Dopamine partial agonists and prodopaminergic drugs for schizophrenia: systematic review and meta-analysis of randomized controlled trials

Designing drugs and chemical probes with the dualsteric approach

Traditionally, drugs are monovalent, targeting only one site on the protein surface. This includes orthosteric and allosteric drugs, which bind the protein at orthosteric and allosteric sites, respectively. Orthosteric drugs are good in potency, whereas allosteric drugs have better selectivity and are solutions to classically undruggable targets. However, it would be difficult to simultaneously reach high potency and selectivity when targeting only one site. Also, both kinds of monovalent drugs suffer from mutation-caused drug resistance. To overcome these obstacles, dualsteric modulators have been proposed in the past twenty years. Compared to orthosteric or allosteric drugs, dualsteric modulators are bivalent (or bitopic) with two pharmacophores. Each of the two pharmacophores bind the protein at the orthosteric and an allosteric site, which could bring the modulator with special properties beyond monovalent drugs. In this study, we comprehensively review the current development of dualsteric modulators. Our main effort reason and illustrate the aims to apply the dualsteric approach, including a "double win" of potency and selectivity, overcoming mutation-caused drug resistance, developments of function-biased modulators, and design of partial agonists. Moreover, the strengths of the dualsteric technique also led to its application outside pharmacy, including the design of highly sensitive fluorescent tracers and usage as molecular rulers. Besides, we also introduced drug targets, designing strategies, and validation methods of dualsteric modulators. Finally, we detail the conclusions and perspectives.

Turning the Spotlight on Apathy: Identification and Treatment in Schizophrenia Spectrum Disorders

Among negative symptoms, apathy is central to the impairments in real-life functioning in schizophrenia spectrum disorders (SSD). Thus, optimizing treatment for apathy appears key to improve outcomes. In treatment research, however, negative symptoms are typically studied as a unifactorial construct. We, therefore, aim to shed necessary light on the status of apathy identification and treatment in SSD.

Efficacy of Serotonin and Dopamine Activity Modulators in the Treatment of Negative Symptoms in Schizophrenia: A Rapid Review

Schizophrenia is among the fifteen most disabling diseases worldwide. Negative symptoms (NS) are highly prevalent in schizophrenia, negatively affect the functional outcome of the disorder, and their treatment is difficult and rarely specifically investigated. Serotonin-dopamine activity modulators (SDAMs), of which aripiprazole, cariprazine, brexpiprazole, and lumateperone were approved for schizophrenia treatment, represent a possible therapy to reduce NS. The aim of this rapid review is to summarize the evidence on this topic to make it readily available for psychiatrists treating NS and for further research. We searched the PubMed database for original studies using SDAM, aripiprazole, cariprazine, brexpiprazole, lumateperone, schizophrenia, and NS as keywords. We included four mega-analyses, eight meta-analyses, two post hoc analyses, and 20 clinical trials. Aripiprazole, cariprazine, and brexpiprazole were more effective than placebo in reducing NS. Only six studies compared SDAMs with other classes of antipsychotics, demonstrating a superiority in the treatment of NS mainly for cariprazine. The lack of specific research and various methodological issues, related to the study population and the assessment of NS, may have led to these partial results. Here, we highlight the need to conduct new methodologically robust investigations with head-to-head treatment comparisons and long-term observational studies on homogeneous groups of patients evaluating persistent NS with first- and second-generation scales, namely the Brief Negative Symptom Scale and the Clinical Assessment Interview for Negative Symptoms. This rapid review can expand research on NS therapeutic strategies in schizophrenia, which is fundamental for the long-term improvement of patients’ quality of life.

Adequate diagnosis of the cause of Parkinsonism and treatment in an elderly patient with schizophrenia: A case report

Background

Parkinsonism is frequently observed in patients with schizophrenia, and most patients are diagnosed with drug-induced parkinsonism. However, comorbidity with idiopathic Parkinson's disease or Parkinson-plus syndrome is also possible. The pathophysiology and treatment for each of these are entirely different, thus an appropriate diagnosis is required. However, distinguishing them based on clinical symptoms alone is often difficult, and many cases are misdiagnosed. Additionally, Parkinsonism is frequently mistaken for negative symptoms.

