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Galbo-Thomma LK, Epperly PM, Blough BE, Landavazo A, Saldaña SJ, Carroll FI, Czoty PW. Cognitive-Enhancing Effects of Acetylcholine Receptor Agonists in Group-Housed Cynomolgus Monkeys Who Drink Ethanol. J Pharmacol Exp Ther 2024; 389:258-267. [PMID: 38135508 PMCID: PMC11125785 DOI: 10.1124/jpet.123.001854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/20/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023] Open
Abstract
The cognitive impairments that are often observed in patients with alcohol use disorder (AUD) partially contribute to the extremely low rates of treatment initiation and adherence. Brain acetylcholine receptors (AChR) mediate and modulate cognitive and reward-related behavior, and their distribution can be altered by long-term heavy drinking. Therefore, AChRs are promising pharmacotherapeutic targets for treating the cognitive symptoms of AUD. In the present study, the procognitive efficacy of two AChR agonists, xanomeline and varenicline, were evaluated in group-housed monkeys who self-administered ethanol for more than 1 year. The muscarinic AChR antagonist scopolamine was used to disrupt performance of a serial stimulus discrimination and reversal (SDR) task designed to probe cognitive flexibility, defined as the ability to modify a previously learned behavior in response to a change in reinforcement contingencies. The ability of xanomeline and varenicline to remediate the disruptive effects of scopolamine was compared between socially dominant and subordinate monkeys, with lighter and heavier drinking histories, respectively. We hypothesized that subordinate monkeys would be more sensitive to all three drugs. Scopolamine dose-dependently impaired performance on the serial SDR task in all monkeys at doses lower than those that produced nonspecific impairments (e.g., sedation); its potency did not differ between dominant and subordinate monkeys. However, both AChR agonists were effective in remediating the scopolamine-induced deficit in subordinate monkeys but not in dominant monkeys. These findings suggest xanomeline and varenicline may be effective for enhancing cognitive flexibility in individuals with a history of heavy drinking. SIGNIFICANCE STATEMENT: Procognitive effects of two acetylcholine (ACh) receptor agonists were assessed in group-housed monkeys who had several years' experience drinking ethanol. The muscarinic ACh receptor agonist xanomeline and the nicotinic ACh receptor agonist varenicline reversed a cognitive deficit induced by the muscarinic ACh receptor antagonist scopolamine. However, this effect was observed only in lower-ranking (subordinate) monkeys and not higher-ranking (dominant monkeys). Results suggest that ACh agonists may effectively remediate alcohol-induced cognitive deficits in a subpopulation of those with alcohol use disorder.
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Affiliation(s)
- Lindsey K Galbo-Thomma
- Department of Physiology and Pharmacology, Wake Forest University School of Medicine, Winston-Salem, North Carolina (L.K.G.-T., P.M.E., S.J.S., P.W.C.) and Center for Drug Discovery, Research Triangle Institute, Research Triangle Park, North Carolina (B.E.B., A.L., F.I.C.)
| | - Phillip M Epperly
- Department of Physiology and Pharmacology, Wake Forest University School of Medicine, Winston-Salem, North Carolina (L.K.G.-T., P.M.E., S.J.S., P.W.C.) and Center for Drug Discovery, Research Triangle Institute, Research Triangle Park, North Carolina (B.E.B., A.L., F.I.C.)
| | - Bruce E Blough
- Department of Physiology and Pharmacology, Wake Forest University School of Medicine, Winston-Salem, North Carolina (L.K.G.-T., P.M.E., S.J.S., P.W.C.) and Center for Drug Discovery, Research Triangle Institute, Research Triangle Park, North Carolina (B.E.B., A.L., F.I.C.)
| | - Antonio Landavazo
- Department of Physiology and Pharmacology, Wake Forest University School of Medicine, Winston-Salem, North Carolina (L.K.G.-T., P.M.E., S.J.S., P.W.C.) and Center for Drug Discovery, Research Triangle Institute, Research Triangle Park, North Carolina (B.E.B., A.L., F.I.C.)
| | - Santiago J Saldaña
- Department of Physiology and Pharmacology, Wake Forest University School of Medicine, Winston-Salem, North Carolina (L.K.G.-T., P.M.E., S.J.S., P.W.C.) and Center for Drug Discovery, Research Triangle Institute, Research Triangle Park, North Carolina (B.E.B., A.L., F.I.C.)
| | - F Ivy Carroll
- Department of Physiology and Pharmacology, Wake Forest University School of Medicine, Winston-Salem, North Carolina (L.K.G.-T., P.M.E., S.J.S., P.W.C.) and Center for Drug Discovery, Research Triangle Institute, Research Triangle Park, North Carolina (B.E.B., A.L., F.I.C.)
| | - Paul W Czoty
- Department of Physiology and Pharmacology, Wake Forest University School of Medicine, Winston-Salem, North Carolina (L.K.G.-T., P.M.E., S.J.S., P.W.C.) and Center for Drug Discovery, Research Triangle Institute, Research Triangle Park, North Carolina (B.E.B., A.L., F.I.C.)
