION Decreased synthesis of GABA and increased synthesis of glutamate might be related to withdrawal symptoms experienced on brutal cessation of chronic alcohol intake.
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Affiliation(s)
- G Brousse
- CHU Clermont Ferrand, Urgences Adultes, 28 Place Henri Dunant BP 69, 63003 Clermont-Ferrand Cedex 01, France.
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Heese P, Linnebank M, Semmler A, Muschler MA, Heberlein A, Frieling H, Stoffel-Wagner B, Kornhuber J, Banger M, Bleich S, Hillemacher T. Alterations of Homocysteine Serum Levels during Alcohol Withdrawal Are Influenced by Folate and Riboflavin: Results from the German Investigation on Neurobiology in Alcoholism (GINA). Alcohol Alcohol 2012; 47:497-500. [DOI: 10.1093/alcalc/ags058] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Hillemacher T, Frieling H, Wilhelm J, Heberlein A, Karagülle D, Bleich S, Lenz B, Kornhuber J. Indicators for elevated risk factors for alcohol-withdrawal seizures: an analysis using a random forest algorithm. J Neural Transm (Vienna) 2012; 119:1449-53. [PMID: 22622368 DOI: 10.1007/s00702-012-0825-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 05/03/2012] [Indexed: 12/20/2022]
Abstract
Alcohol-withdrawal seizures (AWS) are an important and relevant complication during detoxification in alcohol-dependent patients. Therefore, it is important to evaluate the individual risk for AWS. We apply a random forest algorithm to assess possible predictive markers in a large sample of 200 alcohol-dependent patients undergoing alcohol withdrawal. This analysis showed that the combination of homocysteine, prolactin, blood alcohol concentration on admission, number of preceding withdrawals, age and the number of cigarettes smoked may successfully predict AWS. In conclusion, the results of this analysis allow for origination of further research, which should include additional biological and psychosocial parameters as well as consumption behaviour.
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Affiliation(s)
- Thomas Hillemacher
- Center for Addiction Research-CARe, Department for Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
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Karagülle D, Heberlein A, Wilhelm J, Frieling H, Kornhuber J, Bleich S, Hillemacher T. Biological markers for alcohol withdrawal seizures: a retrospective analysis. Eur Addict Res 2012; 18:97-102. [PMID: 22286945 DOI: 10.1159/000335273] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Accepted: 11/21/2011] [Indexed: 11/19/2022]
Abstract
AIMS Alcohol withdrawal seizures (AWS) are among the most important possible complications during the detoxification treatment of alcohol-dependent patients. Pharmacological therapy is often used during detoxification, but can cause dangerous side effects [Eur Addict Res 2010;16:179-184]. In separate studies several biological markers have been described as being associated with AWS risk. We investigated the role of homocysteine (HCT), carbohydrate-deficient transferrin (CDT) and prolactin (PRL) as biological markers for the risk of developing AWS. METHODS The present study included 189 alcohol-dependent patients of whom 51 had a history of AWS. We investigated the HCT, CDT and PRL levels of all patients and calculated sensitivity and specificity. Bayes' theorem was used to calculate positive (PPV) and negative (NPV) predictive values. RESULTS The highest combined sensitivity and specificity for %CDT was reached at a plasma cutoff value of 3.75%. The combination of HCT at a cutoff value of 23.9 μmol/l and %CDT at a cutoff value of 3.75% showed the best predictive values (sensitivity 47.1%, specificity 88.4%, PPV 0.504, NPV 0.870). CONCLUSION A combined assessment of HCT and CDT levels can be a useful method to identify patients at a higher risk of AWS, which may lead to a more individualized therapy.
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Affiliation(s)
- Deniz Karagülle
- Department of Psychiatry, Hannover Medical School, Hannover, Germany. karaguelle.deniz @ mh-hannover.de
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Scher AI, Wu H, Tsao JW, Blom HJ, Feit P, Nevin RL, Schwab KA. MTHFR C677T Genotype As a Risk Factor for Epilepsy Including Post-Traumatic Epilepsy in a Representative Military Cohort. J Neurotrauma 2011; 28:1739-45. [DOI: 10.1089/neu.2011.1982] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ann I. Scher
- Department of Preventive Medicine and Biometrics, Uniformed Services University, Bethesda, Maryland
| | - Holly Wu
- Department of Preventive Medicine and Biometrics, Uniformed Services University, Bethesda, Maryland
| | - Jack W. Tsao
- Department of Neurology, Uniformed Services University, Bethesda, Maryland
| | - Henk J. Blom
- Metabolic Unit, Department of Clinical Chemistry, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Preethy Feit
- Department of Preventive Medicine and Biometrics, Uniformed Services University, Bethesda, Maryland
| | - Remington L. Nevin
- Bayne-Jones Army Community Hospital, Department of Preventive Medicine, Fort Polk, Louisiana
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Wilhelm J, Heberlein A, Karagülle D, Gröschl M, Kornhuber J, Riera R, Frieling H, Bleich S, Hillemacher T. Prolactin Serum Levels During Alcohol Withdrawal Are Associated With the Severity of Alcohol Dependence and Withdrawal Symptoms. Alcohol Clin Exp Res 2010; 35:235-9. [DOI: 10.1111/j.1530-0277.2010.01339.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Acute benzodiazepine administration induces changes in homocysteine metabolism in young healthy volunteers. Prog Neuropsychopharmacol Biol Psychiatry 2009; 33:933-8. [PMID: 19409441 DOI: 10.1016/j.pnpbp.2009.04.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2009] [Revised: 04/16/2009] [Accepted: 04/24/2009] [Indexed: 11/20/2022]
