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Campanale A, Inserra A, Comai S. Therapeutic modulation of the kynurenine pathway in severe mental illness and comorbidities: A potential role for serotonergic psychedelics. Prog Neuropsychopharmacol Biol Psychiatry 2024; 134:111058. [PMID: 38885875 DOI: 10.1016/j.pnpbp.2024.111058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 05/15/2024] [Accepted: 06/14/2024] [Indexed: 06/20/2024]
Abstract
Mounting evidence points towards a crucial role of the kynurenine pathway (KP) in the altered gut-brain axis (GBA) balance in severe mental illness (SMI, namely depression, bipolar disorder, and schizophrenia) and cardiometabolic comorbidities. Preliminary evidence shows that serotonergic psychedelics and their analogues may hold therapeutic potential in addressing the altered KP in the dysregulated GBA in SMI and comorbidities. In fact, aside from their effects on mood, psychedelics elicit therapeutic improvement in preclinical models of obesity, metabolic syndrome, and vascular inflammation, which are highly comorbid with SMI. Here, we review the literature on the therapeutic modulation of the KP in the dysregulated GBA in SMI and comorbidities, and the potential application of psychedelics to address the altered KP in the brain and systemic dysfunction underlying SMI and comorbidities. Psychedelics might therapeutically modulate the KP in the altered GBA in SMI and comorbidities either directly, via altering the metabolic pathway by influencing the rate-limiting enzymes of the KP and affecting the levels of available tryptophan, or indirectly, by affecting the gut microbiome, gut metabolome, metabolism, and the immune system. Despite promising preliminary evidence, the mechanisms and outcomes of the KP modulation with psychedelics in SMI and systemic comorbidities remain largely unknown and require further investigation. Several concerns are discussed surrounding the potential side effects of this approach in specific cohorts of individuals with SMI and systemic comorbidities.
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Affiliation(s)
| | - Antonio Inserra
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Stefano Comai
- Department of Psychiatry, McGill University, Montreal, QC, Canada; Department of Pharmaceutical and Pharmacological Sciences, University of Padova, PD, Italy.; IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Biomedical Sciences, University of Padua, Padua, Italy.
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Could psychedelic drugs have a role in the treatment of schizophrenia? Rationale and strategy for safe implementation. Mol Psychiatry 2023; 28:44-58. [PMID: 36280752 DOI: 10.1038/s41380-022-01832-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 10/02/2022] [Accepted: 10/07/2022] [Indexed: 01/07/2023]
Abstract
Schizophrenia is a widespread psychiatric disorder that affects 0.5-1.0% of the world's population and induces significant, long-term disability that exacts high personal and societal cost. Negative symptoms, which respond poorly to available antipsychotic drugs, are the primary cause of this disability. Association of negative symptoms with cortical atrophy and cell loss is widely reported. Psychedelic drugs are undergoing a significant renaissance in psychiatric disorders with efficacy reported in several conditions including depression, in individuals facing terminal cancer, posttraumatic stress disorder, and addiction. There is considerable evidence from preclinical studies and some support from human studies that psychedelics enhance neuroplasticity. In this Perspective, we consider the possibility that psychedelic drugs could have a role in treating cortical atrophy and cell loss in schizophrenia, and ameliorating the negative symptoms associated with these pathological manifestations. The foremost concern in treating schizophrenia patients with psychedelic drugs is induction or exacerbation of psychosis. We consider several strategies that could be implemented to mitigate the danger of psychotogenic effects and allow treatment of schizophrenia patients with psychedelics to be implemented. These include use of non-hallucinogenic derivatives, which are currently the focus of intense study, implementation of sub-psychedelic or microdosing, harnessing of entourage effects in extracts of psychedelic mushrooms, and blocking 5-HT2A receptor-mediated hallucinogenic effects. Preclinical studies that employ appropriate animal models are a prerequisite and clinical studies will need to be carefully designed on the basis of preclinical and translational data. Careful research in this area could significantly impact the treatment of one of the most severe and socially debilitating psychiatric disorders and open an exciting new frontier in psychopharmacology.