Case Description

We report a case of 68-year-old woman diagnosed with schizophrenia, who was admitted to a welfare center. At approximately age 60, the patient experienced motivation reduction, a loss of appetite, and pain in the extremities. In her mid-60s, tremor and muscle rigidity appeared; nuclear medicine testing was performed for a detailed examination, resulting in a diagnosis of levodopa-responsive Parkinson's syndrome. Notably, the patient's parkinsonism and emotional symptoms, which had been considered negative symptoms thus far, improved with levodopa treatment.

Conclusion

This case report illustrates the importance of properly diagnosing the cause of parkinsonism in patients with schizophrenia.

Enhanced Bioactive Properties of Halloysite Nanotubes via Polydopamine Coating

Halloysite nanotubes (HNT) were coated five times with dopamine (DOPA) in a tris buffer medium at pH 8.5 to acquire polydopamine-coated HNTs (PDOPA@HNT), e.g., PDOPA1@HNT, PDOPA3@HNT, and PDOPA5@HNT. Upon coating HNT with PDOPA, the surface area, pore volume, and pore size were decreased depending on the number of coatings. While the surface area of HNT was 57.9 m²/g, by increasing the number of coatings from 1 to 5, it was measured as 55.9, 53.4, 53.3, 47.4, and 46.4 m²/g, respectively. The isoelectric point (IEP) for HNTs was determined as 4.68, whereas these values are estimated as 2.31 for PDOPA1@HNTs, 3.49 for PDOPA3@HNT, and 3.55 for PDOPA5@HNT. Three different antioxidant studies were conducted for HNT and PDOPA@HNT, and the total phenol (TPC) value of HNT was found to be 150.5 ± 45.9 µmol gallic acid (GA) equivalent. The TPC values for PDOPA1@HNT, PDOPA3@HNT and PDOPA5@HNT coatings were found to be 405.5 ± 25.0, 750.0 ± 69.9, and 1348.3 ± 371.7 µmol GA equivalents, respectively. The Fe(II) chelation capacity of HNT was found to be 20.5% ± 1.2%, while the PDOPA1@HNT, PDOPA3@HNT and PDOPA5@HNT values were found to be 49.9 ± 6.5, 36.6 ± 12.7 and 25.4 ± 1.2%, respectively. HNT and PDOPA@HNTs inhibited the α-glucosidase (AG) enzyme to greater extents than acetylcholinesterase (AChE). As a result, the DOPA modification of HNTs was rendered to provide additional characteristics, e.g., antioxidant properties and higher AChE and AG enzymes inhibition capabilities. Therefore, PDOPA@HNTs have great potential as biomaterials.

Is modafinil an effective adjunct to standard care in the treatment of schizophrenia-spectrum disorders?

Antipsychotics are the cornerstone of schizophrenia management but they are not adequate in treating the negative and cognitive symptoms of the illness. The Cochrane review discussed in this commentary examines the safety and effectiveness of the wakefulness-promoting agent, modafinil, as an adjunct to standard care in the mitigation of negative and cognitive symptoms of schizophrenia. Add-on modafinil, compared to add-on placebo and standard treatment, did not result in a clear benefit. Due to the heterogenous body of evidence, the quality of which ranged from very low to moderate, the review's conclusions are equivocal.

Schizophrenia: A Narrative Review of Etiopathogenetic, Diagnostic and Treatment Aspects

Although schizophrenia is currently conceptualized as being characterized as a syndrome that includes a collection of signs and symptoms, there is strong evidence of heterogeneous and complex underpinned etiological, etiopathogenetic, and psychopathological mechanisms, which are still under investigation. Therefore, the present viewpoint review is aimed at providing some insights into the recently investigated schizophrenia research fields in order to discuss the potential future research directions in schizophrenia research. The traditional schizophrenia construct and diagnosis were progressively revised and revisited, based on the recently emerging neurobiological, genetic, and epidemiological research. Moreover, innovative diagnostic and therapeutic approaches are pointed to build a new construct, allowing the development of better clinical and treatment outcomes and characterization for schizophrenic individuals, considering a more patient-centered, personalized, and tailored-based dimensional approach. Further translational studies are needed in order to integrate neurobiological, genetic, and environmental studies into clinical practice and to help clinicians and researchers to understand how to redesign a new schizophrenia construct.