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Acheson LS, Williams BH, Farrell M, McKetin R, Ezard N, Siefried KJ. Pharmacological treatment for methamphetamine withdrawal: A systematic review and meta-analysis of randomised controlled trials. Drug Alcohol Rev 2023; 42:7-19. [PMID: 35862266 PMCID: PMC10083934 DOI: 10.1111/dar.13511] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/08/2022] [Accepted: 06/21/2022] [Indexed: 01/10/2023]
Abstract
ISSUES Cessation of methamphetamine use may result in a characteristic withdrawal syndrome, no medication has been approved for this indication. This systematic review aims to assess the efficacy of pharmacotherapy for methamphetamine withdrawal, the first comprehensive meta-analysis since 2008. APPROACH MEDLINE (1966-2020), CINAHL (1982-2020), PsychINFO (1806-2020) and EMBASE (1947-2020) were systematically searched. Studies were included if they were randomised controlled trials (RCT) investigating pharmacological treatments for methamphetamine withdrawal, reviewing outcomes of treatment discontinuation, mental health outcomes, withdrawal symptoms (including craving) and patient safety. The relative risk (RR) and weighted mean difference (MD) were used to meta-analyse dichotomous and continuous data respectively, with 95% confidence intervals. Risk of bias and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) assessments were conducted. KEY FINDINGS Nine RCTs of six medications (n = 242 participants) met inclusion criteria, however, only six trials of four medications (n = 186) could be meta-analysed. Mean sample size across studies was 27 participants, and 88% of participants were male. The quality of evidence in this review varies from low to very low on GRADE assessments. Amineptine may reduce discontinuation rates (RR 0.22, 95% confidence interval [CI] 0.07, 0.72, p = 0.01), and improve global state (MD -0.49, 95% CI -0.80, -0.17), compared with placebo, however, this medication is no longer approved. No other medications improved any domain when compared with placebo. Due to lack of reporting safety profiles could not be established. CONCLUSIONS There is insufficient evidence to indicate any medication is effective for the treatment of methamphetamine withdrawal. The poor quality of the evidence indicates a need for better powered, high-quality trials.
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Affiliation(s)
- Liam S Acheson
- The National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia.,Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, Australia.,The National Centre for Clinical Research on Emerging Drugs, c/o UNSW Sydney, Sydney, Australia
| | - Benjamin H Williams
- Department of Psychiatry, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, Australia
| | - Michael Farrell
- The National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Rebecca McKetin
- The National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Nadine Ezard
- The National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia.,Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, Australia.,The National Centre for Clinical Research on Emerging Drugs, c/o UNSW Sydney, Sydney, Australia.,New South Wales Drug and Alcohol Clinical Research and Improvement Network, Sydney, Australia
| | - Krista J Siefried
- The National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia.,Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, Australia.,The National Centre for Clinical Research on Emerging Drugs, c/o UNSW Sydney, Sydney, Australia
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Varenicline and GZ-793A differentially decrease methamphetamine self-administration under a multiple schedule of reinforcement in rats. Behav Pharmacol 2019; 29:87-97. [PMID: 28863003 DOI: 10.1097/fbp.0000000000000340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Methamphetamine is a potent psychostimulant with high abuse rates. Currently, there is no Food and Drug Administration-approved pharmacotherapy for methamphetamine addiction. Ideally, a pharmacotherapy should selectively decrease methamphetamine self-administration without affecting responding for other reinforcers. One way to test this is with the use of a multiple schedule of reinforcement, in which drug and food are available in alternating components within a session. The present study evaluated GZ-793A, a vesicular monoamine transporter-2 inhibitor, and varenicline, a partial agonist at α4β2 and full agonist at α7 nicotinic acetylcholine receptors, for their ability to decrease methamphetamine and food self-administration using a multiple schedule of reinforcement. Male Sprague-Dawley rats self-administered methamphetamine (0.03 mg/kg/intravenous infusion) and food pellets under a multiple schedule of reinforcement. GZ-793A or varenicline was administered before multiple schedule sessions. GZ-793A (5 and 20 mg/kg) significantly decreased methamphetamine intake compared with saline and did not alter food-maintained responding. In contrast, varenicline decreased methamphetamine intake less specifically across time. The results suggest that vesicular monoamine transporter-2 inhibition may be a viable pharmacological target for the treatment of methamphetamine-use disorders.