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Fadahunsi N, Lund J, Breum AW, Mathiesen CV, Larsen IB, Knudsen GM, Klein AB, Clemmensen C. Acute and long-term effects of psilocybin on energy balance and feeding behavior in mice. Transl Psychiatry 2022; 12:330. [PMID: 35953488 PMCID: PMC9372155 DOI: 10.1038/s41398-022-02103-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 07/21/2022] [Accepted: 07/29/2022] [Indexed: 12/13/2022] Open
Abstract
Psilocybin and other serotonergic psychedelics have re-emerged as therapeutics for neuropsychiatric disorders, including addiction. Psilocybin induces long-lasting effects on behavior, likely due to its profound ability to alter consciousness and augment neural connectivity and plasticity. Impaired synaptic plasticity in obesity contributes to 'addictive-like' behaviors, including heightened motivation for palatable food, and excessive food seeking and consumption. Here, we evaluate the effects of psilocybin on feeding behavior, energy metabolism, and as a weight-lowering agent in mice. We demonstrate that a single dose of psilocybin substantially alters the prefrontal cortex transcriptome but has no acute or long-lasting effects on food intake or body weight in diet-induced obese mice or in genetic mouse models of obesity. Similarly, sub-chronic microdosing of psilocybin has no metabolic effects in obese mice and psilocybin does not augment glucagon-like peptide-1 (GLP-1) induced weight loss or enhance diet-induced weight loss. A single high dose of psilocybin reduces sucrose preference but fails to counter binge-like eating behavior. Although these preclinical data discourage clinical investigation, there may be nuances in the mode of action of psychedelic drugs that are difficult to capture in rodent models, and thus require human evaluation to uncover.
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Affiliation(s)
- Nicole Fadahunsi
- grid.5254.60000 0001 0674 042XNovo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jens Lund
- grid.5254.60000 0001 0674 042XNovo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Alberte Wollesen Breum
- grid.5254.60000 0001 0674 042XNovo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Cecilie Vad Mathiesen
- grid.5254.60000 0001 0674 042XNovo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Isabella Beck Larsen
- grid.5254.60000 0001 0674 042XNovo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Gitte Moos Knudsen
- grid.4973.90000 0004 0646 7373Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XFaculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anders Bue Klein
- grid.5254.60000 0001 0674 042XNovo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christoffer Clemmensen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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Flanagan TW, Sebastian MN, Battaglia DM, Foster TP, Maillet EL, Nichols CD. Activation of 5-HT 2 Receptors Reduces Inflammation in Vascular Tissue and Cholesterol Levels in High-Fat Diet-Fed Apolipoprotein E Knockout Mice. Sci Rep 2019; 9:13444. [PMID: 31530895 PMCID: PMC6748996 DOI: 10.1038/s41598-019-49987-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 08/25/2019] [Indexed: 01/14/2023] Open
Abstract
Coronary artery disease (CAD) is a progressive cardiovascular syndrome characterized by cholesterol-induced focal arterial lesions that impair oxygen delivery to the heart. As both innate and adaptive immune cells play critical roles in the formation and progression of arterial plaques and endothelial cell dysfunction, CAD is commonly viewed as a chronic inflammatory disorder. Our lab has previously discovered that 5-HT2A receptor activation with the 5-HT2 receptor selective agonist (R)-2,5-dimethoxy-4-iodoamphetamine [(R)-DOI] has potent anti-inflammatory activity in both cell culture and whole animal models. Here we have examined the putative therapeutic effects of (R)-DOI in the ApoE−/− high fat model of cardiovascular disease. Subcutaneously implanted osmotic minipumps were used to infuse sustained low rates (0.15 μg / hr) of (R)-DOI∙HCl to mice fed a high-fat “Western” diet. (R)-DOI treated mice had significant reductions in expression levels of mRNA for inflammatory markers like Il6 in vascular tissue, normalized glucose homeostasis, and reduced circulating cholesterol levels. As cardiovascular disease is a leading cause of death both globally and in the Western world, activation of 5-HT2A receptors at sub-behavioral levels may represent a new strategy to treat inflammation-based cardiovascular disease.