Abstract
PURPOSE High cortisol plasma concentrations have been shown to be associated with increases in homocysteine levels. Here we studied whether decreases in cortisol concentration, induced by an acute oral dose of a benzodiazepine, could decrease homocysteine, and if changes were similar in both genders. METHODS This was a double-blind, cross-over design study of acute oral flunitrazepam (1.2 mg) and placebo in young, healthy, male and female (n=21) volunteers. Blood samples were collected 3 h after ingestion (after peak-plasma concentration of flunitrazepam was reached). Various biochemical parameters were analysed, such as plasma homocysteine, cysteine, folate, vitamins B6, B12, and sexual hormones. RESULTS Flunitrazepam reduced cortisol (p=0.0011), cysteine (p=0.014) and homocysteine (p=0.028) concentrations, irrespective of gender. No correlations were found between cortisol and other biochemical markers (all r's<0.03). Concentration of cysteine and homocysteine were negatively correlated with plasma flunitrazepam concentration, suggesting that changes in these amino acids might be related to the metabolism of this benzodiazepine. CONCLUSION Acute administration of flunitrazepam decreases plasma homocysteine and cysteine by mechanisms that seem unrelated to changes in cortisol. Given the importance of homocysteine as a marker of life-threatening disorders, the mechanisms involved in the decrease of these amino acids are potential targets for clinical application.
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Hughes JR. Alcohol withdrawal seizures. Epilepsy Behav 2009; 15:92-7. [PMID: 19249388 DOI: 10.1016/j.yebeh.2009.02.037] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2008] [Revised: 02/17/2009] [Accepted: 02/20/2009] [Indexed: 11/30/2022]
Abstract
The topic of alcohol withdrawal syndrome (AWS), including delirium tremens and especially seizures, is reviewed. From mice and rat studies, it is known that both N-methyl-d-aspartate (NMDA) and gamma-aminobutyric acid (GABA) receptors are involved in AWS. During alcohol intoxication chronic adaptations of NMDA and GABA receptors occur, and during alcohol withdrawal a hyperexcitable state develops. In studies on humans, during intoxication the NMDA receptors are activated and mediate tonic inhibition. In withdrawal, a rebound activation of these receptors occurs. Both GABA-A and GABA-B receptors, especially the alpha2 subunit of GABA-A receptors, are also likely involved. Homocysteine increases with active drinking, and in withdrawal, excitotoxicity likely is induced by a further increase in homocysteine, viewed as a risk factor for AWS and also as a screening tool. The dopamine transporter gene is also associated with AWS. Characteristics involves changes in the ECG, especially an increase in QT interval, and EEG changes, including abnormal quantified EEG, at times periodic lateralized epileptiform discharges, and especially seizures, usually occurring 6-48h after the cessation of drinking. Therapy has emphasized benzodiazepines, mainly diazepam and lorazepam, but more standard antiepileptic drugs, like carbamazepine and topiramate, are also effective and safe.
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Affiliation(s)
- John R Hughes
- Department of Neurology, University of Illinois Medical Center, M/C 796, 912 South Wood Street, Chicago, IL 60612, USA.
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Hillemacher T, Kraus T, Rauh J, Weiss J, Schanze A, Frieling H, Wilhelm J, Heberlein A, Gröschl M, Sperling W, Kornhuber J, Bleich S. Role of Appetite-Regulating Peptides in Alcohol Craving: An Analysis in Respect to Subtypes and Different Consumption Patterns in Alcoholism. Alcohol Clin Exp Res 2007; 31:950-4. [PMID: 17433008 DOI: 10.1111/j.1530-0277.2007.00388.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND A role of appetite-regulating peptides like leptin and ghrelin in the neurobiology of alcohol craving has been proposed by several studies. Aim of this analysis was to search for differences regarding an association between these peptides and alcohol craving with respect to different subtypes and beverage consumption patterns in patients with alcohol dependence. METHODS We analyzed a sample of 188 patients at admission for alcohol detoxification regarding leptin and ghrelin (n=117) serum levels. Craving was measured using the Obsessive Compulsive Drinking Scale (OCDS). Patients were classified according to Lesch's typology of alcohol dependence and according to their preferred type of alcoholic beverage (beer, wine, spirits). RESULTS Using general linear models to analyze a possible interaction between subtypes and leptin/ghrelin levels with respect to craving, we found a significant positive association for leptin in patients of Lesch's types 1 and 2, and in patients consuming beer or wine. Ghrelin levels showed a significant trend regarding an association with craving in patients of Lesch's type 1. In the other subgroups we found no significant results. CONCLUSIONS Our findings show that appetite-regulating peptides may be of special importance regarding alcohol craving in subtypes of patients. This may explicate at least in part previous contradictory findings.
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Affiliation(s)
- Thomas Hillemacher
- Department of Psychiatry and Psychotherapy, University Hospital Erlangen, Erlangen, Germany.
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