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Butler K, Le Foll B. Impact of Substance Use Disorder Pharmacotherapy on Executive Function: A Narrative Review. Front Psychiatry 2019; 10:98. [PMID: 30881320 PMCID: PMC6405638 DOI: 10.3389/fpsyt.2019.00098] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 02/11/2019] [Indexed: 12/20/2022] Open
Abstract
Substance use disorders are chronic, relapsing, and harmful conditions characterized by executive dysfunction. While there are currently no approved pharmacotherapy options for stimulant and cannabis use disorders, there are several evidence-based options available to help reduce symptoms during detoxification and aid long-term cessation for those with tobacco, alcohol and opioid use disorders. While these medication options have shown clinical efficacy, less is known regarding their potential to enhance executive function. This narrative review aims to provide a brief overview of research that has investigated whether commonly used pharmacotherapies for these substance use disorders (nicotine, bupropion, varenicline, disulfiram, acamprosate, nalmefene, naltrexone, methadone, buprenorphine, and lofexidine) effect three core executive function components (working memory, inhibitory control and cognitive flexibility). While pharmacotherapy-induced enhancement of executive function may improve cessation outcomes in dependent populations, there are limited and inconsistent findings regarding the effects of these medications on executive function. We discuss possible reasons for the mixed findings and suggest some future avenues of work that may enhance the understanding of addiction pharmacotherapy and cognitive training interventions and lead to improved patient outcomes.
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Affiliation(s)
- Kevin Butler
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Bernard Le Foll
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
- Alcohol Research and Treatment Clinic, Acute Care Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
- Division of Brain and Therapeutics, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
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Designing selective modulators for the nicotinic receptor subtypes: challenges and opportunities. Future Med Chem 2018; 10:433-459. [PMID: 29451400 DOI: 10.4155/fmc-2017-0169] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Nicotinic receptors are membrane proteins involved in several physiological processes. They are considered suitable drug targets for various CNS disorders or conditions, as shown by the large number of compounds which have entered clinical trials. In recent years, nonconventional agonists have been discovered: positive allosteric modulators, allosteric agonists, site-specific agonists and silent desensitizers are compounds able to modulate the receptor interacting at sites different from the orthodox one, or to desensitize the receptor without prior opening. While these new findings can further complicate the pharmacology of these proteins and the design and optimization of ligands, they undoubtedly offer new opportunities to find drugs for the many therapeutic indications involving nicotinic receptors.
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Moszczynska A, Callan SP. Molecular, Behavioral, and Physiological Consequences of Methamphetamine Neurotoxicity: Implications for Treatment. J Pharmacol Exp Ther 2017; 362:474-488. [PMID: 28630283 PMCID: PMC11047030 DOI: 10.1124/jpet.116.238501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 05/09/2017] [Indexed: 04/28/2024] Open
Abstract
Understanding the relationship between the molecular mechanisms underlying neurotoxicity of high-dose methamphetamine (METH) and related clinical manifestations is imperative for providing more effective treatments for human METH users. This article provides an overview of clinical manifestations of METH neurotoxicity to the central nervous system and neurobiology underlying the consequences of administration of neurotoxic METH doses, and discusses implications of METH neurotoxicity for treatment of human abusers of the drug.
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Affiliation(s)
- Anna Moszczynska
- Department of Pharmaceutical Sciences, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan
| | - Sean Patrick Callan
- Department of Pharmaceutical Sciences, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan
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Morley KC, Cornish JL, Faingold A, Wood K, Haber PS. Pharmacotherapeutic agents in the treatment of methamphetamine dependence. Expert Opin Investig Drugs 2017; 26:563-578. [PMID: 28351169 DOI: 10.1080/13543784.2017.1313229] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Methamphetamine use is a serious public health concern in many countries and is second to cannabis as the most widely abused illicit drug in the world. Effective management for methamphetamine dependence remains elusive and the large majority of methamphetamine users relapse following treatment. Areas covered: Progression in the understanding of the pharmacological basis of methamphetamine use has provided us with innovative opportunities to develop agents to treat dependence. The current review summarizes relevant literature on the neurobiological and clinical correlates associated with methamphetamine use. We then outline agents that have been explored for potential treatments in preclinical studies, human laboratory phase I and phase II trials over the last ten years. Expert opinion: No agent has demonstrated a broad and strong effect in achieving MA abstinence in Phase II trials. Agents with novel therapeutic targets appear promising. Advancement in MA treatment, including translation into practice, faces several clinical challenges.