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Affiliation(s)
- Thomas W Flanagan
- Department of Pharmacology and Experimental Therapeutics Louisiana State University Health Sciences Center 1901 Perdido St, New Orleans, LA, 70112, USA
| | - Melaine N Sebastian
- Department of Pharmacology and Experimental Therapeutics Louisiana State University Health Sciences Center 1901 Perdido St, New Orleans, LA, 70112, USA
| | - Diana M Battaglia
- Department of Microbiology, Immunology, and Parasitology Louisiana State University Health Sciences Center 1901 Perdido St, New Orleans, LA, 70112, USA
| | - Timothy P Foster
- Department of Microbiology, Immunology, and Parasitology Louisiana State University Health Sciences Center 1901 Perdido St, New Orleans, LA, 70112, USA
| | - Emeline L Maillet
- Eleusis Benefit Corporation 11 East 44th St., Suite 104, New York, NY, 10017, USA
| | - Charles D Nichols
- Department of Pharmacology and Experimental Therapeutics Louisiana State University Health Sciences Center 1901 Perdido St, New Orleans, LA, 70112, USA.
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Abstract
Over the past decade, a variety of serotonin (5-hydroxytryptamine, 5-HT) receptor/binding sites have been identified. These include 5-HT1, 5-HT2, and 5-HT3 sites. The 5-HT1 sites have been further divided into 5-HT1A, 5-HT1B, 5-HT1C, 5-HT1D and 5-HT1E sites. It would be of interest to identify those pharmacological effects that are specifically mediated by a particular population of 5-HT sites and, indeed, attempts have been made to do this almost since the initial discovery of multiple populations of sites. Unfortunately, much of the early work made use of serotonergic agents that are now known to be somewhat less selective than originally suspected. Nevertheless, there is ample information in the literature suggesting that site-selective serotonergic agents may ultimately lead (and, in some cases, has already led) to the development of therapeutically-useful agents. The present review examines the pharmacological effects that are thought to be related to the individual types of 5-HT sites and provides some clinical implications for agents that act at these sites.
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Affiliation(s)
- R A Glennon
- Department of Medicinal Chemistry, School of Pharmacy Medical College of Virginia, Virginia Commonwealth University, Richmond 23298-0581
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Arvidsson LE, Hacksell U, Glennon RA. Recent advances in central 5-hydroxytryptamine receptor agonists and antagonists. PROGRESS IN DRUG RESEARCH. FORTSCHRITTE DER ARZNEIMITTELFORSCHUNG. PROGRES DES RECHERCHES PHARMACEUTIQUES 1986; 30:365-471. [PMID: 3544048 DOI: 10.1007/978-3-0348-9311-4_11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Abstract
The Drug Enforcement Administration classified the drug methylenedioxymethamphetamine, MDMA, also known as Ecstacy, as a Schedule I controlled substance on July 1, 1985. The controversy surrounding the classification of MDMA is related to the question of its efficacy as an adjunct to psychotherapy and the larger issue of how to regulate the production and use of designer drugs. The authors review the literature on MDMA and its predecessor, MDA, a substance that differs from MDMA by one methyl group.
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Abstract
The acute actions of five prototype hallucinogens administered SC on food consumption in 23 hr food deprived dogs were compared with the anorexic effect of d-amphetamine and the hyperphagic effect of sodium pentobarbital. Comparisons were made on the basis of dose-response relationships. Among the hallucinogens decreasing food intake, both LSD and atropine produced substantial anorexia, but the slopes of their dose-response curves were clearly different from d-amphetamine. Phencyclidine and the opioid SKF 10,047 suppressed food intake also; their individual dose-effect curves were parallel to the amphetamine curve, although both were less potent. Of the hallucinogens tested, only delta-9-tetrahydrocannabinol (delta 9-THC) stimulated food consumption, and though it was less potent, it resembled pentobarbital both qualitatively and by having a parallel dose-response curve. The appetitive responses are discussed in relation to other pharmacologic actions of these hallucinogens in the dog, and consideration is given to the possible modes of action for phencyclidine- and SKF 10,047-induced anorexia.
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