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Affiliation(s)
- Kirsten C Morley
- a NHMRC Centre for Excellence in Mental Health and Substance Use, Discipline of Addiction Medicine , The University of Sydney , Sydney , Australia
| | - Jennifer L Cornish
- b Department of Psychology , Centre for Emotional Health, Macquarie University , Sydney , Australia
| | - Alon Faingold
- c Drug Health Services , Royal Prince Alfred Hospital , Camperdown , Australia
| | - Katie Wood
- a NHMRC Centre for Excellence in Mental Health and Substance Use, Discipline of Addiction Medicine , The University of Sydney , Sydney , Australia
| | - Paul S Haber
- a NHMRC Centre for Excellence in Mental Health and Substance Use, Discipline of Addiction Medicine , The University of Sydney , Sydney , Australia.,c Drug Health Services , Royal Prince Alfred Hospital , Camperdown , Australia
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Vieira-Brock PL, McFadden LM, Nielsen SM, Smith MD, Hanson GR, Fleckenstein AE. Nicotine Administration Attenuates Methamphetamine-Induced Novel Object Recognition Deficits. Int J Neuropsychopharmacol 2015; 18:pyv073. [PMID: 26164716 PMCID: PMC4675982 DOI: 10.1093/ijnp/pyv073] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 06/23/2015] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Previous studies have demonstrated that methamphetamine abuse leads to memory deficits and these are associated with relapse. Furthermore, extensive evidence indicates that nicotine prevents and/or improves memory deficits in different models of cognitive dysfunction and these nicotinic effects might be mediated by hippocampal or cortical nicotinic acetylcholine receptors. The present study investigated whether nicotine attenuates methamphetamine-induced novel object recognition deficits in rats and explored potential underlying mechanisms. METHODS Adolescent or adult male Sprague-Dawley rats received either nicotine water (10-75 μg/mL) or tap water for several weeks. Methamphetamine (4 × 7.5mg/kg/injection) or saline was administered either before or after chronic nicotine exposure. Novel object recognition was evaluated 6 days after methamphetamine or saline. Serotonin transporter function and density and α4β2 nicotinic acetylcholine receptor density were assessed on the following day. RESULTS Chronic nicotine intake via drinking water beginning during either adolescence or adulthood attenuated the novel object recognition deficits caused by a high-dose methamphetamine administration. Similarly, nicotine attenuated methamphetamine-induced deficits in novel object recognition when administered after methamphetamine treatment. However, nicotine did not attenuate the serotonergic deficits caused by methamphetamine in adults. Conversely, nicotine attenuated methamphetamine-induced deficits in α4β2 nicotinic acetylcholine receptor density in the hippocampal CA1 region. Furthermore, nicotine increased α4β2 nicotinic acetylcholine receptor density in the hippocampal CA3, dentate gyrus and perirhinal cortex in both saline- and methamphetamine-treated rats. CONCLUSIONS Overall, these findings suggest that nicotine-induced increases in α4β2 nicotinic acetylcholine receptors in the hippocampus and perirhinal cortex might be one mechanism by which novel object recognition deficits are attenuated by nicotine in methamphetamine-treated rats.
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Affiliation(s)
- Paula L Vieira-Brock
- Department of Pharmacology and Toxicology (Dr Vieira-Brock, Dr McFadden, Ms Nielsen, Dr Smith, Dr Hanson, and Dr Fleckenstein), and School of Dentistry (Drs Smith, Hanson, and Fleckenstein), University of Utah, Salt Lake City, UT
| | - Lisa M McFadden
- Department of Pharmacology and Toxicology (Dr Vieira-Brock, Dr McFadden, Ms Nielsen, Dr Smith, Dr Hanson, and Dr Fleckenstein), and School of Dentistry (Drs Smith, Hanson, and Fleckenstein), University of Utah, Salt Lake City, UT
| | - Shannon M Nielsen
- Department of Pharmacology and Toxicology (Dr Vieira-Brock, Dr McFadden, Ms Nielsen, Dr Smith, Dr Hanson, and Dr Fleckenstein), and School of Dentistry (Drs Smith, Hanson, and Fleckenstein), University of Utah, Salt Lake City, UT
| | - Misty D Smith
- Department of Pharmacology and Toxicology (Dr Vieira-Brock, Dr McFadden, Ms Nielsen, Dr Smith, Dr Hanson, and Dr Fleckenstein), and School of Dentistry (Drs Smith, Hanson, and Fleckenstein), University of Utah, Salt Lake City, UT
| | - Glen R Hanson
- Department of Pharmacology and Toxicology (Dr Vieira-Brock, Dr McFadden, Ms Nielsen, Dr Smith, Dr Hanson, and Dr Fleckenstein), and School of Dentistry (Drs Smith, Hanson, and Fleckenstein), University of Utah, Salt Lake City, UT
| | - Annette E Fleckenstein
- Department of Pharmacology and Toxicology (Dr Vieira-Brock, Dr McFadden, Ms Nielsen, Dr Smith, Dr Hanson, and Dr Fleckenstein), and School of Dentistry (Drs Smith, Hanson, and Fleckenstein), University of Utah, Salt Lake City, UT.
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